@article{2987171,
    title = "Obsessed with healthy eating: A systematic review of observational studies assessing orthorexia nervosa in patients with diabetes mellitus",
    author = "Grammatikopoulou, M.G. and Gkiouras, K. and Polychronidou, G. and Kaparounaki, C. and Gkouskou, K.K. and Magkos, F. and Donini, L.M. and Eliopoulos, A.G. and Goulis, D.G.",
    journal = "Nutrient Cycling in Agroecosystems",
    year = "2021",
    volume = "13",
    number = "11",
    publisher = "MDPI",
    issn = "1385-1314",
    doi = "10.3390/nu13113823",
    keywords = "adult;  age;  aged;  body image;  body mass;  diabetes mellitus;  dietary intake;  dietary supplement;  disease duration;  disease exacerbation;  educational status;  female;  glycemic control;  human;  impaired glucose tolerance;  insulin dependent diabetes mellitus;  male;  marriage;  Newcastle-Ottawa scale;  non insulin dependent diabetes mellitus;  obesity;  orthorexia;  Review;  sex difference;  symptomatology;  systematic review;  cross-sectional study;  diabetes mellitus;  epidemiology;  etiology;  feeding behavior;  observational study;  prevalence;  psychology, Cross-Sectional Studies;  Diabetes Mellitus;  Diet, Healthy;  Feeding Behavior;  Humans;  Observational Studies as Topic;  Orthorexia Nervosa;  Prevalence",
    abstract = "Orthorexia nervosa (ON) is an unspecified feeding or eating disorder (USFED) characterized by an exaggerated, unhealthy obsession with healthy eating. Typical 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–Ottawa 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–DM diagnosis. © 2021 by the authors. Licensee MDPI, Basel, Switzerland."
}