Avoidant‐Restrictive Food Intake Disorder Is Common in Adults With Cyclic Vomiting Syndrome and Is Associated With Malnutrition

BACKGROUND: In cyclic vomiting syndrome (CVS), approximately 30% of patients remain symptomatic between episodes. We hypothesized that avoidance of presumed food triggers contributes to avoidant/restrictive food intake disorder (ARFID) and is associated with nutritional consequences in adults with CVS. METHODS: We prospectively studied adults diagnosed with CVS who completed the Nine-Item ARFID Screen (NIAS), Eating Disorder Questionnaire (EDE-QS), Food Security Questionnaire, and the VioScreen food frequency questionnaire. Nutrition status was assessed by a registered dietitian nutritionist (RDN). KEY RESULTS: Among 80 participants (mean age 39 ± 16 years; 77.5% female), 30 (37.5%) screened positive for ARFID risk (NIAS+). Eight patients (10%) screened positive for eating disorder risk as well and were excluded from analyses. Those at risk for ARFID (NIAS+) were younger (32 ± 11 vs. 46 ± 16 y), had moderate-severe CVS (90% vs. 10%), anxiety (67% vs. 38%), depression (66% vs. 33%), reported more inter-episodic symptoms, and used cannabis more often (50% vs. 30%) (all p < 0.05), though cannabis-use disorder was not higher in this group. Those at risk for ARFID were more likely to be malnourished (73% vs. 30%) and at risk for food insecurity (30% vs. 0%) (both p < 0.001). These participants also consumed fewer calories and had several micronutrient intakes below recommendations. CONCLUSIONS AND INFERENCES: About a third of patients with CVS screened positive for ARFID. This was associated with malnutrition and deficient intake of several micronutrients. Screening for ARFID, disordered eating, and food insecurity is warranted. RDN involvement in developing targeted interventions may impact nutritional outcomes.