Center for Neurointestinal Health, Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA.
Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.
Int J Eat Disord. 2021 Oct;54(10):1782-1792. doi: 10.1002/eat.23520. Epub 2021 Apr 22.
The Nine Item Avoidant/Restrictive Food Intake Disorder (ARFID) Screen (NIAS) has three subscales aligned with ARFID presentations but clinically validated cutoff scores have not been identified. We aimed to examine NIAS subscale (picky eating, appetite, fear) validity to: (1) capture clinically-diagnosed ARFID presentations; (2) differentiate ARFID from other eating disorders (other-ED); and (3) capture ARFID symptoms among individuals with ARFID, individuals with other-ED, and nonclinical participants.
Participants included outpatients (ages 10-76 years; 75% female) diagnosed with ARFID (n = 49) or other-ED (n = 77), and nonclinical participants (ages 22-68 years; 38% female, n = 40). We evaluated criterion-related concurrent validity by conducting receiver operating curve (ROC) analyses to identify potential subscale cutoffs and by testing if cutoffs could capture ARFID with and without use of the Eating Disorder Examination-Questionnaire (EDE-Q).
Each NIAS subscale had high AUC for capturing those who fit versus do not fit each ARFID presentation, resulting in proposed cutoffs of ≥10 (sensitivity = .97, specificity = .63), ≥9 (sensitivity = .86, specificity = .70), and ≥ 10 (sensitivity = .68, specificity = .89) on the NIAS-picky eating, NIAS-appetite, and NIAS-fear subscales, respectively. ARFID versus other-ED had high AUC on the NIAS-picky eating (≥10 proposed cutoff), but not NIAS-appetite or NIAS-fear subscales. NIAS subscale cutoffs had a high association with ARFID diagnosis, but only correctly classified other-ED in combination with EDE-Q Global <2.3.
To screen for ARFID, we recommend using a screening tool for other-ED (e.g., EDE-Q) in combination with a positive score on any NIAS subscale (i.e., ≥10, ≥9, and/or ≥10 on the NIAS-picky eating, NIAS-appetite, and NIAS-fear subscales, respectively).
九项回避/限制食物摄入障碍（ARFID）筛查量表（NIAS）有三个与 ARFID 表现一致的分量表，但尚未确定临床验证的截断分数。我们旨在检查 NIAS 分量表（挑剔进食、食欲、恐惧）的有效性，以：（1）捕捉临床诊断的 ARFID 表现；（2）区分 ARFID 与其他饮食障碍（其他 ED）；（3）捕捉 ARFID 症状在 ARFID 患者、其他 ED 患者和非临床参与者中。
参与者包括门诊患者（年龄 10-76 岁；75%为女性），被诊断为 ARFID（n=49）或其他 ED（n=77），以及非临床参与者（年龄 22-68 岁；38%为女性，n=40）。我们通过进行接收者操作曲线（ROC）分析来评估与标准相关的同时有效性，以确定潜在的分量表截断值，并通过测试是否可以使用饮食障碍检查问卷（EDE-Q）捕获有和没有使用的 ARFID。
NIAS 每个分量表对于捕捉符合与不符合每个 ARFID 表现的个体都具有较高的 AUC，导致提出的截断值分别为≥10（灵敏度=0.97，特异性=0.63）、≥9（灵敏度=0.86，特异性=0.70）和≥10（灵敏度=0.68，特异性=0.89），用于 NIAS-挑剔进食、NIAS-食欲和 NIAS-恐惧分量表。在 NIAS-挑剔进食（≥10 提出的截断值）上，ARFID 与其他 ED 之间具有较高的 AUC，但在 NIAS-食欲或 NIAS-恐惧分量表上则没有。NIAS 分量表截断值与 ARFID 诊断有高度关联，但仅在与 EDE-Q 全球<2.3 结合时正确分类其他 ED。
为了筛查 ARFID，我们建议在使用其他 ED 的筛查工具（例如 EDE-Q）的同时，使用任何 NIAS 分量表上的阳性评分（即分别在 NIAS-挑剔进食、NIAS-食欲和 NIAS-恐惧分量表上≥10、≥9 和/或≥10）。
