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.…”

“…Patients with IBD are at risk for PCM as gut inflammation disrupts the mucosal barrier and causes overt nutrient malabsorption, and pro‐inflammatory cytokines drive catabolic activity which leads to weight loss. 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 …”

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.…”

Avoiding food avoidance in patients with inflammatory bowel disease

“…Avoidant restrictive food intake disorder (ARFID) was reported in IBD, with 17% of patients having a positive ARFID score, that correlated with the risk of malnutrition 13 . While food avoidance is more common in active disease, as was shown by Bonsack, a significant portion of patients report food avoidance during remission phases as well.…”