How-To Guides
2 guidesHow to Consider Fasting Appetite Hormones in ARFID
How can clinicians use fasting CCK and ghrelin findings to interpret symptom patterns and follow-up in youth with ARFID?
How to Track ARFID Symptoms for Your Doctor Visits
How can you keep track of ARFID symptoms in a helpful way to discuss with your doctor?
Frequently Asked Questions
10 questions-
Greater decreases in fasting CCK were associated with greater improvement in ARFID lack-of-interest symptoms at both follow-ups. From Baseline to Year 1, change in CCK was associated with change in PARDI lack-of-interest severity (adjusted R2=0.41, F1,41=4.36, p=.043, f2=0.11), and from Baseline to Year 2 the association remained significant (adjusted R2=0.62, F1,30=7.00, p=.013, f2=0.23).
The authors interpreted this pattern as consistent with a role for CCK in lack-of-interest symptoms such as early satiety and low appetite, rather than in overall ARFID severity.
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Yes. Greater increases in fasting ghrelin were associated with greater decreases in overall ARFID severity at both Year 1 and Year 2. From Baseline to Year 1, the association with PARDI severity was significant (adjusted R2=0.35, F1,41=6.00, p=.02, f2=0.15), and it was also significant from Baseline to Year 2 (adjusted R2=0.50, F1,28=6.38, p=.02, f2=0.23).
In this study, ghrelin tracked with overall ARFID severity rather than with the lack-of-interest symptom dimension.
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Youth who met cutoff for the ARFID lack-of-interest presentation had significantly higher fasting CCK at Year 1 than youth who did not, with a large effect size (partial η2=.180). However, there was no significant group difference in fasting CCK at Baseline or Year 2.
Contrary to the authors' hypothesis, there were no significant differences in fasting ghrelin between participants with versus without the lack-of-interest presentation at any timepoint.
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No. Changes in fasting CCK were not significantly associated with changes in overall ARFID severity at either follow-up in this study. The Year 1 model was not significant for this relationship (adjusted R2=0.27, F1,40=1.86, p=.18), and the Year 2 model was also not significant (adjusted R2=0.36, F1,30=0.39, p=.54).
This suggests that CCK was more closely related to the lack-of-interest symptom domain than to broader ARFID severity as measured by the PARDI severity scale.
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No significant association was found between changes in fasting ghrelin and changes in ARFID lack-of-interest severity at either follow-up. At Year 1, the model did not reach significance (adjusted R2=0.38, F1,42=3.91, p=.06), and at Year 2 it was also nonsignificant (adjusted R2=0.50, F1,29=1.56, p=.22).
In this cohort, ghrelin appeared to be linked to overall ARFID severity rather than to the specific lack-of-interest symptom presentation.
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This was a single-center longitudinal cohort study of 100 youth aged 9-23 years with full (n=88) or subthreshold (n=12) ARFID, recruited in Boston between 2016 and 2021. Participants completed 3 study visits over about 2 years, spaced roughly 12 months apart (mean [SD]=12.0 [3.0] months).
Before each visit, participants fasted overnight, then had blood drawn for fasting CCK and ghrelin. ARFID diagnosis, presentation type, and symptom severity were assessed at each timepoint with the Pica, ARFID, and Rumination Disorder Interview (PARDI).
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The main analyses adjusted for age, sex, and BMI percentile, because these factors can influence endocrine functioning. The longitudinal regression models also adjusted for baseline PARDI scores to account for baseline illness severity and reduce residual variance.
The authors noted that the observed associations between CCK, ghrelin, and symptom change persisted after accounting for these potential confounders.
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Although 100 youth were recruited at Baseline, hormone data were available for fewer participants at follow-up. Fifty-six participants were included in hormone analyses at Year 1 and 43 at Year 2.
The article states that reduced hormone data availability was due to COVID-19 restrictions on in-person sessions, inability to obtain enough blood, or participant refusal at blood draw.
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- Attrition reduced endocrine data availability at follow-up, which may have limited statistical power.
- The study did not control for co-occurring ARFID presentations because of limited sample size and power.
- The observational design means the study could not test causality.
- The sample was predominantly White, which limits generalizability to other racial and ethnic groups.
The authors also noted that some between-group CCK differences may have been missed because the study was likely underpowered at certain timepoints.
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Yes, but only as a future research direction. The authors concluded that the findings identify potentially targetable biological mechanisms, with CCK possibly relevant to lack-of-interest symptoms and ghrelin possibly relevant to overall ARFID severity.
They suggested that CCK antagonists could be explored to reduce inappropriate fullness and that ghrelin agonists could be evaluated to stimulate hunger and meal onset. However, the article also states that ARFID currently has no standardized pharmacologic treatments, and this study did not test any medication.
