Cholecystokinin Elevation Observed in Youth With Avoidant/Restrictive Food Intake Disorder

Avoidant/restrictive food intake disorder (ARFID), introduced in the DSM-5, is defined as food avoidance or restrictive eating not primarily motivated by concerns about body shape or weight. Avoidant/restrictive eating in ARFID has at least one of three motivations, which often co-occur:

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• Sensory sensitivities to food characteristics
• Lack of interest in food/eating; low appetite; high fullness between meals
• Fear of aversive consequences (e.g., choking, vomiting)

Other restrictive eating disorders, including anorexia nervosa, are characterized by disturbances in satiety hormones, notably elevations in cholecystokinin. Secreted in the small bowel, cholecystokinin is a safety-promoting gut–brain peptide that signals satiation in response to food intake and satiety between meals.

In the first study of its type, Massachusetts General Hospital reported in the Journal of Clinical Psychiatry that fasting concentrations of cholecystokinin were higher in children and adolescents with ARFID than in healthy youth. The authors are Helen Burton Murray, PhD, psychologist and the director of the Gastrointestinal Behavioral Health Program in the Center for Neurointestinal Health, Division of Gastroenterology at Mass General, Kendra R. Becker, PhD, a staff psychologist in the Eating Disorders Clinical and Research Program in the Department of Psychiatry,  Jennifer J. Thomas, PhD, co-director of the Program, Elizabeth A. Lawson, MD, MMSc, a physician in the Neuroendocrine Unit in the Endocrinology Division, and colleagues.

Methods

125 male and female participants, ages 10 to 23, were recruited for the study. 83 participants (49% female, mean age 15) were diagnosed with full or subthreshold ARFID, and the 42 others (83% female, mean age 19) were healthy controls.

The single study visit included an early morning fasting blood draw for the measurement of plasma cholecystokinin concentrations. In addition, participants completed the following:

• Visual analog scales (0–100) to report levels of hunger and satiety immediately before the blood draw
• The hunger subscale and satiety responsiveness subscale of the Adult Eating Behavior Questionnaire (AEBQ)
• The Pica, ARFID, and Rumination Disorder Interview (PARDI), a semistructured clinical interview that captures ARFID symptoms

Results

The ARFID group had higher cholecystokinin concentrations than the controls (mean 459 vs. 144 pg/mL; P<0.001) after adjustment for age, sex, and percentile of body mass index. The means were respectively, with a large effect (η_p²=0.17).

Within the ARFID group, cholecystokinin was not significantly associated with BMI percentile, scores on the hunger and satiety visual analog scales, AEBQ–hunger score, AEBQ–satiety responsiveness score, or PARDI score.

Therapeutic Potential

Cholecystokinin antagonists might be a therapeutic option for ARFID, as previously proposed for the related disorders of functional dyspepsia and anorexia nervosa. However, further research is necessary since this study didn't find any association between cholecystokinin and subjective measures of appetite.

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