Journal Article Annotations
2025, 1st Quarter

GI Psychiatry

Annotations by Ashwini Nadkarni, MD
March, 2025

Association between avoidant/restrictive food intake disorder risk, dietary attitudes and behaviors among Chinese patients with inflammatory bowel disease: a cross-sectional study. Longitudinal Study of the MOSAIK Cohort.
Systematic review and meta-analysis of post-traumatic stress disorder as a risk factor for multiple autoimmune diseases.

PUBLICATION #1 — GI Psychiatry

Association between avoidant/restrictive food intake disorder risk, dietary attitudes and behaviors among Chinese patients with inflammatory bowel disease: a cross-sectional study. Longitudinal Study of the MOSAIK Cohort.

Wenjing Tu, Yiting Li, Tingting Yin, Sumin Zhang, Ping Zhang, Guihua Xu.

Abstract: BMC Gastroenterol. 2025 Mar 6;25(1):144. doi: 10.1186/s12876-025-03727-z.

Background:
Restrictive eating behaviors are common among patients with inflammatory bowel disease (IBD), which maydevelop nutritional and/or quality of life impairments into avoidant/restrictive food intake disorder (ARFID). The objective of this study is to estimate the prevalence and characteristics of into avoidant/restrictive food intake disorder in Chinese patients with inflammatory bowel disease, and to investigate the current perceptions and dietary behaviors of patients with and without into avoidant/restrictive food intake disorder.

Methods:
A cross-sectional study was conducted in gastroenterology clinics of four tertiary hospitals in China. Patients with inflammatory bowel disease were asked to complete a structured questionnaire including demographic characteristics, dietary attitudes and behaviors. The diagnosis of avoidant/restrictive food intake disorder was established using Chinese version of the Nine-Item Avoidant/Restrictive Food Intake Disorder Screen questionnaire.

Results:
A total of 483 patients with inflammatory bowel disease completed the questionnaires, and 20.3% met clinical criteria for into avoidant/restrictive food intake disorder. The average score of avoidant/restrictive food intake disorder was 21.9 (interquartile range = 17.0-26.0). Multivariable binary logistic regression results showed that patients with Crohn’s disease (OR = 0.483, 95%CI = 0.280-0.835; p = 0.009), being in an active disease state (OR = 0.220, 95%CI = 0.123-0.392; p < 0.001), holding dietary attitudes regarding symptom control (OR = 2.431, 95%CI = 1.299-4.548; p = 0.005), and reporting a specific dietary history (OR = 27.158, 95%CI = 3.679-200.456; p = 0.001) were significant more likely to suffer from into avoidant/restrictive food intake disorder.

Conclusions:
Avoidant/restrictive food intake disorder is a common problem among patients with inflammatory bowel disease. The incidence of avoidant/restrictive food intake disorder is particularly high among patients with Crohn’s disease, during relapse, and those who hold restrictive dietary attitudes or have a history of specific diets. Therefore, it is imperative to prioritize routine screening and early identification of avoidant/restrictive food intake disorder, especially among high-risk populations, in future research and clinical practice.

Annotation

The finding:
This cross-sectional study aimed to: (1) identify the prevalence and characteristics of avoidant/restrictive food intake disorder among Chinese patients with inflammatory bowel disease and (2) explore the correlations between presence of avoidant/restrictive food intake disorder symptoms and dietary attitudes and practices of patients with inflammatory bowel disease. The study found that patients with inflammatory bowel disease may be a population with a heightened susceptibility to avoidant/restrictive food intake disorder, and that four factors, having Crohn’s Disease, being in an active disease state, holding attitudes about symptom management, and reporting a specific dietary history, were associated with a higher likelihood of avoidant/restrictive food intake disorder among patients with inflammatory bowel disease.

Strength and weaknesses:
This is the first study to estimate the prevalence and characteristics of avoidant/restrictive food intake disorder in Chinese patients with inflammatory bowel disease with findings that can help to contribute to a better understanding of prevalence and characteristics of avoidant/restrictive food intake disorder among Chinese patients with inflammatory bowel disease. However, selection bias was present through variations in food and dietary preferences between individuals who opt to participate in the study and those who do not. Furthermore, more than two-thirds of the participants had at least a college-level education. Given literature showing that dietary preferences and educational attainment can affect interest in nutrition, additional bias may have been introduced to the study. Another limitation was recall bias through questions that asked for dietary attitudes and practices both in the present and the past.

Relevance:
This study highlights factors associated with avoidant/restrictive food intake disorder in inflammatory bowel disease patients, providing valuable information to consultation-liaison psychiatrists on the screening and diagnosis of avoidant/restrictive food intake disorder

PUBLICATION #2 — GI Psychiatry

Systematic review and meta-analysis of post-traumatic stress disorder as a risk factor for multiple autoimmune diseases.

Kevin Mandagere, Savanna Stoy, Nathan Hammerle, Isain Zapata, Benjamin Brook.

Abstract: Front Psychiatry. 2025 Feb 20:16:1523994. doi: 10.3389/fpsyt.2025.1523994. eCollection 2025.

Background:
Post Traumatic Stress Disorder (PTSD) is a prevalent and debilitating psychiatric illness that has been linked to poor health outcomes and increased risk of developing chronic health conditions, including multiple autoimmune diseases such as Systemic Lupus Erythematosus (SLE), Inflammatory Bowel Disease (IBD), Rheumatoid Arthritis (RA), and Multiple Sclerosis (MS).

Aim:
This meta-analysis assesses the epidemiological research in this field and briefly explores the hypothesized neurobiological and immunological mechanisms that may underlie the association between Post Traumatic Stress Disorder and the development of Autoimmune Disease.

Methods:
PubMed, SCOPUS, and Cochrane Reviews databases were searched for all relevant articles in August 2023. Studies were systematically screened for relevance and inclusion criteria by two reviewers before quality assessment and data extraction were performed. Fixed and random-effect meta-analyses were performed to evaluate Post Traumatic Stress Disorder as a risk factor for the development of specific autoimmune diseases. Subgroup analyses examining the roles of biological sex and Post Traumatic Stress Disorder severity were also performed.

Results:
The initial search yielded 3010 articles where only eight prospective and retrospective cohort studies met criteria for inclusion in the meta-analysis. These eight studies were subdivided based on specific disease outcomes. Random effects model for risk of developing any autoimmune disease in persons with Post Traumatic Stress Disorder vs. control was 1.291 (95% CI = 1.179 to 1.412; P <0.001; n=1,984,310; 4 studies included). The strength of the association between PTSD and risk of developing specific autoimmune diseases varied by outcome condition from 1.142 (95% CI = 1.085 to 1.202, P <0.001) for risk of Inflammatory Bowel Disease to 1.302 (1.037 to 1.635, P = 0.023) for risk of MS. Random effects models showed statistically significant associations between Post Traumatic Stress Disorder and Inflammatory Bowel Disease, Lupus, Rheumatoid Arthritis, Multiple Sclerosis, and Thyroiditis.

Conclusion:
These results suggest that the risk for developing autoimmune conditions, including Inflammatory Bowel Disease, Lupus, Rheumatoid Arthritis and Multiple Sclerosis is significantly increased in the setting of Post Traumatic Stress Disorder. This association may have important implications on clinical practice and research into the pathophysiology of stress disorders.

Annotation

The finding:
This review aims to clarify the association between Post-Traumatic Stress Disorder and a spectrum of autoimmune diseases, finding that Post-Traumatic Stress Disorder is associated with the risk of developing a wide range of autoimmune diseases and such risk is unequally distributed, with illnesses such as Lupus and Multiple Sclerosis more often associated with Post-Traumatic Stress Disorder compared to Inflammatory Bowel Disease and Rheumatoid Arthritis.

Strength and weaknesses:
Strengths of this analysis include its inclusion of diverse, mainly high-quality, heterogeneous cohort studies with large sample sizes. Most of these studies drew from datasets with robust demographic and medical information and, in aggregate, examined the effects of important potential confounding factors. These include smoking status, comorbid psychiatric illness, and family history. However, limitations were that several studies in the metanalysis were unable to control for the potentially confounding effects of tobacco and alcohol use in their analyses which is why these studies frequently found stronger associations than other studies. Second, studies were largely unable to assess or control for the impact of childhood trauma, which has itself been associated with a wide range of negative health and psychosocial outcomes. Finally, multiple studies raised concerns regarding accurately assessing the temporality of the association given the long diagnostic lag time present in many autoimmune diseases.

Relevance:
This study adds to a growing body of evidence for post-traumatic stress disorder’s role as a major risk factor for chronic medical conditions and has significant implications for our understanding of traumatic stress effects upon the immune system, highlighting the importance of consultation-liaison psychiatrists diagnosing and treating Post-Traumatic Stress Disorder in patients with disorders such as Inflammatory Bowel Disease.