BACKGROUND: Avoidant/Restrictive Food Intake Disorder (ARFID) is a newly described eating disorder. Adequate levels of food literacy allow individuals to have adequate food choices. This study aimed to assess the prevalence of ARFID and the level of food literacy in patients with inflammatory bowel disease (IBD) and to analyse the correlation between ARFID and food literacy.
METHODS: This cross-sectional study screened for ARFID and assessed food literacy levels in patients with IBD attending four tertiary hospitals in China. ARFID risk was measured using the Nine Item Avoidant/Restrictive Food Intake Disorder Screen (NIAS). Food literacy was assessed using the Food Literacy Evaluation Questionnaire (Chinese version, FLEQ-Ch).The relationship between individual NIAS scores and food literacy variables was analysed to assess which food literacy aspect is positively or negatively associated with NIAS scores. Stepwise linear regression analysis was performed to identify the possible predictors of NIAS scores in patients with IBD.
RESULTS: A total of 372 IBD subjects completed the NIAS and FLEQ-Ch. The overall mean NIAS scores for the IBD cohort was 28.16 ± 8.03 (p < 0.01), and of the 372 participants, 123 (32.5%) had positive ARFID risk scores (≥ 10 NIAS-picky eating, ≥ 9 NIAS-poor appetite, and ≥ 10 NIAS-fear of negative consequences).The NIAS scores were inversely associated with food literacy levels (β =  - 0.299; p < 0.01).Disease phenotype, disease activity, and food literacy in patients with IBD provided valuable predictive insights for avoiding positive outcomes in ARFID.
CONCLUSIONS: This study shows that the risk of ARFID in the cohort of patients with IBD is associated with their inadequate food literacy levels. Therefore, this study supports the notion that patients with IBD should be assessed for food literacy regardless of whether they are currently diagnosed with ARFID. Specifically, for early identification of those at risk for ARFID in IBD, disease phenotype, disease activity, and food literacy should be routinely considered in clinical practice.The food literacy awareness of patients must be investigated and improved to predict the risk occurrence of ARFID and encourage healthy eating behaviour.
Excessive dietary restriction is common in patients with inflammatory bowel disease (IBD) and in severe cases can lead to Avoidant/Restrictive Food Intake Disorder (ARFID).ARFID is a new eating disorder that has been proposed in recent years. Studies have shown that food literacy can influence patients’ eating behaviour to some extent. Research on the risk factors associated with ARFID is necessary to better understand why people with IBD develop ARFID and to inform programmes aimed at reducing these risk factors. In our study, we found that disease phenotype, disease activity, and food literacy in patients with IBD provided valuable predictive insights for avoiding positive outcomes in ARFID. These factors can provide valuable perspectives for healthcare providers and patients at this critical juncture in the disease dietary management process. Therefore, this study supports the notion that patients with IBD should be assessed for food literacy regardless of whether they are currently diagnosed with ARFID. Specifically, for early identification of those at risk for ARFID in IBD, disease phenotype, disease activity, and food literacy should be routinely considered in clinical practice.

Objective: The current study aimed to provide initial psychometric evidence for a Chinese version of the Nine-Item ARFID Screen (C-NIAS), which measures the symptoms of avoidant/restrictive food intake disorder (ARFID), including picky eating, poor appetite/limited interest in eating, and fear of aversive consequences from eating. Method: The NIAS was translated into Chinese according to standard procedures. A total of 1,069 college students from mainland China responded to the C-NIAS. The factor structure was confirmed using confirmatory factor analysis. Convergent and divergent validity were assessed using regression analyses. Finally, measurement invariance was tested, and latent mean differences were compared, between Chinese and American college samples. Results: The measure\'s original three-factor structure was confirmed. Strong measurement invariance between college samples of the United States and China was supported, and Chinese students had significantly higher latent mean scores on all three factors. The subscales showed the expected patterns of correlations with other validity constructs. Conclusions: The C-NIAS shows good psychometric characteristics and holds promise to facilitate much-needed research on subclinical symptoms of this understudied eating disorder in Chinese-speaking adult populations. Moreover, Chinese college students demonstrate greater potential ARFID symptomatology than American counterparts. More attention to ARFID should be called for in China.