Elevated Levels of Satiety-Promoting Hormone Cholecystokinin in Individuals with ARFID

Avoidant/restrictive food intake disorder or ARFID is a feeding and eating disorder characterized by patterns of avoidant or restrictive eating.  Previously called “Selective Eating Disorder”, ARFID is similar to anorexia nervosa in that individuals with both of these disorders limit the amount and/or type of foods they consume; however, unlike anorexia, eating behaviors associated with ARFID are not driven by concerns related to body shape or size or fears of gaining weight.  

Individuals with ARFID often describe a lack of interest in food, noting early satiety (feeling full) when eating and feeling full after and between meals.  Researchers have questioned whether these symptoms — lack of appetite and early satiety – in individuals with ARFID may be the result of underlying abnormalities in appetite regulation. A recent study from Helen Burton Murray, PhD, Director of the GI Behavioral Health Program in the MGH Center for Neurointestinal Health, tested this hypothesis, measuring levels of cholecystokinin (CCK), a satiety-promoting hormone, in female and male adolescents and young adults with ARFID.  CCK is produced when food passes from the stomach into the small intestine; this hormone promotes digestion and also regulates feeding behaviors by producing a sense of satiety.  

In this study, fasting levels of CCK were assessed in 83 patients with full or subthreshold ARFID (as defined by the DSM-5) and 42 healthy controls between 10 and 23 years of age (61% female).  In addition, they completed self-report measures assessing levels of hunger and satiety and eating behaviors and a semistructured interview assessing ARFID severity.

Participants with full/subthreshold ARFID had higher fasting CCK levels (over 3 times higher on average) than healthy controls.  Despite the significant elevation in CCK in the full/subthreshold ARFID group, CCK was not significantly associated with BMI, subjective ratings of appetite, or specific ARFID characteristics.

Next Steps

This study is the first to explore levels of CCK in children and adolescents with full/subthreshold ARFID.  Because this study was cross-sectional, it is not possible to determine if elevated CCK levels in youth with ARFID is a cause of the symptoms; elevated CCK levels may also represent a consequence of restrictive eating behaviors or malnutrition.  Longitudinal studies will help to clarify whether elevated CCK levels contribute to the development of ARFID, are a consequence of ARFID, and/or contribute to the maintenance of avoidant/restrictive eating.

This research also raises the possibility of novel approaches to the treatment of ARFID.  CCK antagonists could be a potential therapeutic option for ARFID and have previously been proposed for functional dyspepsia, anorexia nervosa, and bulimia nervosa.  However, further research is much needed to better understand the relationship between CCK and ARFID symptoms.  At the present time, cognitive-behavioral therapy is first-line treatment for adolescents and young adults with ARFID.