Demographic characteristics, nutritional behaviors, and orthorexic tendencies of women with breast cancer: a case–control study



Breast cancer is one of the most important health problems faced by women. No study was found in the world literature about the eating behavior of women with breast cancer. Therefore, the aim of this study was to determine whether breast cancer patients and healthy controls differ in their orthorexia nervosa levels and to determine any factors that affect orthorexia nervosa (socio-demographic variables and nutritional habits).


The data were collected using a face-to-face interview technique between May 2018 and March 2019 at outpatient clinics and a family health center in Turkey. The data of the study were collected using personal information form and the Orthorexia Nervosa Scale (ORTO-15). A linear regression analysis was performed to investigate the effects of socio-demographic variables and nutritional habits of women on the risk of orthorexia nervosa.


Breast cancer patients had significantly lower ORTO-15 scores (i.e., a higher orthorexia risk) than the healthy controls. For the cancer patients, a regression analysis revealed that ORTO-15 scores were significantly associated with education level, organic food consumption status, receipt of social support for care, and presence of a chronic disease other than cancer. In the healthy controls, body mass index and education level were the primary predictors of ORTO-15 scores.


The higher orthorexia risk of cancer patients has implications for these patients that could be improved through nutritional counseling.

Level of Evidence: III, case-control study.

This is a preview of subscription content, log in to check access.


  1. 1.

    American Cancer Society. Breast cancer facts & figures 2017–2018. Atlanta: American Cancer Society, Inc.2017. pdf. Accessed 20 Sept 2018

  2. 2.

    National Cancer Institute (NCI). Research on Causes of Cancer, 2015. Available from Accessed 20 Sept 2018

  3. 3.

    World Health Organization (WHO). Cancer, 2018. room/fact-sheets/detail/cancer. Accessed 20 Sept 2018

  4. 4.

    Cecchini RS, Costantino JP, Cauley JA et al (2012) Body mass index and the risk for developing invasive breast cancer among high-risk women in NSABP P-1 and STAR breast cancer prevention trials. Cancer Prev Res 5:583–592.

    CAS  Article  Google Scholar 

  5. 5.

    Cancer Research UK. Definite breast cancer risks. N.D. Available from Accessed 5 July 2019

  6. 6.

    World Cancer Research Fund and American Institute for Cancer Research. Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective. Washington DC 2007. Available from: Accessed 5 July 2019

  7. 7.

    Sauter ER (2018) Breast cancer prevention: current approaches and future directions. Eur J Breast Health 14(2):64–71.

    Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Grunfield EA, Ramirez AJ, Hunter MS, Richards MA (2002) Women’s knowledge and beliefs regarding breast cancer. Br J Cancer 86:1373–1378.

    Article  Google Scholar 

  9. 9.

    Ünsar S, Yıldız FÜ, Kurt S et al (2007) Home care and symptom control in cancer patients. Fırat Health Servi J 2(5):89–106

    Google Scholar 

  10. 10.

    Piamjariyakul U, Williams PD, Prapakorn S et al (2010) Cancer therapy-related symptoms and self-care in Thailand. Eur J Oncol Nurs 14(5):387–394.

    Article  PubMed  Google Scholar 

  11. 11.

    Gürsu RU, Kesmezacar Ö, Karaçetin D, Mermut Ö, Ökten B, Güner Şİ (2012) Istanbul research and training hospital oncology division: 18-month results of a newly formed unit. Istanb Med J 13(1):13–18.

    Article  Google Scholar 

  12. 12.

    Demir Ç, Onat H (2011) Nutrition in a patient with cancer-I. In: Mandel NM, Onat H (eds) Approach to cancer patients: diagnosis, treatment, follow-up problems. 2. Nobel Medical Bookstore, Istanbul, pp 489–503

    Google Scholar 

  13. 13.

    Quick VM, McWilliams R, Byrd-Bredbenner C (2012) Case–control study of disturbed eating behaviors and related psychographic characteristics in young adults with and without diet-related chronic health conditions. Eat Behav 13:207–213.

    Article  PubMed  Google Scholar 

  14. 14.

    Grilo C (2006) Eating and weight disorders. Psychology Press, New York

    Google Scholar 

  15. 15.

    Panjari M, Bell RJ, Davis SR (2011) Sexual function after breast cancer. J Sex Med 8:294–302.

    Article  PubMed  Google Scholar 

  16. 16.

    Wright CE, Harvie M, Howell A, Evans DG, Hulbert-Williams N, Donnelly LS (2015) Beliefs about weight and breast cancer: an interview study with high risk women following a 12 month weight loss intervention. Hered Cancer Clin Pract 13:1.

    Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Oberguggenberger A, Meraner V, Sztankay M et al (2018) Health behavior and quality of life outcome in breast cancer survivors: prevalence rates and predictors. Clin Breast Cancer 18(1):38–44.

    Article  PubMed  Google Scholar 

  18. 18.

    Fidan T, Ertekin V, Işıkay S, Kırkpınar I (2015) Prevelance of orthorexia among medical students in Erzurum Turkey. Compr Psychiatry 51(1):49–54.

    Article  Google Scholar 

  19. 19.

    Chaki B, Pal S, Bandyopadhyay A (2013) Exploring scientific legitimacy of orthorexa nervosa: a newly emerging eating disorder. J Hum Sport Exerc (JHSE) 8:1045–1053.

    Article  Google Scholar 

  20. 20.

    Varga M, Thege BK, Dukay-Szabó S, Túry F, Van Furth EF (2014) When eating healthy is not healthy: orthorexia nervosa and its measurement with the ORTO-15 in Hungary. BMC Psychiatry 28:14–59.

    Article  Google Scholar 

  21. 21.

    Cena H, Barthels F, Cuzzolaro M et al (2019) Definition and diagnostic criteria for orthorexia nervosa: a narrative review of the literature. Eat Weight Disord 24(2):209–246.

    Article  PubMed  Google Scholar 

  22. 22.

    Dunn TM, Bratman S (2016) On orthorexia nervosa: a review of the literature and proposed diagnostic criteria. Eat Behav 21(11–17):70.

    Article  Google Scholar 

  23. 23.

    American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub

  24. 24.

    Dunn TM, Gibbs J, Whitney N, Starosta A (2017) Prevalence of orthorexia nervosa is less than 1%: data from a US sample. Eat Weight Disord 22(1):185–192.

    Article  PubMed  Google Scholar 

  25. 25.

    Rock CL, McEligot AJ, Flatt SW et al (2000) Eating pathology and obesity in women at risk for breast cancer recurrence. Int J Eat Disord 27:172–179.

    CAS  Article  PubMed  Google Scholar 

  26. 26.

    Rock CL, Demark-Wahnefried W (2002) Nutrition and survival after the diagnosis of breast cancer: a review of the evidence. J Clin Oncol 20:3302–3316.

    Article  PubMed  PubMed Central  Google Scholar 

  27. 27.

    Cade JE, Burley VJ, Greenwood DC (2007) Dietary fibre and risk of breast cancer in the UK women’s cohort study. Int J Epidemiol 36:431–438.

    Article  PubMed  Google Scholar 

  28. 28.

    Blanchard CM, Denniston MM, Baker F et al (2003) Do adults change their lifestyle behaviors after a cancer diagnosis? Am J Health Behav 27(3):246–256.

    Article  PubMed  Google Scholar 

  29. 29.

    Satia JA, Campbell MK, Galanko JA, James A, Carr C, Sandler RS (2004) Longitudinal changes in lifestyle behaviors and health status in colon cancer survivors. Cancer Epidemiol Biomark Prev 13(6):1022–1031 (

    Google Scholar 

  30. 30.

    Donini LM, Marsilli D, Graziani MP, Imbriale M, Canella C (2005) Orthorexia nervosa: validation of a diagnosis questionnaire. Eat Weight Disord 10(2):e28–e32.

    CAS  Article  PubMed  Google Scholar 

  31. 31.

    Bratman S, Knight D (2000) Health food junkies: overcoming the obsession with healthful eating. Broadway Books, New York

    Google Scholar 

  32. 32.

    Arusoğlu G, Kabakçi E, Köksal G, Merdol TK (2008) Orthorexia nervosa and adaptation of ORTO-11 into Turkish. Turk J Psychiatry 19:283–291

    Google Scholar 

  33. 33.

    Atalay NG, Kızıltan G (2015) Determination of the relationship between orthorexia nervosa, eating behavior disorders in adult type 1 diabetic individuals under carbohydrate counting diet and biochemical and anthropometric measurements. Başkent University, Health Sciences Institute, Department of Nutrition and Dietetics. Doctoral Thesis, 2015. Ankara

  34. 34.

    Donini LM, Marsili D, Graziani MP, Imbriale M, Cannella C (2004) Orthorexia nervosa: a preliminary study with a proposal for diagnosis and an attempt to measure the dimension of the phenomenon. Eat Weight Disord 9(2):151–157.

    CAS  Article  PubMed  Google Scholar 

  35. 35.

    French SA, Perry CL, Leon GR, Fulkerson JA (1994) Food preferences, eating patterns, and physical activity among adolescents: correlates of eating disorders symptoms. J Adolesc Health 15:286–294.

    CAS  Article  PubMed  Google Scholar 

  36. 36.

    Rabin C, Pinto B (2006) Cancer-related beliefs and health behavior change among breast cancer survivors and their first-degree relatives. Psychooncology 15:701–712.

    Article  PubMed  Google Scholar 

  37. 37.

    Thomson CA, Thompson PA (2009) Dietary patterns, risk and prognosis of breast cancer. Future Oncol 5:1257–1269.

    Article  PubMed  Google Scholar 

  38. 38.

    Ramacciotti CE, Perrone P, Coli E et al (2011) Orthorexia nervosa in the general population: a preliminary screening using a self-administered questionnaire (ORTO-15). Eat Weight Disord 16(2):e127–e130.

    CAS  Article  PubMed  Google Scholar 

  39. 39.

    Aksoydan E, Camci N (2009) Prevalence of orthorexia nervosa among Turkish performance artists. Eat Weight Disord 14(1):33–37.

    CAS  Article  PubMed  Google Scholar 

  40. 40.

    McInerney-Ernst E M. Orthorexia nervosa: real construct or newest social trend? USA: ProQuest Information & Learning; 2012. Available from Accessed 20 Sept 2018

  41. 41.

    Karakus B, Hidiroglu S, Keskin N, Karavus M (2017) Orthorexia nervosa tendency among students of the Department of Nutrition and Dietetics at a university in Istanbul. North Clin Istanb 4(2):117–123.

    Article  PubMed  PubMed Central  Google Scholar 

  42. 42.

    Bağcı Bosi AT, Çamur D, Güler C (2007) Prevalence of orthorexia nervosa in resident medical doctors in the faculty of medicine (Ankara, Turkey). Appetite 49(3):661–666.

    Article  PubMed  Google Scholar 

  43. 43.

    Şahin D (1999) Support And Health. Edt., Okyayuz UH Health Psychology, 1st edn. Social Turkish Psychological Association Publications, Ankara, pp 79–106

    Google Scholar 

  44. 44.

    Gülcivan G, Topçu B (2017) Quality of lıfe with breast cancer patıents and evaluatıon of healthy life behaviors. Namık Kemal Med J 5(2):63–74

    Google Scholar 

  45. 45.

    Ansa B, Wonsuk Yoo W, Whitehead M, Coughlin S, Smith S (2016) Beliefs and behaviors about breast cancer recurrence risk reduction among African American breast cancer survivors. Int J Environ Res Public Health 13(46):2–11.

    CAS  Article  Google Scholar 

  46. 46.

    Arslantaş H, Adana F, Öğüt S, Ayakdaş D, Korkmaz A (2017) Relationship between eating behaviors of nursing students and orthorexia nervosa (obsession with healthy eating): a cross-sectional study. J Psychiatr Nurs 8(3):137–144.

    Article  Google Scholar 

  47. 47.

    Oberguggenberger A, Meraner V, Sztankay M et al (2018) Health behavior and quality of life outcome in breast cancer survivors: prevalence rates and predictors. Clin Breast Cancer 18(1):38–44.

    Article  PubMed  Google Scholar 

  48. 48.

    Hossein SA, Bahrami M, Mohamadirizi S, Paknaad Z (2015) Investigation of eating disorders in cancer patients and its relevance with body image. Iran J Nurs Midwifery Res 20:327–333.

    Article  PubMed  PubMed Central  Google Scholar 

  49. 49.

    Rabin C, Pinto B (2006) Cancer-related beliefs and health behavior change among breast cancer survivors and their first-degree relatives. Psycho-oncology 15(8):701–712.

    Article  PubMed  Google Scholar 

  50. 50.

    Lin A, Finch L, Stump T, Hoffman S, Spring B (2019) Cancer prevention beliefs and diet behaviors among females diagnosed with obesity-related cancers (FS13-06-19). Curr Dev Nutr.

    Article  PubMed Central  Google Scholar 

  51. 51.

    Gezer C, Kabaran S (2013) The risk of orthorexia nervosa for female students studying nutrition and dietetics. SDU J Health Sci Inst 4(1):14–22

    Google Scholar 

Download references


We would like to thank all the patients who participated voluntarily in this study conducted at the Medical Center the patients for the support showed research conducted.

Author information



Corresponding author

Correspondence to Ümmühan Aktürk.

Ethics declarations

Conflict of interest

No conflict of interest was declared by the authors.

Ethical approval

This study, written permission was obtained from Health Sciences Scientific Research and Publication Ethics Committee (2018-21/15).

Informed consent

Informed consent was obtained from all the individual participants before they were included in this study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of topical collection on Orthorexia Nervosa.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Aslan, H., Aktürk, Ü. Demographic characteristics, nutritional behaviors, and orthorexic tendencies of women with breast cancer: a case–control study. Eat Weight Disord 25, 1365–1375 (2020).

Download citation


  • Eating disorders
  • Orthorexia nervosa
  • ORTO-15
  • Breast Cancer