Associations of disordered eating with the intestinal microbiota and short-chain fatty acids among young adults with type 1 diabetes

Published:November 15, 2022DOI:
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      • Disordered eating, including insulin restriction, is prevalent in type 1 diabetes.
      • Disordered eating can deplete beneficial gut microbes and their metabolites.
      • Disordered eating was associated with reduced Anaerostipes.
      • Insulin restriction was associated with reduced Lachnospira.
      • Future longitudinal studies should confirm these associations in type 1 diabetes.


      Background and Aims

      Disordered eating (DE) in type 1 diabetes (T1D) includes insulin restriction for weight loss with serious complications. Gut microbiota-derived short chain fatty acids (SCFA) may benefit host metabolism but are reduced in T1D. We evaluated the hypothesis that DE and insulin restriction were associated with reduced SCFA-producing gut microbes, SCFA, and intestinal microbial diversity in adults with T1D.

      Methods and Results

      We collected stool samples at four timepoints in a hypothesis-generating gut microbiome pilot study ancillary to a weight management pilot in young adults with T1D. 16S rRNA gene sequencing measured the normalized abundance of SCFA-producing intestinal microbes. Gas-chromatography mass-spectrometry measured SCFA (total, acetate, butyrate, and propionate). The Diabetes Eating Problem Survey—Revised (DEPS-R) assessed DE and insulin restriction. Adjusted and Bonferroni-corrected generalized estimating equations modeled the associations. COVID-19 interrupted data collection, so models were repeated restricted to pre-COVID-19 data.
      Data were available for 45 participants at 109 visits, which included 42 participants at 65 visits pre-COVID-19. Participants reported restricting insulin “At least sometimes” at 53.3% of visits. Pre-COVID-19, each 5-point DEPS-R increase was associated with a -0.34 (95% CI -0.56, -0.13, p=0.07) lower normalized abundance of genus Anaerostipes; and the normalized abundance of Lachnospira genus was (-0.94 [95% CI -1.5, -0.42], p=0.02) lower when insulin restriction was reported “At least sometimes” compared to “Rarely or Never”.


      DE and insulin restriction were associated with a reduced abundance of SCFA-producing gut microbes pre-COVID-19. Additional studies are needed to confirm these associations to inform microbiota-based therapies in T1D.



      T1D (type 1 diabetes), BMI (body mass index), SCFA (short-chain fatty acids), ACT1ON (Advancing Care for Type 1 Diabetes and Obesity Network), SD (standard deviation), Q1 (quartile 1), Q3 (quartile 3), HbA1c (hemoglobin A1c), DEPS-R (Diabetes Eating Problem Survey, Revised)
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