Increased Risk of Eating Disorders, ARFID Among Cystic Fibrosis Population

Alexandra Kass, MD

Alexandra Kass, MD, Columbia University Irving Medical Center, and a team of investigators examined the prevalence of eating disorders among adolescents and young adults living with cystic fibrosis (CF). Evidence shows that these individuals with chronic illnesses have an increased risk for delevoping eating disorders, particularly those with diet-treated conditions.

Cystic fibrosis can be categorized as a diet-treated illness, but investigators stated that the data on eating disorders in this specific population is less clear. The team aimed to determine the prevalence of these disorders, including avoidant/restrictive food intake disorder (ARFID), which has never been studied in the CF population.

This chronic, progressive multi-system organ disease usually presents with patients experiencing pancreatic insufficiency leading them to require pancreatic enzyme supplementation with all food intake, otherwise they're unable to absorb the dietary fat needed from their diet.

Patients without proper enzyme supplementation can suffer from gastrointestinal distress, constipation, and weight loss. A high calorie, high fat diet is needed for these patients to maintain a normal weight and compensate for their high energy needs, resulting in an emphasized focus on their nutrition and weight management.

Eating Disorder Examinations

The research included patients with cystic fibrosis who were between the ages of 14-35. With the need for attentive weight gain beginning at an early age contradicting the societal pressures to stay thin and the high rates of mental health issues in these patients, body image disturbance is a concern, according to investigators.

Recruited patients completed 3 validated surveys: Eating Disorder Examination Questionnaire (EDE-Q), Nine-Item Avoidant-Restrictive Food Intake Disorder Scale (NIAS), and Cystic Fibrosis Questionnaire-Revised (CFQ-R).

For the analysis, investigators used univariate linear regression to identify baseline risk factors associated with the patient survey scores and variables with a univariate P<0.20 were considered for inclusion in their multivariable linear regression model. The final model was identified by using a backwards stepwise linear regression.

Analyzing Survey Results

The screening and analyses indicated a clinically significant number of patients were positive for eating disorders on the EDE-Q and NIAS. The EDE-Q results from the 52 enrolled patients revealed that 9.6% had a prevalence of a positive screen. For the NIAS, 13.5% displayed a positive screen.

The scores from these surveys were associated with the scores on the eating and weight scales of the CFQ-R.

"The CFQ-R eating and weight subscales were associated with scores on the EDE-Q, and CFQ-R eating subscale and being dF508 homozygous were correlated with the NIAS total score," investigators reported.

While these data were statistically significant, investigators stated that further research is needed to progress understanding and implement optimal screening and treatment tools for this population.

"In order to better identify and treat body image disturbance and eating disorders in adolescents and young adults with CF, it is imperative that CF providers feel comfortable with identifying, screening and either treating or referring for concerning behaviors," they wrote. "There are no screening tools for eating disorders that have been validated in the United States CF population."

The study, "Eating Disorders in Adolescents and Young Adults with Cystic Fibrosis" was published in Pediatric Pulmonology.