Spotlight on avoidant/restrictive eating
Recent studies evaluated how avoidant/restrictive eating may be related to disorders of gut-brain interaction and bowel symptoms.
Two recent studies examined the association of avoidant/restrictive eating with disorders of gut-brain interaction (DGBI) and with bowel symptoms.
The first study was a population-based online survey conducted in the United Kingdom and the United States in 2023 that included the Rome IV diagnostic questionnaire for DGBI, the Nine-Item Avoidant/Restrictive Food Intake Disorder (ARFID) Screen (NIAS), and questions about demographics, body mass index, non-GI somatic symptoms, anxiety and depression, quality of life, and health care use. The survey was funded by Tillotts Pharma and Novonesis. Results were published Sept. 4 by Gastroenterology.
A total of 4,002 adults completed the survey, 2,002 from the United Kingdom and 2,000 from the United States. The median age was 46 years, 50% were female, and 81.7% were White. Overall, 1,704 respondents (42.6%) reported symptoms that were compatible with at least one DGBI. Those with DGBI were significantly more likely to be female (48.3% vs. 36.9%) and younger (median age, 42 years vs. 49 years) than those without (P<0.001 for both comparisons).
Respondents with DGBI were much more likely to screen positive for ARFID than those without DGBI (34.6% vs. 19.4%; adjusted odds ratio, 1.67 [95% CI, 1.43 to 1.94]), and rates were higher in patients with more DGBI anatomic regions (19.4% with none, 27.7% with one, 39.5% with two, 50.0% with three, and 61.4% with four). Among participants with DGBI, the most common items reported on the ARFID screens were lack of interest in eating (21.5%), sensory-based avoidance (18.1%), and fear of aversive consequences (9.9%). Those who reported DGBI plus ARFID were significantly more likely to be underweight (7.9% vs. 1.5%) and had more non-GI somatic symptoms, psychological distress, and health care use as well as worse mental and physical quality of life, compared to those with only DGBI.
Among other limitations, the researchers noted that their study used self-reported data and that their results do not prove causality. They concluded that positive ARFID screens are common in patients with DGBI and are associated with an increased health burden.
“In summary, we suggest that routine screening for ARFID be performed in individuals consulting with any DGBI. This could be performed using brief, validated, screening tools, such as the NIAS, to start a conversation about a patient's relationship with eating,” the authors wrote. “Where implementation of tools like the NIAS is not possible, clinicians may consider asking patients an open-ended question like ‘tell me about your relationship with food’ and/or completing a brief 24-hour dietary recall.”
The second study used an online survey of adults ages 18 to 70 years in Sweden to evaluate the prevalence of avoidant/restrictive eating in those with versus without bowel symptoms and identify factors associated with avoidant/restrictive eating. The study included 825 participants with at least one bowel symptom according to the Rome IV criteria and 1,806 age- and sex-matched controls with no bowel symptoms. Avoidant/restrictive eating was determined by NIAS, and validated questionnaires were used to assess demographic and clinical characteristics. The results were published Aug. 20 by the American Journal of Gastroenterology.
Avoidant/restrictive eating was reported in 22.8% of individuals with bowel symptoms versus 18.2% of controls (P<0.001). Respondents who had both bowel symptoms and avoidant/restrictive eating were more likely to be female, have a lower body mass index, and report overlapping functional dyspepsia. They were also more likely to report more severe bowel, psychological, and somatic symptoms, as well as shape/weight concerns and lower quality of life.
Like the first study, this study could not determine causality, and the authors noted that the results are likely not generalizable to males, among other limitations. “These findings emphasize the need to discuss avoidant/restrictive eating, particularly fear-driven avoidance, and perform careful considerations when recommending dietary restrictions,” they wrote. “However, longitudinal research is needed to assess its impact on treatment outcomes and if restrictive dietary treatments impact avoidant/restrictive eating.”