Risk of avoidant/restrictive food intake disorders in patients with inflammatory bowel disease: a matched cross-sectional case-control study

Background: Individuals with inflammatory bowel disease (IBD) often modify their diet to manage symptoms; however, these behaviors may evolve into eating disorders, including avoidant/restrictive food intake disorder (ARFID). We assessed the risk of eating disorders and ARFID in patients with IBD compared with healthy controls (HC), explored differences by age at diagnosis, and examined associations with malnutrition and disability. Methods: In this cross-sectional study, adult patients with confirmed IBD, stratified by pediatric- vs adult-onset, were matched with HC. ARFID risk was assessed using the Nine-Item ARFID Screen (NIAS-9) and eating disorders risk with the Eating Attitudes Test-26 (EAT-26). Nutritional status was evaluated with the Patient-Generated Subjective Global Assessment (PG-SGA) and disability with the IBD-Disk and modified IBD-Disk. Results: A total of 706 participants completed questionnaires (355 IBD, 351 HC). Eating disorder risk did not differ between groups (11.3% vs 10.8%, P = .91). ARFID risk was higher in IBD (13.5% vs 5.7%, P < .001), with more fear-driven eating (P < .001) and lower picky eating (P < .001) and appetite scores (P = .033). ARFID risk did not differ by age at onset (P = .39). Independent associated factors included active disease (odds ratio [OR] 2.34, 95% confidence interval [CI] 1.10-5.01), malnutrition (OR 2.31, 95% CI 1.04-5.13), dietary changes (OR 4.32, 95% CI 1.92-9.74), and eating disorder risk (OR 7.47, 95% CI 2.95-18.90). Even in remission, ARFID risk remained elevated compared to HC (10.1% vs 5.7%, P = .03). Conclusions: ARFID risk in IBD is nearly twice that of HC and strongly associated with disease activity, malnutrition, and disability, supporting the importance of ARFID screening in routine IBD care.