AVOIDANT RESTRICTIVE FOOD INTAKE DISORDER (ARFID) RISK BEHAVIORS IN PEDIATRIC INFLAMMATORY BOWEL DISEASE (IBD): A HIDDEN BURDEN DESPITE CLINICAL REMISSION

Abstract BACKGROUND Inflammatory bowel disease (IBD) in children is associated with chronic gastrointestinal inflammation and increased psychosocial burden. Avoidant/Restrictive Food Intake Disorder (ARFID) is a disordered eating behavior without body image concerns characterized by inadequate intake due to low appetite, sensory-based avoidance, or fear of aversive consequences resulting in weight loss or growth faltering, nutrient deficiencies, supplement dependence, or psychosocial impairment. Data on the prevalence and clinical correlates of ARFID in pediatric IBD remain limited. Building on prior work identifying ARFID prevalence in this population, we conducted a retrospective chart review to examine clinical associations of patients with ARFID symptoms. Aim (1) Assess associations between ARFID symptoms, disease duration, and IBD phenotype; (2) Evaluate clinical and biochemical disease activity and nutritional status; (3) Examine utilization of multidisciplinary resources in affected youth. METHODS We conducted a single-center, cross-sectional retrospective study of pediatric and young adult patients (ages 8–25 years) with IBD who screened positive for ARFID. Screening tools included the EDY-Q for ages 8–13 and the NIAS and EDE-Q for ages 14–25. Clinical data included disease activity indices short Pediatric Crohn’s Disease Activity Index (sPCDAI), Pediatric Ulcerative Colitis Activity Index (PUCAI), and Physician Global Assessment (PGA), phenotype classification (PARIS), and biochemical markers (calprotectin, ESR, CRP). Nutritional parameters assessed included nutritional status, hemoglobin, ferritin, vitamin D, and vitamin B12 levels. Utilization of multidisciplinary care was evaluated by documenting dietitian and psychologist visits within ±6 months of survey completion. RESULTS Twenty-seven of 100 patients screened positive for ARFID risk: Crohn’s disease (59%), ulcerative colitis (33%), and IBD-unclassified (7%). Most Crohn’s patients had uncomplicated ileocolonic disease, while UC patients frequently had severe pancolitis. Two-thirds had disease duration >4 years. Nutritional failure was present in 33%, anemia in 30%, and vitamin D deficiency in 25%. While 62% were in clinical remission based on sPCDAI/PUCAI and 77% by PGA, Calprotectin was elevated in 63%; ESR and/or CRP in 40%. All patients saw a dietitian; most saw a psychologist. CONCLUSIONS ARFID risk behaviors were identified in a substantial subset of pediatric IBD patients, even among those in clinical remission and without overt nutritional failure. This highlights the need for heightened clinical vigilance. Multidisciplinary care—including early involvement of dietitians and psychologists—appears essential for comprehensive assessment and management.