Prevalence and Characteristics of Avoidant/Restrictive Food Intake Disorder in Adult Neurogastroenterology Patients

Murray, Helen Burton; Bailey, Abbey; Keshishian, Ani C.; Silvernale, Casey J.; Staller, Kyle; Eddy, Kamryn T.; Thomas, Jennifer J.; Kuo, Braden

doi:10.1016/j.cgh.2019.10.030

Cited by 83 publications

(118 citation statements)

References 13 publications

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“…Importantly, the frequency of ARFID symptoms in the present sample was much higher (40%). This higher frequency converges with our retrospective chart review (N = 410) in which we found that likelihood of having ARFID symptoms was significantly increased by having diagnoses that involve dyspepsia/nausea/vomiting and/or abdominal pain 39 . Thus, our findings support that individuals with symptoms of gastroparesis/dyspepsia are likely more prone to have ARFID symptoms.…”

Section: Discussionsupporting

confidence: 87%

“…This higher frequency converges with our retrospective chart review (N = 410) in which we found that likelihood of having ARFID symptoms was significantly increased by having diagnoses that involve dyspepsia/nausea/vomiting and/or abdominal pain. 39 Thus, our findings support that individuals with symptoms of gastroparesis/dyspepsia are likely more prone to have ARFID symptoms. Of note, the EDDS and NIAS have yet to be validated in gastroenterology populations, so further research is needed to understand their psychometric properties.…”

Section: Discussionsupporting

confidence: 77%

“…Recently in the gastroenterology field, there has been increased interest in the overlap of ARFID with disorders of gut‐brain interaction (formerly called functional gastrointestinal disorders) 16 . ARFID symptoms have been reported between 19.6% and 23.7% among patients overall in neurogastroenterology and motility settings, 24,25,39 one of which used the same NIAS self‐report scale as in this study 24 . Importantly, the frequency of ARFID symptoms in the present sample was much higher (40%).…”

Section: Discussionmentioning

confidence: 53%

“…among patients overall in neurogastroenterology and motility settings, 24,25,39 one of which used the same NIAS self-report scale as in this study. 24 Importantly, the frequency of ARFID symptoms in the present sample was much higher (40%).…”

Section: Discussionmentioning

confidence: 99%

“…The gastroenterology provider may then ask follow‐up questions to determine if the patient meets any of the below ARFID medical or psychosocial impairment criteria. Providers may also specifically choose to screen patients with certain presenting complaints, particularly patients with eating or weight‐related presenting complaints 39 . In our clinical experience, providing an explicit diagnosis of ARFID is not always necessary, as problematic avoidant/restrictive eating lies along a spectrum.…”

Section: Discussionmentioning

confidence: 99%

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Avoidant/restrictive food intake disorder symptoms are frequent in patients presenting for symptoms of gastroparesis

Murray

Jehangir

Silvernale

et al. 2020

Neurogastroenterology Motil

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Introduction: Patients with symptoms of gastroparesis/dyspepsia often avoid foods or restrict eating for symptom management. There is growing interest in understanding risk for feeding/eating disorders (FEDs) like avoidant/restrictive food intake disorder (ARFID). Among patients presenting with gastroparesis/dyspepsia symptoms, we aimed to determine: (a) FED symptom frequency, and (b) relation of FED symptoms to gastrointestinal symptom severity and gastric retention abnormalities. Methods: Adult patients (N = 288; 78% female) referred for gastroparesis/dyspepsia symptoms at two academic medical centers from January 2018-February 2019 completed self-report surveys for gastrointestinal symptom severity and FED symptoms. Gastric retention data were available for 210 patients, using 4-hour EggBeater gastric emptying scintigraphy (GES). Results: Clinically significant FED symptoms were present in 158 patients (54.9%). Interestingly, 115 patients (39.9%) met conservative self-report cutoff for ARFID symptoms, with 67 (23.3%) patients having documented psychosocial/medical impairment. Of those with survey data for other FEDs (n = 239), only 28 patients (11.7%) had restrictive eating disorders (anorexia nervosa; unspecified FED). Likelihood of having FED symptoms was significantly associated with greater gastroparesis symptom severity (OR = 2.23, P < .001), but not GES. In addition, gastroparesis symptom severity was moderately and significantly associated with greater ARFID symptom severity (b = 0.45, P < .001), but neither GES nor other FED symptoms. Discussion: In patients presenting with gastroparesis/dyspepsia symptoms, FED symptoms were frequent (55%), particularly ARFID, and were associated with greater gastrointestinal symptom severity, but not gastric retention. Gastroparesis/ dyspepsia symptoms may mimic FEDs, particularly ARFID. Clinicians should be cautious about diagnosing ARFID in gastroparesis/dyspepsia patients, and screening for ARFID could assist behavioral treatment referral.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Avoidant/restrictive food intake disorder symptoms are frequent in patients presenting for symptoms of gastroparesis

Murray

Jehangir

Silvernale

et al. 2020

Neurogastroenterology Motil

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Etiology of the Broad Avoidant Restrictive Food Intake Disorder Phenotype in Swedish Twins Aged 6 to 12 Years

et al. 2023

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ImportanceAvoidant restrictive food intake disorder (ARFID) is characterized by an extremely limited range and/or amount of food eaten, resulting in the persistent failure to meet nutritional and/or energy needs. Its etiology is poorly understood, and knowledge of genetic and environmental contributions to ARFID is needed to guide future research.ObjectiveTo estimate the extent to which genetic and environmental factors contribute to the liability to the broad ARFID phenotype.Design, Setting, and ParticipantsThis nationwide Swedish twin study includes 16 951 twin pairs born between 1992 and 2010 whose parents participated in the Child and Adolescent Twin Study in Sweden (CATSS) at twin age 9 or 12 years. CATSS was linked to the National Patient Register (NPR) and the Prescribed Drug Register (PDR). Data were collected from July 2004 to April 2020, and data were analyzed from October 2021 to October 2022.Main Outcomes and MeasuresFrom CATSS, NPR, and PDR, all parent reports, diagnoses, procedures, and prescribed drugs that were relevant to the DSM-5 ARFID criteria were extracted when twin pairs were aged 6 to 12 years and integrated into a composite measure for the ARFID phenotype (ie, avoidant/restrictive eating with clinically significant impact, such as low weight or nutritional deficiency, and with fear of weight gain as an exclusion). In sensitivity analyses, autism and medical conditions that could account for the eating disturbance were controlled for. Univariate liability threshold models were fitted to estimate the relative contribution of genetic and environmental variation to the liability to the ARFID phenotype.ResultsOf 33 902 included children, 17 151 (50.6%) were male. A total of 682 children (2.0%) with the ARFID phenotype were identified. The heritability of ARFID was 0.79 (95% CI, 0.70-0.85), with significant contributions from nonshared environmental factors (0.21; 95% CI, 0.15-0.30). Heritability was very similar when excluding children with autism (0.77; 95% CI, 0.67-0.84) or medical illnesses that could account for the eating disturbance (0.79; 95% CI, 0.70-0.86).Conclusions and RelevancePrevalence and sex distribution of the broad ARFID phenotype were similar to previous studies, supporting the use of existing epidemiological data to identify children with ARFID. This study of the estimated genetic and environmental etiology of ARFID suggests that ARFID is highly heritable, encouraging future twin and molecular genetic studies.

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Disorders of gut–brain interaction common among outpatients with eating disorders including avoidant/restrictive food intake disorder

Murray

Kuo

Eddy

et al. 2020

Intl J Eating Disorders

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Objective Little research exists on Rome IV disorders of gut–brain interaction (DGBI; formerly called functional gastrointestinal disorders) in outpatients with eating disorders (EDs). These data are particularly lacking for avoidant/restrictive food intake disorder (ARFID), which shares core features with DGBI. We aimed to identify the frequency and nature of DGBI symptoms among outpatients with EDs. Method Consecutively referred pediatric and adult patients diagnosed with an ED (n = 168, 71% female, ages 8–76 years) in our tertiary care ED program between March 2017 and July 2019 completed a modified Rome IV Questionnaire for DGBI and psychopathology measure battery. Results The majority (n = 122, 72%) of participants reported at least one bothersome gastrointestinal symptom. Sixty‐six (39%) met criteria for a DBGI, most frequently functional dyspepsia—post‐prandial distress syndrome subtype (31%). DGBI were surprisingly less frequent among patients with ARFID (30%) versus EDs that are associated with shape or weight concerns (45%; X2[1] = 3.61, p = .058, Cramer's V = .147). Among those with ARFID, DGBI presence was associated with the fear of aversive consequences prototype and multiple comorbid prototype presence. Discussion We demonstrated notable overlap between DGBI and EDs, particularly post‐prandial distress symptoms. Further research is needed to examine if gastrointestinal symptoms predict or are a result of greater ED pathology, including ARFID prototypes.

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Prevalence and Characteristics of Avoidant/Restrictive Food Intake Disorder in Adult Neurogastroenterology Patients

Cited by 83 publications

References 13 publications

Avoidant/restrictive food intake disorder symptoms are frequent in patients presenting for symptoms of gastroparesis

Avoidant/restrictive food intake disorder symptoms are frequent in patients presenting for symptoms of gastroparesis

Etiology of the Broad Avoidant Restrictive Food Intake Disorder Phenotype in Swedish Twins Aged 6 to 12 Years

Disorders of gut–brain interaction common among outpatients with eating disorders including avoidant/restrictive food intake disorder

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