The Prevalence and Burden of Avoidant/Restrictive Food Intake Disorder (ARFID) 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 pre-defined demographic quotas was conducted across the UK and USA in 2023. The survey included the Rome IV diagnostic questionnaire for DGBI, the Nine-Item ARFID Screen (NIAS), and questions regarding demographics, body mass index, non-gastrointestinal somatic symptoms, anxiety and depression, quality of life and healthcare use.

Results: 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 one DGBI. The prevalence of ARFID-positive screens was significantly higher among participants with DGBI compared to those without DGBI (34.6% vs. 19.4%, adjusted OR 1.67, 95% CI 1.43-1.94), with similar findings noted in each country. Among participants with DGBI, positive ARFID screens by NIAS 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 anatomical regions, ranging from 19.4% in those with no DGBI, 27.7% with DGBI in one region, 39.5% for DGBI in two regions, 50.0% for DGBI in three regions, and 61.4% for DGBI in four regions (p<0.001). Individuals with DGBI plus ARFID, compared to those with DGBI alone, were significantly more likely to be underweight (7.9% vs. 1.5%), have greater non-gastrointestinal somatic symptoms and psychological distress, reduced mental and physical quality of life, and increased healthcare utilization.

Conclusion: 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.