Avoidant Restrictive Food Intake Disorder Prevalent Among Patients With Inflammatory Bowel Disease

Abstract

Inflammatory Bowel Diseases Restrictive Eating Behaviors Inflammation Symptoms MalnutritionBACKGROUND & AIMS: Inflammatory bowel disease (IBD) patients alter their dietary behaviors to reduce diseaserelated symptoms, avoid feared food triggers, and control inflammation. This study aimed to estimate the prevalence of avoidant/restrictive food intake disorder (ARFID), evaluate risk factors, and examine the association with risk of malnutrition in patients with IBD. METHODS:This cross-sectional study recruited adult patients with IBD from an ambulatory clinic. ARFID risk was measured using the Nine-Item ARFID Screen. Nutritional risk was measured with the Patient Generated-Subjective Global Assessment. Logistic regression models were used to evaluate the association between clinical characteristics and a positive ARFID risk screen. Patient demographics, disease characteristics, and medical history were abstracted from medical records. RESULTS:Of the 161 participants (Crohn's disease, 45.3%; ulcerative colitis, 51.6%; IBD-unclassified, 3.1%), 28 (17%) had a positive ARFID risk score ( ‡24). Most participants (92%) reported avoiding 1 or more foods while having active symptoms, and 74% continued to avoid 1 or more foods even in the absence of symptoms. Active symptoms (odds ratio, 5.35; 95% confidence interval, 1.91-15.01) and inflammation (odds ratio, 3.31; 95% confidence interval, 1.06-10.29) were significantly associated with positive ARFID risk. Patients with a positive ARFID risk screen were significantly more likely to be at risk for malnutrition (60.7% vs 15.8%; P < .01).

Impact of malnutrition and nutrition support in hospitalised patients with inflammatory bowel disease

“…Additionally, disease activity drives symptoms of abdominal pain, nausea, vomiting and diarrhoea, which result in avoidant/restrictive food intake behaviours that can further promote malnutrition. 1,2 Both higher disease activity and avoidance of specific foods during disease flares have been shown to be strong predictors of PCM in IBD patients. 3,4 Disease-related malnutrition has a number of known sequelae that contribute to morbidity and mortality, including delayed wound healing, impaired immune function and functional impairment via decreased muscle function.…”

Current evidence for avoidant restrictive food intake disorder: Implications for clinical practice and future directions

“…Consideration of differential diagnoses of medical conditions is important as such symptoms could be related to alternative explanatory conditions. A thorough physical assessment can identify important underlying disorders that may impact eating behaviours including Crohn's disease, ulcerative colitis, and irritable bowel syndrome (Yelencich et al., 2022). Assessing bowel health is also important to determine the presence of constipation which may contribute to, or be a result of, restricted eating or poor fluid intake (Harris et al., 2021).…”

Patients’ perspectives on, experience with and concerns about crohn's disease: insights from Chinese social media

“…Indeed, a Western-style diet rich in saturated fat and low in fiber has been implicated in the onset of the disease. This leads patients to seek dietary solutions for disease management [ 47 ]. However, current dietary recommendations are based largely on low-quality studies.…”