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 1 bowel symptom used to diagnose a functional bowel disorder according to the Rome IV criteria, and an age-matched and sex-matched control group without bowel symptoms. Cutoffs for the Nine-Item Avoidant/Restrictive food intake disorder screen were 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 with controls (n = 1806) (22.8% vs 18.2%, P < 0.001). 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.