P3018 - Avoidant/Restrictive Food Intake Disorder Characteristics and Prevalence in Adult Celiac Disease Patients

Audrey Bennett, MD¹, Alexandra Bery, MD¹, Patricia Esposito, MS, RD, LD, CNSC¹, Hana Zickgraf, PhD², Dawn Adams, MD, MS^1
1Vanderbilt University Medical Center, Nashville, TN; ²University of South Alabama, Mobile, AL

Introduction: Celiac disease (CD) affects 1% of the United States population. Currently, the only treatment for CD is a strict gluten-free diet, but some patients (pts) can develop dysfunctional eating habits including avoidant/restrictive food intake disorder (ARFID). In this study, the objective was to identify the prevalence of ARFID in adult CD pts and assess metabolic complications, disease control, diet adherence and association with symptom and quality-of-life metrics.

Methods: This was a retrospective study of 137 biopsy proven adult CD pts who completed an ARFID survey between 2018-2020 within the CD clinic. Demographics, clinical results, standardized diet assessment, and results of Celiac Disease Symptom Diary (CDSD) score and Impact of a Gluten Free Diet Questionnaire (IGFD) were reviewed.

Results: Seventy-eight pts (57%) met clinical or subclinical ARFID criteria. Pt demographics are described in Table 1. There was no difference in age, gender, body mass index, micronutrient deficiencies or bone disease in pts with or without ARFID. There was no difference in surveillance duodenal biopsy activity or adherence to a gluten-free diet in pts with or without ARFID. There was slightly higher tissue transglutaminase IgG positivity in ARFID pts, but not in other serologies (2% vs.15%, p=0.007). The top reasons for restrictive eating were fear of gastrointestinal (GI) discomfort including irritable bowel syndrome (IBS) (48%), picky eating (14%), poor appetite (11%), fear of GI discomfort excluding IBS (11%), fear of choking (5%), fear of weight gain (5%), orthorexia (5%), and fear of vomiting (3%). Food and social burden on IGFD questionnaire were most predictive of ARFID (p=0.008 and 0.002, respectively).

Discussion: ARFID is common and has a high impact in CD pts. Although some eating behavior is certainly due to CD, there was no distinct difference in disease control between pts with or without ARFID, suggesting these maladaptive behaviors are not necessary for disease control. There was no increase in metabolic or bone disease complications over 2 years. Better understanding of social and food impacts on pts that score high on the ARFID survey may prevent further deficiencies and impaired, long-term detrimental eating behaviors. The use of a validated tool to screen for ARFID can help identify pts who struggle with this disorder and can guide the physician and a CD trained dietitian in dietary and behavioral management.

Characteristic	Patients Without ARFID (n=59)	Patients With ARFID (n=78)	p-value
Age at ARFID Survey (years)	46 (29, 66)	42 (28, 55)	0.20
Age at Celiac Disease Diagnosis	41 (25, 61)	36 (26, 49)	0.20
Gender (female)	46 (78%)	61 (78%)	0.97
Body Mass Index	25 (23, 33)	27 (23, 32)	0.98
Microscopic Colitis	4 (7%)	6 (8%)	0.84
Non-Diabetic	51 (86%)	71 (91%)	0.29
Type 1 Diabetes Mellitus	3 (5%)	5 (6%)
Type 2 Diabetes Mellitus	5 (8%)	2 (3%)
Osteoporosis or Osteopenia	22/48 (46%)	19/49 (39%)	0.48
Micronutrient Deficiency	22 (37%)	33 (42%)	0.55
Any Positive Celiac Serology on Surveillance Labs	35 (59%)	43 (55%)	0.62
Impact of a Gluten Free Diet (IGFD) Questionnaire Score, Emotional	1.5 (1.2, 2.0)	1.9 (1.4, 2.4)	0.013
Impact of a Gluten Free Diet (IGFD) Questionnaire Score, Social	1.5 (1.0, 2.0)	2.5 (1.5, 3.0)	0.002
Impact of a Gluten Free Diet (IGFD) Questionnaire Score, Food	2.3 (1.7, 3.0)	3.0 (2.3, 3.3)	0.008
Celiac Disease Symptom Diary (CDSD) Non-Stool Score	3.2 (0.5, 10.0)	7.2 (5.2, 13.0)	0.016
Celiac Disease Symptom Diary (CDSD) Diarrhea Score	0 (0, 0)	0 (0, 2)	0.062
Standardized Dietitian Evaluation (SDE) Score	2.0 (1.5, 3.0)	2.0 (1.0, 3.0)	0.34
Surveillance Duodenal Biopsy Marsh Score			0.20
Marsh Score 0	23/39 (59%)	18/45 (40%)
Marsh Score 1	2/39 (5%)	5/45 (11%)
Marsh Score 2	0 (0%)	0 (0%)
Marsh Score 3	14/39 (36%)	22/45 (49%)

Table: Characteristics of Adult Celiac Disease Patients With and Without Avoidant/Restrictive Food Intake Disorder (ARFID)

**Values are expressed as median (lower and upper quartile range).


Disclosures:
Audrey Bennett indicated no relevant financial relationships.
Alexandra Bery indicated no relevant financial relationships.
Patricia Esposito indicated no relevant financial relationships.
Hana Zickgraf indicated no relevant financial relationships.
Dawn Adams indicated no relevant financial relationships.


Audrey Bennett, MD¹, Alexandra Bery, MD¹, Patricia Esposito, MS, RD, LD, CNSC¹, Hana Zickgraf, PhD², Dawn Adams, MD, MS¹. P3018 - Avoidant/Restrictive Food Intake Disorder Characteristics and Prevalence in Adult Celiac Disease Patients, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.