Avoidant Restrictive Food Intake Disorder Symptoms in Adults with Systemic Sclerosis: A Nationwide Study in Spain.

Objective: Patients with systemic sclerosis (SSc) may restrict food intake to manage their symptoms (particularly gastrointestinal). Whether some patients may develop nutritional and/or quality of life impairments indicative of an eating disorder, avoidant/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 between ARFID symptoms, GI symptom burden and health-related quality of life METHODS: Cross-sectional internet survey nationwide in Spain, patients with SSc completed the Spanish Nine-Item ARFID Screen and assessments of gastrointestinal symptom burden (UCLA SCTC GIT 2.0) and health-related quality of life (SF-12).

Results: Of 200 patients with SSc, 99 (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 (e.g., 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). worse health-related quality of life, in all domains and both the physical and mental components of by SF-12 (all p<0.05).

Conclusions: 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 versus pathological restriction indicative of ARFID warranting behavioral treatment.