Abstract Background Avoidant/Restrictive Food Intake Disorder (ARFID) is common among patients with Crohn’s disease (CD). Dietary therapies are an integral part of CD management, however their impact on ARFID risk remains unclear. We aimed to evaluate whether following a diet for treatment of CD is associated with a higher likelihood of ARFID. Methods This cross-sectional study was conducted at a tertiary center between December 2024 and February 2025. Adult patients with CD filled an anonymous questionnaire that included the Nine-Item Avoidant/Restrictive Food Intake Disorder Screen (NIAS) to assess risk for ARFID. A NIAS score ≥24 indicated positive ARFID risk, categorized into three subscales: picky eating, poor appetite, and fear of consequence of eating (fear-of-consequence). Questionnaires with incomplete NIAS data, reported pregnancy, and a preexisting eating disorder were excluded. Patients were classified as following a diet for treatment of CD (either in the past or currently) or not, and adjusted odds ratios (aOR) for ARFID risk were determined using a multivariable logistic regression. Results A total of 260 questionnaires were included in the final analysis (54.4% females, 43.4% young adults 18-35 years, 169 65.0% were following a diet for CD; 87 patients 33.5% in the past and 82 patients 31.5% currently). Forty-four patients (16.9%) met the screening criteria for ARFID. Following a diet for CD was associated with an increased risk of fear-of-consequence NIAS subscale (aOR=2.76; 95%CI: 1.32-5.80, p = 0.007). Patients currently following a diet tended towards an increased overall ARFID risk (aOR=1.95; 95%CI: 0.98-3.93, p = 0.056) and had a higher risk of fear-of-consequence compared to patients who followed a diet in the past or who never followed a diet for CD (aOR=3.52 95%CI: 1.86-6.65, p 0.001). Conclusion Following dietary treatment for CD is associated with an increased risk of fear-of-consequence NIAS subscale. Currently following a diet demonstrated a higher risk of fear-of-consequence, with a trend toward a twofold increase of aOR for ARFID. Patients with CD following dietary treatments should be closely monitored and guided by a specialized inflammatory bowel disease dietitian due to increased risk of avoidant eating behavior. Conflict of interest: Dr. Thurm, Tamar: No conflict of interest Shemer, Maayan: No conflict of interest Irma, Elashvili: No conflict of interest Leibovitzh, Haim: I declare that they I have no conflict of interest Hirsch, Ayal: No conflict of interest Ron, Yulia: No conflict of interest Cohen, Nathaniel Aviv: No conflict of interest Bromberg, Ahuva: No conflict of interest Shilton, Shahar: No conflict of interest Simanovich, Meitar: No conflict of interest Anbar, Ronit: No conflict of interest Yuval, Jonathan Benjamin: No conflict of interest Sarbagili Shabat, Chen: No conflict of interest Maharshak, Nitsan: Grant support from Janssen, Abbott, Abbvie, Pfizer, BMS, Nestle, Helmsley Charitable Trust Personal fees/ advisory board- from Abbvie, Magentiq eye, Lilly, Pfizer, Janssen, BMS, Nestle, Teva, Baemek Advanced Technologies
Thurm et al. (Thu,) studied this question.