Associations Between Depression, Arterial Stiffness, and Metabolic Syndrome Among Adults in the UK Biobank Population Study: A Mediation Analysis

Identifying influencing factors of metabolic syndrome in patients with major depressive disorder: A real-world study with Bayesian network modeling

BACKGROUND

The bidirectional relationships between metabolic syndrome (MetS) and major depressive disorder (MDD) were discovered, but the influencing factors of the comorbidity were barely investigated. We aimed to fully explore the factors and their associations with MetS in MDD patients.

METHODS

The data were retrieved from the electronic medical records of a tertiary psychiatric hospital in Beijing from 2016 to 2021. The influencing factors were firstly explored by univariate analysis and multivariate logistic regressions. The propensity score matching was used to reduce the selection bias of participants. Then, the Bayesian networks (BNs) with hill-climbing algorithm and maximum likelihood estimation were preformed to explore the relationships between influencing factors with MetS in MDD patients.

RESULTS

Totally, 4126 eligible subjects were included in the data analysis. The proportion rate of MetS was 32.6 % (95 % CI: 31.2 %-34.1 %). The multivariate logistic regression suggested that recurrent depression, uric acid, duration of depression, marriage, education, number of hospitalizations were significantly associated with MetS. In the BNs, number of hospitalizations and uric acid were directly connected with MetS. Recurrent depression and family history psychiatric diseases were indirectly connected with MetS. The conditional probability of MetS in MDD patients with family history of psychiatric diseases, recurrent depression and two or more times of hospitalizations was 37.6 %.

CONCLUSION

Using the BNs, we found that number of hospitalizations, recurrent depression and family history of psychiatric diseases contributed to the probability of MetS, which could help to make health strategies for specific MDD patients.

Exposure to ambient air pollutants during circadian syndrome and subsequent cardiovascular disease and its subtypes and death: A trajectory analysis

BACKGROUND

The association between exposure to air pollutants and cardiovascular disease (CVD) trajectory in individuals with circadian syndrome remains inconclusive.

METHODS

The individual exposure levels of air pollutants, including particulate matter (PM) with aerodynamic diameter ≤ 2.5 μm (PM2.5), PM with aerodynamic diameter ≤ 10 μm (PM10), PM2.5 absorbance, PM with aerodynamic diameter between 2.5 μm and 10 μm, nitrogen dioxide (NO2), nitrogen oxides (NOx), and air pollution score (overall air pollutants exposure), were estimated for 48,850 participants with circadian syndrome from the UK Biobank. Multistate regression models were employed to estimate associations between exposure to air pollutants and trajectories from circadian syndrome to CVD/CVD subtypes (including coronary heart disease [CHD], atrial fibrillation [AF], heart failure [HF], and stroke) and death. Mediation roles of CVD/CVD subtypes in the associations between air pollutants and death were evaluated.

RESULTS

After a mean follow-up time over 12 years, 12,570 cases of CVD occurred, including 8192 CHD, 1693 AF, 1085 HF, and 1600 stroke cases. In multistate model, per-interquartile range increment in PM2.5 (hazard ratio: 1.08; 95 % confidence interval: 1.06, 1.10), PM10 (1.04; 1.01, 1.06), PM2.5 absorbance (1.04; 1.02, 1.06), NO2 (1.07; 1.03, 1.11), NOx (1.08; 1.04, 1.12), or air pollution score (1.06; 1.03, 1.08) was associated with trajectory from circadian syndrome to CVD. Significant associations between the above-mentioned air pollutants and trajectories from circadian syndrome and CVD to death were observed. CVD, particularly CHD, significantly mediated the associations of PM2.5, NO2, NOx, and air pollution score with death.

CONCLUSIONS

Long-term exposure to air pollutants during circadian syndrome was associated with subsequent CVD and death. CHD emerged as the most prominent CVD subtype in CVD progression driven by exposure to air pollutants during circadian syndrome. Our study highlights the importance of controlling air pollutants exposure and preventing CHD in people with circadian syndrome.

Relationship between metabolic syndrome and depression: A study based on Rafsanjan Youth Cohort Study

BACKGROUND

Depressed people are susceptible to metabolic syndrome ression and metabolic syndrome in the Rafsanjan Youth Cohort Study in 2021.

METHODS

In this cross-sectional study, the data of 3005 young people aged 15-35 under the coverage of urban and rural health centers was investigated in the enrollment stage of the Rafsanjan Youth Cohort Study as a part of the prospective epidemiological research studies in IrAN (PERSIAN). Data was collected using face-to-face interview and electronic questionnaires of the Rafsanjan Youth Cohort Study.

RESULTS

Age of the youth was 25.78 ± 6.06 years, 56 % (n = 1682) were female. The prevalence of metabolic syndrome (MetS) was 7.7 % (95 % CI: 6.8 %-8.8 %) and the prevalence of depression was 11.1 % (95 % CI: 10.0 %-12.3 %). Depression did not have a significant impact on the odds ratio of developing MetS in young people (P = 0.604). The odds ratio (OR) of MetS increases by 1.057 times with increasing age (95 % CI for OR: 1.020-1.094). This OR is also 1.715 times higher in married young people than in unmarried Youth (95 % CI for OR: 1.715-2.692) and 0.196 times lower in young people with medium and high MET index than in young people with low MET index (95 % CI for OR: 0.048-0.811).

LIMITATIONS

Inability to determine a causal relationship between MetS and depression.

CONCLUSION

Due to the growing trend of components of MetS among the young population, this issue needs to be addressed in future policies and planning for prevention and control as a health priority.

Discrepancies between general and central obesity in arterial stiffness: observational studies and Mendelian randomization study

BACKGROUND

Obesity has been linked to arterial stiffness, while no consensus was reached on the association. We aimed to clarify the association of general and central obesity with arterial stiffness by combining observational studies and Mendelian randomization (MR) study.

METHODS

Two cross-sectional studies were performed in UK Biobank and Fuqing Cohort, respectively. Two-sample MR study was conducted using summary data of GWASs from GIANT consortium and UK Biobank. General obesity and central obesity were measured using body mass index (BMI) and waist circumference (WC), respectively. Arterial stiffness was measured by arterial stiffness index (ASI) in UK Biobank or branchial-ankle pulse wave velocity (baPWV) in Fuqing Cohort.

RESULTS

Two observational studies found a consistent positive association of BMI and WC with arterial stiffness when adjusting for age, sex, education, smoking, alcohol drinking, physical activity, and LDL cholesterol. However, when additionally adjusting for metabolic traits (i.e., systolic blood pressure, diastolic blood pressure, blood glucose, triglycerides, high-density lipoprotein cholesterol, and WC or BMI), the association with BMI changed to be inverse. As compared to the lowest quintile group, the adjusted ORs across groups of second to fifth quintile were 0.93, 0.90, 0.83, and 0.72 in UK Biobank and 0.88, 0.65, 0.63, and 0.50 in Fuqing Cohort. In contrast, the positive relationship with WC remained stable with the adjusted ORs of 1.23, 1.46, 1.60, and 1.56 in UK Biobank and 1.35, 1.44, 1.77, and 1.64 in Fuqing Cohort. MR analyses provided supportive evidence of the negative association with BMI (OR = 0.97, 95%CI = 0.94-1.00) and the positive association with WC (OR = 1.14, 95%CI = 1.08-1.20).

CONCLUSIONS

Observational and genetic analyses provide concordant results that central obesity is independently related to arterial stiffness, while the role of general obesity depends on metabolic status.

Impact of healthy lifestyle on the incidence and progression trajectory of mental disorders: A prospective study in the UK Biobank

BACKGROUND

Healthier lifestyle decreased the risk of mental disorders (MDs) such as depression and anxiety. However, research on the effects of a comprehensive healthy lifestyle on their progression is lacking.

METHODS

385,704 individuals without baseline MDs from the UK Biobank cohort were included. A composite healthy lifestyle score was computed by assessing alcohol intake, smoking status, television viewing time, physical activity, sleep duration, fruit and vegetable intake, oily fish intake, red meat intake, and processed meat intake. Follow-up utilized hospital and death register records. Multistate model was used to examine the role of healthy lifestyle on the progression of specific MDs, while a piecewise Cox regression model was utilized to assess the influence of healthy lifestyle across various phases of disease progression.

RESULTS

Higher lifestyle score reduced risks of transitions from baseline to anxiety and depression, as well as from anxiety and depression to comorbidity, with corresponding hazard ratios (HR) and 95 % confidence intervals (CI) of 0.94 (0.93, 0.95), 0.90 (0.89, 0.91), 0.94 (0.91, 0.98), and 0.95 (0.92, 0.98), respectively. Healthier lifestyle decreased the risk of transitioning from anxiety to comorbidity within 2 years post-diagnosis, with HR 0.93 (0.88, 0.98). Higher lifestyle scores at 2-4 years and 4-6 years post-depression onset were associated with reduced risk of comorbidity, with HR 0.93 (0.87, 0.99) and 0.92 (0.86, 0.99), respectively.

LIMITATION

The generalizability to other ethnic groups is limited.

CONCLUSION

This study observed a protective role of holistic healthy lifestyle in the trajectory of MDs and contributed to identifying critical progression windows.

Deconstructing depression by machine learning: the POKAL-PSY study

Unipolar depression is a prevalent and disabling condition, often left untreated. In the outpatient setting, general practitioners fail to recognize depression in about 50% of cases mainly due to somatic comorbidities. Given the significant economic, social, and interpersonal impact of depression and its increasing prevalence, there is a need to improve its diagnosis and treatment in outpatient care. Various efforts have been made to isolate individual biological markers for depression to streamline diagnostic and therapeutic approaches. However, the intricate and dynamic interplay between neuroinflammation, metabolic abnormalities, and relevant neurobiological correlates of depression is not yet fully understood. To address this issue, we propose a naturalistic prospective study involving outpatients with unipolar depression, individuals without depression or comorbidities, and healthy controls. In addition to clinical assessments, cardiovascular parameters, metabolic factors, and inflammatory parameters are collected. For analysis we will use conventional statistics as well as machine learning algorithms. We aim to detect relevant participant subgroups by data-driven cluster algorithms and their impact on the subjects' long-term prognosis. The POKAL-PSY study is a subproject of the research network POKAL (Predictors and Clinical Outcomes in Depressive Disorders; GRK 2621).

Chronic Low-Grade Inflammation and Brain Structure in the Middle-Aged and Elderly Adults

Low-grade inflammation (LGI) mainly acted as the mediator of the association of obesity and inflammatory diet with numerous chronic diseases, including neuropsychiatric diseases. However, the evidence about the effect of LGI on brain structure is limited but important, especially in the context of accelerating aging. This study was then designed to close the gap, and we leveraged a total of 37,699 participants from the UK Biobank and utilized inflammation score (INFLA-score) to measure LGI. We built the longitudinal relationships of INFLA-score with brain imaging phenotypes using multiple linear regression models. We further analyzed the interactive effects of specific covariates. The results showed high level inflammation reduced the volumes of the subcortex and cortex, especially the globus pallidus (β [95% confidence interval] = -0.062 [-0.083, -0.041]), thalamus (-0.053 [-0.073, -0.033]), insula (-0.052 [-0.072, -0.032]), superior temporal gyrus (-0.049 [-0.069, -0.028]), lateral orbitofrontal cortex (-0.047 [-0.068, -0.027]), and others. Most significant effects were observed among urban residents. Furthermore, males and individuals with physical frailty were susceptive to the associations. The study provided potential insights into pathological changes during disease progression and might aid in the development of preventive and control targets in an age-friendly city to promote great health and well-being for sustainable development goals.

Association of both depressive symptoms scores and specific depressive symptoms with all-cause and cardiovascular disease mortality

BACKGROUND

The presence of depression related to an increased risk of all-cause and cardiovascular disease (CVD) mortality has been reported. However, studies conducted on certain specific depressive symptoms are scarce. Our purpose was to assess the effect of both depressive symptoms scores and certain specific depressive symptoms on all-cause and CVD mortality.

METHODS

In the present cohort study, all participants, aged 18 years or older, were enrolled in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2014. Depressive symptoms score was assessed using the validated 9-item Patient Health Questionnaire Depression Scale (PHQ-9), which ranges from 0 to 27, with a PHQ-9 score ≥ 10 diagnosed as depression. The outcome events were all-cause and CVD mortality, which were followed up from 2005 to 2014. The associations of both depressive symptoms score and certain specific depressive symptoms with all-cause and CVD mortality were examined by weighted multivariable proportional hazards models.

RESULTS

A total of 26,028 participants aged ≥ 18 years were included in the statistical analysis, including 12,813 (49.2%) males and 13,215 (50.8%) females, with a mean (SD) age of 47.34 (18.86) years. During the 9.32 (3.20) years of mean (SD) follow-up, 3261 deaths were recorded, of which 826 were cardiovascular deaths. All-cause mortality was 16.87/1000 person-years in subjects with depression. In terms of CVD mortality, these figures were 4.53/1000 person-years. In the full model (model 3), elevated depressive symptoms scores were independently associated with an increased risk of all-cause mortality (Highest depression symptom score group: adjusted hazard ratio, 1.63; 95% CI 1.44-1.85) and CVD mortality (Highest depression symptom score group: adjusted hazard ratio, 1.73; 95% CI 1.34-2.24). All 9 specific depressive symptoms that make up the PHQ-9 were related to an increased risk of all-cause mortality. However, only 3 symptoms, including trouble sleeping or sleeping too much, poor appetite or overeating, and suicidal ideation, were no significantly associated with an increased risk of CVD mortality.

CONCLUSIONS

The elevated depressive symptoms scores were strongly associated with an increased risk of all-cause and CVD mortality in US adults. Furthermore, all 9 specific depressive symptoms were associated with high all-cause mortality. However, trouble sleeping or sleeping too much, poor appetite or overeating, and suicidal ideation might not increase the risk of CVD mortality.

Prevalence and factors associated with dyslipidemia in patients with first hospitalization for major depressive disorder: a large sample cross-sectional study

BACKGROUND

Major depressive disorder (MDD) is a severe mental illness with high relapse rates and high mortality. Depression not only severely limits psychosocial functioning but also reduces quality of life. It can also negatively affect patients' clinical parameters, including lipid metabolism markers. This study aimed to investigate the prevalence and risk factors of hyperlipidemia (HL) in patients with MDD who were hospitalized for the first time.

METHODS

In this study, we enrolled 981 patients with MDD who were hospitalized for the first time, collected their demographic data and biochemical indicators, and evaluated their clinical symptoms. We divided the patients into HL and non-HL subgroups based on whether they had co-morbid HL. We compared whether there were significant differences between the two groups regarding demographics and general clinical information.

RESULTS

A total of 708 of 981 MDD patients were described as being in the hyperlipidemic group, with an incidence of 72.17%. Clinical Global Impression Scale-Severity of Illness (CGI-SI) score and Hamilton Depression Scale (HAMD) score are risk factors for co-morbid HL in patients with MDD. The area under the ROC curve for the CGI-SI and HAMD score and their combined discriminatory ability was approximately 63%, 67%, and 68%, respectively.

CONCLUSION

The prevalence of HL was high in patients with MDD who were first hospitalized; Higher HAMD score and CGI-SI score were risk factors for the development of HL in MDD; The HAMD score and the CGI-SI score are predictive of the severity of HL.

The brain structure, inflammatory, and genetic mechanisms mediate the association between physical frailty and depression

Cross-sectional studies have demonstrated strong associations between physical frailty and depression. However, the evidence from prospective studies is limited. Here, we analyze data of 352,277 participants from UK Biobank with 12.25-year follow-up. Compared with non-frail individuals, pre-frail and frail individuals have increased risk for incident depression independent of many putative confounds. Altogether, pre-frail and frail individuals account for 20.58% and 13.16% of depression cases by population attributable fraction analyses. Higher risks are observed in males and individuals younger than 65 years than their counterparts. Mendelian randomization analyses support a potential causal effect of frailty on depression. Associations are also observed between inflammatory markers, brain volumes, and incident depression. Moreover, these regional brain volumes and three inflammatory markers-C-reactive protein, neutrophils, and leukocytes-significantly mediate associations between frailty and depression. Given the scarcity of curative treatment for depression and the high disease burden, identifying potential modifiable risk factors of depression, such as frailty, is needed.

Association between metabolic syndrome and kidney cancer risk: a prospective cohort study

BACKGROUND

Kidney cancer has become known as a metabolic disease. However, there is limited evidence linking metabolic syndrome (MetS) with kidney cancer risk. This study aimed to investigate the association between MetS and its components and the risk of kidney cancer.

METHODS

UK Biobank data was used in this study. MetS was defined as having three or more metabolic abnormalities, while pre-MetS was defined as the presence of one or two metabolic abnormalities. Hazard ratios (HRs) and 95% confidence intervals (CIs) for kidney cancer risk by MetS category were calculated using multivariable Cox proportional hazards models. Subgroup analyses were conducted for age, sex, BMI, smoking status and drinking status. The joint effects of MetS and genetic factors on kidney cancer risk were also analyzed.

RESULTS

This study included 355,678 participants without cancer at recruitment. During a median follow-up of 11 years, 1203 participants developed kidney cancer. Compared to the metabolically healthy group, participants with pre-MetS (HR= 1.36, 95% CI: 1.06-1.74) or MetS (HR= 1. 70, 95% CI: 1.30-2.23) had a significantly greater risk of kidney cancer. This risk increased with the increasing number of MetS components (P for trend < 0.001). The combination of hypertension, dyslipidemia and central obesity contributed to the highest risk of kidney cancer (HR= 3.03, 95% CI: 1.91-4.80). Compared with participants with non-MetS and low genetic risk, those with MetS and high genetic risk had the highest risk of kidney cancer (HR= 1. 74, 95% CI: 1.41-2.14).

CONCLUSIONS

Both pre-MetS and MetS status were positively associated with kidney cancer risk. The risk associated with kidney cancer varied by combinations of MetS components. These findings may offer novel perspectives on the aetiology of kidney cancer and assist in designing primary prevention strategies.

Could the association between ozone and arterial stiffness be modified by fish oil supplementation?

BACKGROUND

Arterial stiffness (AS) is an important predicting factor for cardiovascular disease. However, no epidemiological studies have ever explored the mediating role of biomarkers in the association between ozone and AS, nor weather fish oil modified such association.

METHODS

Study participants were drawn from the UK biobank, and a total of 95,699 middle-aged and older adults were included in this study. Ozone was obtained from Community Multiscale Air Quality (CMAQ) model matched to residential addresses, fish oil from self-reported intake, and arterial stiffness was based on device measurements. First, we applied a double robust approach to explore the association between ozone or fish oil intake and arterial stiffness, adjusting for potential confounders at the individual and regional levels. Then, how triglycerides, apolipoprotein B (Apo B)/apolipoprotein A (ApoA) and non-high-density lipoprotein cholesterol (Non-HDL-C) mediate the relationship between ozone and AS. Last, the modifying role of fish oil was further explored by stratified analysis.

RESULTS

The mean age of participants was 55 years; annual average ozone exposure was associated with ASI (beta:0.189 [95%CI: 0.146 to 0.233], P < 0.001), and compared to participants who did not consume fish oil, fish oil users had a lower ASI (beta: 0.061 [95%CI: -0.111 to -0.010], P = 0.016). The relationship between ozone exposure and AS was mediated by triglycerides, ApoB/ApoA, and Non-HDL-C with mediation proportions ranging from 10.90% to 18.30%. Stratified analysis showed lower estimates on the ozone-AS relationship in fish oil users (P = 0.011).

CONCLUSION

Ozone exposure was associated with higher levels of arterial stiffness, in contrast to fish oil consumption, which showed a protective association. The association between ozone exposure and arterial stiffness was partially mediated by some biomarkers. In the general population, fish oil consumption might provide protection against ozone-related AS.

Perils of the nighttime: Impact of behavioral timing and preference on mental health in 73,888 community-dwelling adults

Mental health is independently influenced by the inclination to sleep at specific times (chronotype) and the actual sleep timing (behavior). Chronotype and timing of actual sleep are, however, often misaligned. This study aims to determine how chronotype, sleep timing, and the alignment between the two impact mental health. In a community-dwelling cohort of middle- and older-aged adults (UK Biobank, n = 73,888), we examined the impact of chronotype (questionnaire-based), the timing of behavior (determined with 7-day accelerometry), and the alignment between the two on mental, behavioral, neurodevelopmental disorders (MBN), depression, and anxiety, as assessed through ICD-10 codes. As compared to morning types with early behavior (aligned), morning types with late behavior (misaligned) had an increased risk of having MBN, depression, and anxiety (p's<0.001). As compared to evening-types with late behavior (aligned), however, evening-types with early behavior (misaligned) had a decreased risk of depression (p < 0.01), with a trend for MBN (p = 0.04) and anxiety (p = 0.05). Longitudinal analyses, in which the likelihood of developing de novo mental health disorders was associated with chronotype, behavioral timing, and alignment between the two, confirmed cross-sectional findings. To age healthily, individuals should start sleeping before 1AM, despite chronobiological preferences.

Risk factor control and incident cardiovascular disease in patients with diabetes: Sex-specific relations

AIM

Women with diabetes are at higher risk of cardiovascular diseases (CVD) than men with diabetes; however, the sex difference in the association between the degree of risk factor control and the risk of CVD in patients with diabetes is unclear.

METHODS

In total, 17 260 participants diagnosed with diabetes from the UK Biobank were included and matched with 86 300 non-diabetes controls based on age, sex and assessment centre. The main exposure was the number of risk factors within the target range, including glycated haemoglobin level <53 mol/mol (7%), blood pressure <140/90 mm/Hg, low-density lipoprotein cholesterol <100 mg/dl, non-current smoking and absence of microalbuminuria.

RESULTS

During a median follow-up of 13.3 years, a total of 3338 incident CVD cases, including 2807 ischaemic heart disease and 793 strokes, were documented. A more stringent control of risk factors was significantly associated with a lower risk of incident CVD, and such an association was significantly stronger in women than men. Compared with non-diabetes participants, the diabetes-related risk of CVD appeared to be eliminated if more than three risk factors were well controlled among women and men with diabetes. Moreover, clinical biomarkers (e.g. glycated haemoglobin and blood pressure) showed greater relative importance than other factors in women, whereas socio-economic and psychological factors (e.g. education and depression) exhibited similar relative importance to clinical biomarkers in men with diabetes.

CONCLUSION

Our findings highlighted the importance of raising awareness of sex differences in the management of CVD risk factors among patients with diabetes.

Mediation of the association between depression and coronary heart disease by metabolic syndrome components

BACKGROUND

Depression is associated with incident coronary heart disease (CHD) via a pathway that may be causal, but the mechanisms underlying this association are unclear. We assessed the extent to which metabolic syndrome (MetS) and its components (i.e., elevated waist circumference, low high-density lipoprotein [HDL] cholesterol, elevated triglycerides, elevated blood pressure, and elevated fasting plasma glucose) may mediate this association.

METHODS

Data were Framingham Heart Study Research Materials obtained from the National Heart, Lung, and Blood Institute (NHLBI) Biologic Specimen and Data Repository Information Coordinating Center. We used Cox proportional hazards regression to estimate adjusted hazard ratios (aHR) representing the total effect (aHRTE) of probable depression, measured via the Centers for Epidemiological Studies - Depression scale, on incident CHD over approximately 18 years. Using inverse odds ratio weighting, we decomposed this estimate into natural direct effects (aHRNDE) and natural indirect effects (aHRNIE) through potential mediators (measured approximately three years after depression).

RESULTS

Probable depression was associated with incident CHD (aHRTE=1.45, 95% confidence interval [CI]: 0.93, 2.25), and elevated waist circumference partially mediated this association (aHRNDE=1.34, 95% CI: 0.76-2.32; aHRNIE=1.08, 95% CI: 0.63-1.91). We did not find evidence of additional mediation by additional MetS components.

CONCLUSIONS

Elevated waist circumference appears to play a role in the association between depression and CHD.

Dysregulated cerebral blood flow, rather than gray matter Volume, exhibits stronger correlations with blood inflammatory and lipid markers in depression

Arterial spin labeling (ASL) can be used to detect differences in perfusion for multiple brain regions thought to be important in major depressive disorder (MDD). However, the potential of cerebral blood flow (CBF) to predict MDD and its correlations between the blood lipid levels and immune markers, which are closely related to MDD and brain function change, remain unclear. The 451 individuals - 298 with MDD and 133 healthy controls who underwent MRI at a single time point with arterial spin labelling and a high resolution T1-weighted structural scan. A proportion of MDD also provided blood samples for analysis of lipid and immune markers. We performed CBF case-control comparisons, random forest model construction, and exploratory correlation analyses. Moreover, we investigated the relationship between gray matter volume (GMV), blood lipids, and the immune system within the same sample to assess the differences in CBF and GMV. We found that the left inferior parietal but supramarginal and angular gyrus were significantly different between the MDD patients and HCs (voxel-wise P < 0.001, cluster-wise FWE correction). And bilateral inferior temporal (ITG), right middle temporal gyrus and left precentral gyrus CBF predict MDD (the area under the receiver operating characteristic curve of the random forest model is 0.717) and that CBF is a more sensitive predictor of MDD than GMV. The left ITG showed a positive correlation trend with immunoglobulin G (r = 0.260) and CD4 counts (r = 0.283). The right ITG showed a correlation trend with Total Cholesterol (r = -0.249) and tumour necrosis factor-alpha (r = -0.295). Immunity and lipids were closely related to CBF change, with the immunity relationship potentially playing a greater role. The interactions between CBF, plasma lipids and immune index could therefore represent an MDD pathophysiological mechanism. The current findings provide evidence for targeted regulation of CBF or immune properties in MDD.

Genetic evidence for the causal relations between metabolic syndrome and psychiatric disorders: a Mendelian randomization study

Emerging evidence reveals associations between metabolic syndrome (MetS) and psychiatric disorders (PDs), although causality remains uncertain. Consequently, we conducted Mendelian randomization (MR) to systematically evaluate the causality between MetS and PDs. Linkage disequilibrium score regression estimated the heritability of PDs and their genetic correlations with MetS. In primary analyses, the main model employed inverse variance weighting method, with sensitivity analyses using various MR models to ensure robustness. Replication MR analyses, involving cohorts distinct from those in the primary analyses, were performed to validate the generalizability of the findings. Multivariable MR analyses were carried out to account for genetically predicted body mass index (BMI). As a result, genetic correlations of MetS with attention-deficit/hyperactivity disorder(ADHD), anorexia nervosa(ANO), major depressive disorder(MDD), and schizophrenia were identified. Causal effects of MetS on ADHD (OR: 1.59 [95% CI:1.45-1.74]), ANO (OR: 1.42 [95% CI:1.25-1.61]), MDD(OR: 1.23 [95% CI: 1.13-1.33]), and the effects of ADHD (OR: 1.03 [95% CI: 1.02-1.04]) and ANO (OR: 1.01 [95% CI: 1.01-1.02]) on MetS were observed in primary analyses. Results from sensitivity analyses and replication analyses were generally consistent with the primary analyses, confirming the robustness and generalizability of the findings. Associations between MetS and ADHD, as well as ANO persisted after adjusting for BMI, whereas the statistical significance of the association between MetS and MDD was no longer observable. These results contribute to a deeper understanding of the mechanisms underlying PDs, suggesting potential modifiable targets for public prevention and clinical intervention in specific PDs related to metabolic pathways.

Association between polycyclic aromatic hydrocarbons exposure with red cell width distribution and ischemic heart disease: insights from a population-based study

This study investigates the association between polycyclic aromatic hydrocarbon (PAH) exposure, red blood cell distribution width (RDW), and ischemic heart disease (IHD) in a sample of 3003 participants from the National Health and Nutrition Examination Survey (NHANES). We hypothesize that RDW may mediate the effect of hydroxylated PAHs (OH-PAH) on IHD. Logistic regression models reveal significant associations between increased urinary PAH metabolite concentrations and IHD, as well as positive associations between PAH metabolites and RDW. Weighted Quantile Sum (WQS) regression and Bayesian Kernel Machine Regression (BKMR) analyses confirm the significant associations of the OH-PAH mixture with IHD and RDW. Mediation analysis demonstrates that RDW partially mediates the relationship between PAH exposure and IHD, accounting for 2-4.6% of the total effects. Our findings highlight the potential underlying mechanisms linking PAH exposure, RDW, and IHD and emphasize the importance of addressing environmental pollutants like PAHs in maintaining cardiovascular health and informing public health policies.

Income inequality and depressive symptoms among Chinese adults: a quasi-experimental study

OBJECTIVE

There is a lack of causal evidence on the impact of income inequality on depressive symptoms. The impact of China's Targeted Poverty Alleviation (TPA) policy on depressive symptoms is also unclear. Using a quasi-experimental design, this study aims to investigate the causal effects of TPA and income inequality on depressive symptoms among Chinese adults.

STUDY DESIGN

This is a population-based study.

METHODS

Three waves (2012, 2016, and 2018) of the China Family Panel Studies (CFPS), a nationally representative sample of China, were included in this study. We performed difference-in-difference (DID) models to assess the effect of TPA and income inequality on depressive symptoms. We further conducted the mixed effect models to examine the impact of income inequality on depressive symptoms. The study considered a range of spatial factors and spatial splines to address spatial autocorrelations.

RESULTS

This study included valid measures of depressive symptoms (Center for Epidemiologic Studies Depression Scale [CES-D-8] score) from 14,442 adults of CFPS. The DID results indicated that at the provincial level, the CES-D-8 score of the TPA treatment group was on average 0.570 (95% confidence interval [CI]: 0.358-0.783) less than the control group. Furthermore, a 0.1 increase in Gini index would lead to a 0.256 (95% CI: 0.064-0.448) increase in CES-D-8 score. The mixed effect model showed that income inequality was a risk factor for depressive symptoms at the provincial level (excess risk = 5.602% [95% CI: 3.047%-8.219%]).

CONCLUSIONS

Our findings suggest that income inequality adversely affects mental health, but China's Targeted Poverty Alleviation improves the mental health of the Chinese population.

A mediation analysis of metabolic and inflammatory factors in the severe sleep apnea-coronary heart disease association

BACKGROUND

It is unclear whether metabolic and inflammatory factors mediate the association between severe sleep apnea and coronary heart disease (CHD) in observational studies based on the large-scale population. This study aims to assess the association between severe sleep apnea and CHD and to explore the extent to which this association is mediated by metabolic factors and C-reactive protein (CRP).

METHODS

In UK Biobank, 213 442 CHD-free (mean age: 55.00) adults were followed up for 15 years to detect incident CHD. Metabolic factors included hyperglycemia, hypertension, dyslipidemia, hypertriglyceridemia, and hyperuricemia. A higher CRP concentration level was defined as a cutoff point of >3.0 mg/l. Data were analyzed using Cox proportional hazards models and the generalized structural equation model.

RESULTS

During follow-up, 9278 participants developed incident CHD (4.3%). The multi-adjusted hazard ratio and 95% confidence interval of CHD related to severe sleep apnea were 1.76 (1.44-2.15). In the mediation analysis, the strongest indirect association was for dyslipidemia, accounting for 20.8% of the association between severe sleep apnea and CHD (β = 0.22, 95% confidence interval = 0.16-0.28), followed by hypertriglyceridemia (12.3%). The proportion of mediation increased to 29.1% when CRP was added to the metabolic mediators.

CONCLUSIONS

Severe sleep apnea was associated with an increased risk of CHD. Lipid factors might play an essential role in the severe sleep apnea-CHD relationship. CRP increased the magnitude of mediation effects of overall metabolic factors. What is already known on this topic It is unknown whether the association between severe sleep apnea and CHD among the large population-based cohort study. Evidence on the mediating effect of metabolic and inflammatory factors in the severe sleep apnea-CHD association remains unclear. What this study adds Lipid factors were the biggest mediation driver in the severe sleep apnea-CHD path. C-reactive protein increased the magnitude of mediation effects of overall metabolic factors. How this study might affect research, practice or policy Investigating mediation analyses not only enhances comprehension of the pathophysiological connection between severe sleep apnea and CHD but also offers valuable insights into preventing CHD.

Sex and age disparities in the influence of tobacco smoking on depression: Evidence from the Taiwan Biobank

INTRODUCTION

The global tobacco epidemic poses a notable challenge to global health due to its association with various tobacco-related diseases. Although tobacco smoking is associated with depression, the exact mechanism by which tobacco smoking increases the risk of depression is unclear. This study explored the potential effects of tobacco smoking on depression.

METHODS

We used data in the analysis from the Taiwan Biobank of 27916 individuals recruited from 2015 to 2020. To investigate the associations between tobacco use and depression, the results of the depression-measuring subscale of the Patient Health Questionnaire-4 as well as data on participants' tobacco consumption and other relevant covariates, were analyzed.

RESULTS

Participants who smoked were more likely to report depression than those who did not smoke (AOR=1.50; 95% CI: 1.21-1.86). Furthermore, depression was significantly higher in women who smoked than in their male counterparts (females: AOR=1.68; 95% CI: 1.27-2.23, and males: AOR=1.32; 95% CI: 0.96-1.80). Women aged <55 years and who smoked were more likely to report depression, whereas this trend was not observed in those aged ≥55 years (<55 years: AOR=1.75; 95% CI: 1.23-2.48), and ≥55 years: AOR=1.58; 95% CI: 0.97-2.56).

CONCLUSIONS

Tobacco smoking is a significant factor associated with depression, particularly in younger women. The increasing prevalence of tobacco use for years among younger women in Taiwan might contribute to shifts in the associations between depression and tobacco use in women.

Investigating the role of the relaxin-3/RXFP3 system in neuropsychiatric disorders and metabolic phenotypes: A candidate gene approach

The relaxin-3/RXFP3 system has been implicated in the modulation of depressive- and anxiety-like behaviour in the animal literature; however, there is a lack of human studies investigating this signalling system. We seek to bridge this gap by leveraging the large UK Biobank study to retrospectively assess genetic risk variants linked with this neuropeptidergic system. Specifically, we conducted a candidate gene study in the UK Biobank to test for potential associations between a set of functional, candidate single nucleotide polymorphisms (SNPs) pertinent to relaxin-3 signalling, determined using in silico tools, and several outcomes, including depression, atypical depression, anxiety and metabolic syndrome. For each outcome, we used several rigorously defined phenotypes, culminating in subsample sizes ranging from 85,881 to 386,769 participants. Across all outcomes, there were no associations between any candidate SNP and any outcome phenotype, following corrections for multiple testing burden. Regression models comprising several SNPs per relevant candidate gene as exploratory variables further exhibited no prediction of outcome. Our findings corroborate conclusions from previous literature about the limitations of candidate gene approaches, even when based on firm biological hypotheses, in the domain of genetic research for neuropsychiatric disorders.

Exploring the relationship between depression and multimorbidity in Chinese middle-aged and older people based on propensity score matching

BACKGROUND

This study aimed to explore the relationship between depression and multimorbidity among middle-aged and older people in China.

METHODS

The cross-sectional study used the 2018 China Longitudinal Study of Health and Retirement and included a sample of 19,761 middle-aged and older adults aged 45 years and above. Propensity score matching was used to match samples of individuals with and without depression symptoms. The association between depression symptoms and multimorbidity and dose-response relationships were analyzed using logistic regression and restricted cubic spline (RCS) models for matched samples.

RESULTS

Logistic regression analysis showed that the prevalence of multimorbidity was 1.49 times higher among middle-aged and older adults in the depression symptom group compared to the non-depression group (95% CI:1.24, 1.80). The RCS curves for the relationship between depression and multimorbidity showed an overall increasing trend (P = 0.028). And prevalence of arthritis and digestive disease in the depressed and non-depressed groups is 3.6% and 3.9%, respectively.

LIMITATIONS

It was difficult to draw conclusions about causation since the study was cross-sectional, and CESD-10 scores do not represent the population study finally diagnosed with depression, the conclusions should be promoted with caution.

CONCLUSIONS

Middle-aged and older people with depressive symptoms are more likely to have multimorbidity than non-depressed individuals. Furthermore, the likelihood of multimorbidity increases with higher depression scores, and the binary combinations were similarly distributed. Therefore, attention should be paid to the management of mental health in the middle-aged and older adult population to alleviate and prevent any mental health issues they might face.

Added value of arterial stiffness index for the 10-year atherosclerotic cardiovascular disease risk determination in a middle-aged population-based study

OBJECTIVE

Atherosclerotic cardiovascular disease (ASCVD) is considered the leading cause of mortality worldwide. Arterial stiffness, measured by arterial stiffness index (ASI), could be a main predictor in target damage of organs. Uncertainty remains regarding the contribution of ASI to estimated ASCVD risk. This study investigates the added value of ASI in ASCVD risk determination using the general UK Biobank middle-aged population.

METHODS

Among 100,598 participants from the UK Biobank population, ASI was assessed and associations between ASCVD risk were stratified by sex and estimated using multiple linear and logistic regressions adjusted for heart rate, physical activity, alcohol status, smocking pack years, BMI categories and CKD.

RESULTS

Males presented higher ASCVD risk than females (8.58% vs. 2.82%, p < 0.001) and higher ASI levels (9.50 m/s vs. 7.00 m/s, p < 0.001). The Youden index was determined at 9.70 m/s in males (p < 0.001) and 10.46 m/s in females (p < 0.001). Among females, participants with ASI > 10.46 m/s showed higher ASCVD risk than others (3.64% vs. 2.56%, p < 0.001), similar results were observed for males (9.92% vs. 7.21%, p < 0.001). In males, ASI showed significant added value information when including overall covariates (AUC = 0.695 vs. AUC = 0.663, p < 0.001). Similar results were observed in females (AUC = 0.693 vs. AUC = 0.687, p = 0.001). In both genders, for the association between ASI and ASCVD risk, nonlinear relationships were observed with higher accuracies than linear models.

CONCLUSION

Further studies should investigate ASCVD risk stratification management depending on ASI measurement.

Dissecting the mediating and moderating effects of depression on the associations between traits and coronary artery disease: A two-step Mendelian randomization and phenome-wide interaction study

Background

Depression is often present concurrently with coronary artery disease (CAD), a disease with which it shares many risk factors. However, the manner in which depression mediates and moderates the association between traits (including biomarkers, anthropometric indicators, lifestyle behaviors, etc.) and CAD is largely unknown.

Methods

In our causal mediation analyses using two-step Mendelian randomization (MR), univariable MR was first used to investigate the causal effects of 108 traits on liability to depression and CAD. The traits with significant causal effects on both depression and CAD, but not causally modulated by depression, were selected for the second-step analyses. Multivariable MR was used to estimate the direct effects (independent of liability to depression) of these traits on CAD, and the indirect effects (mediated via liability to depression) were calculated. To investigate the moderating effect of depression on the association between 364 traits and CAD, a cross-sectional phenome-wide interaction study (PheWIS) was conducted in a study population from UK Biobank (UKBB) (N=275,257). Additionally, if the relationship between traits and CAD was moderated by both phenotypic and genetically predicted depression at a suggestive level of significance (Pinteraction≤0.05) in the PheWIS, the results were further verified by a cohort study using Cox proportional hazards regression.

Results

Univariable MR indicated that 10 of 108 traits under investigation were significantly associated with both depression and CAD, which showed a similar direct effect compared to the total effect for most traits. However, the traits "drive faster than speed limit" and "past tobacco smoking" were both exceptions, with the proportions mediated by depression at 24.6% and 7.2%, respectively. In the moderation analyses, suggestive evidence of several traits was found for moderating effects of phenotypic depression or susceptibility to depression, as estimated by polygenic risk score, including chest pain when hurrying, reason of smoking quitting and weight change. Consistent results were observed in survival analyses and Cox regression.

Conclusion

The independent role of traits in CAD pathogenesis regardless of depression was highlighted in our mediation analyses, and the moderating effects of depression observed in our study may be helpful for CAD risk stratification and optimized allocation of scarce medical resources.

Evaluation of Arterial Stiffness in Depression Patients

Background

It has been known that there is a significant correlation between depression and cardiovascular diseases. However, the reasons behind this correlation that could affect mortality and morbidity were not fully identified. The present study aimed to analyze arterial stiffness diagnosed with ultrasonography, which could be associated with cardiovascular disease risks in depression patients, and to compare the findings with those of healthy controls.

Methods

The study was conducted with 35 depression patients and 35 healthy individuals. Routine complete blood and biochemistry tests were requested for all patients, and their weight and height, waist circumference, and diastolic and systolic arterial blood pressure were measured. Femoral and carotid artery intima-media thickness and other arterial stiffness parameters were determined with Doppler ultrasonography.

Results

It was determined that the systolic pressure (P = .028) was higher in the patient group (P = .028). Also, the carotid elastic modulus (P = .048) was significantly higher in the patient group. A negative and significant correlation was determined between femoral compliance and chlorpromazine equivalent dose (P = .021, r = -0.389).

Conclusion

It was determined that the systolic blood pressure and carotid elastic modulus arterial stiffness parameters were significantly higher in depression patients. Measurable arterial stiffness parameters should be investigated in depression patients as cardiovascular risk markers. Furthermore, the determination of the effects of psychotropic drugs employed in arterial stiffness treatment could play an important role in the determination of cardiovascular disease risk in these patients.

Reduced reward responsiveness in treatment resistant depression of middle-aged adults: Association with carotid artery stiffness and tetrahydrobiopterin

Nearly one third of the population diagnosed with major depressive disorder (MDD) fail to respond to two or more antidepressant drugs of adequate dose and duration. This necessitates identification of confounding psychological and physiological factors that could contribute to treatment resistant depression (TRD). The present longitudinal study investigated the influence of behavioural inhibition system (BIS) and behavioural approach system (BAS) in treatment resistance. Further, the association of depression severity with physiological factors contributing to arterial stiffness was also investigated. Baseline data was acquired from 101 middle-aged (36-56 years) patients on immediate diagnosis with MDD using DSM-V criteria. Follow ups were conducted at 06 months and 12 months during treatment. Psychological assessment battery at baseline and follow ups comprised of Hamilton depression rating (HAM-D) for depression severity, WHODAS-2 and BIS-BAS score. Atherosclerosis and central arterial stiffness were measured by intima-media thickness of internal carotid artery and brachial-ankle pulse wave velocity. Physiological factors influencing central vascular function viz., body-mass index, estimated glomerular filtration rate, HbA1c, central systolic and diastolic blood pressure, heart rate and tetrahydrobiopterin were also investigated. Our results show lower reward responsiveness (BAS-RR) and higher BIS scores in TRD patients along with differentially higher intima-media thickness of left internal carotid artery. Higher depression severity at all stages of the study was correlated with lower tetrahydrobiopterin and BAS-RR scores. We, therefore, suggest that vascular depression resulting due to increased intima-media thickness of left carotid artery and lower tetrahydrobiopterin could be contributing factors for treatment resistance in middle-aged MDD patients.

Joint association of loneliness and traditional risk factor control and incident cardiovascular disease in diabetes patients

AIMS

To investigate the prospective associations of the loneliness and social isolation scales with cardiovascular disease (CVD) risk in diabetes patients and compare the relative importance of loneliness and social isolation with traditional risk factors. Also, the interactions of loneliness or isolation with the degree of risk factor control in relation to CVD risk were evaluated.

METHODS AND RESULTS

A total of 18 509 participants diagnosed with diabetes from the UK Biobank were included. A two-item scale and a three-item scale were used to assess loneliness and isolation levels, respectively. The degree of risk factor control was defined as numbers of glycated hemoglobin (HbA1c), blood pressure (BP), low-density lipoprotein cholesterol (LDL-C), smoking, and kidney condition controlled within the target range. During a mean follow-up of 10.7 years, 3247 total CVD incidents were documented, including 2771 coronary heart disease and 701 strokes. In the fully adjusted model, compared with participants with the lowest loneliness score (zero), hazard ratios (95% confidence interval) for CVD were 1.11 (1.02 and 1.20) and 1.26 (1.11 and 1.42) for participants with a loneliness scale of 1 and 2, respectively (P-trend < 0.001). No significant associations were observed for social isolation. Loneliness ranked higher in relative strength for predicting CVD than the lifestyle risk factors in diabetes patients. A significant additive interaction between loneliness and the degree of risk factor control on the risk of CVD was observed (P for additive interaction = 0.005).

CONCLUSION

Among diabetes patients, loneliness, but not social isolation scale, is associated with a higher risk of CVD and shows an additive interaction with the degree of risk factor control.

The association between coffee consumption and risk of incident depression and anxiety: Exploring the benefits of moderate intake

Accumulating evidence has reported the associations of coffee consumption with physical conditions and mortality, but the associations with mental disorders were limited. The objective of this study was to examine the associations of coffee consumption with incident depression and anxiety, and to assess whether the associations differed by coffee subtypes (instant, ground, and decaffeinated coffee) or additives (milk, sugar-sweetened, and artificial-sweetened). In this prospective cohort study, we utilized data from the UK Biobank and included a total of 146,566 participants who completed the touchscreen questionnaire at baseline between 2006 and 2010. During the follow-up, incident depression and anxiety were measured in 2016 using the Patient Health Questionnaire (PHQ)-9 and the Generalised Anxiety Disorder Assessment (GAD)-7, respectively. Multivariable-adjusted logistic regression models and restricted cubic splines were used to assess the associations. Approximately 80.7% of participants reported consuming coffee, and most drank 2 to 3 cups per day (41.2%). We found J-shaped associations between coffee consumption and both incident depression and anxiety, with the lowest risk of the mental disorders occurring at around 2-3 cups per day. Results were similar for participants who drank 2-3 cups of ground coffee, milk-coffee, or unsweetened coffee. Our findings highlight that 2-3 cups of coffee consumption could be recommended as part of a healthy lifestyle to improve mental health.

Exploring the role of adult attachment, major depression and childhood trauma in arterial stiffness: A preliminary study

OBJECTIVE

Prior research indicates a noteworthy and intricate connection between depression and subclinical atherosclerosis. Nevertheless, the biological and psychological mechanisms that underlie this association are not yet fully understood. To address this gap, this exploratory study aimed to examine the relationship between active clinical depression and arterial stiffness (AS), with a particular focus on the potential mediating roles of attachment security and childhood trauma.

METHODS

In this cross-sectional study, we examined 38 patients with active major depression free of dyslipidemia, diabetes mellitus, hypertension, and obesity and 32 healthy controls. All participants underwent blood tests, psychometric assessments, and AS measurements using the Mobil-O-Graph arteriograph system. AS severity was evaluated using an augmentation index (AIx) normalized to 75 beats/min.

RESULTS

In the absence of defined clinical cardiovascular risk factors, there was no significant difference in AIx between individuals with depression and healthy controls (p = .75). Patients with longer intervals between depressive episodes had lower AIx (r = -0.44, p < .01). Insecure attachment and childhood trauma did not significantly associate with AIx in patients. Whereas insecure attachment was positively correlated with AIx only in healthy controls (r = 0.50, p = 01).

CONCLUSIONS

Our analysis of established risk factors for atherosclerosis revealed that depression and childhood trauma had no significant relationship with AS. However, we did identify a novel finding: insecure attachment was significantly associated with AS severity in healthy adults without defined cardiovascular risk factors for the first time. To our knowledge, this is the first study to demonstrate this relationship.

Mediterranean diet lowers all-cause and cardiovascular mortality for patients with metabolic syndrome

A Mediterranean-style diet (MED) can promote people lengthen the span of life and avoid atherosclerotic cardiovascular disease (ASCVD) in primary prevention. Metabolic syndrome (MetS) can significantly reduce life expectancy and increase the risk of ASCVD. However, few studies have focused on the role of the Mediterranean diet in patients with MetS. Participants in the National Health and Nutrition Examination Survey (NHANES) with MetS (N = 8301) from 2007 to 2018 were examined. A 9-point evaluation scorewas used to measure the degree of adherence to the MED diet. In order to compare the various levels of adherence to the MED diet and the effects of the specific MED diet components on all-cause and cardiovascular mortality, Cox regression models were utilized. Among the 8301 participants with MetS, about 13.0% (1080 of 8301) died after a median follow-up of 6.3 years. In this study, participants with MetS with adherence to high-quality and moderate-quality Mediterranean diet were significantly associated with lower all-cause mortality as well as cardiovascular mortality during the follow-up period. Futhermore, in joint analysis of the Mediterranean diet and sedentary behavior or depression, we found that high-quality or moderate-quality Mediterranean diet could attenuate, even reverse the adverse effects of sedentary behavior and depression on all-cause and cardiovascular mortality in participants with MetS. Among the components of the MED diet, greater intakes of vegetables, legumes, nuts and high MUFA/SFA ratio were significantly associated with lower all-cause mortality and greater vegetables intake was significantly associated with lower cardiovascular mortality, while more red/processed meat intake was significantly associated with higher cardiovascular mortality in participants with MetS.

Association of serum alkaline phosphatase and depression in US adults: a population-based cross-sectional study

Background

Depression, a serious public health disorder, is increasingly prevalent worldwide. An association between alkaline phosphatase (ALP) and neurological disorders has been reported. However, data on ALP and depression risk are scarce, which warrants attention.

Methods

We assessed the association between ALP and risk of depression in adults from the 2007-2014 National Health and Nutrition Examination Survey (NHANES). Depression was assessed using the Patient Health Questionnaire-9. Univariate and multivariate logistic regression were used to assess the association between ALP and risk of depression, and subgroup analyses were also performed.

Results

A total of 17,485 participants were included. The prevalence of depression was 9.3% (1,631/17,485) and ALP was significantly associated with the risk of depression when ALP was a categorical variable (quadratic or categorized by 79 U/L) in a multivariate logistic regression model after adjusting for confounding factors (≥79 U/L vs. <79 U/L, adjusted OR, 1.15; 95%CI, 1.02-1.29). Each 1-unit increase in ALP (log₂) was associated with a 20% increase in depression prevalence (adjusted OR, 1.20; 95%CI, 1.06-1.36) when ALP was used as a continuous variable. Subgroup analysis showed that ALP was positively associated with the risk of depression with different characteristics.

Conclusion

Our findings suggest that higher alkaline phosphatase levels, even within the normal range, are significantly associated with a higher risk of depression in US adults. Such findings require further prospective studies to provide more evidence.

(Poly)phenol intake, plant-rich dietary patterns and cardiometabolic health: a cross-sectional study

Diet is an important modifiable risk factor for cardiometabolic diseases. Plant foods contain a complex mixture of nutrients and bioactive compounds such as (poly)phenols. Plant-rich dietary patterns have been associated with reduced cardiometabolic risk in epidemiological studies. However, studies have not fully considered (poly)phenols as a mediating factor in the relationship. A cross-sectional analysis was conducted in 525 healthy participants, aged 41.6 ± 18.3 years. Volunteers completed the validated European Prospective Investigation into Diet and Cancer (EPIC) Norfolk Food Frequency Questionnaire (FFQ). We investigated the associations between plant-rich dietary patterns, (poly)phenol intake, and cardiometabolic health. Positive associations were found between (poly)phenols and higher adherence to dietary scores, except for the unhealthy Plant-based Diet Index (uPDI), which was negatively associated with (poly)phenol intake. Correlations were significant for healthy PDI (hPDI), with positive associations with proanthocyanidins (r = 0.39, p < 0.01) and flavonols (r = 0.37, p < 0.01). Among dietary scores, Dietary Approaches to Stop Hypertension (DASH) showed negative associations with diastolic blood pressure (DBP), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and non-high-density lipoprotein cholesterol (Non-HDL-C) (stdBeta -0.12 to -0.10, p < 0.05). The Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) score was positively associated with flow-mediated dilation (FMD, stdBeta = 0.10, p = 0.02) and negatively associated with the 10-year Atherosclerotic Cardiovascular Disease (ASCVD) risk score (stdBeta = -0.12, p = 0.01). Higher intake of flavonoids, flavan-3-ols, flavan-3-ol monomers, theaflavins, and hydroxybenzoic acids (stdBeta: -0.31 to -0.29, p = 0.02) also showed a negative association with a 10-year ASCVD risk score. Flavanones showed significant associations with cardiometabolic markers such as fasting plasma glucose (FPG) (stdBeta = -0.11, p = 0.04), TC (stdBeta = -0.13, p = 0.03), and the Homeostasis Model Assessment (HOMA) of beta cell function (%B) (stdBeta = 0.18, p = 0.04). Flavanone intake was identified as a potential partial mediator in the negative association between TC and plant-rich dietary scores DASH, Original Mediterranean diet scores (O-MED), PDI, and hPDI (proportion mediated = 0.01% to 0.07%, p < 0.05). Higher (poly)phenol intake, particularly flavanone intake, is associated with higher adherence to plant-rich dietary patterns and favourable biomarkers of cardiometabolic risk indicating (poly)phenols may be mediating factors in the beneficial effects.

Residential greenspace and risk of cancer: A prospective cohort study from the UK Biobank

BACKGROUND

Growing evidence suggests that proximity to greenspace is linked to multiple health outcomes, but its association with the risk of cancer is not fully understood. The mechanism for greenspace's influences on cancer incidence may be through reducing depressive symptoms and increasing physical activity. Our study aimed to investigate the associations between exposure to residential greenspace and the risk of common types of cancer and whether the associations were modified or mediated by depressive symptoms and physical activity.

METHODS

This prospective cohort study included 401,189 participants in the UK Biobank between 2006 and 2010 who were free of cancer and followed up until 2021. Residential greenspace was defined as the percentage of outdoor greenspace surrounding the residential location of each participant across 1000 m and 300 m buffers, which were estimated with land use data. Electronic health records were used to assess the incidence of 25 types of cancer. Cox proportional hazards regressions were performed to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) per an interquartile range (IQR) increase of greenspace after multiple comparisons using Bonferroni correction.

RESULTS

During a median follow-up of 12.4 years, a total of 43,273 incident cancer cases were documented. We found that exposure to greenspace at a 1000 m buffer was significantly associated with prostate cancer (HR = 0.93, 95 % CI: 0.89-0.96), and suggestively associated with oral cavity (HR = 0.86, 95 % CI: 0.76-0.98) and bladder cancer (HR = 1.08, 95 % CI: 1.01-1.15), but not with other cancers. Moreover, the association between greenspace and prostate cancer was mediated by physical activity, and was modified by depressive symptoms (P for heterogeneity = 0.022). Similar findings were also observed for greenspace at a 300 m buffer.

CONCLUSION

Our study revealed an association between exposure to greenspace and prostate cancer, but not with other cancers.

Mechanism of the association between sleep quality and mortality in middle-aged and older adults: A prospective study analysis of the UK Biobank

BACKGROUND

Although sleep quality is known to be associated with mortality, how poor sleep quality contributes to an increased risk of mortality is still unknown. We aimed to examine whether lifestyle, psychosocial and biological factors mediate the association.

METHODS

205,654 participants from UK Biobank were used for the analysis. The outcome was all-cause, cardiovascular disease (CVD) and cancer mortality by February 2022. Exposure was assessed by a sleep score consisting of five sleep behaviors at baseline. Lifestyle, psychosocial, and biological factors are regarded as potential mediators. Mediation analysis based on Cox proportional hazards models was performed.

RESULTS

Poor sleep quality was associated with a higher risk of all-cause (Hazard Ratio [HR] = 1.098; 95% CI: 1.058-1.140), CVD (HR = 1.139; 95% CI: 1.045-1.243) and cancer mortality (HR = 1.095; 95% CI: 1.040-1.152). Lifestyle mediators (smoking, physical activity, sedentary, BMI and diet) could explain between 2.6% and 34.0% of the increased risk of all-cause mortality in individuals with poor sleep quality. Self-reported health, frailty, depression, and loneliness were significant psychosocial mediators of this association pathway. About one-fifth of the association can be explained by the biological role of CRP. Similar mediating patterns were observed for CVD and cancer mortality.

LIMITATIONS

Both exposure and mediators were measured at baseline, so the possibility of reverse causality cannot be ruled out.

CONCLUSIONS

Poor sleep quality is associated with an increased risk of death through a combination of lifestyle, psychosocial and biological pathways. Adopting healthy lifestyles and staying psychosocial well-being are cost-effective interventions to lower the risk of death.

The associations of physical activity and lifetime depression with all-cause and cause-specific mortality: evidence from a prospective cohort study

This study aims to explore the joint associations of physical activity and lifetime depression with all-cause and cause-specific mortality. The present study using data from UK Biobank, included 316568 participants aged 37 to 73 years recruited from 22 centers between 2006 and 2010. Total physical activity (TPA), moderate-to-vigorous physical activity (MVPA) and vigorous physical activity (VPA), assessed by metabolic equivalent task (MET) were used and Cox-proportional hazard models were performed in this study. The incidence rate of all-cause, CVD, and cancer mortality was 4.35(95%CI: 4.29-4.42), 0.69 (95%CI: 0.67-0.72), and 2.23 (95%CI: 2.19-2.28) per 1000 person-years after an average follow-up time of 12.49 years. Lower levels of TPA, MVPA, and VPA were all independently associated with elevated risk of all-cause and cancer mortality. Lifetime depression was significantly associated with increased risk of all-cause (HR=1.46, 95%CI: 1.40-1.52), CVD (HR=1.48, 95%CI: 1.33-1.64), and cancer mortality (HR=1.13, 95%CI: 1.06-1.21). Significant interactive effect of low levels of TPA, MVPA, and VPA and lifetime depression on all-cause mortality were found in this study. The risk of all-cause mortality associated with lifetime depression was deteriorated with low levels of physical activity. Relevant interventions for regular PA should be performed among depressed population.

Banxia Xiexin decoction alleviates AS co-depression disease by regulating the gut microbiome-lipid metabolic axis

ETHNOPHARMACOLOGICAL RELEVANCE

Banxia Xiexin decoction (BXD) is a classic Chinese herbal formulation consisting of 7 herbs including Pinelliae Rhizoma, Scutellariae Radix, Zingiberis Rhizoma, Ginseng Radix, Glycyrrhizae Radix, Coptidis Rhizoma, and Jujubae Fructus, which can exert effects on lowering lipids and alleviating depressive mood disorders via affecting gastrointestinal tract.

AIM OF THE STUDY

The pathogenesis of atherosclerosis (AS) co-depression disease has not been well studied, and the current clinical treatment strategies are not satisfactory. As a result, it is critical to find novel methods of treatment. Based on the hypothesis that the gut microbiome may promote the development of AS co-depression disease by regulating host lipid metabolism, this study sought to evaluate the effectiveness and action mechanism of BXD in regulation of the gut microbiome via an intervention in AS co-depression mice.

MATERIALS AND METHODS

To determine the primary constituents of BXD, UPLC-Q/TOF-MS analysis was carried out. Sixteen C56BL/6 mice were fed normal chow as a control group; 64 ApoE^-/- mice were randomized into four groups (model group and three treatment groups) and fed high-fat chow combined with daily bind stimulation for sixteen weeks to develop the AS co-depression mouse model and were administered saline or low, medium or high concentrations of BXD during the experimental modeling period. The antidepressant efficacy of BXD was examined by weighing, a sucrose preference test, an open field test, and a tail suspension experiment. The effectiveness of BXD as an anti-AS treatment was evaluated by means of biochemical indices, the HE staining method, and the Oil red O staining method. The impacts of BXD on the gut microbiome structure and brain (hippocampus and prefrontal cortex tissue) lipids in mice with the AS co-depression model were examined by 16S rDNA sequencing combined with lipidomics analysis.

RESULTS

The main components of BXD include baicalin, berberine, ginsenoside Rb1, and 18 other substances. BXD could improve depression-like behavioral characteristics and AS-related indices in AS co-depression mice; BXD could regulate the abundance of some flora (phylum level: reduced abundance of Proteobacteria and Deferribacteres; genus level: reduced abundance of Clostridium_IV, Helicobacter, and Pseudoflavonifractor, Acetatifactor, Oscillibacter, which were significantly different). The lipidomics analysis showed that the differential lipids between the model and gavaged high-dose BXD (BXH) groups were enriched in glycerophospholipid metabolism, and lysophosphatidylcholine (LPC(20:3)(rep)(rep)) in the hippocampus and LPC(20:4)(rep) in the prefrontal cortex both showed downregulation in BXH. The correlation analysis illustrated that the screened differential lipids were mainly linked to Deferribacteres and Actinobacteria.

CONCLUSION

BXD may exert an anti-AS co-depression therapeutic effect by modulating the abundance of some flora and thus intervening in peripheral lipid and brain lipid metabolism (via downregulation of LPC levels).

Plasma β2-microglobulin and cerebrospinal fluid biomarkers of Alzheimer's disease pathology in cognitively intact older adults: the CABLE study

BACKGROUND

Previous studies have suggested a correlation between elevated levels of β₂-microglobulin (B2M) and cognitive impairment. However, the existing evidence is insufficient to establish a conclusive relationship. This study aims to analyze the link of plasma B2M to cerebrospinal fluid (CSF) Alzheimer's disease (AD) biomarkers and cognition.

METHODS

To track the dynamics of plasma B2M in preclinical AD, 846 cognitively healthy individuals in the Chinese Alzheimer's Biomarker and LifestylE (CABLE) cohort were divided into four groups (suspected non-AD pathology [SNAP], 2, 1, 0) according to the NIA-AA criteria. Multiple linear regression models were employed to examine the plasma B2M's relationship with cognitive and CSF AD biomarkers. Causal mediation analysis was conducted through 10,000 bootstrapped iterations to explore the mediating effect of AD pathology on cognition.

RESULTS

We found that the levels of plasma B2M were increased in stages 1 (P = 0.0007) and 2 (P < 0.0001), in contrast to stage 0. In total participants, higher levels of B2M were associated with worse cognitive performance (P = 0.006 for MMSE; P = 0.012 for MoCA). Moreover, a higher level of B2M was associated with decreases in Aβ_1-42 (P < 0.001) and Aβ_1-42/Aβ_1-40 (P = 0.015) as well as increases in T-tau/Aβ_1-42 (P < 0.001) and P-tau/Aβ_1-42 (P < 0.001). The subgroup analysis found B2M correlated with Aβ_1-42 in non-APOE ε4 individuals (P < 0.001) but not in APOE ε4 carriers. Additionally, the link between B2M and cognition was partially mediated by Aβ pathology (percentage: 8.6 to 19.3%), whereas tau pathology did not mediate this effect.

CONCLUSIONS

This study demonstrated the association of plasma B2M with CSF AD biomarkers as well as a possible important role of Aβ pathology in the association between B2M and cognitive impairment, particularly in cognitively normal individuals. The results indicated that B2M could be a potential biomarker for preclinical AD and might have varied functions throughout various stages of preclinical AD progression.

The mediation effects of metabolic and immune-inflammation factors on the depression-premature coronary heart disease association

BACKGROUND

Accumulated evidence confirmed depression was positively associated with CHD. But evidence of the association between depression and premature CHD is still unknown.

OBJECTIVES

To explore the association between depression and premature CHD, and to investigate whether and to what extent the association is mediated by metabolic factors and systemic immune-inflammation index (SII).

METHODS

In this large population-based cohort study based on the UK Biobank, 176,428 CHD-free (mean age: 52.70) adults were followed up for 15 years to detect incident premature CHD. Depression and premature CHD (mean age: female, 54.53; male, 48.13) were ascertained from self-report data and linked hospital-based clinical diagnosis. Metabolic factors included central obesity, hypertension, dyslipidemia, hypertriglyceridemia, hyperglycemia, and hyperuricemia. Systemic inflammation was evaluated by calculating SII, which equals platelet count (/L) × neutrophil count (/L) / lymphocyte count (/L). Data were analyzed using Cox proportional hazards models and generalized structural equation model (GSEM).

RESULTS

During follow-up (median: 8.0 years, interquartile range: 4.0 to 14.0 years), 2990 participants developed premature CHD (1.7 %). The adjusted hazard ratio (HR) and 95 % confidence interval (CI) of premature CHD related to depression were 1.72 (1.44-2.05). The association between depression and premature CHD was 32.9 % mediated by comprehensive metabolic factors (β = 0.24, 95 % CI: 0.17-0.32) and 2.7 % by SII (β = 0.02, 95 % CI = 0.01-0.04), respectively. Concerning metabolic factors, the strongest indirect association was for central obesity, accounting for 11.0 % of the association between depression and premature CHD (β = 0.08, 95 % CI: 0.05-0.11).

CONCLUSIONS

Depression was associated with an increased risk of premature CHD. Our study provided evidence that metabolic and inflammatory factors might play a mediating role in the association between depression and premature CHD, especially central obesity.

Genetic susceptibility and lifestyle modify the association of long-term air pollution exposure on major depressive disorder: a prospective study in UK Biobank

BACKGROUND

Evidence linking air pollution to major depressive disorder (MDD) remains sparse and results are heterogeneous. In addition, the evidence about the interaction and joint associations of genetic risk and lifestyle with air pollution on incident MDD risk remains unclear. We aimed to examine the association of various air pollutants with the risk of incident MDD and assessed whether genetic susceptibility and lifestyle influence the associations.

METHODS

This population-based prospective cohort study analyzed data collected between March 2006 and October 2010 from 354,897 participants aged 37 to 73 years from the UK Biobank. Annual average concentrations of PM_2.5, PM₁₀, NO₂, and NO_x were estimated using a Land Use Regression model. A lifestyle score was determined based on a combination of smoking, alcohol drinking, physical activity, television viewing time, sleep duration, and diet. A polygenic risk score (PRS) was defined using 17 MDD-associated genetic loci.

RESULTS

During a median follow-up of 9.7 years (3,427,084 person-years), 14,710 incident MDD events were ascertained. PM_2.5 (HR: 1.16, 95% CI: 1.07-1.26; per 5 μg/m³) and NO_x (HR: 1.02, 95% CI: 1.01-1.05; per 20 μg/m³) were associated with increased risk of MDD. There was a significant interaction between the genetic susceptibility and air pollution for MDD (P-interaction < 0.05). Compared with participants with low genetic risk and low air pollution, those with high genetic risk and high PM_2.5 exposure had the highest risk of incident MDD (PM_2.5: HR: 1.34, 95% CI: 1.23-1.46). We also observed an interaction between PM_2.5 exposure and unhealthy lifestyle (P-interaction < 0.05). Participants with the least healthy lifestyle and high air pollution exposures had the highest MDD risk when compared to those with the most healthy lifestyle and low air pollution (PM_2.5: HR: 2.22, 95% CI: 1.92-2.58; PM₁₀: HR: 2.09, 95% CI: 1.78-2.45; NO₂: HR: 2.11, 95% CI: 1.82-2.46; NO_x: HR: 2.28, 95% CI: 1.97-2.64).

CONCLUSIONS

Long-term exposure to air pollution is associated with MDD risk. Identifying individuals with high genetic risk and developing healthy lifestyle for reducing the harm of air pollution to public mental health.

Cardiovascular disease burden is associated with worsened depression symptoms in the U.S. general population

BACKGROUND

Cardiovascular disease (CVD) and depression are the leading causes of disability in the U.S. Using five cycles (2009-2018) of the U.S. National Health and Nutrition Examination Survey, we examined the cross-sectional association between CVD risk factor burden and depression severity in nonpregnant adults with no history of CVD events.

METHODS

With at least 3000 participants per cycle, the overall N was 18,175. CVD risk factors were ascertained through self-report, lab tests, or medications. The sum of hypertension, diabetes, dyslipidemia, and current smoking represented a CVD risk score variable (range: 0-4). Depression severity was assessed using scores on the 9-item patient health questionnaire: 0-9 (none-mild) and 10-27 (moderate-to-severe). Logistic regression models were performed to investigate the association between CVD risk score categories and moderate-to-severe depression. Cycle-specific odds ratios (OR) were meta-analyzed to obtain a pooled OR (95 % CI) (Q-statistic p > 0.05).

RESULTS

Compared to participants with no CVD risk factors, participants with risk scores of 1, 2, 3, and 4, had 1.28 (0.92-1.77), 2.18 (1.62-2.94), 2.53 (1.86-3.49), 2.97 (1.67-5.31) times higher odds of moderate-to-severe depression, respectively, after adjusting for socio-demographics and antidepressant use (linear trend p < 0.0001). This relationship persisted after additionally adjusting for lifestyle variables.

LIMITATIONS

NHANES data is cross-sectional and self-reported, thus preventing causal assessments and leading to potential recall bias.

CONCLUSIONS

Among U.S. adults, CVD risk factor burden was associated with worsened depression symptoms. Integrated mental and physical healthcare services could improve risk stratification among persons with CVD and depression, possibly reducing long-term disability and healthcare costs.

Association of serum uric acid with the risk of developing hypertension: A prospective cohort study with mediation analysis

Elevated serum uric acid (SUA) is associated with the incidence of hypertension, but whether relevant metabolic factors have mediating effects is not certain. Our study was based on a functional community cohort established in Beijing. In 2015, a total of 7482 individuals without hypertension were recruited and followed up until 2019. Multivariate logistic regression analysis was used to investigate the association between SUA and hypertension. Cross-lagged panel analysis and mediation analysis were used to explore the effects of metabolic factors on the association between SUA and incident hypertension. During the average 4-year follow-up, the cumulative incidence of hypertension was 10.9% (n = 580). SUA was an independent risk factor for hypertension, and the RRs (95% CI) for subjects with baseline SUA levels in quartile 2, quartile 3 and quartile 4 were 1.20 (0.88-1.63), 1.50 (1.10-2.05), and 1.57 (1.11-2.22) compared to those in quartile 1, respectively. The cross-lagged panel analysis showed that the increases in Cr, TG, LDL, ALT, AST and WBC occurred after SUA increased (P < 0.001). Among these factors, TG, WBC and ALT played an intermediary role in both men (TG: 14.76%; WBC: 11.61%; ALT: 15.93%) and women (TG: 14.55%; WBC: 8.55%; ALT: 6.89%). The elevated SUA concentration was an independent risk factor for hypertension in the Chinese population, and TG, WBC and ALT had important mediating effects on the association between SUA and hypertension.

Association of metabolic syndrome with depression in US adults: A nationwide cross-sectional study using propensity score-based analysis

Background

The association of metabolic syndrome (MetS) with depression has been previously reported; however, the results are ambiguous due to imbalanced confounding factors. Propensity score-based analysis is of great significance to minimize the impact of confounders in observational studies. Thus, the current study aimed to clarify the influence of MetS on depression incidence in the U.S. adult population by using propensity score (PS)-based analysis.

Methods

Data from 11,956 adults aged 20-85 years from the National Health and Nutrition Examination Survey (NHANES) database between 2005 and 2018 were utilized. Using 1:1 PS matching (PSM), the present cross-sectional study included 4,194 participants with and without MetS. A multivariate logistic regression model and three PS-based methods were applied to assess the actual association between MetS and depression incidence. Stratified analyses and interactions were performed based on age, sex, race, and components of MetS.

Results

After PSM, the risk of developing depression in patients with MetS increased by 40% in the PS-adjusted model (OR = 1.40, 95% confidence interval [CI]: 1.202-1.619, P < 0.001), and we could still observe a positive association in the fully adjusted model (OR = 1.37, 95% CI: 1.172-1.596, P < 0.001). Regarding the count of MetS components, having four and five conditions significantly elevated the risk of depression both in the PS-adjusted model (OR = 1.78, 95% CI: 1.341-2.016, P < 0.001 vs. OR = 2.11, 95% CI: 1.626-2.699, P < 0.001) and in the fully adjusted model (OR = 1.56, 95 CI%: 1.264-1.933, P < 0.001 vs. OR = 1.90, 95% CI: 1.458-2.486, P < 0.001). In addition, an elevation in MetS component count was associated with a significant linear elevation in the mean score of PHQ-9 (F =2.8356, P < 0.001). In the sensitivity analysis, similar conclusions were reached for both the original and weighted cohorts. Further interaction analysis revealed a clear gender-based difference in the association between MetS and depression incidence.

Conclusion

MetS exhibited the greatest influence on depression incidence in US adults, supporting the necessity of early detection and treatment of depressive symptoms in patients with MetS (or its components), particularly in female cases.

Sleep Duration and Risks of Incident Cardiovascular Disease and Mortality Among People With Type 2 Diabetes

OBJECTIVE

People with type 2 diabetes may have insufficient or prolonged sleep that could accelerate cardiovascular disease (CVD) onset, but existing evidence from prospective studies has been limited. We examined the association of sleep duration with CVD incidence and mortality in this high-risk population.

RESEARCH DESIGN AND METHODS

This prospective study included 18,876 participants with type 2 diabetes in the UK Biobank who were free of CVD and cancer at baseline. Habitual sleep duration was obtained using a baseline questionnaire. Cox proportional hazards regression models were used to examine the association between sleep duration and CVD events.

RESULTS

During an average follow-up of 11.0-12.0 years, we documented 2,570 incident cases of atherosclerotic cardiovascular disease (ASCVD) and 598 CVD deaths. Compared with sleeping for 7 h/day, the multivariable-adjusted hazard ratios of ≤5 and ≥10 h/day were 1.26 (95% CI 1.08, 1.48) and 1.41 (1.16, 1.70) for incident ASCVD, 1.22 (0.99, 1.50) and 1.16 (0.88, 1.52) for coronary artery disease, 1.70 (1.23, 2.35) and 2.08 (1.44, 3.01) for ischemic stroke, 1.02 (0.72, 1.44) and 1.45 (1.01, 2.10) for peripheral artery disease, and 1.42 (1.02, 1.97) and 1.85 (1.30, 2.64) for CVD mortality. Similar results were observed in most sensitivity analyses that aimed to address potential reverse causation and in the joint analyses of sleep duration and metabolic control or diabetes severity status.

CONCLUSIONS

Short and long sleep durations were independently associated with increased risks of CVD onset and death among people with type 2 diabetes.

Role of depression in the development of cardiometabolic multimorbidity: Findings from the UK Biobank study

BACKGROUND

Depression has been acknowledged as a risk factor for cardiometabolic diseases, but its role in the development of cardiometabolic multimorbidity (CM) remains unclear. We aimed to prospectively investigate how depression affected the development of CM based on the UK Biobank study.

METHODS

We included 459,747 participants with none or one prior cardiometabolic disease. Depression was assessed by the clinical diagnosis and Patient Health Questionnaire (PHQ-2). CM was defined as the coexistence of two or more conditions of type 2 diabetes, stroke, and coronary heart disease (CHD). Multistate models were used to examine the role of depression in the transitions from baseline to single cardiometabolic diseases and subsequently to CM.

RESULTS

During a median follow-up of 12.07 years, we documented 3413 incident CM cases among initially disease-free participants and 7461 cases among participants with one prior cardiometabolic disease, respectively. The hazard of developing CM associated with depression was higher among disease-free individuals than that among individuals with one cardiometabolic disease (HR, 95 % CI: 1.68, 1.54-1.83 vs 1.28, 1.20-1.35). Moreover, depression was significantly associated with all transitions from baseline to diabetes (HR, 95 % CI: 1.43, 1.37-1.50), stroke (1.28, 1.20-1.38), and CHD (1.35, 1.31-1.40). After the onset of these cardiometabolic diseases, the HR values (95 % CIs) of progression to CM were 1.26 (1.09-1.46) for diabetes, 1.43 (1.16-1.76) for stroke, and 1.23 (1.08-1.40) for CHD.

CONCLUSIONS

Depression was an independent risk factor for CM, and adversely influenced the whole progression from disease-free status to CM.

Association between level of depression and coronary heart disease, stroke risk and all-cause and cardiovascular mortality: Data from the 2005-2018 National Health and Nutrition Examination Survey

Research on the association between level of depression and coronary heart disease (CHD), stroke risk, and all-cause and cardiovascular mortality is lacking in large-scale or population-based studies incorporating cardiovascular disease (CVD) endpoints. We aim to assess the relationship between the level of a person's depression and their risk of CHD, stroke, and all-cause and cardiovascular mortality. Utilizing data from the United States National Health and Nutrition Examination Survey (NHANES), multicycle cross-sectional design and mortality linkage studies were conducted. The study sample included 30918 participants aged 20-85 years old during the 2005-2018 period. Depression was assessed using the nine-item Patient Health Questionnaire (PHQ-9), with scores of 5, 10, 15, and 20 being the cut-off points for mild, moderate, moderately severe, and severe depression, respectively. A series of weighted logistic regression analyses and Cox proportional hazards models were utilized to examine the relationship between the level of depression with the risk of CHD, stroke, all-cause, and cardiovascular mortality. Trend analyses were conducted by entering the level of depression as a continuous variable and rerunning the corresponding regression models. Weighted logistic regression models consistently indicated a statistically significant association between the level of depression and increased risk of CHD and stroke, and those linear trend tests were statistically significant (P for trend < 0.001). Furthermore, weighted Cox regression analyses consistently indicated that participants who had a more severe degree of depression were at a higher risk of all-cause death, and trend analyses suggested similar results (P for trend < 0.001). Another weighted Cox regression analysis also consistently indicated that except for severe depression, the hazard of cardiovascular death was increased with each additional level increase of depression. Our study confirmed that the level of depression was strongly associated with CHD, stroke, and all-cause and cardiovascular mortality, even after accounting for other factors that could impact risk, including variables of age, gender, ethnicity, income, education, body mass index (BMI), marital, and smoking status.

Symptoms of Depression and Anxiety in Adults with High-Grade Glioma: A Literature Review and Findings in a Group of Patients before Chemoradiotherapy and One Year Later

Simple Summary

High-grade glioma (HGG) is the most severe type of brain cancer. At different stages of the disease, affected persons are at high risk of symptoms of depression and anxiety. If undiagnosed and untreated, these symptoms might become severe and compromise the patient’s quality of life. Improved knowledge on the prevalence, mechanisms and clinical risk factors underlying the etiology of depression and anxiety in this population is required. This may help to increase awareness on the importance of integrating consistent assessment of mood symptoms with the clinical follow-up and provide insights for developing personalized psychosocial interventions.

Abstract

High-grade glioma (HGG) is associated with several external and internal stressors that may induce mood alterations at all stages of the disease. Symptoms of depression and anxiety in persons with glioma have multifactorial etiology and require active follow-up. We reviewed the literature data on the prevalence, mechanisms likely involved in the etiology of mood alterations in persons with HGG and psychosocial interventions found beneficial in treating these symptoms. We also investigated the prevalence and clinical variables that could increase the risk of depression and anxiety symptoms in a group of patients with HGG at two disease time-points: after surgery, before and 1 year after chemoradiotherapy. Literature findings revealed complex mechanisms underlying these symptoms and highlighted the importance of providing early access to palliative care. Our results show a high rate of anxiety and depression symptoms in the first stage of the disease and increased concomitance of these symptoms at the 1-year follow-up. Depression and anxiety symptoms at 1 year after the end of chemoradiotherapy were associated with the presence of symptoms at the first stage of the disease and tumor progression. Antiepileptic drugs and corticosteroid intake did not increase the risk of depressive and anxious symptoms among patients. Active management of mood alterations is an essential part of the care and contributes to patients’ well-being and quality of life.

The Hybrid Excess and Decay (HED) model: an automated approach to characterising changes in the photoplethysmography pulse waveform

Photoplethysmography offers a widely used, convenient and non-invasive approach to monitoring basic indices of cardiovascular function, such as heart rate and blood oxygenation. Systematic analysis of the shape of the waveform generated by photoplethysmography might be useful to extract estimates of several physiological and psychological factors influencing the waveform. Here, we developed a robust and automated method for such a systematic analysis across individuals and across different physiological and psychological contexts. We describe a psychophysiologically-relevant model, the Hybrid Excess and Decay (HED) model, which characterises pulse wave morphology in terms of three underlying pressure waves and a decay function. We present the theoretical and practical basis for the model and demonstrate its performance when applied to a pharmacological dataset of 105 participants receiving intravenous administrations of the sympathomimetic drug isoproterenol (isoprenaline). We show that these parameters capture photoplethysmography data with a high degree of precision and, moreover, are sensitive to experimentally-induced changes in interoceptive arousal within individuals. We conclude by discussing the possible value in using the HED model as a complement to standard measures of photoplethysmography signals.

Quantification of diet quality utilizing the rapid eating assessment for participants-shortened version in bipolar disorder: Implications for prospective depression and cardiometabolic studies

OBJECTIVES

Recognizing bipolar disorder as a multi-system metabolic condition driven, in part, by binge eating behavior and atypical depressive symptoms, this study aimed to quantify diet quality and evaluate clinical correlates in a bipolar disorder cohort.

METHODS

Participants from the Mayo Clinic Bipolar Disorder Biobank (n = 734) completed the Rapid Eating Assessment for Participants - Shortened version (REAP-S) to determine diet quality. The average REAP-S score for a U.S. omnivorous diet is 32 (range 13 to 39) with higher scores indicating healthier diet. Demographic variables were collected in a standardized clinical questionnaire. Depressive symptoms were assessed by the Bipolar Inventory of Symptoms Scale. Cardiometabolic variables were retrieved from the electronic health record. Associations between continuous variables and REAP-S scores (total, 'healthy foods' and 'avoidance of unhealthy foods') were assessed using linear regression.

RESULTS

Overall, our sample had a mean REAP-S score of 27.6 (4.9), suggestive of a lower diet quality than the average general population in the US. There was a significant inverse relationship between mean REAP-S lower scores with increased BMI, waist circumference, disordered eating and depression. All these associations were significantly stronger in female participants.

LIMITATIONS

EHR cross-sectional data.

CONCLUSIONS

Our data suggest unhealthy diet quality in bipolar disorder is associated with depression, obesity and cardiometabolic abnormalities. Additional work is encouraged to prospectively track mood and diet quality to further understand the bidirectional relationship and clarify if dietary interventions can positively impact mood. Further delineating potential sex differences in diet quality and depression may provide greater appreciation of modifiable risk factors for future cardiometabolic burden.