The Contribution of Binge Eating to the Glycometabolic Risk Factors Is Mediated by Nutritional Status and Body Composition in People with Overweight and Obesity

Binge eating (BE) has been associated with an increased risk of obesity and diabetes. However, it is unclear whether the relationship between BE and glycometabolic risk factors is direct or mediated by other factors, such as lifestyle, nutritional status, and body composition. To clarify this issue, we conducted 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 ICANS, University of Milan. All subjects underwent a clinical examination. Anthropometric measurements (weight, height and body fat estimation by body skinfold), visceral and subcutaneous abdominal adipose tissue thicknesses measured by ultrasound, and fasting blood parameters (glucose, insulin and HOMA) were measured. Lifestyle was assessed, with particular regard to smoking, physical activity, and adherence to the Mediterranean diet (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 presented BE, with higher prevalence in women (22.8%) than in men (9.1%, p<0.001) and in people with obesity (22.4%) than overweight (15.0%, p<0.001). In the linear regression model adjusted for sex and age, BES was significantly 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 (β=0.03, 95%CI: 0.02, 0.04; p<0.001). The significant association between BES and glycometabolic risk factors remained after inclusion of lifestyle factors (smoking, physical activity and adherence to the Mediterranean diet). However, after inclusion of BMI, total and abdominal fat, the significance was lost. Our data do not support the hypothesis of a direct contribution of BE to the glycometabolic risk. The contribution of BE seems to be mediated by nutritional status and body composition.