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Dietary patterns as a red flag for higher risk of eating disorders among female teenagers with and without type I diabetes mellitus

Adolescents with type I diabetes mellitus are a risk factor for eating disorders: a case-control study

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Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity Aims and scope Submit manuscript

Abstract

Background

Female adolescents with type I diabetes mellitus (TIDM) have an increased risk of developing eating disorders (ED) due to the dietary recommendations.

Objective

Investigate the association between dietary intake and increased risk of ED.

Methods

Case-control study with 50 T1DM female adolescents (11–16 years) and 100 healthy peers (CG). Measures included food frequency questionnaire (FFQ-PP), Child-EDE.12, economic and anthropometric data.

Results

Comparing female adolescents with T1DM vs CG, the first had higher intake of: bread, cereal, rice, and pasta (29.7 vs 23.8%, p = 0.001), vegetables (6.5 vs 2.8%, p < 0.001), milk yogurt and cheese (9.9 vs 7.6%, p = 0.032), fat, and oils (8.2 vs 5.9%, p = 0.003), besides higher fiber intake (19.2 vs 14.7%, p = 0.006) and lower consumption of sweets (13.6 vs 30.7%, p < 0.001). No differences on ED psychopathology (Child-EDE subscales and global score) were found between groups. In unadjusted association between the ED psychopathology and dietary intake, a diet rich in fiber was significantly associated with both the global and eating concern scores. Among CG, increased intake of meat, poultry, fish, and eggs and decreased bread, cereal, rice, and pasta consumption were significantly associated with higher ED psychopathology. When BMI and age are adjusted, the association between fiber intake and ED psychopathology is no longer significant among diabetic participants; however, in the CG, this association remains.

Conclusions

The study suggests that an association between dietary intake and ED psychopathology might exist in female adolescents with and without TIDM and that careful evaluation of the dietary profile and risk of developing an ED should be considered in clinical practice.

Level of evidence

Level III, case-control study.

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References

  1. Pinhas-Hamiel O, Levy-Shraga Y (2013) Eating disorders in adolescents with type 2 and type 1 diabetes. Curr Diabetes Rep 13(2):289–297. doi:10.1007/s11892-012-0355-7

    Article  CAS  Google Scholar 

  2. Young V, Eiser C, Johnson B, Brierley S, Epton T, Elliott J, Heller S (2013) Eating problems in adolescents with type 1 diabetes: a systematic review with meta-analysis. Diabet Med 30(2):189–198. doi:10.1111/j.1464-5491.2012.03771.x

    Article  CAS  PubMed  Google Scholar 

  3. Gagnon C, Aimé A, Bélanger C (2017) Predictors of comorbid eating disorders and diabetes in people with type 1 and type 2 diabetes. Can J Diabetes 41(1):52–57. doi:10.1016/j.jcjd.2016.06.005

    Article  PubMed  Google Scholar 

  4. Regmi PR, Alloh F, Pant PR, Simkhada P, Van Teijlingen E (2017) Mental health in BME groups with diabetes: an overlooked issue? Lancet 389(10072):904–905. doi:10.1016/S0140-6736(17)30051-X

    Article  PubMed  Google Scholar 

  5. Powers MA, Richter SA, Ackard DM, Cronemeyer C (2016) Eating disorders in persons with type 1 diabetes: a focus group investigation of early eating disorder risk. J Health Psychol 21(12):2966–2976. doi:10.1177/1359105315589799

    Article  PubMed  Google Scholar 

  6. Falcão MA, Francisco R (2017) Diabetes, eating disorders and body image in young adults: an exploratory study about diabulimia? Eat Weight Disord. doi:10.1007/s40519-017-0406-9

    Article  PubMed  Google Scholar 

  7. Racicka E, Bryńska A (2015) Eating disorders in children and adolescents with type 1 and type 2 diabetes—prevalence, risk factors, warning signs. Psychiatr Pol 49(5):1017–1024. doi:10.12740/PP/39536

    Article  PubMed  Google Scholar 

  8. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders (DSM-5). American Psychiatric Pub, Washington, DC

  9. Snell-Bergeon JK, Chartier-Logan C, Maahs DM, Ogden LG, Hokanson JE, Kinney GL et al (2009) Adults with type 1 diabetes eat a high-fat atherogenic diet that is associated with coronary artery calcium. Diabetologia 52(5):801–809. doi:10.1007/s00125-009-1280-4

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Davidson J (2014) Diabulimia: how eating disorders can affect adolescents with diabetes. Nurs Stand 29(2):44–49. doi:10.7748/ns.29.2.44.e7877

    Article  PubMed  Google Scholar 

  11. Overby NC, Flaaten V, Veierød MB, Bergstad I, Margeirsdottir HD, Dahl-Jørgensen K, Andersen LF (2007) Children and adolescents with type 1 diabetes eat a more atherosclerosis-prone diet than healthy control subjects. Diabetologia 50(2):307–316. doi:10.1007/s00125-006-0540-9

    Article  CAS  PubMed  Google Scholar 

  12. Margeirsdottir HD, Larsen JR, Brunborg C, Øverby NC, Dahl-Jørgensen K, Norwegian Study Group for Childhood Diabetes (2008). High prevalence of cardiovascular risk factors in children and adolescents with type 1 diabetes: a population-based study. Diabetologia 51(4):554. doi:10.1007/s00125-007-0921-8

    Article  CAS  PubMed  Google Scholar 

  13. Lodefalk M, Aman J (2006) Food habits, energy and nutrient intake in adolescents with type 1 diabetes mellitus. Diabet Med 23(11):1225–1232. doi:10.1111/j.1464-5491.2006.01971.x

    Article  CAS  PubMed  Google Scholar 

  14. Mayer-Davis EJ, Nichols M, Liese AD, Bell RA, Dabelea DM, Johansen JM et al (2006) Dietary intake among youth with diabetes: the SEARCH for diabetes in youth study. J Am Diet Assoc 106(5):689–697. doi:10.1016/j.jada.2006.02.002

    Article  CAS  PubMed  Google Scholar 

  15. Sundberg F, Augustsson M, Forsander G, Cederholm U, Axelsen M (2014) Children under the age of seven with diabetes are increasing their cardiovascular risk by their food choices. Acta Paediatr 103(4):404–410. doi:10.1111/apa.12533

    Article  CAS  PubMed  Google Scholar 

  16. Virtanen SM, Ylönen K, Räsänen L, Ala-Venna E, Mäenpää J, Åkerblom HK (2000) Two year prospective dietary survey of newly diagnosed children with diabetes aged less than 6 years. Arch Dis Child 82(1):21–26 (PMID: 10630905)

    Article  CAS  Google Scholar 

  17. Helgeson VS, Viccaro L, Becker D, Escobar O, Siminerio L (2006) Diet of adolescents with and without diabetes: trading candy for potato chips? Diabetes Care 29(5):982–987. doi:10.2337/diacare.295982

    Article  PubMed  Google Scholar 

  18. Meissner T, Wolf J, Kersting M, Fröhlich-Reiterer E, Flechtner-Mors M, Salgin B et al (2014) Carbohydrate intake in relation to BMI, HbA1c and lipid profile in children andadolescents with type 1 diabetes. Clin Nutr 33(1):75–78. doi:10.1016/j.clnu.2013.03.017

    Article  CAS  PubMed  Google Scholar 

  19. Särnblad S, Ekelund U, Aman J (2005) Physical activity and energy intake in adolescent girls with type 1 diabetes. Diabet Med 22(7):893–899. doi:10.1111/j.1464-5491.2005.01544.x

    Article  PubMed  Google Scholar 

  20. Gellar LA, Schrader K, Nansel TR (2007) Healthy eating practices perceptions, facilitators, and barriers among youth with diabetes. Diabet Educ 33(4):671–679. doi:10.1177/0145721707303807

    Article  Google Scholar 

  21. Mehta SN, Haynie DL, Higgins LA, Bucey NN, Rovner AJ, Volkening LK et al (2009) Emphasis on carbohydrates may negatively influence dietary patterns in youth with type 1 diabetes. Diabetes Care 32(12):2174–2176. doi:10.2337/dc09-1302

    Article  PubMed  PubMed Central  Google Scholar 

  22. Tse J, Nansel TR, Haynie DL, Mehta SN, Laffel LMB (2012) Disordered eating behaviors are associated with poorer diet quality in adolescents with type 1 diabetes. J Acad Nutr Diet 112(11):1810–1814. doi:10.1016/j.jand.2012.06.359

    Article  PubMed  PubMed Central  Google Scholar 

  23. Brady LM, Lindquist CH, Herd SL, Goran MI (2000) Comparison of children’s dietary intake patterns with US dietary guidelines. Br J Nutr 84(3):361–367 (PMID: 10967615)

    Article  CAS  Google Scholar 

  24. Moore LV, Dodd KW, Thompson FE, Grimm KA, Kim SA, Scanlon KS (2015) Using behavioral risk factor surveillance system data to estimate the percentage of the population meeting US Department of Agriculture food patterns fruit and vegetable intake recommendations. Am J Epidemiol 181(12):979–988. doi:10.1093/aje/kwu461

    Article  PubMed  PubMed Central  Google Scholar 

  25. Almeida MC, Claudino DA, Claudino AM, Grigolon R, Mendes N, Ribeiro W, Spinola A. Eating behavior among children and adolescents with diabetes type I. Set/2014 (ed), vol 1, fascículo 1, série 1. World Psychiatric Association, Madrid

  26. WHO Multicentre Growth Reference Study Group (2006) WHO child growth standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development. World Health Organization, Geneva

    Google Scholar 

  27. abep.org (Internet). Associação Brasileira de Empresas de Pesquisas (ABEP), São Paulo. http://www.abep.org.br. cited 2012

  28. Martinez MF, Philippi ST, Estima C, Leal G (2013) Validity and reproducibility of a food frequency questionnaire to assess food group intake in adolescents. Cad Saúde Públ 29(9):1795–1804 (PMID: 24068225)

    Article  Google Scholar 

  29. Philippi ST (2015) Pirâmide dos alimentos: fundamentos básicos da nutrição, 2nd edn. Manole, São Paulo

    Google Scholar 

  30. Monteiro JBR, Esteves E (2001) Diet Pro, versão 4.0: Sistema de suporte à avaliação nutricional e prescrição de dietas [CD-ROM]. A Agromídia Software, São Paulo

    Google Scholar 

  31. Bryant-Waugh RJ, Cooper PJ, Taylor CL, Lask BD (1996) The use of the eating disorder examination with children: a pilot study. Int J Eat Disord 19(4):391–397. doi:10.1002/(SICI)1098-108X(199605)19:4<391::AID-EAT6>3.0.CO;2-G

    Article  Google Scholar 

  32. Fairburn CG, Wilson GT, Schleimer K (1993) Binge eating: nature, assessment, and treatment. Guilford Press, New York, pp 317–360

    Google Scholar 

  33. Cooper Z, Cooper PJ, Fairburn CG (1989) The validity of the eating disorder examination and its subscales. Br J Psychiatry 154(6):807–812 (PMID 2597887)

    Article  CAS  Google Scholar 

  34. Kuhn M, Johnson K (2013) Applied predictive modeling, vol 26. Springer, New York

    Book  Google Scholar 

  35. Reshef DN, Reshef YA, Finucane HK, Grossman SR, McVean G, Turnbaugh PJ et al (2011) Detecting novel associations in large data sets. Science 334:1518–1524. doi:10.1126/science.1205438

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Paatero P, Tapper U (1994) Positive matrix factorization: a non negative factor model with optimal utilization of error estimates of data values. Environmetrics 5(2):111–126. doi:10.1002/env.3170050203

    Article  Google Scholar 

  37. Faraway JJ (2014) Linear models with R. CRC Press

  38. Canadian Paediatric Society (2004) Dieting in adolescence. Paediatr Child Health 9(7):487–503 (PMID 3245517)

  39. Tsai MR, Chang YJ, Lien PJ, Wong Y (2011) Survey on eating disorders related thoughts, behaviors and dietary intake in female junior high school students in Taiwan. Asia Pac J Clin Nutr 20(2):196–205 (PMID 21669588)

    PubMed  Google Scholar 

  40. Colton P, Rodin G, Bergenstal RPC (2009) Eating disorders and diabetes: introduction and overview. Diabetes Spectr 22(3):138–142. doi:10.2337/diaspect.22.3.135

    Article  Google Scholar 

  41. Takii M, Uchigata Y, Kishimoto J, Morita C, Hata T, Nozaki T et al (2011) The relationship between the age of onset of type 1 diabetes and the subsequent development of a severe eating disorder by female patients. Pediatr Diabetes 12:396–401. doi:10.1111/j.1399-5448.2010.00708.x

    Article  PubMed  Google Scholar 

  42. Jones JM, Lawson ML, Daneman D, Olmsted MP, Rodin G (2000) Eating disorders in adolescent females with and without type 1 diabetes: cross sectional study. BMJ 320(7249):1563–1566

  43. Frank MR (2005) Psychological issues in the care of children and adolescents with type 1 diabetes. Paediatr Child Health 10(1):18–20 PMID: 2720894.

    PubMed  PubMed Central  Google Scholar 

  44. Johnson B, Eiser C, Young V, Brierley S, Heller S (2013) Prevalence of depression among young people with type 1 diabetes: a systematic review. Diabet Med 30(2):199–208. doi:10.1111/j.1464-5491.2012.03721.x

    Article  CAS  PubMed  Google Scholar 

  45. Sivertsen B, Petrie KJ, Wilhelmsen-Langeland A, Hysing M (2014) Mental health in adolescents with type 1 diabetes: results from a large population-based study. BMC Endocr Disord 14(1):83. doi:10.1186/1472-6823-14-83

    Article  PubMed  PubMed Central  Google Scholar 

  46. Kovacs M, Mukerji P, Iyengar S, Drash A (1996) Psychiatric disorder and metabolic control among youths with IDDM: a longitudinal study. Diabetes Care 19(4):318–323 (PMID 8729153)

    Article  CAS  Google Scholar 

  47. Leidy HJ, Clifton PM, Astrup A, Wycherley TP, Westerterp-Plantenga MS, Luscombe-Marsh ND et al (2015) The role of protein in weight loss and maintenance. Am J Clin Nutr 101(6):1320S–1329S. doi:10.3945/ajcn.114.084038

    Article  CAS  Google Scholar 

  48. Westerterp-Plantenga MS, Nieuwenhuizen A, Tome D, Soenen S, Westerterp KR (2009) Dietary protein, weight loss, and weight maintenance. Annu Rev Nutr 29:21–41. doi:10.1146/annurev-nutr-080508-141056

    Article  CAS  PubMed  Google Scholar 

  49. Gosby AK, Conigrave AD, Raubenheimer D, Simpson SJ (2014) Protein leverage and energy intake. Obes Rev 15(3):183–191. doi:10.1111/obr.12131

    Article  CAS  PubMed  Google Scholar 

  50. Leidy HJ, Ortinau LC, Douglas SM, Hoertel HA (2013) Beneficial effects of a higher-protein breakfast on the appetitive, hormonal, and neural signals controlling energy intake regulation in overweight/obese, “breakfast-skipping”, late-adolescent girls. Am J Clin Nutr 97(4):677–688. doi:10.3945/ajcn.112.053116

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Martens EA, Lemmens SG, Westerterp-Plantenga MS (2013) Protein leverage affects energy intake of high-protein diets in humans. Am J Clin Nutr 97(1):86–93. doi:10.3945/ajcn.112.046540

    Article  CAS  PubMed  Google Scholar 

  52. Gosby AK, Conigrave AD, Lau NS, Iglesias MA, Hall RM, Jebb SA et al (2011). Testing protein leverage in lean humans: a randomised controlled experimental study.PLoS One 6(10):e25929. doi:10.1371/journal.pone.0025929

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Gosby AK, Soares-Wynter S, Campbell C, Badaloo A, Antonelli M, Hall RM et al (2010) Design and testing of foods differing in protein to energy ratios. Appetite 55(2):367–370. doi:10.1016/j.appet.2010.06.009

    Article  PubMed  Google Scholar 

  54. Leidy HJ, Racki EM (2010) The addition of a protein-rich breakfast and its effects on acute appetite control and food intake in “breakfast-skipping” adolescents. Int J Obes (2005) 34(7):1125–1133. doi:10.1038/ijo.2010.3

    Article  CAS  Google Scholar 

  55. Weigle DS, Breen PA, Matthys CC, Callahan HS, Meeuws KE, Burden VR, Purnell JQ (2005) A high-protein diet induces sustained reductions in appetite, ad libitum caloric intake, and body weight despite compensatory changes in diurnal plasma leptin and ghrelin concentrations. Am J Clin Nutr 82(1):41–48 (PMID 16002798)

    Article  CAS  Google Scholar 

  56. Cunningham W, Hyson D (2006) The skinny on high-protein, low-carbohydrate diets. Prev Cardiol 9(3):166–173 (PMID 16849880)

    Article  CAS  Google Scholar 

  57. Jeor STS, Howard BV, Prewitt TE, Bovee V, Bazzarre T, Eckel RH, AHA Nutrition Committee (2001) Dietary protein and weight reduction. Circulation 104(15):1869–1874 (PMID 11591629)

    Article  Google Scholar 

  58. Leidy HJ, Lepping RJ, Savage CR, Harris CT (2011) Neural responses to visual food stimuli after a normal vs. higher protein breakfast in breakfast-skipping teens: a pilot fMRI study. Obesity 19(10):2019–2025. doi:10.1038/oby.2011.108

    Article  CAS  PubMed  Google Scholar 

  59. Leidy HJ (2014) Increased dietary protein as a dietary strategy to prevent and/or treat obesity. Mo Med 111(1):54–58 (PMID 24645300)

    PubMed  PubMed Central  Google Scholar 

  60. Institute of Medicine of the National Academies (2015) Dietary Reference Intakes for Energy, Carbohydrate. Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (2002/2005). www.nap.edu. Accessed 27 July 2015

  61. American Diabetes Association (2017) Standards of medical care in diabetes. J Clin Appl Res Educ 40:1–142. doi:10.2337/dc16-S003

    Article  CAS  Google Scholar 

  62. American Diabetes Association (2009) Standards of medical care in diabetes. Diabetes Care. doi:10.2337/dc09-S013

    Article  PubMed Central  Google Scholar 

  63. Laurenzi A, Bolla AM, Panigoni G, Doria V, Uccellatore A, Peretti E et al (2011) Effects of carbohydrate counting on glucose control and quality of life over 24 weeks in adult patients with type 1 diabetes on continuous subcutaneous insulin infusion. Diabetes Care 34(4):823–827. doi:10.2337/dc10-1490

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Reed JL, Bowell JL, Hill BR, Williams BA, De Souza MJ, Williams NI (2011) Exercising women with menstrual disturbances consume low energy dense foods and beverages. Appl Physiol Nutr Metab 36(3):382–394. doi:10.1139/h11-030

    Article  CAS  PubMed  Google Scholar 

  65. Melin A, Tornberg B, Skouby S, Moller SS, Faber J, Sundgot-Borgen J et al (2016) Low-energy density and high fiber intake are dietary concerns in female endurance athletes. Scand J Med Sci Sport 26(9):1060–1071. doi:10.1111/sms.12516

    Article  CAS  Google Scholar 

  66. Misra M, Tsai P, Anderson EJ, Hubbard JL, Gallagher K, Soyka LA et al (2006) Nutrient intake in community-dwelling adolescent girls with anorexia nervosa and in healthy adolescents. Am J Clin Nutr 84:698–706 (pii 84/4/698)

    Article  CAS  Google Scholar 

  67. Rolls B (2009) The relationship between dietary energy density and energy intake. Physiol Behav 97(5):609–615. doi:10.1016/j.physbeh.2009.03.011

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  68. Lin Y, Huybrechts I, Vereecken C, Mouratidou T, Valtueña J, Kersting M et al (2014) Dietary fiber intake and its association with indicators of adiposity and serum biomarkers in European adolescents: the HELENA study. Eur J Nutr 54(5):771–782. doi:10.1007/s00394-014-0756-2

    Article  CAS  PubMed  Google Scholar 

  69. Mathern JR, Raatz SK, Thomas W SJ (2009) Effects of fenugreek fiber on satiety, blood glucose and insulin response and energy intake in obese subjects. Phytother Res 23:1543–1548. doi:10.1002/ptr.2795

    Article  CAS  PubMed  Google Scholar 

  70. Holt SH, Miller JC, Petocz PFE (1995) A satiety index of common foods. Eur J Clin Nutr 49(9):675–690 (PMID: 7498104)

    CAS  PubMed  Google Scholar 

  71. Kristensen M (2009) Wholegrains and dietary fibres: impact on body weight, appetite regulation and nutrient digestibility. University of Copenhagen, Copenhagen, Denmark

  72. Nordic Council of Ministers (2014) Nordic nutrition recommendations 2012. doi:10.6027/Nord2014-002

  73. Custal N, Arcelus J, Aguera Z, Bove FI, Wales J, Granero R et al (2014) Treatment outcome of patients with comorbid type 1 diabetes and eating disorders. BMC Psychiatry 14:140. doi:10.1186/1471-244x-14-140

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Medical Psychiatric and Psychology Department, Federal University of São Paulo, Rua Borges Lagoa, 570, cj 7 Vila Clementino, São Paulo, Brazil

    Ruth Bartelli Grigolon, Karin Louise Lenz Dunker, Mireille Coelho Almeida, Denise Claudino Achôa & Angélica Medeiros Claudino

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  1. Ruth Bartelli Grigolon
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Federal University of São Paulo - UNIFESP/EPM, SP, Brazil, nº 014116/2014 as recommended by Resolution 196/96.

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Parents and/or guardians and adolescents who agreed to participate in the study signed the informed consent form prior to data collection.

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Grigolon, R.B., Dunker, K.L.L., Almeida, M.C. et al. Dietary patterns as a red flag for higher risk of eating disorders among female teenagers with and without type I diabetes mellitus. Eat Weight Disord 24, 151–161 (2019). https://doi.org/10.1007/s40519-017-0442-5

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