Avoidant or Restrictive Food Intake Disorder Symptoms in Adults With Systemic Sclerosis: A Nationwide Study in Spain

Patients with systemic sclerosis (SSc) may restrict food intake to manage their symptoms (particularly gastrointestinal [GI]). Whether some patients may develop nutritional and/or quality-of-life impairments indicative of an eating disorder, avoidant or restrictive food intake disorder (ARFID), is unknown. We aimed to (1) identify the prevalence and characteristics of ARFID symptoms in patients with SSc and (2) explore the relationship among ARFID symptoms, GI symptom burden, and health-related quality of life.

In a cross-sectional internet survey nationwide in Spain, patients with SSc completed the Spanish Nine-Item ARFID Screen and assessments of gastrointestinal symptom burden (University of California Los Angeles Scleroderma Clinical Trial Consortium GI tract 2.0 [UCLA SCTC GIT 2.0]) and health-related quality of life (12-item Short Form Survey [SF-12]).

Of 200 patients with SSc, 99 patients (49.5%) screened positive for ARFID. Just over half of those who screened positive for ARFID (n = 53) screened positive based on having a fear of aversive consequences around eating (eg, GI discomfort). A positive ARFID screen was associated with a greater frequency of self-reported enteral nutrition, weight loss, and self-initiated (vs provider-monitored) diet restrictions. ARFID symptoms were moderately associated with worse GI symptom severity by UCLA GIT 2.0 total score (r = 0.408, P < 0.001) but not for the reflux subscale (r = 0.058, P = 0.420) and constipation subscale (r = 0.090, P = 0.209) and with worse health-related quality of life in all domains and both the physical and mental components of the SF-12 (all P < 0.05).

ARFID symptoms were relatively common in patients with SSc. Future research is needed to identify when a positive screen for ARFID reflects an adaptive response to disease or pathologic restriction indicative of ARFID warranting behavioral treatment.