Emotional eating and disordered eating behaviors in children and adolescents with type 1 diabetes

www.nature.com/scientificreports OPEN Emotional eating and disordered eating behaviors in children and adolescents with type 1 diabetes Carlo Ripoli 1*, Maria Rossella Ricciardi 1, Ester Zuncheddu 1, Maria Rosaria Angelo 1, Anna Paola Pinna 2 & Daniela Ripoli 3 Disordered eating behaviors (DEB) are more common in adolescents with type 1 diabetes (T1D) than in peers without diabetes. Emotional eating is a risk factor for binge eating in children and adolescents in the general population and is associated with increased intake of high energy-dense foods rich in sugars and fats. The primary objective is to evaluate whether emotional eating is associated with the metabolic control (glycated hemoglobin, plasma lipids and uric acid) in children and adolescents with type 1 diabetes and whether subjects with DEB (DEPS-R ≥ 20) have higher emotional eating than those without DEB. The secondary objective is to evaluate whether emotional eating is associated with the different symptoms of DEB. Emotional eating is positively correlated with HbA1c, total and LDL cholesterol values in children and adolescents with T1D. Subjects with DEB have a higher emotional eating score than subjects without DEB. Disinhibition is the most common disordered eating behavior in children and adolescents with T1D and is associated with a higher emotional eating score. Early identification and treatment of emotional eating could be tools for preventing DEB in people with type 1 diabetes. A total of 212 adolescents with T1D completed two self-administered questionnaires: the Diabetes Eating Problem Survey-Revised (DEPS-R) and the Emotional Eating Scale for Children and Adolescents (EES-C). Demographic (age, sex, duration of the disease), anthropometric (weight, height, BMI, BMI-SDS), therapeutic (type of insulin therapy, daily insulin dose) and metabolic (HbA1c, total cholesterol, HDL, LDL, triglycerides, uric acid) data were taken from the patients’ medical records. The presence of other autoimmune diseases was also recorded. Type 1 diabetes mellitus (T1D) is a chronic disease that requires lifelong insulin replacement therapy. This can be performed with multiple daily injections or with the use of an insulin pump and must be combined with blood glucose monitoring and quantification of carbohydrate intake at meals to establish the correct doses of insulin. This has a major impact on the quality of life of children with diabetes and their families and can lead to diabetes-related stress1. A recent national study in Sweden found that children and young people with T1D have more than twice the risk of psychiatric illness than their peers and siblings without d iabetes2. Eating disorders (ED), after substance abuse, are the most frequent psychiatric disorders in adolescents with T1D and, as in the general population, predominantly affect females2,3. Disordered eating behaviors (DEB) is a term that encompasses the whole spectrum of pathological behaviors related to eating, i.e., food restriction, excessive exercise to control body weight, binge eating, self-induced vomiting, and use of diuretics and laxatives. In DEB, these pathological behaviors often occur with reduced frequency and intensity that do not allow a diagnosis of ED4. Young people with diabetes also have another unique way of controlling body weight, which is the voluntary reduction/omission of insulin therapy, to induce hyperglycemia, glycosuria, ketonuria and weight l oss5–7. DEB is also more common in young people with T1D than in peers without diabetes4,8,9. A recent Italian study performed in 690 adolescents with T1D aged 11–19 found a prevalence of DEB of 28.1% (21% in boys and 35% in girls). Teens with DEB were associated with higher HbA1c, BMI, and emotional and behavioral problems compared to adolescents without DEB. Furthermore, 39% of patients reduced/omitted insulin therapy and had higher glycated hemoglobin values than subjects who did not manipulate the t herapy10. In some studies, the presence of DEB was also associated with alterations in plasma 1 Pediatric Diabetology Unit, ASL Cagliari, Sardinia, Italy. 2Pediatric Emergency Unit, Arnas G. Brotzu Cagliari, Sardinia, Italy. 3Quartu Sant’Elena (Cagliari), Sardinia, Italy. *email: Scientific Reports | (2022) 12:21854 | https://doi.org/10.1038/s41598-022-26271-2 1 Vol.:(0123456789) www.nature.com/scientificreports/ lipids11. These data are consistent with those of several other s tudies12–14. Binge eating is one of the most frequent DEB in screenings performed in adolescents with T1D (30%)15. A study performed in 506 Danish adolescents showed that 8.4% had overeating, 18% subclinical binge eating and 7.9% clinical binge eating. Patients with clinical binge eating (defined as ≥ 4 binge eating episodes over the past 28 days) had significantly higher HbA1c values than subjects without o vereating16. It is therefore very important to identify individuals at risk of developing DEB at an early stage. In 2010 Markovitz et al. proposed a screening questionnaire for DEB specific for people with diabetes, the Diabetes Eating Problem Survey—Revised (DEPS-R)17. This test, consisting of 16 items, allows the identification of individuals at higher risk of developing DEB who should be referred for psychiatric evaluation. The psychometric properties of the DEPS-R were subsequently confirmed by Wisting et al.18. Recently Calcaterra et al., starting from a clinimetric evaluation, proposed a division of the 16 items of the DEPS-R into four factors: restriction and body dissatisfaction, disinhibition, compensatory behaviors, and diabetes management, which are better suited than the original factors to the symptoms of D EB19,20. Emotional eating is an eating pattern that consists of using food in response to negative emotions such as anxiety, sadness, loneliness, anger, and depression. It is frequent in children and adolescents of the general population and is considered a risk factor for binge eating21. It is associated with a dietary pattern characterized by the intake of hyperpalatable foods rich in sugars and fats22–24. In 2007 Tanofsky-Kraff modified the Emotional Eating Scale for adults (EES)25 adapting it to use in children (Emotional Eating Scale adapted for use in children and adolescents, EES-C). This scale has good convergent and discriminating validity and adequate reliability in the test retest and is considered a suitable tool for assessing emotional eating in children and adolescents between 8 and 18 years26. Currently, the role of emotional eating as a risk factor for DEB in children and adolescents with T1D has not been thoroughly investigated. A survey of a small number of patients showed that adolescents with T1D have a higher frequency of emotional eating than their peers and that this correlates positively with HbA1c v alues27. The identification and treatment of emotional eating in adolescents with T1D could be the subject of intervention for the prevention of DEB. T (...truncated)