Disturbed eating behavior in Iranian adolescent and young females with type‑1 diabetes compared to non diabetic peers: A cross‑sectional study

Hamid Reza Roohafza, Zahra Abdeyazdan, Parvaneh Amini, Saied Pahlavanzadeh, Pedram Shokouh


Background: An association of eating disorder with diabetes mellitus may lead to a serious lack of metabolic control, higher mortality and morbidity. There is no recent study conducted in the Iranian population about eating disorder and its variants. The aim of the present study is investigation of frequency of disturbed eating behaviors in adolescent girls with type 1 diabetes mellitus (T1DM) compared to non-diabetics.
Materials and Methods: In this cross-sectional study, disturbed eating behavior were evaluated and compared in two groups of 12–22 year old adolescent and young females (126 with diabetes and 325 without diabetes). A self-report questionnaire including demographic data, Children’s Depression Inventory (CDI), and Eating Attitude Test (EAT-26) was used for data gathering. Independent t-test, Chi-square test, and logistic regression [odds ratio (OR)] were used for data analyses in SPSS 15.
Results: Findings revealed that higher percentage of diabetic girls are likely to have eating disturbances (67.9% vs. 53.8%, P = 0.01). Diabetic group obtained higher scores in both dieting (14.95 ± 6.28 vs. 11.79 ± 5.62, P < 0.001) and bulimia scales (4.9 ± 3.13 vs. 4.12 ± 2.89, P = 0.017), which supports a role for T1DM in inducing the symptoms. Diabetic girls were at more than double the risk of developing eating disturbance.
Conclusions: The results indicate that a significantly higher percentage of diabetic girls are likely to have eating disturbances. Also, diabetic subjects had an increased probability of getting higher scores in all three EAT-26 subscales. Therefore, healthcare professionals, especially diabetic nurses, should be aware of the potential effects of the subclinical and clinical eating behaviors on adolescents with T1DM and evaluate them for these disturbances.


Adolescent; behavior; diabetes mellitus; eating disorder; eating disturbance; Iran; nurse; type 1; type 1 diabetes mellitus

Full Text:



Alemzadeh R, Ali O. Diabetes mellitus in children. In: Kliegman RM, Stanton BM, St. Geme J, Schor N, Behrman RE, editors. Nelson Textbook of Pediatrics. 19th ed. Philadelphia: Saunders; 2011. p. 583.

Olmsted MP, Colton PA, Daneman D, Rydall AC, Rodin GM. Prediction of the onset of disturbed eating behavior in adolescent girls with type 1 diabetes. Diabetes Care 2008;31:1978‑82.

Pereira RF, Alvarenga M. Disordered eating: Identifying, treating, preventing, and differentiating it from eating disorders. Diabetes Spectrum 2007;20:141‑8.

Pinar R. Disordered eating behaviors among Turkish adolescents with and without type 1 diabetes. J Pediatr Nurs 2005;20:383‑8.

Jones JM, Lawson ML, Daneman D, Olmsted MP, Rodin G. Eating disorders in adolescent females with and without type 1 diabetes: Cross sectional study. BMJ 2000;320:1563‑66.

Grylli V, Hafferl‑Gattermayer A, Wagner G, Schober E, Karwautz A. Eating disorders and eating problems among adolescents with type 1 diabetes: Exploring relationships with temperament and character. J Pediatr Psychol 2005;30:197‑206.

Colton PA, Olmsted MP, Daneman D, Rydall AC, Rodin GM. Five‑year prevalence and persistence of disturbed eating behavior and eating disorders in girls with type 1 diabetes. Diabetes Care 2007;30:2861‑2.

Philippi ST, Cardoso MG, Koritar P, Alvarenga M. Risk behaviors for eating disorder in adolescents and adults with type 1 diabetes. Rev Bras Psiquiatr 2013;35:150‑6.

Turner H, Peveler R. Eating disorders and type 1 diabetes mellitus. Psychiatry: Eat Disord 2005;4:30‑3.

Kyle T, Carman S. Essentials of Pediatric Nursing. 2nd ed. California, Lippincott Williams and Wilkins; 2013. p. 694-748.

Alice Hsu YY, Chen BH, Huang MC, Lin SJ, Lin MF. Disturbed eating behaviors in Taiwanese adolescents with type 1 diabetes mellitus: A comparative study. Pediatr Diabetes 2009:10:74‑81.

Garner DM, Olmsted MP, Bohr Y, Garfinkel PE. The eating attitudes test: Psychometric features and clinical correlates. Psychol Med 1982;12:871-8.

Steel JM, Young RJ, Lloyd GG, Macintyre CC. Abnormal eating attitudes in young insulin-dependent diabetics. Br J Psychiatry 1989;155:515-21.

Kovacs M. Children’s Depression Inventory (CDI) Manual North Tonowanda. New York, NY: Multi‑Health Systems; 1992.

Colton P, Olmsted M, Daneman D, Rydall A, Rodin G. Disturbed eating behavior and eating disorders in preteen and early teenage girls with type 1 diabetes: A case‑controlled study. Diabetes Care 2004;27:1654‑9.

Nielsen S. Eating disorders in females with type 1 diabetes: An update of a meta‑analysis. Eur Eat Disorders Rev 2002;10:241‑54.

Pinhas‑Hamiel O, Hamiel U, Levy‑Shraga Y. Eating disorders in adolescents with type 1 diabetes: Challenges in diagnosis and treatment. World J Diabetes 2015;6:517‑26.

Hoffman RP. Eating disorders in adolescents with type 1 diabetes. A closer look at a complicated condition. Postgrad Med 2001;109:67‑9, 73‑4.


  • There are currently no refbacks.