History of trying exclusion diets and association with avoidant/restrictive food intake disorder in neurogastroenterology patients: A retrospective chart review

Abstract

Background: Exclusion diets for gastrointestinal symptom management have been hypothesized to be a risk factor for avoidant/restrictive food intake disorder (ARFID; a non-body image-based eating disorder). In a retrospective study of pediatric and adult neurogastroenterology patients, we aimed to (1) identify the prevalence and characteristics of an exclusion diet history and (2) evaluate if an exclusion diet history was concurrently associated with the presence of ARFID symptoms. Methods:We conducted a chart review of 539 consecutive referrals (ages 6-90, 69% female) to adult (n = 410; January-December 2016) and pediatric (n = 129; January 2016-December 2018) neurogastroenterology clinics. Masked coders (n = 4) retrospectively applied DSM-5 criteria for ARFID and a separate coder assessed documentation of exclusion diet history. We excluded patients with no documentation of diet in the chart (n = 35) or who were not orally fed (n = 9).Results: Of 495 patients included, 194 (39%) had an exclusion diet history, and 118 (24%) had symptoms of ARFID. Of reported diets, dairy-free was the most frequent (45%), followed by gluten-free (36%). Where documented, exclusion diets were selfinitiated by patients/parents in 66% of cases, and recommended by gastroenterology providers in 30%. Exclusion diet history was significantly associated with the presence of ARFID symptoms (OR = 3.12[95% CI 1.92-5.14], p < 0.001). Conclusions: History of following an exclusion diet was common and was most oftenpatient-initiated among pediatric and adult neurogastroenterology patients. As patients with self-reported exclusion diet history were over three times as likely to have ARFID symptoms, providers should be cognizant of this potential association when considering dietary interventions. K E Y W O R D Savoidant/restrictive food intake disorder, disorders of gut-brain interaction, feeding and eating disorders, functional gastrointestinal disorders How to cite this article: Atkins M, Zar-Kessler C, Madva EN, et al. History of trying exclusion diets and association with avoidant/restrictive food intake disorder in neurogastroenterology patients: A retrospective chart review.

The Intersection of Disorders of Gut-Brain Interaction With Avoidant/Restrictive Food Intake Disorder

“…Among those with DGBI, disordered eating patterns (such as food restriction, binge eating, purging) ranges from 5% to 44% 28 . More recently, the phenomenon of ARFID in DGBI has been recognized with cross-sectional and retrospective studies 4,10,11,29–36 …”

“…Dietary approaches involve exclusion diets (eg, where specific foods that are high in short-chain carbohydrates that the small intestine is unable to absorb are removed from the diet temporarily as in the low FODMAP diet 74–76 or specific foods are removed entirely as in a gluten-free or dairy-free diet), modified intake of specific foods (eg, low-fat, low-particle diet for gastroparesis/dyspepsia), 22,77 and modified food timing (eg, small frequent meals for gastroparesis/dyspepsia) 22,77 . An investigation of 495 adult and pediatric patients presenting for neurogastroenterology evaluation found that 39% had a history of exclusion diets, and those with exclusion diet histories were over 3 times as likely to have ARFID symptoms 30 . Another study reported that of the 13% of gastroenterology patients that already met ARFID criteria, 89% were prescribed a low FODMAP diet 33 .…”

“…It is important for patients to be educated on proper diet implementation for both effectiveness and ARFID prevention. Many patients believe that certain foods 80 or food sensitivities 81 aggravate symptoms and may frequently self-initiate exclusion diets 30 . In addition, there are many diets without quality evidence of effectiveness that patients may know about, have already tried, or were recommended by previous providers.…”

“…28 More recently, the phenomenon of ARFID in DGBI has been recognized with cross-sectional and retrospective studies. 4,10,11,[29][30][31][32][33][34][35][36] Overlapping Prevalence Between ARFID and DGBI…”

Assessment and management of disorders of gut–brain interaction in patients with eating disorders

“…low FODMAP diet, gluten-free diet), may also put patients at risk for, exacerbate, or cause patients with EDs in remission to relapse. One retrospective study found that that patients who had a history of trying an exclusion diet were over three times as likely to have avoidant/restrictive food intake disorder symptoms [ 25 ]. Another study also found that patients with IBS who screened positively for EDs were more adherent to the low FODMAP diet [ 26 ].…”