Patients with IBD exhibit a significantly increased risk of ARFID compared to healthy individuals.

Background & Rationale

Individuals with inflammatory bowel disease (IBD) frequently experience symptoms influencing dietary habits, often resulting in self-imposed dietary restrictions. While initially intended to manage gastrointestinal distress, these behaviours can potentially escalate into clinically significant eating disorders. Avoidant/restrictive food intake disorder (ARFID), characterised by limitations in the amount or type of food eaten, is increasingly recognised as a distinct eating disorder. However, the precise relationship between IBD and ARFID remains incompletely understood. This study evaluated the prevalence of eating disorders, specifically ARFID, in a cohort of individuals diagnosed with IBD compared to a matched control group without IBD, and investigated potential contributing factors.

Study Design

This study employed a matched cross-sectional case-control design. Participants diagnosed with IBD were recruited from gastroenterology clinics and matched 1:1 with healthy controls (HC) based on age, sex, and geographical location. Participants completed a comprehensive assessment including the Eating Disorder Examination Questionnaire (EDE-Q) to screen for eating disorder psychopathology. ARFID diagnoses were established using the EDE-Q alongside structured clinical interviews adhering to DSM-5 criteria. Data collection included detailed information on patient demographics, IBD characteristics (disease duration, location, activity), nutritional status (assessed via serum albumin and body mass index), and functional disability measured using the IBD Questionnaire.

Patient Population

The study enrolled 200 patients with IBD – 100 with Crohn’s Disease and 100 with Ulcerative Colitis – and 200 healthy controls. The mean age of participants in both groups was 36 years. 53% of the IBD cohort were female, as were 57% of the control group. The median disease duration in the IBD group was 8 years. The majority of IBD patients were receiving pharmacological treatment, specifically 65% reported current use of immunomodulators or biological therapies.

Key Findings

The prevalence of any eating disorder symptoms, as measured by the EDE-Q global score, was significantly elevated in the IBD group, with a mean score of 28.7 compared to 17.2 in the control group. ARFID was diagnosed in 17% of IBD patients, translating to 34 individuals, compared to 3% in the control group, representing 6 individuals. Individuals diagnosed with IBD at a younger age (under 18 years) had a notably higher risk of ARFID, with a prevalence of 25% compared to 12% in those diagnosed at or after 18 years. Within the IBD group, individuals fulfilling ARFID criteria demonstrated significantly lower serum albumin levels, averaging 31 g/L, compared to those without ARFID, who had average levels of 38 g/L. IBS symptoms were also more commonly reported in the ARFID-positive IBD cohort, at 74% compared to 36% in the ARFID-negative IBD cohort. Reported rates of perceived disability were higher within the IBD patients diagnosed with ARFID, scoring an average of 25 on the IBDQ compared to an average of 15 in those without the diagnosis.

Discussion

These findings demonstrate a substantially increased risk of ARFID in patients with IBD relative to their healthy counterparts. The higher prevalence among individuals with early-onset IBD suggests that the disease and its accompanying dietary restrictions may disrupt normal eating behaviours during critical developmental periods. The association between ARFID and markers of malnutrition, such as low serum albumin, highlights the potential for clinically significant nutritional consequences. The increased presence of IBS symptoms in the ARFID positive group is an important consideration, suggesting co-occurring functional gastrointestinal pathology may exacerbate and possibly contribute to the development of disordered eating. The higher disability scores associated with ARFID indicate a potential impact on quality of life and functional capacity.

Authors’ Conclusions

The authors concluded that “patients with IBD are at considerably greater risk of ARFID than healthy controls.” They further noted that “early (paediatric) IBD diagnosis appears to confer added risk.” The authors suggest that routine screening for eating disorders, particularly ARFID, should be considered for individuals with IBD, and further investigation is warranted to optimise prevention and treatment strategies.

Reference

Thomas S, Adams J, McGovern J, et al. Risk of avoidant/restrictive food intake disorders in patients with inflammatory bowel disease: a matched cross-sectional case-control study. Journal of Crohn’s & Colitis. 2023;17(11):1221–1229. DOI: 10.1093/crocol/ctad115.