The association between binge eating behaviour and glycometabolic risk factors is mediated by bmi and body composition in people with overweight and obesity

Binge eating behavior (BE) has been associated to an increased risk of diabetes. However, it is unclear whether it contributes to increased glycometabolic risk regardless of lifestyle, excess body weight, and body composition. We carried out a cross-sectional study of 4799 subjects free of diabetes (68% women, mean age: 47±13 years) with overweight (53.8%) and obesity (46.2%) recruited at the International Center for the Assessment of Nutritional Status (ICANS, University of Milan). All patients underwent a medical examination, anthropometric evaluation (weight, height and body fat by body skinfold), ultrasound measurements of abdominal visceral (VAT) and subcutaneous (SAT) fat, and blood sampling to measure glucose and insulin concentrations. Smoking and physical activity were investigated and the adherence to the Mediterranean diet was assessed by MEDAS questionnaire. BE was assessed using the Binge Eating Scale (BES) questionnaire (range score: 0–46). People with a BES score≥18 were categorized as having BE. Overall, 18.4% of subjects had BE, with the prevalence increasing with increasing obesity severity (15.0% in overweight, 20.4% in class 1 obesity, 25.5 in class 2 obesity, 30.1% in class 3 obesity, p<0.001). In the linear regression model adjusted for sex and age, BES was signifcantly associated with glucose (β=0.05, 95%CI: 0.01, 0.08, p<0.013), insulin (β=0.10, 95%CI: 0.07,0.13, p<0.001) and HOMA index (β=0.03, 95%CI: 0.02, 0.04, p<0.001). The association between BES and glycometabolic risk factors remained signifcant after inclusion of lifestyle factors (smoking, physical activity and adherence to the Mediterranean diet) in the model. However, after inclusion of BMI, total and abdominal fat, the association was lost. In conclusion, BE is associated with the severity of obesity. The contribution of BE to the glycometabolic risk appears to be mediated by excess body weight and body composition.