P0457 Food avoidance, eating disorders and disability in Inflammatory Bowel Disease: a cross-sectional analysis of risk factors
Authors: Nardone O M , D’Amico F , Calabrese G , Parigi T L , La Mantia A , Bencardino S , Gargiulo M A , Rutoli L , Palumbo F , Bonacci L , Rispo A , Testa A , Danese S , Castiglione F 
Published: January 2025

Background

Patients with inflammatory bowel disease (IBD) often adjust their diet to manage symptoms and avoid perceived food triggers. However, these habits can increase the risk of eating disorders (ED) and avoidant/restrictive food intake disorder (ARFID), which may potentially contribute to disability. This study aimed to estimate the prevalence of ARFID and ED in patients with IBD. Additionally, we investigated disability and risk factors associated with ARFID.

Methods

This cross-sectional study was conducted at two academic tertiary centers in Italy. Patients diagnosed with IBD during paediatric age ,between 2014 and October 2024, were consecutively recruited. ARFID was assessed using the Nine-Item ARFID Screen (NIAS), where a score&gt;23 indicated ARFID risk. ED was evaluated using the Eating Attitudes Test (EAT-26), with a score≥20 suggesting the risk of ED. Malnutrition risk was measured with the Patient-Generated Subjective Global Assessment (PG-SGA) with a score&gt;2 indicating the need for nutritional intervention. Disability was assessed using a modified version of IBD-Disk (mIBD -Disk), including a total of 11 questions with the additional question specifically addressing dietary habits1.

Results

A total of 144 patients 50.7% with Crohn’s disease (CD) were recruited (median age at time of inclusion: 24 years (21–28), 54.2% female) [Table.1]. One-third had clinically active disease, and the median BMI was 21.8(20.1–24.2). ARFID risk was identified in 24 participants (16.7%), with food-related fears being the most prevalent domain (13.2%). The median EAT-26 score was 5(3–12), with ED observed in 17 patients (11.8%). Malnutrition (PG-SGA score ≥6) was observed in 22.9% of participants. NIAS scores correlated with PG-SGA scores (p&lt; 0.001, ρ=0.56). Patients at risk of ARFID were more likely to require nutritional interventions than those without ARFID risk (79.2%,19/24 vs. 38.3%, 46/120,p&lt; 0.001). Univariate and multivariate analysis identified that moderate-to-severe disability (OR:4.03; 95%CI:1.23–13.17;p =0.02), a score &gt;4 on mIBD-Disk question 11 (OR:3.49;95%CI:1.06–11.47;p =0.04), and the need for nutritional interventions (OR:3.09; 95% CI: 0.99–9.70; p=0.05) were independently associated with ARFID risk. Receiver Operating Characteristic (ROC) curve analysis showed that the mIBD-Disk had 81% diagnostic accuracy (95%CI:0.73–0.90) for predicting ARFID.

Conclusion

Patients diagnosed with IBD in paediatric age have an increased risk for ARFID and ED. Incorporating the mIBD-Disk into clinical practice could facilitate early screening and timely referral for nutritional and psychological interventions for individuals at risk of eating behaviors and malnutrition

References

1.Nardone OM et al, Italian validation of the ibd-disk tool for the assessment of disability in inflammatory bowel diseases: a cross-sectional multicenter study, Digestive and Liver Disease, Nov 2024 on press