Food avoidance and restriction in adults: a cross-sectional pilot study comparing patients from an immunology clinic to a general practice

Abstract

BackgroundWith the introduction of avoidant/restrictive food intake disorder (ARFID) in the Diagnostic and Statistical Manual – fifth edition, there is an increased need to understand the prevalence and pattern of food avoidance and restriction in adults. High rates of food allergy and intolerance in immunology clinic populations, and subsequent high rates of elimination diets, place these individuals at a greater risk of developing pathological eating behaviours. This descriptive cross sectional pilot study aims to provide preliminary data on the prevalence and nature of food avoidance and restriction in an adult population, and to explore the reasons for this behaviour.MethodA self-administered questionnaire was designed and distributed to adults presenting to an immunology clinic and a general practice over the course of 6 months to describe the prevalence and nature of avoidant and restrictive eating behaviours in this population. Pearson’s chi square test was used to examine the strength of a potential link to a formal diagnosis of avoidant restrictive food intake disorder in these patients.ResultsA total of 102 completed questionnaires were used for data analysis. Food avoidance or restriction was detected in 81 respondents (79%), with rates not significantly higher in the immunology clinic group compared to the general practice group (p = .242). Food allergy and intolerance were the most common reasons for disturbed eating patterns. Life impact secondary to food avoidance and restriction was reported by 26% of respondents, with significantly higher rates observed in the immunology clinic cohort compared to the general practice (p = .011).ConclusionsEating disturbances similar to those characteristic of ARFID are very common in adults. Food avoidance and restriction due to perceived food allergy and intolerance are significant reasons for such disordered eating patterns, particularly in an immunology clinic population. Further investigation is needed to determine if such eating behaviours are pathological and whether they qualify for a diagnosis of ARFID.Electronic supplementary materialThe online version of this article (doi:10.1186/s40337-017-0160-4) contains supplementary material, which is available to authorized users.

Avoidant/restrictive food intake disorder: Psychopathological similarities and differences in comparison to anorexia nervosa and the general population

“…In our study, patients with ARFID had significantly more antecedents in their medical and psychiatric histories. It is congruent with literature revised referring to a greater medical risk found in young people with ARFID (Becker et al, 2019;Bryson et al, 2018;Coglan & Otasowie, 2019;Fitzgerald & Frankum, 2017;Makhzoumi et al, 2019;Norris et al, 2016;Zia et al, 2017;Zimmerman & Fisher, 2017). Some of these physical and mental conditions may be in turn a risk factor in developing ARFID.…”

Interdisciplinary Significance of Food-Related Adverse Reactions in Adulthood

“…As patients may tend to attribute a wide range of complaints to food allergies, the early symptoms of many diseases could remain hidden. Although the risk of over-restricted diets in childhood is more pronounced, adults-especially elderly patients-could be affected in several respects as well (e.g., malnutrition and its consequences) [32,[39][40][41][42].…”

“…Psychogenic reactions related to food and meals in general can also be classified as pseudoallergies and should be considered within the differential diagnosis (e.g., aversion, avoidant/restrictive food intake disorder according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5)) [32].…”

Australia IBD Microbiome (AIM) Study: protocol for a multicentre longitudinal prospective cohort study

“…The food diary can be emailed directly from the Easy Diet Diary smartphone app (available on both Android and iPhone) to the researcher and be readily imported into the FoodWorks Professional (V.10) nutrient analysis software 17 and broken down based on Australian food composition databases to over 50 nutrients and components. 18 19 Weighing of food is not required; the app allows the user to enter portion sizes in household measures or using typical serve sizes, (3) a food avoidance and restriction questionnaire 20 that contains 12 questions designed to understand the prevalence and pattern of food avoidance and restriction, and to explore reasons for this behaviour. The questionnaire is based on criteria for the diagnosis of Avoidant Restrictive Food Intake Disorder and has been validated in a cohort of Australian adults in 2017.…”