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

Abstract

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. We aimed 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 higher anxiety symptoms. Methods: In a cross-sectional sample of 80 subjects with full and subthreshold ARFID aged 10-23 years (F=39, M=41) and enrolled in an avoidant/restrictive eating study (R01MH108595), 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 Leibowitz 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=0.012), BAI/BAI-Y T-scores (r=-0.28, p=0.010) and LSAS scores (r=-0.3, p=0.027), all with medium effect sizes. Conclusions: These findings demonstrate that lower levels of ghrelin are associated with more severe anxiety symptoms in youth with full and subthreshold ARFID and raise the question of whether ghrelin pathways could be targeted in the treatment of ARFID.