More than half of the patients with celiac disease had coexisting Avoidant/Restrictive Food Intake Disorder (ARFID) in a retrospective study reported in the journal Gastro Hep Advances.¹

The study examined data from 137 adult patients with celiac disease between 2018 and 2020; 107 of the participants were women. These patients completed questionnaires seeking information about their diet and the symptoms of ARFID.

Results showed that 78 (57%) had features of suspected AFRID; of these, 30 patients had symptoms compatible with clinical ARFID, while 48 had symptoms in accordance with subclinical ARFID. No between-group differences in age, gender, body mass index (BMI), micronutrient deficiencies or bone disease in those with or without ARFID were evident. But patients in the AFRID group had higher levels of tissue transglutaminase IgG antibody on serology; 15% versus 2%, respectively. 

The likelihood of co-existent AFRID was higher in those who scored high on the social and food components of the Impact of the Gluten Free Diet questionnaire (IGFDQ) with odds ratio of 1.59 and 1.64 respectively. Emotional parameters were the least predictive for AFRID.

ARFID, or selective eating disorder as it was earlier known as, is characterized by lack of interest in food and picky “selective” eating. Similar to anorexia, persons with ARFID restrict their intake of food, both amount and types of foods. They may avoid eating some foods due to their sensory characteristics such as color, consistency, odor. However, in contrast to anorexia or bulimia, persons with ARFID are not overly concerned about body shape and size.

Patients with celiac disease are highly likely to have eating disorders because of the need to strictly adhere to a gluten-free diet. This study has shown a high prevalence of ARFID in patients with celiac disease. Hence, patients should be screened for coexisting harmful eating behaviors such as ARFID, which will help clinicians in dietary and behavioral management of the disease.

Reference

1. Bennett A, et al. Avoidant/Restrictive Food Intake Disorder characteristics and prevalence in adult celiac disease patients. Gastro Hep Adv. Jan. 21, 2022. DOI: https://doi.org/10.1016/j.gastha.2022.01.002