ARFID & IBD

June 6, 2022

Issue 11

Clinical Question

How common is avoidant/restrictive food intake disorder among IBD patients?

Editor’s Bottom Line

Although these findings need confirmation in larger and less selective cohorts, avoidant/restrictive food intake disorder may be common among patients with IBD. Careful dietary histories and early dietary intervention should be considered for patients at risk.

Reference

Yelencich E, Truong E, Widaman AM, et al. Avoidant Restrictive Food Intake Disorder Prevalent Among Patients with Inflammatory Bowel Disease. Clin Gastroenterol Hepatol. 2022;20(6):1282–89.e1; https://www.cghjournal.org/article/S1542-3565(21)00864-8/fulltext

Synopsis

Researchers at the University of California Los Angeles (UCLA) documented the prevalence of avoidant/restrictive food intake disorder (ARFID) in 73 patients with Crohn’s disease, 83 individuals with ulcerative colitis, and five patients with IBD-unclassified. ARFID is included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and defined as a set of eating behaviors that cause insufficient caloric and/or nutrient intake and significant weight loss, significant nutritional deficiency, dependence on nutritional supplements, and/or marked psychosocial impairment. The investigators screened for ARFID using the Nine-Item ARFID Screen.

Malnutritional risk was also evaluated using the Patient Generated-Subjective Global Assessment, which asks patients about their weight history, food intake, the presence of symptoms with possible nutrition impact, daily activities and functional status.

Individuals were excluded if they had a diagnosis of celiac disease, anorexia nervosa, bulimia nervosa, alcohol use disorder, or if they had any other unmanaged psychological disorder or were pregnant. Participants were a mean 41 years of age and were divided roughly evenly by sex.

The authors found that 17% of patients screened positive for ARFID, with particularly high scores on domains of “picky eating,” “poor appetite” and “fear of negative consequences” of eating specific foods. Ninety-two percent of all participants said they avoided one or more foods during periods of disease activity and 74% said they did so even in the absence of symptoms. The most commonly-avoided foods included lactose, spicy foods, alcohol and deep fried or fatty foods.

In multivariate analyses, predictors of ARFID included the presence of active IBD symptoms (Odds Ratio [OR]: 5.35; 95% Confidence Interval [CI], 1.9–15; p<0.01) and active inflammation (OR: 3.31; 95% CI, 1.06–10.3; p=0.04). Patients who screened positive for ARFID were more likely to be at risk of malnutrition (60.7% vs. 15.8%; p<0.01).

Details

Study Design: Cross-sectional

Funding: Not disclosed

Allocation: Not applicable

Setting: Single center

Level of Evidence: 2b