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Original Research

Lower Ghrelin Levels Are Associated With Higher Anxiety Symptoms in Adolescents and Young Adults With Avoidant/Restrictive Food Intake Disorder

Aluma Chovel Sella, MDa,b; Natalia Hadaway, BSa; Casey Stern, BSc; Kendra R. Becker, PhDc,d; Laura M. Holsen, PhDe; Kamryn T. Eddy, PhDc,d; Nadia Micali, MD, PhDf,g; Madhusmita Misra, MD, MPHa,b,h,i,‡; Jennifer J. Thomas, PhDc,d,‡; and Elizabeth A. Lawson, MD, MMSca,i,*,‡

Published: May 3, 2023


Objective: Avoidant/restrictive food intake disorder (ARFID) is associated with increased risk for anxiety, which may adversely affect prognosis. The appetite-stimulating hormone, ghrelin, increases in response to stress, and exogenous ghrelin decreases anxiety-like behaviors in animal models. The aim of this study was to evaluate the relationship between ghrelin levels and measures of anxiety in youth with ARFID. We hypothesized that lower ghrelin levels would be associated with increased anxiety symptoms.

Methods: We studied a cross-sectional sample of 80 subjects with full and subthreshold ARFID diagnosed by DSM-5 criteria, aged 10–23 years (female, n = 39; male, n = 41). Subjects were enrolled in a study of the neurobiology of avoidant/restrictive eating conducted from August 2016 to January 2021. We assessed fasting ghrelin levels and anxiety symptoms (State-Trait Anxiety Inventory [STAI] and STAI for Children [STAI-C] measuring general trait anxiety; Beck Anxiety Inventory [BAI] and BAI for youth [BAI-Y] assessing cognitive, emotional, and somatic symptoms of anxiety; and Liebowitz Social Anxiety Scale [LSAS] assessing symptoms of social anxiety).

Results: Consistent with our hypothesis, ghrelin levels were inversely associated with anxiety symptoms as assessed by STAI/STAI-C T scores (r = −0.28, P = .012), BAI/BAI-Y T scores (r = −0.28, P = .010), and LSAS scores (r = −0.3, P = .027), all with medium effect sizes. Findings held in the full threshold ARFID group when adjusting for body mass index z scores (STAI/STAI-C T scores, β = −0.27, P = .024; BAI/BAI-Y T scores, β = −0.26, P = .034; LSAS, β = −0.34, P = .024).

Conclusions: These findings demonstrate that lower levels of ghrelin are associated with more severe anxiety symptoms in youth with ARFID and raise the question of whether ghrelin pathways could be targeted in the treatment of ARFID.

Volume: 84

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