Avoidant/restrictive eating in people with and without bowel symptoms in the general population: Prevalence, Clinical Profile and Associated Factors

Introduction: We aimed to investigate the prevalence of avoidant/restrictive eating in individuals with versus without bowel symptoms in the general population, and identify factors associated with avoidant/restrictive eating. Methods: In this Swedish population-based internet health survey, we included individuals with at least one bowel symptom used to diagnose a functional bowel disorder according to the Rome IV criteria, and an age- and sex-matched control group without bowel symptoms. Cutoffs for the Nine-Item avoidant/restrictive food intake disorder screen (NIAS) was used to determine the prevalence of avoidant/restrictive eating. Demographics and clinical characteristics were assessed using validated questionnaires, and independent factors associated with avoidant/restrictive eating were determined by hierarchical multiple regression analysis. Results: Avoidant/restrictive eating was more common in individuals with bowel symptoms (n=825) compared to controls (n=1806) (22.8% vs 18.2%, p<.001). Individuals with bowel symptoms with avoidant/restrictive eating were more often female, had lower body mass index, more likely to report overlapping functional dyspepsia, reported more severe bowel, psychological and somatic symptoms, shape/weight concerns, and a lower quality of life. Bowel symptom severity emerged as the strongest factor explaining the variability of avoidant/restrictive eating severity. Discussion: Avoidant/restrictive eating is common in individuals with bowel symptoms and associated with a more severe clinical profile, indicating a need to discuss eating behavior with patients. However, avoidant/restrictive eating is also common in individuals in the general population without bowel symptoms.