Evaluation of biomarkers of eating disorders in patients with prediabetes

Introduction. In primary prevention, increasing attention is paid to the influence of behavioral factors on the development of carbohydrate disorders. The ability to assess biomarkers associated with eating disorders will optimize the diagnosis of these disorders.

Aim. To establish the levels of markers-regulators of eating behavior associated with eating disorders in patients with early disorders of carbohydrate metabolism.

Materials and methods. A cross-sectional cohort study was conducted on a sample of patients from Tyumen with prediabetes, 122 people, average age – 46.2 ± 8.2 years. Eating disorder manifestations were assessed according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition – DSM-V. Eating behavior patterns according to restrictive, emotiogenic and external types were assessed using the Dutch Eating Behavior Questionnaire (DEBQ). The levels of biomarkers of eating disorders – ghrelin and leptin – were assessed. ROC analysis with calculation of AUC, specificity and sensitivity were used to assess the prognostic significance of the index and determine the threshold score.

Results. According to the results of the ROC analysis with the determination of the cut-off point for ghrelin in relation to the risk of developing CP, the area under the ROC curve was 0.851 ± 0.027 with CI 95%: 0.798–0.905 (p < 0.001). The threshold value of ghrelin at the cut-off point is 45.9 ng/ml, a decrease in the level below the threshold value predicts the development of CP. The sensitivity of the model is 72.6%, the specificity is 78.9%. According to the results of the ROC analysis with the determination of the cut-off point for leptin, the area under the ROC curve was 0.831 ± 0.039 CI 95%: 0.756–0.932 in relation to the risk of developing CP, a model was built with an assessment of the probability of having an eating disorder (p < 0.001). The threshold value of leptin at the cut-off point was 0.69 ng/ml.

Conclusions. Patients with early carbohydrate metabolism disorders are recommended to undergo assessment of eating disorders and pathological patterns in terms of food intake during examination at the stage of primary prevention in order to optimize assessment of the risk of developing type 2 diabetes mellitus and subsequent comprehensive work with behavioral risk factors. Assessment of ghrelin and leptin levels as predictors of eating disorders can be used as paraclinical markers.

1. Balanova YuA, Shalnova SA, Imaeva AE, Kutsenko VA, Kapustina AV, Evstifeeva SE et al. Prediabetes: prevalence, associations with cardiovascular risk factors and contribution to survival in the Russian population. Cardiovascular Therapy and Prevention (Russian Federation). 2024;23(5):4022. (In Russ.) https://doi.org/10.15829/1728-8800-2024-4022.

2. Dedov II, Shestakova MV, Vikulova OK, Zheleznyakova AV, Isakov MА. Epidemiological characteristics of diabetes mellitus in the Russian Federation: clinical and statistical analysis according to the Federal diabetes register data of 01.01.2021. Diabetes Mellitus. 2021;24(3):204–221. (In Russ.) https://doi.org/10.14341/DM12759.

3. Водолагин МВ, Эккерт НВ. Заболеваемость населения Российской Федерации сахарным диабетом: основные факторы риска и пути решения проблемы. В: Гайдаров ГМ (ред.). Актуальные вопросы общественного здоровья и здравоохранения на уровне субъекта Российской Федерации: материалы Всероссийской научно-практической конференции (с международным участием), посвященной 100-летию Факультетских клиник ИГМУ (1920–2020). Иркутск, 8 декабря 2020 г. Иркутск: ФГБНУ «Иркутский научный центр хирургии и травматологи»; 2020. Т. 1. С. 151–152. Режим доступа: http://doi.org/10.13140/ RG.2.2.31864.37121.

4. Isakova D, Petrov I, Evgenyeva E, Troshina I, Platitsyna N. Assessment of eating behavior in patients with metabolic disorders. Human. Sport. Medicine. 2023;23(2):91–98. (In Russ.) Available at: https://hsm.susu.ru/hsm/en/article/view/2124.

5. Kobyakova OS, Kulikov ES, Malykh RD, Chernogoryuk GE, Deev IA, Starovoytova EA et al. Strategies for the prevention of chronic noncommunicable diseases: a modern look at the problem. Cardiovascular Therapy and Prevention (Russian Federation). 2019;18(4):92–98. (In Russ.) https://doi.org/10.15829/1728-8800-2019-4-92-98.

6. Драпкина ОМ, Мокрышева НГ, Шестакова МВ, Лавренова ЕА, Галстян ГР, Дзгоева ФХ и др. Диспансерное наблюдение пациентов с предиабетом врачом-терапевтом в первичном звене здравоохранения. М.: РОПНИЗ; 2024. 36 с. Режим доступа: https://gnicpm.ru/wp-content/uploads/ 2024/03/mr_prediabet-2025.pdf.

7. Marks KP, Aalders J, Liu S, Broadley M, Thastum M, Jensen MB et al. Associations between Disordered Eating Behaviors and HbA in Young People with Type 1 Diabetes: A Systematic Review and Meta-analysis. Curr Diabetes Rev. 2024;20(4):e220823220144. https://doi.org/10.2174/1573399820666230822095939.

8. Raevuori A, Suokas J, Haukka J, Gissler M, Linna M, Grainger M, Suvisaari J. Highly increased risk of type 2 diabetes in patients with binge eating disorder and bulimia nervosa. Int J Eat Disord. 2015;48(6):555–562. https://doi.org/10.1002/eat.22334.

9. Nagata JM, Garber AK, Tabler JL, Murray SB, Bibbins-Domingo K. Prevalence and Correlates of Disordered Eating Behaviors Among Young Adults with Overweight or Obesity. J Gen Intern Med. 2018;33(8):1337–1343. https://doi.org/10.1007/s11606-018-4465-z.

10. Nicolau J, Simó R, Sanchís P, Ayala L, Fortuny R, Zubillaga I, Masmiquel L. 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. Acta Diabetol. 2015;52(6):1037–1044. https://doi.org/10.1007/s00592-015-0742-z.

11. Nieto-Martínez R, González-Rivas JP, Medina-Inojosa JR, Florez H. Are Eating Disorders Risk Factors for Type 2 Diabetes? A Systematic Review and Meta-analysis. Curr Diab Rep. 2017;17(12):138. https://doi.org/10.1007/s11892-017-0949-1.

12. Silva-Júnior AED, Macena ML, Bueno NB. The prevalence of food addiction and its association with type 2 diabetes: a systematic review with metaanalysis. Br J Nutr. 2025;133(4):558–566. https://doi.org/10.1017/S000711452500008X.

13. Nip ASY, Reboussin BA, Dabelea D, Bellatorre A, Mayer-Davis EJ,Kahkoska AR et al. Disordered Eating Behaviors in Youth and Young Adults With Type 1 or Type 2 Diabetes Receiving Insulin Therapy: The SEARCH for Diabetes in Youth Study. Diabetes Care. 2019;42(5):859–866. https://doi.org/10.2337/dc18-2420.

14. Gendall KA, Joyce PR, Carter FA, McIntosh VV, Bulik CM. The effect of bulimia nervosa on plasma glucose and lipids. Physiol Behav. 2002;77(1):99–105. https://doi.org/10.1016/s0031-9384(02)00829-6.

15. Yang F, Liu A, Li Y, Lai Y, Wang G, Sun C et al. Food Addiction in Patients with Newly Diagnosed Type 2 Diabetes in Northeast China. Front Endocrinol. 2017;8:218. https://doi.org/10.3389/fendo.2017.00218.

16. Dean YE, Motawea KR, Aslam M, Pintado JJL, Popoola-Samuel HAO, Salam M et al. Association Between Type 1 Diabetes Mellitus and Eating Disorders: A Systematic Review and Meta-Analysis. Endocrinol Diabetes Metab. 2024;7(3):e473. https://doi.org/10.1002/edm2.473.

17. Berger G, Waldhoer T, Barrientos I, Kunkel D, Rami-Merhar BM, Schober E et al. Association of insulin-manipulation and psychiatric disorders: A systematic epidemiological evaluation of adolescents with type 1 diabetes in Austria. Pediatr Diabetes. 2019;20(1):127–136. https://doi.org/10.1111/pedi.12784.

18. Cassioli E, Lucherini Angeletti L, Rossi E, Selvi G, Riccardi E, Siviglia S et al. Leptin Levels in Acute and Recovered Eating Disorders: An Arm-Based Network MetaAnalysis. Eur Eat Disord Rev. 2025;33(3):525–537. https://doi.org/10.1002/erv.3163.

19. Monteleone P, Bortolotti F, Fabrazzo M, La Rocca A, Fuschino A, Maj M. Plamsa leptin response to acute fasting and refeeding in untreated women with bulimia nervosa. J Clin Endocrinol Metab. 2000;85(7):2499–2503. https://doi.org/10.1210/jcem.85.7.6673.

20. Jimerson DC, Mantzoros C, Wolfe BE, Metzger ED. Decreased serum leptin in bulimia nervosa. J Clin Endocrinol Metab. 2000;85(12):4511–4514. https://doi.org/10.1210/jcem.85.12.7051.

21. Mikhaylova AP, Ivanova DA, Shtrakhova AV. Issues of qualification and psychological assessment of eating behavior under normal and disordered conditions. Vestnik Yuzhno-Uralskogo Gosudarstvennogo Universiteta. Seriya: Psikhologiya. 2019;12(1):97–117. (In Russ.) https://doi.org/10.14529/psy190110.

22. Geliebter A, Hashim SA, Gluck ME. Appetite-related gut peptides, ghrelin, PYY, and GLP-1 in obese women with and without binge eating disorder (BED). Physiol Behav. 2008;94(5):696–699. https://doi.org/10.1016/j.physbeh.2008.04.013.

23. Hernandez D, Mehta N, Geliebter A. Meal-Related Acyl and Des-Acyl Ghrelin and Other Appetite-Related Hormones in People with Obesity and Binge Eating. Obesity. 2019;27(4):629–635. https://doi.org/10.1002/oby.22431.

24. Seidel M, Markmann Jensen S, Healy D, Dureja A, Watson HJ, Holst B et al. A Systematic Review and Meta-Analysis Finds Increased Blood Levels of All Forms of Ghrelin in Both Restricting and Binge-Eating/Purging Subtypes of Anorexia Nervosa. Nutrients. 2021;13(2):709. https://doi.org/10.3390/nu13020709.

25. Page LC, Gastaldelli A, Gray SM, D’Alessio DA, Tong J. Interaction of GLP-1 and Ghrelin on Glucose Tolerance in Healthy Humans. Diabetes. 2018;67(10):1976–1985. https://doi.org/10.2337/db18-0451.