# Avoidant/Restrictive Food Intake Disorder and Food Neophobia in Adult Patients with Food Allergy: A Preliminary Study

## TL;DR

This study explores how adults with food allergies may develop eating disorders or fear of new foods, and highlights the need for psychological and dietary support.

## Contribution

The study is the first to investigate ARFID and food neophobia in adult food allergy patients, identifying correlations with anxiety and eating behaviors.

## Key findings

- 25% of participants scored positively for ARFID and 73% for food neophobia.
- Food neophobia was positively correlated with ARFID and food allergy anxiety.
- Restrained eating was associated with higher ARFID and food neophobia scores.

## Abstract

Background/Objectives: Patients with food allergy (FA) may exhibit dysfunctional eating behaviours and/or food aversions that extend beyond the necessary allergen elimination diet and may result in avoidant/restrictive food intake disorder (ARFID) or food neophobia (FN); however, no data are available on adults. This study aimed to explore ARFID, FN, FA anxiety, and eating styles in adults with FA, analysing influences of sociodemographic and clinical factors. Methods: This cross-sectional preliminary study involved 79 adults with FA, who completed the Nine Item ARFID screen (NIAS), Food Neophobia Scale (FNS), Scale of Food Allergy Anxiety (SOFAA), and Dutch Eating Behaviour Questionnaire (DEBQ—brief). Pearson and Spearman correlation coefficients and multiple linear regressions were performed (p < 0.05). Results: In total, 25% and 73% of participants scored positively for ARFID and FN, respectively. A positive correlation was observed between FN and ARFID levels (p < 0.006), and between FN and FA anxiety (p < 0.001). Current psychological problems positively correlated with ARFID (p = 0.004), FN (p = 0.006), and FA anxiety scores (p = 0.03). Restrained eating was positively associated with female gender (p < 0.001), and ARFID (p = 0.002) and FN scores (p = 0.028). External eating was negatively correlated with ARFID (p = 0.004). Adrenaline auto-injector (AAI) prescription was negatively associated with ARFID (p < 001) and restrained eating (p = 0.006), while previous anaphylaxis was negatively associated with ARFID (p = 0.020) and positively associated with external eating (p = 0.021). Multiple logistic regression models confirmed that restrained eating was associated with a higher probability of both ARFID (p = 0.031) and FN (p = 0.074). Conclusions: Clinicians should be aware of the risk of ARFID and FN among adult patients with FA and recommend appropriate psychological and dietary support. Further studies are needed to better understand the protective and precipitating factors of ARFID and FN to develop effective prevention and treatment strategies.