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Song J. Amygdala activity and amygdala-hippocampus connectivity: Metabolic diseases, dementia, and neuropsychiatric issues. Biomed Pharmacother 2023; 162:114647. [PMID: 37011482 DOI: 10.1016/j.biopha.2023.114647] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 04/04/2023] Open
Abstract
With rapid aging of the population worldwide, the number of people with dementia is dramatically increasing. Some studies have emphasized that metabolic syndrome, which includes obesity and diabetes, leads to increased risks of dementia and cognitive decline. Factors such as insulin resistance, hyperglycemia, high blood pressure, dyslipidemia, and central obesity in metabolic syndrome are associated with synaptic failure, neuroinflammation, and imbalanced neurotransmitter levels, leading to the progression of dementia. Due to the positive correlation between diabetes and dementia, some studies have called it "type 3 diabetes". Recently, the number of patients with cognitive decline due to metabolic imbalances has considerably increased. In addition, recent studies have reported that neuropsychiatric issues such as anxiety, depressive behavior, and impaired attention are common factors in patients with metabolic disease and those with dementia. In the central nervous system (CNS), the amygdala is a central region that regulates emotional memory, mood disorders, anxiety, attention, and cognitive function. The connectivity of the amygdala with other brain regions, such as the hippocampus, and the activity of the amygdala contribute to diverse neuropathological and neuropsychiatric issues. Thus, this review summarizes the significant consequences of the critical roles of amygdala connectivity in both metabolic syndromes and dementia. Further studies on amygdala function in metabolic imbalance-related dementia are needed to treat neuropsychiatric problems in patients with this type of dementia.
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Affiliation(s)
- Juhyun Song
- Department of Anatomy, Chonnam National University Medical School, Hwasun 58128, Jeollanam-do, Republic of Korea.
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2
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Kauffman BY, Bakhshaie J, Zvolensky MJ. The association between distress tolerance and eating expectancies among trauma-exposed college students with obesity. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:478-483. [PMID: 32369425 PMCID: PMC7641918 DOI: 10.1080/07448481.2020.1754223] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 02/26/2020] [Accepted: 03/29/2020] [Indexed: 06/11/2023]
Abstract
Objective Obesity is a significant health concern among college populations, and trauma-exposed students are particularly at risk for behaviors associated with weight gain. There is need for further understanding of factors that may contribute to increased obesity among this population. Participants: Participants included 139 trauma-exposed college students with obesity (76.3% females; Mage = 25.4 years, SD = 8.07). Method: The current cross-sectional study examined distress tolerance in terms of expectancies of eating to help manage negative affect and to lead to feeling out of control among trauma-exposed college students with obesity. Results: Results indicated that lower perceived distress tolerance was associated with greater expectancies of eating to help manage negative affect and to lead to feeling out of control. Conclusions: These findings suggest that distress tolerance may be a clinically significant target for treatment in order to better understand and treat expectancies of eating among trauma-exposed college students with obesity.
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Affiliation(s)
| | - Jafar Bakhshaie
- Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, United States
| | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, United States
- Department of Behavioral Sciences, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
- Health Institute, University of Houston, Houston, Texas, United States
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3
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Tavernier RLE, Mason SM, Levy RL, Seburg EM, Sherwood NE. Association of childhood abuse with behavioral weight-loss outcomes: Examining the mediating effect of binge eating severity. Obesity (Silver Spring) 2022; 30:96-105. [PMID: 34932887 PMCID: PMC8970345 DOI: 10.1002/oby.23320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The study aims were to (1) document the relationship between a history of childhood abuse and weight change during behavioral obesity treatment and (2) estimate the indirect effect of childhood abuse on weight change through binge eating severity. METHODS Participants (n = 431) were enrolled in a behavioral weight-loss intervention. Childhood physical and emotional abuse history and current binge eating severity were self-reported. Percent weight loss at 6 months was calculated using measured weight. Adjusted mediation models examined whether there was an indirect effect of childhood physical and emotional abuse on 6-month percent weight loss that operated through binge eating severity. RESULTS After covariate adjustment, childhood physical abuse, but not emotional abuse, predicted a lower percent weight loss (B = -1.78%; 95% CI: -3.10% to -0.47%). Although childhood physical and emotional abuse were positively related to baseline binge eating severity, binge eating severity did not mediate the associations between either childhood abuse type and percent weight loss. CONCLUSIONS Individuals with a childhood physical abuse history had a lower percent weight loss than those without such histories during behavioral obesity treatment. This effect was not explained by binge eating severity. Individuals with a history of childhood abuse may benefit from trauma-informed obesity care.
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Affiliation(s)
- Rebecca L. Emery Tavernier
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth campus, Duluth, MN, USA
| | - Susan M. Mason
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Rona L. Levy
- School of Social Work, University of Washington, Seattle, WA, USA
| | | | - Nancy E. Sherwood
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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4
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Hoerster KD, Tanksley L, Sulayman N, Bondzie J, Brier M, Damschroder L, Coggeshall S, Houseknecht D, Hunter-Merrill R, Monty G, Saelens BE, Sayre G, Simpson T, Wong E, Nelson K. Testing a tailored weight management program for veterans with PTSD: The MOVE! + UP randomized controlled trial. Contemp Clin Trials 2021; 107:106487. [PMID: 34144246 DOI: 10.1016/j.cct.2021.106487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 10/21/2022]
Abstract
Post-traumatic stress disorder (PTSD), prevalent among Veterans, increases risk for having a high Body Mass Index. Although the Veterans Health Administration (VHA) offers an evidence-based behavioral weight management program called MOVE!, participants with PTSD lose less weight than those without mental health conditions, despite comparable participation. PTSD symptoms can interfere with one's ability to be physically active and maintain a healthy diet, the key targets in weight management programs. We developed and piloted a behavioral weight management program called MOVE! + UP that targets PTSD-related weight loss barriers. MOVE! + UP includes 16 group sessions with training in evidence-based weight management strategies, coupled with Cognitive Behavior Therapy (CBT) skills to address PTSD-specific barriers. The 16 sessions also include 30-min community walks to address PTSD-related barriers that may impede exercise. Two individual dietician sessions are provided. This hybrid type 1 randomized controlled trial (RCT) will compare MOVE! + UP to standard care-MOVE!-among 164 Veterans with BMI ≥ 25 who are receiving care for PTSD. We will randomize participants to MOVE! + UP or standard care and will compare absolute post-baseline change in weight at 6 (primary outcome) and 12 (secondary outcome) months, and PTSD symptom severity at 6 and 12 months (secondary outcome). Exploratory analyses will compare the treatment conditions on treatment targets measured at 6 months (e.g., physical activity, eating behavior, social support). Finally, we will estimate intervention costs, and identify MOVE! + UP implementation barriers and facilitators. If effective, MOVE! + UP could be an efficient way to simultaneously address physical and mental health for Veterans with PTSD.
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Affiliation(s)
- Katherine D Hoerster
- VA Puget Sound Healthcare System, Seattle Division, Mental Health Service; 1660 South Columbian Way (S-116), Seattle, WA 98108, United States; VA Puget Sound Healthcare System, Seattle Division, Health Services Research and Development, 1660 South Columbian Way (S-152), Seattle, WA 98108, United States; University of Washington, Department of Psychiatry and Behavioral Sciences, 100 NE 45(th) Street, Suite 300, Seattle, WA 98105; United States.
| | - Lamont Tanksley
- VA Puget Sound Healthcare System, Seattle Division, Mental Health Service; 1660 South Columbian Way (S-116), Seattle, WA 98108, United States.
| | - Nadiyah Sulayman
- VA Puget Sound Healthcare System, Seattle Division, Health Services Research and Development, 1660 South Columbian Way (S-152), Seattle, WA 98108, United States.
| | - Juliana Bondzie
- VA Puget Sound Healthcare System, Seattle Division, Health Services Research and Development, 1660 South Columbian Way (S-152), Seattle, WA 98108, United States.
| | - Moriah Brier
- VA Puget Sound Healthcare System, Anesthesiology Service, 1660 South Columbian Way, Seattle, WA 98108, United States.
| | - Laura Damschroder
- VA Ann Arbor Center for Clinical Management Research, 2800 Plymouth Rd. NCRC Bldg 16 (152), Ann Arbor, MI 48105, USA.
| | - Scott Coggeshall
- VA Puget Sound Healthcare System, Seattle Division, Health Services Research and Development, 1660 South Columbian Way (S-152), Seattle, WA 98108, United States.
| | - Dakota Houseknecht
- VA Puget Sound Healthcare System, Seattle Division, Health Services Research and Development, 1660 South Columbian Way (S-152), Seattle, WA 98108, United States.
| | - Rachel Hunter-Merrill
- VA Puget Sound Healthcare System, Seattle Division, Health Services Research and Development, 1660 South Columbian Way (S-152), Seattle, WA 98108, United States.
| | - Gillian Monty
- VA Puget Sound Healthcare System, Seattle Division, Health Services Research and Development, 1660 South Columbian Way (S-152), Seattle, WA 98108, United States.
| | - Brian E Saelens
- Seattle Children's Research Institute, 1920 Terry Avenue, Seattle, WA 98101, United States of America; University of Washington, Department of Pediatrics, 1959 NE Pacific Street, Seattle, WA 98195, United States of America.
| | - George Sayre
- VA Puget Sound Healthcare System, Seattle Division, Health Services Research and Development, 1660 South Columbian Way (S-152), Seattle, WA 98108, United States; VA Puget Sound Health Care System, Center of Excellence in Substance Addiction Treatment and Education (CESATE), 1660 South Columbian Way, Seattle, WA 98108, United States; University of Washington, School of Public Health, Department of Health Services, United States.
| | - Tracy Simpson
- VA Puget Sound Healthcare System, Seattle Division, Mental Health Service; 1660 South Columbian Way (S-116), Seattle, WA 98108, United States; VA Puget Sound Health Care System, Center of Excellence in Substance Addiction Treatment and Education (CESATE), 1660 South Columbian Way, Seattle, WA 98108, United States; University of Washington, School of Public Health, Department of Health Services, United States.
| | - Edwin Wong
- VA Puget Sound Healthcare System, Seattle Division, Health Services Research and Development, 1660 South Columbian Way (S-152), Seattle, WA 98108, United States.
| | - Karin Nelson
- VA Puget Sound Healthcare System, Seattle Division, Health Services Research and Development, 1660 South Columbian Way (S-152), Seattle, WA 98108, United States; VA Puget Sound Health Care System, Center of Excellence in Substance Addiction Treatment and Education (CESATE), 1660 South Columbian Way, Seattle, WA 98108, United States; University of Washington, School of Public Health, Department of Health Services, United States; University of Washington, Department of Medicine, 1959 NE Pacific St, Seattle, WA 98195, United States.
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Santiago Santana JM, Vega-Torres JD, Ontiveros-Angel P, Bin Lee J, Arroyo Torres Y, Cruz Gonzalez AY, Aponte Boria E, Zabala Ortiz D, Alvarez Carmona C, Figueroa JD. Oxidative stress and neuroinflammation in a rat model of co-morbid obesity and psychogenic stress. Behav Brain Res 2021; 400:112995. [PMID: 33301815 PMCID: PMC8713435 DOI: 10.1016/j.bbr.2020.112995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/28/2020] [Accepted: 10/29/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is growing recognition for a reciprocal, bidirectional link between anxiety disorders and obesity. Although the mechanisms linking obesity and anxiety remain speculative, this bidirectionality suggests shared pathophysiological processes. Neuroinflammation and oxidative damage are implicated in both pathological anxiety and obesity. This study investigates the relative contribution of comorbid diet-induced obesity and stress-induced anxiety to neuroinflammation and oxidative stress. METHODS Thirty-six (36) male Lewis rats were divided into four groups based on diet type and stress exposure: 1) control diet unexposed (CDU) and 2) exposed (CDE), 3) Western-like high-saturated fat diet unexposed (WDU) and 4) exposed (WDE). Neurobehavioral tests were performed to assess anxiety-like behaviors. The catalytic concentrations of glutathione peroxidase and reductase were measured from plasma samples, and neuroinflammatory/oxidative stress biomarkers were measured from brain samples using Western blot. Correlations between behavioral phenotypes and biomarkers were assessed with Pearson's correlation procedures. RESULTS We found that WDE rats exhibited markedly increased levels of glial fibrillary acidic protein (185 %), catalase protein (215 %), and glutathione reductase (GSHR) enzymatic activity (418 %) relative to CDU rats. Interestingly, the brain protein levels of glutathione peroxidase (GPx) and catalase were positively associated with body weight and behavioral indices of anxiety. CONCLUSIONS Together, our results support a role for neuroinflammation and oxidative stress in heightened emotional reactivity to obesogenic environments and psychogenic stress. Uncovering adaptive responses to obesogenic environments characterized by high access to high-saturated fat/high-sugar diets and toxic stress has the potential to strongly impact how we treat psychiatric disorders in at-risk populations.
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Affiliation(s)
- Jose M Santiago Santana
- Neuroregeneration Division, Neuroscience Research Laboratory, Natural Sciences Department, University of Puerto Rico Carolina Campus, Puerto Rico
| | - Julio D Vega-Torres
- Center for Health Disparities and Molecular Medicine and Department of Basic Sciences, Physiology Division, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, United States
| | - Perla Ontiveros-Angel
- Center for Health Disparities and Molecular Medicine and Department of Basic Sciences, Physiology Division, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, United States
| | - Jeong Bin Lee
- Center for Health Disparities and Molecular Medicine and Department of Basic Sciences, Physiology Division, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, United States
| | - Yaria Arroyo Torres
- Neuroregeneration Division, Neuroscience Research Laboratory, Natural Sciences Department, University of Puerto Rico Carolina Campus, Puerto Rico; Universidad Metropolitana de Cupey Sciences and Technology School, Puerto Rico
| | - Alondra Y Cruz Gonzalez
- Neuroregeneration Division, Neuroscience Research Laboratory, Natural Sciences Department, University of Puerto Rico Carolina Campus, Puerto Rico
| | - Esther Aponte Boria
- Neuroregeneration Division, Neuroscience Research Laboratory, Natural Sciences Department, University of Puerto Rico Carolina Campus, Puerto Rico
| | - Deisha Zabala Ortiz
- Neuroregeneration Division, Neuroscience Research Laboratory, Natural Sciences Department, University of Puerto Rico Carolina Campus, Puerto Rico
| | - Carolina Alvarez Carmona
- Neuroregeneration Division, Neuroscience Research Laboratory, Natural Sciences Department, University of Puerto Rico Carolina Campus, Puerto Rico
| | - Johnny D Figueroa
- Center for Health Disparities and Molecular Medicine and Department of Basic Sciences, Physiology Division, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, United States.
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Truszczyńska-Baszak A, Guszkowska M, Dadura E, Tarnowski A. Prognostic factors of post-traumatic stress disorder risk in patients with surgical treatment of hip acetabular fracture. Original study. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01488-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AbstractThe aim of the study was to assess the risk of developing post-traumatic stress disorder in patients after hip acetabular fracture surgery. The study involved 42 patients fulfilling inclusion criteria. Physical ability levels of the patients were determined with the Harris Hip Score, and modified Merle d’Aubigné scale. High risk of post-traumatic stress disorder was assessed with the PTSD-C questionnaire. Patients had in PTSD-C questionnaire 42.86 ± 28,10 points. In Harris Hip Score 63.64 ± 16.06, in Merle scale 11.10 ± 2.82, that was poor results in both scales. Positive correlation with age reached the level of tendency (ρ = 0.294; p = 0.059). Patients at risk of PTSD were in worse functional state measured by HHS (U = 136.0; p = 0.034) and Merle scale (U = 132.0; p = 0.026) and they were older (U = 147.5; p = 0.068). The groups differed significantly in gender ratio (χ2 = 4.01; p = 0.045). Women (8/10) were more often than men (14/32) at risk of PTSD. Patients after surgical fixation of the acetabulum experience significant functional disability. Increased level of disability after fracture and surgery, older age and female sex make patients vulnerable to PTSD. It is advisable to make medical staff who treat accident victims aware towards aspects which may be related to disorders of the patients’ psychological health.
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Mindful Attention and Eating Expectancies among College Students with Obesity and a History of Trauma Exposure. Mindfulness (N Y) 2021; 11:2113-2120. [PMID: 33584871 DOI: 10.1007/s12671-020-01419-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objectives Trauma exposure and obesity are highly prevalent among college students and both are associated with disordered eating. There is a need to understand psychological factors that may be related to maladaptive eating behavior among college students with obesity and a history of trauma exposure. Methods Participants included 139 college students with obesity (defined as a BMI ≥ 30) and a history of trauma exposure (76.3% females; M age = 25.4 years, SD = 8.07). The current study conducted three separate two-step hierarchical regressions examining mindful attention, and its relation to eating expectancies (expectancies of eating to help manage negative affect, expectancies of eating to alleviate boredom, and expectancies of eating to lead to feeling out of control). Results Results indicated that lower levels of mindful attention were related to greater levels of expectancies of eating to help manage negative affect (b = -4.16, SE = 1.08, p = .023, CI95% = -7.72, -0.60, sr2 = .04), expectancies of eating to alleviate boredom (b = -1.09, SE = 0.39, p = .006, CI95% = -1.86, -0.32, sr2 = .06), and expectancies of eating to lead to feeling out of control (b = -1.62, SE = 0.40, p < .001, CI95% = -2.41, -0.83, sr2 = .11). Results were observed over, and above variance accounted for by sex (assigned at birth), body mass index (BMI), and posttraumatic stress disorder (PTSD) symptom severity. Conclusions Overall, the results from the present investigation suggest the potential importance and need for future research in the role of mindful attention in relation to several distinct eating expectancies associated with maladaptive eating.
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McGlennon TW, Buchwald JN, Pories WJ, Yu F, Roberts A, Ahnfeldt EP, Menon R, Buchwald H. Part 2: Bypassing TBI-Metabolic Surgery and the Link Between Obesity and Traumatic Brain Injury-A Review. Obes Surg 2021; 31:26-35. [PMID: 33405185 DOI: 10.1007/s11695-020-05142-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 11/30/2020] [Accepted: 11/30/2020] [Indexed: 01/22/2023]
Abstract
Obesity is a common outcome of traumatic brain injury (TBI) that exacerbates principal TBI symptom domains identified as common areas of post-TBI long-term dysfunction. Obesity is also associated with increased risk of later-life dementia and Alzheimer's disease. Patients with obesity and chronic TBI may be more vulnerable to long-term mental abnormalities. This review explores the question of whether weight loss induced by bariatric surgery could delay or perhaps even reverse the progression of mental deterioration. Bariatric surgery, with its induction of weight loss, remission of type 2 diabetes, and other expressions of the metabolic syndrome, improves metabolic efficiency, leads to reversal of brain lesions seen on imaging studies, and improves function. These observations suggest that metabolic/bariatric surgery may be the most effective therapy for TBI.
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Affiliation(s)
- T W McGlennon
- Statistics Division, McGlennon MotiMetrics, Maiden Rock, WI, USA
| | - J N Buchwald
- Division of Scientific Research Writing, Medwrite, Maiden Rock, WI, USA
| | - Walter J Pories
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Fang Yu
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | | | - Eric P Ahnfeldt
- Uniformed Services University of the Health Sciences, Bethesda, MA, USA
| | - Rukmini Menon
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Henry Buchwald
- University of Minnesota Medical School, Minneapolis, MN, USA.
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Scherrer JF, Salas J, Friedman MJ, Cohen BE, Schneider FD, Lustman PJ, van den Berk-Clark C, Chard KM, Tuerk P, Norman SB, Schnurr PP. Clinically meaningful posttraumatic stress disorder (PTSD) improvement and incident hypertension, hyperlipidemia, and weight loss. Health Psychol 2020; 39:403-412. [PMID: 32223280 PMCID: PMC8340539 DOI: 10.1037/hea0000855] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) is associated with increased risk for cardiometabolic disease. Clinically meaningful PTSD improvement is associated with a lower risk for diabetes, but it is not known if similar associations exist for incident hypertension, hyperlipidemia, and clinically relevant weight loss (i.e., ≥5% loss). METHOD Medical record data from Veterans Health Affairs patients with clinic encounters between fiscal year (FY) 2008 to 2015 were used to identify patients with worsening or no PTSD improvement (i.e., PTSD checklist (PCL) score decrease <10), small (10-19 point PCL decrease), and large (≥20 point PCL decrease) PTSD improvement. To estimate the association between degree of PTSD improvement and incident hypertension (n = 979), incident hyperlipidemia (n = 1,139) and incident ≥5% weight loss (1,330), we computed Cox proportional hazard models, controlling for confounding using inverse probability of exposure weighting (IPEW). RESULTS Overall, patients were about 40 years of age, 80% male and 65% White. Worsening or no PCL change occurred in about 60%, small improvement in 20%, and large improvement in 20%. After weighting data, compared with worsening or no change, both small and large PTSD improvements were associated, albeit not significantly, with lower risks for hypertension (HR = 0.68; 95% confidence interval, CI [0.46, 1.01] and HR = 0.79; 95% CI [0.53, 1.18], respectively). In weighted data, PTSD improvement was not associated with incident hyperlipidemia or ≥5% weight loss. CONCLUSIONS We observed limited evidence for an association between PTSD improvement and decreased hypertension risk. PCL decreases were not associated with hyperlipidemia or ≥5% weight loss. Further studies that measure potential physical health benefits of change in specific PTSD symptoms are needed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Jeffrey F. Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis MO. 63104
- Harry S. Truman Veterans Administration Medical Center, Columbia, MO
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis MO. 63104
- Harry S. Truman Veterans Administration Medical Center, Columbia, MO
| | - Matthew J. Friedman
- National Center for PTSD and Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Beth E. Cohen
- Department of Medicine, University of California San Francisco School of Medicine and San Francisco VAMC, San Francisco, CA
| | - F. David Schneider
- Department of Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Patrick J. Lustman
- Department of Psychiatry, Washington University School of Medicine, St. Louis MO
- The Bell Street Clinic Opioid Treatment Program, Mental Health Service, VA St. Louis Health Care System, St. Louis, MO
| | - Carissa van den Berk-Clark
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis MO. 63104
| | - Kathleen M. Chard
- Trauma Recovery Center Cincinnati VAMC and Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH
| | - Peter Tuerk
- Sheila C. Johnson Center for Clinical Services, Department of Human Services, University of Virginia, Charlottesville, VA
| | - Sonya B. Norman
- National Center for PTSD, VA Center of Excellence for Stress and Mental Health and Department of Psychiatry, University of California San Diego
| | - Paula P. Schnurr
- National Center for PTSD and Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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Hoerster KD, Tanksley L, Simpson T, Saelens BE, Unützer J, Black M, Greene P, Sulayman N, Reiber G, Nelson K. Development of a Tailored Behavioral Weight Loss Program for Veterans With PTSD (MOVE!+UP): A Mixed-Methods Uncontrolled Iterative Pilot Study. Am J Health Promot 2020; 34:587-598. [PMID: 32162528 DOI: 10.1177/0890117120908505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Veterans with post-traumatic stress disorder (PTSD) lose less weight in the Veterans Affairs (VA) weight management program (MOVE!), so we developed MOVE!+UP. DESIGN Single-arm pre-post pilot to iteratively develop MOVE!+UP (2015-2018). SETTING Veterans Affairs Medical Center. PARTICIPANTS Overweight Veterans with PTSD (5 cohorts of n = 5-11 [N = 44]; n = 39 received ≥1 MOVE+UP session, with cohorts 1-4 [n = 31] = "Development" and cohort 5 [n = 8] = "Final" MOVE!+UP). INTERVENTION MOVE!+UP weight management for Veterans with PTSD modified after each cohort. Final MOVE!+UP was coled by a licensed clinical psychologist and Veteran peer counselor in 16 two-hour in-person group sessions and 2 individual dietician visits. Sessions included general weight loss support (eg, behavioral monitoring with facilitator feedback, weekly weighing), cognitive-behavioral skills to address PTSD-specific barriers, and a 30-minute walk to a nearby park. MEASURES To inform post-cohort modifications, we assessed weight, PTSD, and treatment targets (eg, physical activity, diet), and conducted qualitative interviews. ANALYSIS Baseline to 16-week paired t tests and template analysis. RESULTS Development cohorts suggested improvements (eg, additional sessions and weight loss information, professional involvement) and did not lose weight (mean [M] = 1.8 lbs (standard deviation [SD] = 8.2); P = .29. Conversely, the final cohort reported high satisfaction and showed meaningful weight (M = -14 pounds [SD = 3.7] and 71% lost ≥5% baseline weight) and PTSD (M = -17.9 [SD = 12.2]) improvements, P < .05. CONCLUSIONS The comprehensive, 16-week, in-person, cofacilitated Final MOVE!+UP was acceptable and may improve the health of people with PTSD. Iterative development likely produced a patient-centered intervention, needing further testing.
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Affiliation(s)
- Katherine D Hoerster
- Health Services Research and Development Service, VA Puget Sound Health Care System, Seattle Division, Seattle, WA, USA.,Mental Health Service, VA Puget Sound Health Care System, Seattle Division, Seattle, WA, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Lamont Tanksley
- Mental Health Service, VA Puget Sound Health Care System, Seattle Division, Seattle, WA, USA
| | - Tracy Simpson
- Mental Health Service, VA Puget Sound Health Care System, Seattle Division, Seattle, WA, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.,Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle Division, Seattle, WA, USA
| | - Brian E Saelens
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.,Seattle Children's Research Institute, Seattle, WA, USA
| | - Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Marissa Black
- Geriatric Research Education and Clinical Center (GRECC), VA Puget Sound Health Care System, Seattle Division, Seattle, WA, USA
| | - Preston Greene
- Health Services Research and Development Service, VA Puget Sound Health Care System, Seattle Division, Seattle, WA, USA
| | - Nadiyah Sulayman
- Health Services Research and Development Service, VA Puget Sound Health Care System, Seattle Division, Seattle, WA, USA
| | - Gayle Reiber
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA.,Health Services Research Center of Innovation, Salt Lake City, UT, USA
| | - Karin Nelson
- Health Services Research and Development Service, VA Puget Sound Health Care System, Seattle Division, Seattle, WA, USA.,General Internal Medicine Service, VA Puget Sound Health Care System, Seattle Division, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
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PTSD is associated with poor health behavior and greater Body Mass Index through depression, increasing cardiovascular disease and diabetes risk among U.S. veterans. Prev Med Rep 2019; 15:100930. [PMID: 31338278 PMCID: PMC6627033 DOI: 10.1016/j.pmedr.2019.100930] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 06/05/2019] [Accepted: 06/27/2019] [Indexed: 01/13/2023] Open
Abstract
Posttraumatic stress disorder (PTSD) is a risk factor for cardiovascular disease (CVD) and diabetes. Dedert and colleagues hypothesized a model whereby PTSD leads to poor health behaviors, depression, and pre-clinical disease markers, and that these factors lead to CVD and diabetes (Ann Behav Med, 2010, 61–78). This study provides a preliminary test of that model. Using data from a mailed cross-sectional survey conducted 2012–2013, path analysis was conducted among N = 657 with complete demographic data. We first analyzed the hypothesized model, followed by four alternatives, to identify the best-fitting model. The alternate model that specified pathways from depression to health behaviors had the best fit. Contrary to hypotheses, higher PTSD symptoms were associated with better physical activity and diet quality. Of the specific indirect pathways from PTSD to Body Mass Index (BMI), only the path through depression was significant. Higher depression symptoms were significantly associated with less physical activity, poorer diet, and greater likelihood of smoking. In addition, the specific indirect effect from depression to BMI through physical activity was significant. Current smoking and higher BMI were associated with greater likelihood of diabetes, and hypertension was associated with greater likelihood of CVD. PTSD symptoms may increase risk for CVD and diabetes through the negative impact of depression on health behaviors and BMI. With or without PTSD, depression may be an important target in interventions targeting cardiovascular and metabolic diseases among veterans. We examined a model of the association of PTSD with CVD and diabetes in veterans. PTSD without depression was associated with better physical activity and diet quality. Depression accounted for associations of PTSD with BMI and poor health behaviors. Health behaviors should be targeted in those with depression to improve health.
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Scherrer JF, Lustman PJ. Posttraumatic Stress Disorder and Incident Type 2 Diabetes: Is Obesity to Blame? ACTA ACUST UNITED AC 2019; 3. [PMID: 32395677 PMCID: PMC7213584 DOI: 10.1177/2470547019863415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA.,Harry S. Truman Veterans Administration Medical Center, Columbia, MO, USA
| | - Patrick J Lustman
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.,Bell Street Clinic Opioid Addiction Treatment Program, VA St. Louis Health Care System, St. Louis, MO, USA
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13
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Scherrer JF, Salas J, Lustman PJ, van den Berk-Clark C, Schnurr PP, Tuerk P, Cohen BE, Friedman MJ, Norman SB, Schneider FD, Chard KM. The Role of Obesity in the Association Between Posttraumatic Stress Disorder and Incident Diabetes. JAMA Psychiatry 2018; 75:1189-1198. [PMID: 30090920 PMCID: PMC6248094 DOI: 10.1001/jamapsychiatry.2018.2028] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Posttraumatic stress disorder (PTSD) is associated with an increased risk of type 2 diabetes mellitus (T2DM). Existing literature has adjusted for obesity in combination with other confounders, which does not allow estimating the contribution of obesity alone on the association of PTSD with incident T2DM. OBJECTIVE The current study was designed to determine if obesity accounted for the association between PTSD and incident T2DM. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from Veterans Health Administration medical records collected from patients with PTSD and without PTSD from 2008 to 2015. Patients were eligible for study inclusion if they were free of prevalent PTSD and T2DM for 12 months prior to index date. To estimate whether the association of PTSD and incident T2DM remained independent of obesity, Cox proportional hazard models were computed before and after adding obesity to the model and then further expanded by adding psychiatric disorders, psychotropic medications, physical conditions, smoking status, and demographics. Additional Cox models were computed to compare the risk of incident T2DM in patients with PTSD with and without obesity. Data analysis was completed from February 2018 to May 2018. EXPOSURES Two International Classification of Diseases, Ninth Revision (ICD-9) codes for PTSD in the same 12 months and obesity, defined by a body mass index of 30 or more or an ICD-9 code for obesity. MAIN OUTCOMES AND MEASURES Incident T2DM, as defined by ICD-9 codes. RESULTS Among 2204 patients without PTSD, the mean (SD) age was 47.7 (14.3) years; 1860 (84.4%) were men, 1426 (64.7%) were white, and 956 (43.4%) were married. Among 3450 patients with PTSD, the mean (SD) age was 42.8 (14.2) years; 2983 (86.5%) were men, 2238 (64.9%) were white, and 1525 (44.2%) were married. The age-adjusted association between PTSD and incident T2DM was significant (hazard ratio [HR], 1.33 [95% CI, 1.08-1.64]; P = .01), and after adding obesity to the model, this association was reduced and no longer significant (HR, 1.16 [95% CI, 0.94-1.43]; P = .18). Results of the full model, which included additional covariate adjustment, revealed no association between PTSD and incident T2DM (HR, 0.84 [95% CI, 0.64-1.10]; P = .19). Among patients with PTSD with obesity, the age-adjusted incidence of T2DM was 21.0 per 1000 person-years vs 5.8 per 1000 person-years in patients without obesity. In patients without PTSD, it was 21.2 per 1000 person-years for patients with obesity vs 6.4 per 1000 person-years in those without obesity. CONCLUSIONS AND RELEVANCE In this study of patients who use the Veterans Health Administration for health care, obesity moderated the association between PTSD and incident T2DM. The incidence of T2DM in patients with PTSD who are not obese is similar to the national incidence rate in the United States. These results suggest PTSD is not likely to have a causal association with incident T2DM. Future research is needed to determine if PTSD remission can lead to weight loss and reduced T2DM incidence.
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Affiliation(s)
- Jeffrey F. Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri,Harry S. Truman Veterans Administration Medical Center, Columbia, Missouri
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri,Harry S. Truman Veterans Administration Medical Center, Columbia, Missouri
| | - Patrick J. Lustman
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Carissa van den Berk-Clark
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Paula P. Schnurr
- National Center for PTSD, White River Junction, Vermont,Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Peter Tuerk
- Ralph H. Johnson VA Medical Center, Charleston, South Carolina,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Beth E. Cohen
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco,San Francisco VA Medical Center, San Francisco, California
| | | | - Sonya B. Norman
- National Center for PTSD, White River Junction, Vermont,Department of Psychiatry, University of California, San Diego
| | - F. David Schneider
- Department of Family and Community Medicine, University of Texas Southwestern, Dallas
| | - Kathleen M. Chard
- Trauma Recovery Center Cincinnati VA Medical Center, Cincinnati, Ohio,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio
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Mellon SH, Gautam A, Hammamieh R, Jett M, Wolkowitz OM. Metabolism, Metabolomics, and Inflammation in Posttraumatic Stress Disorder. Biol Psychiatry 2018; 83:866-875. [PMID: 29628193 DOI: 10.1016/j.biopsych.2018.02.007] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 02/08/2018] [Accepted: 02/14/2018] [Indexed: 02/06/2023]
Abstract
Posttraumatic stress disorder (PTSD) is defined by classic psychological manifestations, although among the characteristics are significantly increased rates of serious somatic comorbidities, such as cardiovascular disease, immune dysfunction, and metabolic syndrome. In this review, we assess the evidence for disturbances that may contribute to somatic pathology in inflammation, metabolic syndrome, and circulating metabolites (implicating mitochondrial dysfunction) in individuals with PTSD and in animal models simulating features of PTSD. The clinical and preclinical data highlight probable interrelated features of PTSD pathophysiology, including a proinflammatory milieu, metabolomic changes (implicating mitochondrial and other processes), and metabolic dysregulation. These data suggest that PTSD may be a systemic illness, or that it at least has systemic manifestations, and the behavioral manifestations are those most easily discerned. Whether somatic pathology precedes the development of PTSD (and thus may be a risk factor) or follows the development of PTSD (as a result of either shared pathophysiologies or lifestyle adaptations), comorbid PTSD and somatic illness is a potent combination placing affected individuals at increased physical as well as mental health risk. We conclude with directions for future research and novel treatment approaches based on these abnormalities.
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Affiliation(s)
- Synthia H Mellon
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California-San Francisco, San Francisco, California
| | - Aarti Gautam
- Integrative Systems Biology, United States Army Medical Research and Material Command, United States Army Center for Environmental Health Research, Fort Detrick, Frederick, Maryland
| | - Rasha Hammamieh
- Integrative Systems Biology, United States Army Medical Research and Material Command, United States Army Center for Environmental Health Research, Fort Detrick, Frederick, Maryland
| | - Marti Jett
- Integrative Systems Biology, United States Army Medical Research and Material Command, United States Army Center for Environmental Health Research, Fort Detrick, Frederick, Maryland.
| | - Owen M Wolkowitz
- Department of Psychiatry, University of California-San Francisco, San Francisco, California
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Western High-Fat Diet Consumption during Adolescence Increases Susceptibility to Traumatic Stress while Selectively Disrupting Hippocampal and Ventricular Volumes. eNeuro 2016; 3:eN-NWR-0125-16. [PMID: 27844058 PMCID: PMC5099604 DOI: 10.1523/eneuro.0125-16.2016] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 09/23/2016] [Accepted: 10/26/2016] [Indexed: 11/29/2022] Open
Abstract
Psychological trauma and obesity co-occur frequently and have been identified as major risk factors for psychiatric disorders. Surprisingly, preclinical studies examining how obesity disrupts the ability of the brain to cope with psychological trauma are lacking. The objective of this study was to determine whether an obesogenic Western-like high-fat diet (WD) predisposes rats to post-traumatic stress responsivity. Adolescent Lewis rats (postnatal day 28) were fed ad libitum for 8 weeks with either the experimental WD diet (41.4% kcal from fat) or the control diet (16.5% kcal from fat). We modeled psychological trauma by exposing young adult rats to a cat odor threat. The elevated plus maze and the open field test revealed increased psychological trauma-induced anxiety-like behaviors in the rats that consumed the WD when compared with control animals 1 week after undergoing traumatic stress (p < 0.05). Magnetic resonance imaging showed significant hippocampal atrophy (20% reduction) and lateral ventricular enlargement (50% increase) in the animals fed the WD when compared with controls. These volumetric abnormalities were associated with behavioral indices of anxiety, increased leptin and FK506-binding protein 51 (FKBP51) levels, and reduced hippocampal blood vessel density. We found asymmetric structural vulnerabilities to the WD, particularly the ventral and left hippocampus and lateral ventricle. This study highlights how WD consumption during adolescence impacts key substrates implicated in post-traumatic stress disorder. Understanding how consumption of a WD affects the developmental trajectories of the stress neurocircuitry is critical, as stress susceptibility imposes a marked vulnerability to neuropsychiatric disorders.
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16
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Michopoulos V, Vester A, Neigh G. Posttraumatic stress disorder: A metabolic disorder in disguise? Exp Neurol 2016; 284:220-229. [PMID: 27246996 PMCID: PMC5056806 DOI: 10.1016/j.expneurol.2016.05.038] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 05/24/2016] [Accepted: 05/26/2016] [Indexed: 12/30/2022]
Abstract
Posttraumatic stress disorder (PTSD) is a heterogeneous psychiatric disorder that affects individuals exposed to trauma and is highly co-morbid with other adverse health outcomes, including cardiovascular disease and obesity. The unique pathophysiological feature of PTSD is the inability to inhibit fear responses, such that individuals suffering from PTSD re-experience traumatic memories and are unable to control psychophysiological responses to trauma-associated stimuli. However, underlying alterations in sympathetic nervous system activity, neuroendocrine systems, and metabolism associated with PTSD are similar to those present in traditional metabolic disorders, such as obesity and diabetes. The current review highlights existing clinical, translational, and preclinical data that support the notion that underneath the primary indication of impaired fear inhibition, PTSD is itself also a metabolic disorder and proposes altered function of inflammatory responses as a common underlying mechanism. The therapeutic implications of treating PTSD as a whole-body condition are significant, as targeting any underlying biological system whose activity is altered in both PTSD and metabolic disorders, (i.e. HPA axis, sympathetic nervous systems, inflammation) may elicit symptomatic relief in individuals suffering from these whole-body adverse outcomes.
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Affiliation(s)
- Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States; Yerkes National Primate Research Center, Atlanta, GA, United States
| | - Aimee Vester
- Department of Environmental Health Sciences, Rollins School of Public Health, Atlanta, GA, United States
| | - Gretchen Neigh
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States; Yerkes National Primate Research Center, Atlanta, GA, United States; Department of Physiology, Emory University School of Medicine, Atlanta, GA, United States.
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17
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Abstract
Previous reports have suggested a high prevalence of overweight and obesity among individuals with posttraumatic stress disorder (PTSD). Few studies, however, systematically analyze the relationship between PTSD and body mass index (BMI). We conducted a systematic review and meta-analysis aimed at estimating the association between PTSD and BMI. Fifty-four articles were reviewed, 30 of which (with 191,948 individuals with PTSD and 418,690 trauma-exposed individuals or healthy controls) were eligible for inclusion in the meta-analysis. The pooled standard mean difference, based on a random-effects model, was 0.41 (95% confidence interval, 0.28-0.54; z = 6.26; p < .001). Statistical heterogeneity between the included studies was high (p < .001; I = 99%). Despite limitations, the findings of this systematic review and meta-analysis suggest an association between PTSD and BMI. Furthermore, longitudinal studies tentatively indicate that PTSD may lead to an increase in BMI and, as such, to the development of overweight/obesity, particularly in women. Further prospective studies and research elaborating the nature and etiology of the association are required.
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18
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Klingaman EA, Hoerster KD, Aakre JM, Viverito KM, Medoff DR, Goldberg RW. Veterans with PTSD report more weight loss barriers than Veterans with no mental health disorders. Gen Hosp Psychiatry 2016; 39:1-7. [PMID: 26719103 DOI: 10.1016/j.genhosppsych.2015.11.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 11/07/2015] [Accepted: 11/12/2015] [Indexed: 01/29/2023]
Abstract
OBJECTIVE This study characterized and compared Veterans of the United States Armed Forces with posttraumatic stress disorder (PTSD) to Veterans with no mental health disorders on self-reported measures of factors that influence success in weight management programs. METHOD We examined the relation of PTSD diagnosis with weight loss plan, reasons for overweight/obesity and barriers to dieting and physical exercise among 171,884 Veterans. Statistically significant variables in chi-square tests (P<.05) with at least a small effect size were then compared via multivariate logistic regression analyses. RESULTS Both groups reported high ratings of importance and confidence regarding changing weight loss behaviors and were preparing or actively engaging in efforts to manage their weight. Compared to Veterans without mental health disorders, more Veterans with PTSD endorsed 27 of the 28 barriers to changing eating and physical habits. CONCLUSIONS The results of this study help to explain the lower rates of success of Veterans with PTSD in weight loss programs. Results suggest that a comprehensive, integrated approach to promoting weight loss in Veterans with PTSD is needed.
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Affiliation(s)
- Elizabeth A Klingaman
- U.S. Department of Veterans Affairs Capitol Healthcare Network Mental Illness Research, Education and Clinical Center, 10 North Greene Street, Annex Suite 720, Baltimore, MD 21201, USA; University of Maryland School of Medicine Department of Psychiatry, 737 West Lombard Street, Baltimore, MD 21201, USA.
| | - Katherine D Hoerster
- Mental Health Service, VA Puget Sound Healthcare System, Seattle Division, 1660 South Columbian Way (S-116), Seattle, WA 98108, USA; University of Washington Department of Psychiatry and Behavioral Sciences, 1959 Northeast Pacific Street, Box 356560, Room BB1644, Seattle, WA 98195, USA.
| | - Jennifer M Aakre
- U.S. Department of Veterans Affairs Capitol Healthcare Network Mental Illness Research, Education and Clinical Center, 10 North Greene Street, Annex Suite 720, Baltimore, MD 21201, USA; University of Maryland School of Medicine Department of Psychiatry, 737 West Lombard Street, Baltimore, MD 21201, USA.
| | - Kristen M Viverito
- Central Arkansas Veterans Healthcare System, Health Services Research and Development Service, Center for Mental Healthcare and Outcomes Research, North Little Rock, AR 72114, USA; Division of Health Services Research, Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 West Markham, #554, Little Rock, AR 72205, USA.
| | - Deborah R Medoff
- University of Maryland School of Medicine Department of Psychiatry, 737 West Lombard Street, Baltimore, MD 21201, USA; U.S. Department of Veterans Affairs Capitol Healthcare Network Mental Illness Research, Education and Clinical Center, 10 North Greene Street, Annex Suite 720, Baltimore, MD 21201, USA.
| | - Richard W Goldberg
- U.S. Department of Veterans Affairs Capitol Healthcare Network Mental Illness Research, Education and Clinical Center, 10 North Greene Street, Annex Suite 720, Baltimore, MD 21201, USA; University of Maryland School of Medicine Department of Psychiatry, 737 West Lombard Street, Baltimore, MD 21201, USA.
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19
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Masodkar K, Johnson J, Peterson MJ. A Review of Posttraumatic Stress Disorder and Obesity: Exploring the Link. Prim Care Companion CNS Disord 2016; 18:15r01848. [PMID: 27247845 PMCID: PMC4874765 DOI: 10.4088/pcc.15r01848] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 08/20/2015] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE The incidence of posttraumatic stress disorder (PTSD) and obesity are on the rise, and evidence continues to support the observation that individuals who have symptoms of PTSD are more likely to develop obesity in their lifetime. The incidence of obesity in individuals with PTSD, including war veterans, women, and children exposed to trauma, is not solely attributable to psychotropic medications, but actual pathophysiologic mechanisms have not been fully delineated. Additionally, there are no studies to date demonstrating that obese individuals are predisposed to developing PTSD compared to the general population. This review explores the pathogenic pathways common to both PTSD and obesity, which include inflammation, the renin-angiotensin-aldosterone system, cellular structures, and neuroendocrine activation. DATA SOURCES AND SYNTHESIS A PubMed search for the years 2000-2015 with the keywords PTSD and obesity was performed. There were no language restrictions. RESULTS More research is needed in human subjects to understand the pathogenic pathways common to both PTSD and obesity and to further clarify the direction of identified associations. Ideally, in the future, clinical interventions targeting these pathways may be able to modify the course of PTSD and obesity. The outcome of studies investigating the utility of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in the treatment of PTSD symptoms will be relevant to control both PTSD and obesity. Importantly, outcomes assessing inflammation, obesity, and cardiac function in the same subjects also should be determined. CONCLUSION Research is needed to reveal the multidimensional and intricate relationship between PTSD and obesity. The implications of this research would be essential for treatment, prevention, and potential public health reforms.
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Affiliation(s)
| | - Justine Johnson
- Department of Psychiatry, Texas Tech University Health Science Center, Lubbock
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20
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Rosenbaum S, Sherrington C, Tiedemann A. Exercise augmentation compared with usual care for post-traumatic stress disorder: a randomized controlled trial. Acta Psychiatr Scand 2015; 131:350-9. [PMID: 25443996 DOI: 10.1111/acps.12371] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2014] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To investigate the impact of a 12-week exercise programme in addition to usual care for post-traumatic stress disorder (PTSD). METHOD An assessor-blinded randomized controlled trial was conducted among 81 participants with a DSM-IV-TR diagnosis of primary PTSD. Participants were recruited after admission to an in-patient programme at a private hospital. Participants were randomized to receive either usual care (n=42), or exercise in addition to usual care (n=39). The exercise intervention involved three, 30-min resistance-training sessions/week and a pedometer-based walking programme. Usual care involved psychotherapy, pharmaceutical interventions, and group therapy. Primary outcome was PTSD symptoms assessed via the PTSD checklist-civilian version (PCL-C). Secondary outcomes included symptoms of depression, anthropometry, physical activity, mobility, strength, and sleep quality. RESULTS Participants had a mean (SD) age of 47.8 years (12.1), 84% male. PTSD symptoms in the intervention group significantly reduced compared with the usual care group (mean difference=-5.4, 95% CI -10.5 to -0.3, P=0.04, n=58). There were significant between-group differences at follow-up for depressive symptoms, waist circumference, sleep quality, and sedentary time. CONCLUSION This study provides the first evidence that an exercise intervention is associated with reduced PTSD and depressive symptoms, reduced waist circumference, and improved sleep quality.
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Affiliation(s)
- S Rosenbaum
- Musculoskeletal Division, The George Institute for Global Health and School of Public Health, University of Sydney, Sydney, NSW, Australia; St John of God Health Care Richmond Hospital, Sydney, NSW, Australia
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Hoerster KD, Jakupcak M, Hanson R, McFall M, Reiber G, Hall KS, Nelson KM. PTSD and depression symptoms are associated with binge eating among US Iraq and Afghanistan veterans. Eat Behav 2015; 17:115-8. [PMID: 25687231 DOI: 10.1016/j.eatbeh.2015.01.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 11/25/2014] [Accepted: 01/28/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE US Iraq and Afghanistan Veterans with post-traumatic stress disorder (PTSD) and depression are at increased risk for obesity. Understanding the contribution of health behaviors to this relationship will enhance efforts to prevent and reduce obesity. Therefore, we examined the association of PTSD and depression symptoms with binge eating, a risk factor for obesity, among Iraq/Afghanistan Veterans. METHOD Iraq/Afghanistan Veterans were assessed at intake to the VA Puget Sound Healthcare System-Seattle post-deployment clinic (May 2004-January 2007). The Patient Health Questionnaire was used to measure depression and binge eating symptoms, and the PTSD Checklist-Military Version assessed PTSD symptoms. RESULTS The majority of the sample (N=332) was male (91.5%) and Caucasian (72.6%), with an average age of 31.1 (SD=8.5) years; 16.3% met depression screening criteria, 37.8% met PTSD screening criteria, and 8.4% met binge eating screening criteria. In adjusted models, those meeting depression (odds ratio (OR)=7.53; 95% CI=2.69, 21.04; p<.001) and PTSD (OR=3.37; 95% CI=1.34, 8.46; p=.01) screening criteria were more likely to meet binge eating screening criteria. Continuous measures of PTSD and depression symptom severity were also associated with meeting binge eating screening criteria (ps<.05). CONCLUSION PTSD and depression are common conditions among Iraq/Afghanistan Veterans. In the present study, PTSD and depression symptoms were associated with meeting binge eating screening criteria, identifying a possible pathway by which psychiatric conditions lead to disproportionate burden of overweight and obesity in this Veteran cohort. Tailored dietary behavior interventions may be needed for Iraq/Afghanistan Veterans with co-morbid obesity and psychiatric conditions.
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Affiliation(s)
- Katherine D Hoerster
- VA Puget Sound Healthcare System, Seattle Division, Mental Health Service, 1660 S. Columbian Way, Seattle, WA 98108, United States; University of Washington, Department of Psychiatry and Behavioral Sciences, 1959 NE Pacific Street, Box 356560, Rm BB1644, Seattle, WA 98195, United States.
| | - Matthew Jakupcak
- VA Puget Sound Healthcare System, Seattle Division, Mental Health Service, 1660 S. Columbian Way, Seattle, WA 98108, United States; University of Washington, Department of Psychiatry and Behavioral Sciences, 1959 NE Pacific Street, Box 356560, Rm BB1644, Seattle, WA 98195, United States.
| | - Robert Hanson
- VA Puget Sound Healthcare System, Seattle Division, Research and Development Service, 1660 S. Columbian Way, Seattle, WA 98108, United States.
| | - Miles McFall
- VA Puget Sound Healthcare System, Seattle Division, Mental Health Service, 1660 S. Columbian Way, Seattle, WA 98108, United States; University of Washington, Department of Psychiatry and Behavioral Sciences, 1959 NE Pacific Street, Box 356560, Rm BB1644, Seattle, WA 98195, United States.
| | - Gayle Reiber
- VA Puget Sound Healthcare System, Seattle Division, Research and Development Service, 1660 S. Columbian Way, Seattle, WA 98108, United States; University of Washington School of Public Health, Departments of Health Services and Epidemiology, 1959 NE Pacific Street, Box 356560, Rm BB1644, Seattle, WA 98195, United States.
| | - Katherine S Hall
- Durham Veterans Affairs Medical Center Geriatric Research, Education, and Clinical Center, 508 Fulton St., Durham, NC 27705, United States; Duke University Medical Center, Department of Medicine, 201 Trent Drive, Box 3003 DUMC, Rm 3502 Busse Building, Durham, NC 27710, United States.
| | - Karin M Nelson
- VA Puget Sound Healthcare System, Seattle Division, Research and Development Service, 1660 S. Columbian Way, Seattle, WA 98108, United States; VA Puget Sound Healthcare System, General Internal Medicine Service, 1660 S. Columbian Way, Seattle, WA 98108, United States; University of Washington Department of Medicine, 1959 N.E. Pacific St. Seattle, WA 98195, United States.
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22
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Boitard C, Maroun M, Tantot F, Cavaroc A, Sauvant J, Marchand A, Layé S, Capuron L, Darnaudery M, Castanon N, Coutureau E, Vouimba RM, Ferreira G. Juvenile obesity enhances emotional memory and amygdala plasticity through glucocorticoids. J Neurosci 2015; 35:4092-103. [PMID: 25740536 PMCID: PMC6605580 DOI: 10.1523/jneurosci.3122-14.2015] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 01/23/2015] [Accepted: 01/28/2015] [Indexed: 11/21/2022] Open
Abstract
In addition to metabolic and cardiovascular disorders, obesity is associated with adverse cognitive and emotional outcomes. Its growing prevalence during adolescence is particularly alarming since recent evidence indicates that obesity can affect hippocampal function during this developmental period. Adolescence is a decisive period for maturation of the amygdala and the hypothalamic-pituitary-adrenal (HPA) stress axis, both required for lifelong cognitive and emotional processing. However, little data are available on the impact of obesity during adolescence on amygdala function. Herein, we therefore evaluate in rats whether juvenile high-fat diet (HFD)-induced obesity alters amygdala-dependent emotional memory and whether it depends on HPA axis deregulation. Exposure to HFD from weaning to adulthood, i.e., covering adolescence, enhances long-term emotional memories as assessed by odor-malaise and tone-shock associations. Juvenile HFD also enhances emotion-induced neuronal activation of the basolateral complex of the amygdala (BLA), which correlates with protracted plasma corticosterone release. HFD exposure restricted to adulthood does not modify all these parameters, indicating adolescence is a vulnerable period to the effects of HFD-induced obesity. Finally, exaggerated emotional memory and BLA synaptic plasticity after juvenile HFD are alleviated by a glucocorticoid receptor antagonist. Altogether, our results demonstrate that juvenile HFD alters HPA axis reactivity leading to an enhancement of amygdala-dependent synaptic and memory processes. Adolescence represents a period of increased susceptibility to the effects of diet-induced obesity on amygdala function.
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Affiliation(s)
- Chloé Boitard
- INRA, Nutrition and Integrative Neurobiology, UMR 1286, 33076 Bordeaux, France, Université de Bordeaux, Nutrition and Integrative Neurobiology, UMR 1286, 33076 Bordeaux, France
| | - Mouna Maroun
- Sagol Department of Neurobiology, Faculty of Natural Sciences, University of Haifa, Haifa 31905, Israel
| | - Frédéric Tantot
- INRA, Nutrition and Integrative Neurobiology, UMR 1286, 33076 Bordeaux, France, Université de Bordeaux, Nutrition and Integrative Neurobiology, UMR 1286, 33076 Bordeaux, France
| | - Amandine Cavaroc
- INRA, Nutrition and Integrative Neurobiology, UMR 1286, 33076 Bordeaux, France, Université de Bordeaux, Nutrition and Integrative Neurobiology, UMR 1286, 33076 Bordeaux, France
| | - Julie Sauvant
- INRA, Nutrition and Integrative Neurobiology, UMR 1286, 33076 Bordeaux, France, Université de Bordeaux, Nutrition and Integrative Neurobiology, UMR 1286, 33076 Bordeaux, France
| | - Alain Marchand
- CNRS, Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, UMR 5287, 33076 Bordeaux, France, and Université de Bordeaux, Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, UMR 5287, 33076 Bordeaux, France
| | - Sophie Layé
- INRA, Nutrition and Integrative Neurobiology, UMR 1286, 33076 Bordeaux, France, Université de Bordeaux, Nutrition and Integrative Neurobiology, UMR 1286, 33076 Bordeaux, France
| | - Lucile Capuron
- INRA, Nutrition and Integrative Neurobiology, UMR 1286, 33076 Bordeaux, France, Université de Bordeaux, Nutrition and Integrative Neurobiology, UMR 1286, 33076 Bordeaux, France
| | - Muriel Darnaudery
- INRA, Nutrition and Integrative Neurobiology, UMR 1286, 33076 Bordeaux, France, Université de Bordeaux, Nutrition and Integrative Neurobiology, UMR 1286, 33076 Bordeaux, France
| | - Nathalie Castanon
- INRA, Nutrition and Integrative Neurobiology, UMR 1286, 33076 Bordeaux, France, Université de Bordeaux, Nutrition and Integrative Neurobiology, UMR 1286, 33076 Bordeaux, France
| | - Etienne Coutureau
- CNRS, Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, UMR 5287, 33076 Bordeaux, France, and Université de Bordeaux, Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, UMR 5287, 33076 Bordeaux, France
| | - Rose-Marie Vouimba
- CNRS, Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, UMR 5287, 33076 Bordeaux, France, and Université de Bordeaux, Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, UMR 5287, 33076 Bordeaux, France
| | - Guillaume Ferreira
- INRA, Nutrition and Integrative Neurobiology, UMR 1286, 33076 Bordeaux, France, Université de Bordeaux, Nutrition and Integrative Neurobiology, UMR 1286, 33076 Bordeaux, France,
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