The prevalence and burden of avoidant/restrictive food intake disorder symptoms in adults with disorders of gut-brain interaction: a population-based study

Background & Aims

Individuals with disorders of gut-brain interaction (DGBI) may experience avoidant/restrictive food intake disorder (ARFID) symptoms. However, extant findings have been limited to specialist neurogastroenterology clinics. We assessed the association between DGBI and ARFID within the adult general population.

Methods

A population-based Internet survey with predefined demographic quotas was conducted across the United Kingdom and the United States in 2023. The survey included the Rome IV diagnostic questionnaire for DGBI, the Nine-Item ARFID Screen, and questions regarding demographics, body mass index, nongastrointestinal somatic symptoms, anxiety and depression, quality of life, and healthcare use.

Results

In this study, 4002 adults (median age, 46 [range, 18–91] years; 50% female) completed the survey, of whom 1704 (42.6%) had symptoms compatible with at least 1 DGBI. The prevalence of ARFID-positive screens was significantly higher among participants with DGBI compared with those without DGBI (34.6% vs 19.4%; adjusted odds ratio, 1.67; 95% confidence interval, 1.43–1.94), with similar findings noted in each country. Among participants with DGBI, positive ARFID screens using the Nine-Item ARFID Screen subscale were lack of interest in eating (21.5%), sensory-based avoidance (18.1%), and fear of aversive consequences (9.9%). The presence of ARFID increased with the number of DGBI anatomic regions, ranging from 19.4% in those with no DGBI, 27.7% with DGBI in 1 region, 39.5% for DGBI in 2 regions, 50.0% for DGBI in 3 regions, and 61.4% for DGBI in 4 regions (P < .001). Individuals with DGBI plus ARFID, compared with those with DGBI alone, were significantly more likely to be underweight (7.9% vs 1.5%), have greater nongastrointestinal somatic symptoms and psychological distress, reduced mental and physical quality of life, and increased healthcare use.

Conclusions

Positive ARFID screens are common in DGBI and associated with increased general health burden. Routine screening for ARFID in DGBI will inform the multi-integrated care plan provided by clinicians, dietitians, and psychologists.