{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:31:33Z","timestamp":1790728293801,"version":"4.1.0"},"reference-count":78,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2021,10,27]],"date-time":"2021-10-27T00:00:00Z","timestamp":1635292800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Orthorexia nervosa (ON) is an unspecified feeding or eating disorder (USFED) characterized by an exaggerated, unhealthy obsession with healthy eating. \u03a4ypical eating disorders (EDs) and USFEDs are common among patients with diabetes mellitus (DM), which complicates metabolic control and disease outcomes. The present systematic review summarizes the evidence on the prevalence of ON symptomatology among patients with DM. PubMed, Web of Science, Scopus, and grey literature were searched, and relevant observational studies were screened using the Rayyan software. The quality of the studies was assessed using the appraisal tool for cross-sectional studies (AXIS) and the Newcastle\u2013Ottawa scale (NOS). Out of 4642 studies, 6 fulfilled the predefined criteria and were included in the qualitative synthesis. Most studies relied on the ORTO-15 or its adaptations to identify ON among patients with DM. No apparent sex or age differences exist regarding the prevalence of ON symptoms. None of the studies compared the prevalence of ON in patients with type 1 and type 2 DM. Most of the research was of average to good methodological quality. In conclusion, patients with DM often exhibit ON tendencies, although research is still limited regarding the etiology or mechanistic drivers behind ON and the characteristics of patients with a dual ON\u2013DM diagnosis.<\/jats:p>","DOI":"10.3390\/nu13113823","type":"journal-article","created":{"date-parts":[[2021,10,27]],"date-time":"2021-10-27T23:24:42Z","timestamp":1635377082000},"page":"3823","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Obsessed with Healthy Eating: A Systematic Review of Observational Studies Assessing Orthorexia Nervosa in Patients with Diabetes Mellitus"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4167-6595","authenticated-orcid":false,"given":"Maria G.","family":"Grammatikopoulou","sequence":"first","affiliation":[{"name":"Department of Nutritional Sciences & Dietetics, Faculty of Health Sciences, Alexander Campus, International Hellenic University, GR-57400 Thessaloniki, Greece"},{"name":"Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Papageorgiou General Hospital, GR-56429 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6407-8494","authenticated-orcid":false,"given":"Konstantinos","family":"Gkiouras","sequence":"additional","affiliation":[{"name":"Medical School, Faculty of Health Sciences, University Campus, Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8018-7300","authenticated-orcid":false,"given":"Georgia","family":"Polychronidou","sequence":"additional","affiliation":[{"name":"Medical School, Faculty of Health Sciences, University Campus, Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0400-4063","authenticated-orcid":false,"given":"Chrysi","family":"Kaparounaki","sequence":"additional","affiliation":[{"name":"Medical School, Faculty of Health Sciences, University Campus, Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalliopi K.","family":"Gkouskou","sequence":"additional","affiliation":[{"name":"Laboratory of Biology, School of Medicine, National and Kapodistrian University of Athens, GR-11527 Athens, Greece"},{"name":"Embiodiagnostics Biology Research Company, GR-71305 Heraklion, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1312-7364","authenticated-orcid":false,"given":"Faidon","family":"Magkos","sequence":"additional","affiliation":[{"name":"Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, 1958 Frederiksberg, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4692-4754","authenticated-orcid":false,"given":"Lorenzo Maria","family":"Donini","sequence":"additional","affiliation":[{"name":"Department of Experimental Medicine-Medical Pathophysiology, Food Science and Endocrinology Section, Sapienza University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6403-6761","authenticated-orcid":false,"given":"Aristides G.","family":"Eliopoulos","sequence":"additional","affiliation":[{"name":"Laboratory of Biology, School of Medicine, National and Kapodistrian University of Athens, GR-11527 Athens, Greece"},{"name":"Biomedical Research Foundation of the Academy of Athens, GR-11527 Athens, Greece"},{"name":"Center for New Biotechnologies and Precision Medicine, School of Medicine, National and Kapodistrian University of Athens, GR-11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5005-1995","authenticated-orcid":false,"given":"Dimitrios G.","family":"Goulis","sequence":"additional","affiliation":[{"name":"Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Papageorgiou General Hospital, GR-56429 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,10,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association.","DOI":"10.1176\/appi.books.9780890425596"},{"key":"ref_2","unstructured":"Bratman, S., and Knight, D. (2000). Health Food Junkies, Broadway Books."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1136\/medhum-2019-011681","article-title":"Orthorexia: Eating right in the context of healthism","volume":"46","year":"2020","journal-title":"Med. Humanit."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"385","DOI":"10.2147\/NDT.S61665","article-title":"The clinical basis of orthorexia nervosa: Emerging perspectives","volume":"11","author":"Koven","year":"2015","journal-title":"Neuropsychiatr. Dis. Treat."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"365","DOI":"10.2190\/3H2H-3XJN-3KAY-G9NY","article-title":"Healthism and the medicalization of everyday life","volume":"10","author":"Crawford","year":"1980","journal-title":"Int. J. Health Serv."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1320","DOI":"10.1016\/j.jand.2019.04.002","article-title":"Guidelines for Medical Nutrition Therapy in Gestational Diabetes Mellitus: Systematic Review and Critical Appraisal","volume":"119","author":"Tsirou","year":"2019","journal-title":"J. Acad. Nutr. Diet."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Katsaridis, S., Grammatikopoulou, M.G., Gkiouras, K., Tzimos, C., Papageorgiou, S.T., Markaki, A.G., Exiara, T., Goulis, D.G., and Papamitsou, T. (2020). Low Reported Adherence to the 2019 American Diabetes Association Nutrition Recommendations among Patients with Type 2 Diabetes Mellitus, Indicating the Need for Improved Nutrition Education and Diet Care. Nutrients, 12.","DOI":"10.3390\/nu12113516"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"731","DOI":"10.2337\/dci19-0014","article-title":"Nutrition Therapy for Adults with Diabetes or Prediabetes: A Consensus Report","volume":"42","author":"Evert","year":"2019","journal-title":"Diabetes Care"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1016\/S0022-3999(02)00305-7","article-title":"Eating disorders in young women with type 1 diabetes mellitus","volume":"53","author":"Rodin","year":"2002","journal-title":"J. Psychosom. Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"683","DOI":"10.2337\/dc08-1077","article-title":"Disordered eating behavior in individuals with diabetes: Importance of context, evaluation, and classification","volume":"33","author":"Davis","year":"2010","journal-title":"Diabetes Care"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1186\/s40337-018-0223-1","article-title":"Binge eating disorder and night eating syndrome in adults with type 2 diabetes: A systematic review","volume":"6","author":"Abbott","year":"2018","journal-title":"J. Eat. Disord."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/j.dsx.2016.08.004","article-title":"Eating disoders in type 2 diabetic people: Brief review","volume":"11","year":"2017","journal-title":"Diabetes Metab. Syndr. Clin. Res. Rev."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s40337-020-0282-y","article-title":"Diabetes and disordered eating behaviours in a community-based sample of Australian adolescents","volume":"8","author":"Pursey","year":"2020","journal-title":"J. Eat. Disord."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1002\/eat.20928","article-title":"Characteristics of persons with an eating disorder and type 1 diabetes and psychological comparisons with persons with an eating disorder and no diabetes","volume":"45","author":"Powers","year":"2012","journal-title":"Int. J. Eat. Disord."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2861","DOI":"10.2337\/dc07-1057","article-title":"Five-year prevalence and persistence of disturbed eating behavior and eating disorders in girls with type 1 diabetes","volume":"30","author":"Colton","year":"2007","journal-title":"Diabetes Care"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1016\/S0002-8223(98)00155-2","article-title":"Insulin misuse by women with type 1 diabetes mellitus complicated by eating disorders does not favorably change body weight, body composition, or body fat distribution","volume":"98","author":"Affenito","year":"1998","journal-title":"J. Am. Diet. Assoc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1007\/s11892-020-01320-0","article-title":"Eating Disorders and Diabetes","volume":"20","author":"Winston","year":"2020","journal-title":"Curr. Diab. Rep."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1007\/BF03346646","article-title":"Diabese youngsters have 3.7 more chances in developing metabolic syndrome compared with the obese","volume":"33","author":"Grammatikopoulou","year":"2010","journal-title":"J. Endocrinol. Investig."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"277","DOI":"10.3945\/an.112.003608","article-title":"Chronic illness and disordered eating: A discussion of the literature","volume":"4","author":"Quick","year":"2013","journal-title":"Adv. Nutr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.2337\/dc20-2989","article-title":"Association and Familial Coaggregation of Type 1 Diabetes and Eating Disorders: A Register-Based Cohort Study in Denmark and Sweden","volume":"44","author":"Tate","year":"2021","journal-title":"Diabetes Care"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1002\/eat.22238","article-title":"Is disordered eating behavior more prevalent in adolescents with early-onset type 1 diabetes than in their representative peers?","volume":"47","author":"Baechle","year":"2014","journal-title":"Int. J. Eat. Disord."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Calcaterra, V., Mazzoni, C., Ballardini, D., Tomba, E., Zuccotti, G.V., Mameli, C., De Giuseppe, R., and Cena, H. (2020). Disturbed Eating Behaviors in Youth with Type 1 Diabetes: An Exploratory Study about Challenges in Diagnosis. Diagnostics, 10.","DOI":"10.3390\/diagnostics10121044"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1111\/pedi.12653","article-title":"Increased prevalence of disordered eating in the dual diagnosis of type 1 diabetes mellitus and celiac disease","volume":"19","author":"Rachmiel","year":"2018","journal-title":"Pediatr. Diabetes"},{"key":"ref_24","first-page":"323","article-title":"Reliability and validity of the diabetes eating problem survey in Turkish children and adolescents with type 1 diabetes mellitus","volume":"9","author":"Meseri","year":"2017","journal-title":"JCRPE J. Clin. Res. Pediatr. Endocrinol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1146\/annurev-clinpsy-050212-185546","article-title":"The Genetics of Eating Disorders","volume":"9","author":"Trace","year":"2013","journal-title":"Annu. Rev. Clin. Psychol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1002\/eat.23481","article-title":"One size does not fit all. Genomics differentiates among anorexia nervosa, bulimia nervosa, and binge-eating disorder","volume":"54","author":"Abdulkadir","year":"2021","journal-title":"Int. J. Eat. Disord."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"850","DOI":"10.1176\/appi.ajp.2017.16121402","article-title":"Significant locus and metabolic genetic correlations revealed in genome-wide association study of anorexia nervosa","volume":"174","author":"Duncan","year":"2017","journal-title":"Am. J. Psychiatry"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1214","DOI":"10.1038\/s41588-019-0439-2","article-title":"Genome-wide Association Study Identifies Eight Risk Loci and Implicates Metabo-Psychiatric Origins for Anorexia Nervosa","volume":"51","author":"Watson","year":"2019","journal-title":"Nat. Genet."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1186\/s13643-016-0384-4","article-title":"Rayyan-a web and mobile app for systematic reviews","volume":"5","author":"Ouzzani","year":"2016","journal-title":"Syst. Rev."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.1177\/1049732312452938","article-title":"Beyond PICO: The SPIDER tool for qualitative evidence synthesis","volume":"22","author":"Cooke","year":"2012","journal-title":"Qual. Health Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e011458","DOI":"10.1136\/bmjopen-2016-011458","article-title":"Development of a critical appraisal tool to assess the quality of cross-sectional studies (AXIS)","volume":"6","author":"Downes","year":"2016","journal-title":"BMJ Open"},{"key":"ref_32","unstructured":"Wells, G., Shea, B., O\u2019Connell, D., Peterson, J., Welch, V., Losos, M., and Tugwell, P. (2009). The Newcastle-Ottawa Scale (NOS) for Assessing the Quality If Nonrandomized Studies in Meta-Analyses, University of Ottawa. Available online: http:\/\/www.ohri.ca\/programs\/clinical_epidemiology\/oxford.asp."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_34","first-page":"1","article-title":"Orthorexia Nervosa and Family Functionality in Children and Adolescents with Type 1 Diabetes Mellitus","volume":"1","author":"Fidan","year":"2017","journal-title":"J. Med. Orig. Artic."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"233","DOI":"10.4274\/jcrpe.galenos.2019.2019.0128","article-title":"The Effects of Risk Behaviors and Orthorexic Behavior on Glycemic Control in Adolescents with Type 1 Diabetes","volume":"12","author":"Mengen","year":"2020","journal-title":"J. Clin. Res. Pediatr. Endocrinol."},{"key":"ref_36","unstructured":"Shoemaker, C.J. (2020). Orthorexia Nervosa Prevalence in US Adults with Type 1 and Type 2 Diabetes. [Ph.D. Thesis, University of Minnesota]."},{"key":"ref_37","first-page":"EP327","article-title":"Prevalence of orthorexia in diabetic patients","volume":"37","author":"Anil","year":"2015","journal-title":"Endocr. Abstr."},{"key":"ref_38","unstructured":"Kamanli, B. (2017). T\u0130P 2 Diyabetli Bireylerde Beslenme Durumu ve Sa\u011fl\u0131kl\u0131 Beslenme Tak\u0131nt\u0131s\u0131 Aras\u0131ndaki \u0130li\u015fkinin De\u011ferlendirilmesi, Sa\u011fl\u0131k Bilimleri Enstit\u00fcs\u00fc, \u0130stanbul \u00dcniversitesi."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1007\/s00592-020-01547-z","article-title":"Prevalence of orthorexic traits in type 2 diabetes mellitus: At the crossroads between nutritional counseling and eating disorders","volume":"57","author":"Barbanti","year":"2020","journal-title":"Acta Diabetol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e28","DOI":"10.1007\/BF03327537","article-title":"Orthorexia nervosa: Validation of a diagnosis questionnaire","volume":"10","author":"Donini","year":"2005","journal-title":"Eat. Weight Disord."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Niedzielski, A., and Ka\u017amierczak-Wojta\u015b, N. (2021). Prevalence of orthorexia nervosa and its diagnostic tools\u2014A literature review. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18105488"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1007\/s40519-018-0606-y","article-title":"Definition and Diagnostic Criteria for Orthorexia Nervosa: A Narrative Review of the Literature","volume":"24","author":"Cena","year":"2019","journal-title":"Eat. Weight Disord."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1007\/s40519-020-00924-5","article-title":"Introducing ORTO-R: A revision of ORTO-15: Based on the re-assessment of original data","volume":"26","author":"Rogoza","year":"2020","journal-title":"Eat. Weight Disord."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Rogowska, A.M., Kwa\u015bnicka, A., and Ochnik, D. (2021). Development and Validation of the Test of Orthorexia Nervosa (TON-17). J. Clin. Med., 10.","DOI":"10.3390\/jcm10081637"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1007\/s40519-020-00896-6","article-title":"Orthorexia Nervosa Inventory (ONI): Development and validation of a new measure of orthorexic symptomatology","volume":"26","author":"Oberle","year":"2020","journal-title":"Eat. Weight Disord."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1007\/s40519-018-0556-4","article-title":"The Barcelona Orthorexia Scale (BOS): Development process using the Delphi method","volume":"24","author":"Bauer","year":"2018","journal-title":"Eat. Weight Disord."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1026\/1616-3443\/a000310","article-title":"D\u00fcesseldorf orthorexia scale\u2013construction and evaluation of a questionnaire measuring orthorexic eating behavior","volume":"44","author":"Barthels","year":"2015","journal-title":"Z. Klin. Psychol. Psychother"},{"key":"ref_48","first-page":"1","article-title":"Measuring \u201corthorexia\u201d: Development of the Eating Habits Questionnaire","volume":"12","author":"Gleaves","year":"2013","journal-title":"Int. J. Educ. Psychol. Assess."},{"key":"ref_49","first-page":"282","article-title":"Bidimensional Structure of the Orthorexia: Development and Initial Validation of a New Instrument","volume":"34","author":"Barrada","year":"2018","journal-title":"Anal. Psicol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.eatbeh.2015.12.006","article-title":"On orthorexia nervosa: A review of the literature and proposed diagnostic criteria","volume":"21","author":"Dunn","year":"2016","journal-title":"Eat. Behav."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Missbach, B., Hinterbuchinger, B., Dreiseitl, V., Zellhofer, S., Kurz, C., and K\u00f6nig, J. (2015). When Eating Right, Is Measured Wrong! A Validation and Critical Examination of the ORTO-15 Questionnaire in German. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0135772"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"104840","DOI":"10.1016\/j.appet.2020.104840","article-title":"\u2018\u2018And it snowballed from there\u2019\u2019: The development of orthorexia nervosa from the perspective of people who self-diagnose","volume":"155","author":"Valente","year":"2020","journal-title":"Appetite"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"517","DOI":"10.4239\/wjd.v6.i3.517","article-title":"Eating disorders in adolescents with type 1 diabetes: Challenges in diagnosis and treatment","volume":"6","author":"Hamiel","year":"2015","journal-title":"World J. Diabetes"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1007\/s00592-015-0742-z","article-title":"Eating disorders are frequent among type 2 diabetic patients and are associated with worse metabolic and psychological outcomes: Results from a cross-sectional study in primary and secondary care settings","volume":"52","author":"Nicolau","year":"2015","journal-title":"Acta Diabetol."},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Depa, J., Barrada, J.R., and Roncero, M. (2019). Are the Motives for Food Choices Different in Orthorexia Nervosa and Healthy Orthorexia?. Nutrients, 11.","DOI":"10.3390\/nu11030697"},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Gramaglia, C., Brytek-Matera, A., Rogoza, R., and Zeppegno, P. (2017). Orthorexia and anorexia nervosa: Two distinct phenomena? A cross-cultural comparison of orthorexic behaviours in clinical and non-clinical samples. BMC Psychiatry, 17.","DOI":"10.1186\/s12888-017-1241-2"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1002\/eat.20625","article-title":"Gender difference in the prevalence of eating disorder symptoms","volume":"42","author":"Rosselli","year":"2009","journal-title":"Int. J. Eat. Disord."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1007\/BF03339961","article-title":"Prevalence of binge eating disorder in obese adults seeking weight loss treatment","volume":"2","author":"Vamado","year":"1997","journal-title":"Eat. Weight Disord."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1002\/eat.23118","article-title":"Eating disorder symptoms across the weight spectrum in Australian adolescents","volume":"52","author":"Hughes","year":"2019","journal-title":"Int. J. Eat. Disord."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1111\/j.1464-5491.2012.03771.x","article-title":"Eating problems in adolescents with Type 1 diabetes: A systematic review with meta-analysis","volume":"30","author":"Young","year":"2013","journal-title":"Diabet. Med."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1007\/BF03347221","article-title":"Eating disorders in patients with Type 1 diabetes: A meta-analysis","volume":"28","author":"Mannucci","year":"2014","journal-title":"J. Endocrinol. Investig."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"2547","DOI":"10.3389\/fpsyg.2020.556520","article-title":"Body Image Problems and Disordered Eating Behaviors in Italian Adolescents With and Without Type 1 Diabetes: An Examination With a Gender-Specific Body Image Measure","volume":"11","author":"Troncone","year":"2020","journal-title":"Front. Psychol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1183","DOI":"10.1002\/eat.22746","article-title":"Gender differences in disordered eating behaviors and body dissatisfaction among adolescents with type 1 diabetes: Results from diabetes MILES youth-Australia","volume":"50","author":"Araia","year":"2017","journal-title":"Int. J. Eat. Disord."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1186\/s40337-020-00353-w","article-title":"Disordered eating behaviors in youths with type 1 diabetes during COVID-19 lockdown: An exploratory study","volume":"8","author":"Troncone","year":"2020","journal-title":"J. Eat. Disord."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1007\/s40519-017-0417-6","article-title":"Orthorexia vs. theories of healthy eating","volume":"22","author":"Bratman","year":"2017","journal-title":"Eat. Weight Disord."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1016\/j.psym.2014.03.003","article-title":"Microthinking About Micronutrients: A Case of Transition From Obsessions About Healthy Eating to Near-Fatal \u201cOrthorexia Nervosa\u201d and Proposed Diagnostic Criteria","volume":"56","author":"Moroze","year":"2015","journal-title":"Psychosomatics"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"32","DOI":"10.5049\/EBP.2011.9.1.32","article-title":"Orthorexia nervosa with hyponatremia, subcutaneous emphysema, pneumomediastinum, pneumothorax, and pancytopenia","volume":"9","author":"Park","year":"2011","journal-title":"Electrolyte Blood Press."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1111\/jhn.12797","article-title":"Assessing psychological and nutritional impact of suspected orthorexia nervosa: A cross-sectional pilot study","volume":"34","author":"Mitrofanova","year":"2000","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Hanachi, M., Dicembre, M., Rives-Lange, C., Ropers, J., Bemer, P., Zazzo, J.-F., Poupon, J., Dauvergne, A., and Melchior, J.-C. (2019). Micronutrients Deficiencies in 374 Severely Malnourished Anorexia Nervosa Inpatients. Nutrients, 11.","DOI":"10.3390\/nu11040792"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1111\/ppc.12507","article-title":"Use of dietary supplements among nursing students in Turkey in the last 12 months and its relation with orthorexia nervosa","volume":"56","year":"2020","journal-title":"Perspect. Psychiatr. Care"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1007\/s40519-019-00657-0","article-title":"Health beliefs, behaviors, and symptoms associated with orthorexia nervosa","volume":"24","author":"Oberle","year":"2019","journal-title":"Eat. Weight Disord."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"189","DOI":"10.4239\/wjd.v2.i11.189","article-title":"Disordered eating behaviors in type 1 diabetic patients","volume":"2","author":"Docet","year":"2011","journal-title":"World J. Diabetes"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1007\/s11892-017-0949-1","article-title":"Are Eating Disorders Risk Factors for Type 2 Diabetes? A Systematic Review and Meta-analysis","volume":"17","author":"Florez","year":"2017","journal-title":"Curr. Diab. Rep."},{"key":"ref_74","doi-asserted-by":"crossref","unstructured":"Hendrieckx, C., Halliday, J., Beeney, L., and Speight, J. (2019). Diabetes and Emotional Health: A Practical Guide for Healthcare Professionals Supporting Adults with Type 1 and Type 2 Diabetes, Diabetes UK. [2nd ed.].","DOI":"10.2196\/15007"},{"key":"ref_75","unstructured":"Vist, G.E., Reinar, L.M., Straumann, G.H., and Wisting, L. (2015). Treatment of Persons who Suffer from Both an Eating Disorder and Diabetes, Knowledge Centre for the Health Services at The Norwegian Institute of Public Health (NIPH)."},{"key":"ref_76","unstructured":"Storch, E.A., McKay, D., and Abramowitz , J.S. (2020). Treatment of pathologic healthy eating (orthorexia nervosa). Advanced Casebook of Obsessive-Compulsive and Related Disorders: Conceptualizations and Treatment, Elsevier Academic Press."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1007\/s40519-016-0310-8","article-title":"Orthorexia nervosa by proxy?","volume":"21","author":"Cuzzolaro","year":"2016","journal-title":"Eat. Weight Disord."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"555","DOI":"10.3389\/fpsyg.2019.00555","article-title":"Orthorexia Nervosa: Disorder or Not? Opinions of Dutch Health Professionals","volume":"10","author":"Ryman","year":"2019","journal-title":"Front. Psychol."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/11\/3823\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:21:14Z","timestamp":1760167274000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/11\/3823"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,27]]},"references-count":78,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2021,11]]}},"alternative-id":["nu13113823"],"URL":"https:\/\/doi.org\/10.3390\/nu13113823","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,27]]}}}