Dietary patterns as a red flag for higher risk of eating disorders among female teenagers with and without type I diabetes mellitus
- 287 Downloads
Female adolescents with type I diabetes mellitus (TIDM) have an increased risk of developing eating disorders (ED) due to the dietary recommendations.
Investigate the association between dietary intake and increased risk of ED.
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.
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.
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.
KeywordsEating disorder Type I diabetes Food intake Adolescent Risk Diet
Compliance with ethical standards
Conflict of interest
The authors declare that there is no conflict of interest regarding the publication of this paper.
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.
Parents and/or guardians and adolescents who agreed to participate in the study signed the informed consent form prior to data collection.
- 8.American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders (DSM-5). American Psychiatric Pub, Washington, DCGoogle 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 CrossRefGoogle 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)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 CrossRefGoogle 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, MadridGoogle Scholar
- 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, GenevaGoogle Scholar
- 27.abep.org (Internet). Associação Brasileira de Empresas de Pesquisas (ABEP), São Paulo. http://www.abep.org.br. cited 2012
- 29.Philippi ST (2015) Pirâmide dos alimentos: fundamentos básicos da nutrição, 2nd edn. Manole, São PauloGoogle 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 PauloGoogle 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 CrossRefGoogle Scholar
- 32.Fairburn CG, Wilson GT, Schleimer K (1993) Binge eating: nature, assessment, and treatment. Guilford Press, New York, pp 317–360Google Scholar
- 37.Faraway JJ (2014) Linear models with R. CRC PressGoogle Scholar
- 38.Canadian Paediatric Society (2004) Dieting in adolescence. Paediatr Child Health 9(7):487–503 (PMID 3245517)Google Scholar
- 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)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 CrossRefGoogle 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):1563–1566Google Scholar
- 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.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 CrossRefGoogle 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)CrossRefGoogle 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)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
- 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 CrossRefGoogle 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)Google Scholar
- 71.Kristensen M (2009) Wholegrains and dietary fibres: impact on body weight, appetite regulation and nutrient digestibility. University of Copenhagen, Copenhagen, DenmarkGoogle Scholar
- 72.Nordic Council of Ministers (2014) Nordic nutrition recommendations 2012. doi: 10.6027/Nord2014-002