Screening for ARFID-like symptoms in inflammatory bowel disease: insights from NIAS-Fr subscales

Objective Avoidant/restrictive food intake disorder (ARFID) has gained increasing attention in gastrointestinal diseases, but its frequency and clinical correlates in inflammatory bowel disease (IBD) remain poorly characterised. In routine IBD care, distinguishing ARFID from medically indicated dietary restriction is challenging. We aimed to screen for ARFID-like symptoms in IBD and explore clinical, psychological and nutritional correlates. Design/method In this monocentric cross-sectional study, adult patients with Crohn’s disease or ulcerative colitis completed the French version of the Nine-Item ARFID Screen (NIAS-Fr) along with validated questionnaires assessing anxiety (Generalized Anxiety Disorder 7-item scale), depression (Patient Health Questionnaire 9-item scale), visceral sensitivity (Visceral Sensitivity Index) and disability (Inflammatory Bowel Disease–Disk disability score). NIAS-Fr was used as a screening tool only, with ARFID-like symptoms defined using published subscale-specific cut-offs. Nutritional status and muscle strength were assessed. Results Among 65 patients screened (median age 34 years, 60% women), 32.3% were positive for ARFID-like symptoms. These symptoms were numerically more frequent in women and in patients with Crohn’s disease, without reaching statistical significance. ARFID-like symptoms were associated with higher anxiety and depressive symptoms, greater disability (p=0.007) and increased visceral sensitivity (p=0.018). Subscale analyses suggested distinct profiles, including associations between low appetite and surgical history, fear of eating and visceral hypersensitivity, and picky eating with younger age and low muscle mass. Conclusion ARFID-like restrictive eating behaviours identified by NIAS-Fr screening were frequent in this tertiary care IBD cohort and were associated with psychological distress, greater disability and nutritional vulnerability. These findings reflect ARFID-like symptoms rather than confirmed Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnoses. A positive screen should prompt careful clinical review of disease activity, obstructive symptoms, medication-related effects and dietary advice before considering formal ARFID assessment.