Dataset Information

Validation of the Nine-Item Avoidant/Restrictive Food Intake Disorder Screen Among Transgender and Nonbinary Youth and Young Adults.

ABSTRACT:

Purpose

The purpose of the study was to provide initial evidence for the internal consistency and convergent validity of the nine-item avoidant/restrictive food intake disorder screen (NIAS) in a sample of transgender and nonbinary (TGNB) youth and young adults.

Methods

Returning patients at a Midwestern gender clinic (n=164) ages 12-23 completed the NIAS, sick, control, one stone, fat, food (SCOFF), patient health questionnaire 9 (PHQ-9), and generalized anxiety disorder 7 (GAD-7) during their clinic visit. Age, sex assigned at birth, gender identity, weight, and height were also collected. Confirmatory factor analysis was used to establish the hypothesized three-factor structure of the NIAS in this sample. Relationships between the NIAS subscales and anthropometric data, SCOFF, PHQ-9, GAD-7, and sex assigned at birth were explored for convergent and divergent validity, and proposed screening cutoff scores were used to identify the prevalence of likely avoidant/restrictive food intake disorder (ARFID) in this population.

Results

The three-factor structure of the NIAS was an excellent fit to the current data. Approximately one in five (22%) of the participants screened positive for ARFID. Approximately one in four participants scored above the picky eating (27.4%) or appetite (23.9%) cutoffs. Assigned female at birth participants scored significantly higher on the NIAS-Total, Appetite, and Fear subscales than those assigned male at birth. NIAS-Total was significantly related to all convergent validity variables other than age, with a moderate-strong correlation with other symptom screeners (SCOFF, PHQ-9, GAD-7), and a small negative correlation with body mass index percentile.

Conclusions

Evidence supports the NIAS as a valid measure to screen for ARFID among TGNB youth and young adults.

SUBMITTER: Zickgraf HF

PROVIDER: S-EPMC10066774 | biostudies-literature | 2023 Apr

REPOSITORIES: biostudies-literature

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Publications

Validation of the Nine-Item Avoidant/Restrictive Food Intake Disorder Screen Among Transgender and Nonbinary Youth and Young Adults.

Zickgraf Hana F HF Garwood Sarah K SK Lewis Christopher B CB Giedinghagen Andrea M AM Reed Jamie L JL Linsenmeyer Whitney R WR

Transgender health 20230331 2

<h4>Purpose</h4>The purpose of the study was to provide initial evidence for the internal consistency and convergent validity of the nine-item avoidant/restrictive food intake disorder screen (NIAS) in a sample of transgender and nonbinary (TGNB) youth and young adults.<h4>Methods</h4>Returning patients at a Midwestern gender clinic (<i>n</i>=164) ages 12-23 completed the NIAS, sick, control, one stone, fat, food (SCOFF), patient health questionnaire 9 (PHQ-9), and generalized anxiety disorder 7 ...[more]

PMID: 37013088

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Project description:ImportanceThe neurobiology of avoidant/restrictive food intake disorder (ARFID) is poorly understood.ObjectiveTo evaluate whether individuals with ARFID exhibit disruptions in fear, appetite, and disgust brain regions compared with healthy control (HC) participants when shown images of food and objects.Design, setting, and participantsIn this case-control study conducted from July 2016 to January 2021, children, adolescents, and young adults completed structured interviews and a validated functional magnetic resonance imaging (fMRI) food cue paradigm. The study was conducted at a single academic medical center. Data analysis was conducted from April 2023 to August 2024.ExposuresPresence vs absence of ARFID and its phenotypes (ARFID-fear, ARFID-lack of interest in eating, ARFID-sensory sensitivity); pictures of food vs objects during fMRI food cue paradigm.Main outcomes and measuresBlood oxygenation level-dependent activation in regions of interest (ROIs; amygdala, hypothalamus, insula, anterior cingulate cortex [ACC]) and the whole brain.ResultsParticipants were 110 children, adolescents, and young adults with full or subthreshold ARFID (75 participants; mean [SD] age, 16.2 [3.8] years; 41 [55%] female) and age-matched HC participants (35 participants; mean [SD] age, 17.3 [4.0] years; 27 [69%] female) recruited for studies of the neurobiology of ARFID and restrictive eating disorders. Participants with ARFID demonstrated greater activation than HC participants of the ACC (mean difference, 0.48 [95% CI, 0.19 to 0.77]; P = .009), sensory association cortex (mean difference on left side, 0.54 [95% CI, 0.29 to 0.79]; P = .005; right side, 0.52 [95% CI, 0.28 to 0.76]; P = .02), and supplementary motor cortex (mean difference, 0.81 [95% CI, 0.47 to 1.15]; P = .04). The ARFID-fear group showed greater amygdala activation vs HC (mean difference, 0.49 [95% CI, 0.16 to 0.82]; P = .04), and greater lack of interest was associated with lower hypothalamus activation in the ARFID-lack of interest group (r = -0.38 [95% CI, -0.69 to -0.11]; P = .03). The ARFID-sensory sensitivity group did not show greater insula activation vs HC but showed greater activation of the ACC (mean difference, 0.48 [95% CI, 0.22 to 0.74]; P = .005) and somatosensory cortex (mean difference on left side, 0.60 [95% CI, 0.33-0.87]; P = .001; right side, 0.54 [95% CI, 0.29 to 0.80]; P = .03).Conclusions and relevanceResults indicate generalized hyperactivation of ACC, sensory association cortex, and supplementary motor cortex in response to visual food stimuli in children, adolescents, and young adults with ARFID, suggesting a novel neurobiological circuit associated with this disorder. Activation appears consistent with ARFID phenotypic rationales for food avoidance, with hyperactivation of fear regions in ARFID-fear and hypoactivation of appetite regions with increasing ARFID-lack of interest severity.

Project description:ObjectiveAvoidant/restrictive food intake disorder (ARFID) is a relatively new feeding and eating disorder category in DSM-5 characterized by extreme food avoidance/restriction. Much is unknown about ARFID, with limited understanding of its prevalence and comorbidities in general pediatric populations. This study aimed to classify ARFID prevalence and characteristics in children within the Generation R Study, a population-based Dutch cohort (N = 2,862).MethodARFID was assessed via an Index that comprised parent-reported questionnaires and researcher-assessed measures of picky eating, energy intake, diet quality, growth, and psychosocial impact, all in the absence of body/weight dissatisfaction to align with DSM-5 criteria. Parents also reported on child appetitive traits and emotional/behavioral problems (eg, anxiety, depression, attention problems).ResultsUsing DSM-5-based categorization, 183 (6.4%) of 2,862 children were classified as presenting with ARFID symptoms. Compared with children not exhibiting symptoms, children classified with ARFID symptomatology expressed other avoidant eating behavior, including decreased enjoyment of food (d = -1.06, false discovery rate-corrected p [p FDR] < .001), increased satiety responsiveness (d = 1.06, p FDR < .001), and emotional undereating (d = 0.21, p FDR < .01), as well as more emotional problems, including withdrawn/depressed (d = 0.38, p FDR < .001), social problems (d = 0.34, p FDR < 0.001), attention problems (d = 0.38, p FDR < .001), anxiety (d = 0.30, p FDR < .001), obsessive/compulsive problems (d = 0.15, p FDR < .05), and autistic traits (d = 0.22; p FDR < .05). Associations did not differ by sex.ConclusionThis is the first large-scale community-based study to characterize ARFID and to demonstrate that ARFID symptom classification is common in children aged ≤10 years. Findings suggest that appetitive, emotional, and behavioral comorbidities may underlie or reinforce the presentation of ARFID.Diversity & inclusion statementWe worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. Diverse cell lines and/or genomic datasets were not available. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. We actively worked to promote sex and gender balance in our author group. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science.

Dataset Information

Validation of the Nine-Item Avoidant/Restrictive Food Intake Disorder Screen Among Transgender and Nonbinary Youth and Young Adults.

Purpose

Methods

Results

Conclusions

Publications

Validation of the Nine-Item Avoidant/Restrictive Food Intake Disorder Screen Among Transgender and Nonbinary Youth and Young Adults.

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