1
|
Lin C, Lee SH, Huang CM, Wu YW, Chang YX, Liu HL, Ng SH, Cheng YC, Chiu CC, Wu SC. Cognitive protection and brain entropy changes from omega-3 polyunsaturated fatty acids supplement in late-life depression: A 52-week randomized controlled trial. J Affect Disord 2024; 351:15-23. [PMID: 38281596 DOI: 10.1016/j.jad.2024.01.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND Late-life depression (LLD) is associated with risk of dementia, yet intervention of LLD provides an opportunity to attenuate subsequent cognitive decline. Omega-3 polyunsaturated fatty acids (PUFAs) supplement is a potential intervention due to their beneficial effect in depressive symptoms and cognitive function. To explore the underlying neural mechanism, we used resting-state functional MRI (rs-fMRI) before and after omega-3 PUFAs supplement in older adults with LLD. METHODS A 52-week double-blind randomized controlled trial was conducted. We used multi-scale sample entropy to analyze rs-fMRI data. Comprehensive cognitive tests and inflammatory markers were collected to correlate with brain entropy changes. RESULTS A total of 20 patients completed the trial with 11 under omega-3 PUFAs and nine under placebo. While no significant global cognitive improvement was observed, a marginal enhancement in processing speed was noted in the omega-3 PUFAs group. Importantly, participants receiving omega-3 PUFAs exhibited decreased brain entropy in left posterior cingulate gyrus (PCG), multiple visual areas, the orbital part of the right middle frontal gyrus, and the left Rolandic operculum. The brain entropy changes of the PCG in the omega-3 PUFAs group correlated with improvement of language function and attenuation of interleukin-6 levels. LIMITATIONS Sample size is small with only marginal clinical effect. CONCLUSION These findings suggest that omega-3 PUFAs supplement may mitigate cognitive decline in LLD through anti-inflammatory mechanisms and modulation of brain entropy. Larger clinical trials are warranted to validate the potential therapeutic implications of omega-3 PUFAs for deterring cognitive decline in patients with late-life depression.
Collapse
Affiliation(s)
- Chemin Lin
- Department of Psychiatry, Keelung Chang Gung Memorial Hospital, Keelung City, Taiwan; College of Medicine, Chang Gung University, Taoyuan County, Taiwan.; Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Keelung, Taiwan
| | - Shwu-Hua Lee
- College of Medicine, Chang Gung University, Taoyuan County, Taiwan.; Department of Psychiatry, Linkou Chang Gung Memorial Hospital, Taoyuan County, Taiwan
| | - Chih-Mao Huang
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Yu-Wen Wu
- Department of Engineering and System Science, National Tsing Hua University, Hsinchu, Taiwan
| | - You-Xun Chang
- Department of Engineering and System Science, National Tsing Hua University, Hsinchu, Taiwan
| | - Ho-Ling Liu
- Department of Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Shu-Hang Ng
- Department of Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Department of Diagnostic Radiology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Ying-Chih Cheng
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical University, Hsinchu, Taiwan; Research Center of Big Data and Meta-analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chih-Chiang Chiu
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Department of Psychiatry, Taipei Medical University, Taipei, Taiwan.
| | - Shun-Chi Wu
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.
| |
Collapse
|
2
|
Vyas CM, Kang JH, Mischoulon D, Cook NR, Reynolds III CF, Chang G, Mora S, De Vivo I, Manson JE, Okereke OI. Apolipoprotein E and Its Association With Cognitive Change and Modification of Treatment Effects of Vitamin D3 and Omega-3s on Cognitive Change: Results From the In-Clinic Subset of a Randomized Clinical Trial. J Gerontol A Biol Sci Med Sci 2024; 79:glad260. [PMID: 37952113 PMCID: PMC10876077 DOI: 10.1093/gerona/glad260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Apolipoprotein E (APOE)-ε4 allele is associated with cognitive decline; however, its potential to modify effects of vitamin D3 and omega-3s supplementation on later-life cognition is unclear. Our objectives were to estimate among the in-clinic subset of a randomized trial: (1) associations between APOE-ε4 and global and domain-specific cognitive change, with exploration of potential sex and race differences; and (2) modification by APOE-ε4 of effects of vitamin D3 and omega-3s supplementation on cognitive change. METHODS From an ancillary study of depression prevention within a completed 2 × 2 factorial trial testing vitamin D3 (2 000 IU per day), omega-3s (1 g per day), and/or placebos, we included 743 older adults with baseline in-person neuropsychiatric assessments and APOE genotyping data. The primary outcome was change in global cognition (averaging z-scores of 9 tests) over 2 years. Secondarily, episodic memory and executive function/attention z-scores were examined. General linear models of response profiles with multiplicative interaction terms were constructed; stratified results were reported. RESULTS Mean age (standard deviation) was 67.1 (5.3) years; 50.6% were females; 24.9% were APOE-ε4 carriers. Compared to noncarriers, APOE-ε4 carriers had worse 2-year change in global cognition and episodic memory; differences were more apparent among females than males. There was no variation by race in APOE-ε4 associations with cognition. APOE-ε4 did not significantly modify effects of vitamin D3 or omega-3s, compared to placebo, on change in global cognition, episodic memory, or executive function/attention. CONCLUSIONS APOE-ε4 was associated with worse cognition but did not modify overall effects of vitamin D3 or omega-3 supplementation on cognition over 2 years.
Collapse
Affiliation(s)
- Chirag M Vyas
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jae H Kang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David Mischoulon
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy R Cook
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Charles F Reynolds III
- Department of Psychiatry, UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Grace Chang
- Department of Psychiatry, VA Boston Healthcare System, Harvard Medical School, Boston, Massachusetts, USA
| | - Samia Mora
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Immaculata De Vivo
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - JoAnn E Manson
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Olivia I Okereke
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
3
|
Vyas CM, Mischoulon D, Chang G, Reynolds CF, Cook NR, Weinberg A, Copeland T, Bubes V, Bradwin G, Lee IM, Buring JE, Mora S, Rifai N, Manson JE, Okereke OI. Relation of serum BDNF to major depression and exploration of mechanistic roles of serum BDNF in a study of vitamin D3 and omega-3 supplements for late-life depression prevention. J Psychiatr Res 2023; 163:357-364. [PMID: 37267732 PMCID: PMC10306120 DOI: 10.1016/j.jpsychires.2023.05.069] [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: 02/07/2023] [Revised: 04/11/2023] [Accepted: 05/25/2023] [Indexed: 06/04/2023]
Abstract
This study: 1) examined cross-sectional and longitudinal relations of serum brain-derived neurotrophic factor (BDNF) to late-life depression (LLD); 2) tested effects of vitamin D3 and omega-3s on change in BDNF; 3) explored modifying or mediating roles of BDNF on effects of vitamin D3 and omega-3s for LLD. We selected 400 adults from a completed trial of vitamin D3 and omega-3 supplements for LLD prevention. BDNF was measured using an enzyme-linked immunosorbent assay. We administered semi-structured diagnostic interviews and Patient Health Questionnaire [PHQ]-9 to ascertain outcomes at baseline (depression caseness vs. non-caseness; PHQ-9) and at 2-year follow-up among baseline non-depressed individuals (incident vs. no incident MDD; change in PHQ-9). At baseline, while there were no significant differences in mean serum BDNF comparing depression cases and non-cases, being in the lowest vs. highest serum BDNF quartile was significantly associated with worse depressive symptoms. There were no significant longitudinal associations between serum BDNF and LLD. Neither supplement significantly affected change in BDNF; serum BDNF did not appear to modify or mediate treatment effects on LLD. In conclusion, we observed significant cross-sectional but not longitudinal associations between serum BDNF levels and LLD. Vitamin D3 or omega-3s did not alter serum BDNF over 2 years.
Collapse
Affiliation(s)
- Chirag M Vyas
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - David Mischoulon
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Grace Chang
- Department of Psychiatry, VA Boston Healthcare System and Harvard Medical School, Boston, MA, USA
| | - Charles F Reynolds
- Department of Psychiatry, UPMC and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Nancy R Cook
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Alison Weinberg
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Trisha Copeland
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Vadim Bubes
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Gary Bradwin
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, MA, USA
| | - I-Min Lee
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Julie E Buring
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Samia Mora
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nader Rifai
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, MA, USA
| | - JoAnn E Manson
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Olivia I Okereke
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
4
|
Vyas CM, Mischoulon D, Chang G, Cook NR, Weinberg A, Copeland T, Kang JH, Bubes V, Friedenberg G, LeBoff MS, Lee IM, Buring JE, Manson JE, Reynolds CF, Okereke OI. Effects of Vitamin D 3 and Marine Omega-3 Fatty Acids Supplementation on Indicated and Selective Prevention of Depression in Older Adults: Results From the Clinical Center Sub-Cohort of the VITamin D and OmegA-3 TriaL (VITAL). J Clin Psychiatry 2023; 84:22m14629. [PMID: 37378490 PMCID: PMC10328718 DOI: 10.4088/jcp.22m14629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
Objective: To test vitamin D3 and omega-3 fatty acids (omega-3s) for late-life depression prevention under the National Academy of Medicine framework for indicated (targeting subthreshold depression) and selective (targeting presence of high-risk factors) prevention. Methods: The VITamin D and OmegA-3 TriaL (VITAL) is a 2 × 2 factorial trial of vitamin D3 (2,000 IU/d) and/or omega-3s (1 g/d) for cardiovascular and cancer prevention (enrollment: November 2011-March 2014; end date: December 31, 2017). In this targeted prevention study, we included 720 VITAL clinical sub-cohort participants who completed neurobehavioral assessments at baseline and 2 years (91.9% retention). High-risk factors were subthreshold or clinical anxiety, impaired activities of daily living, physical/functional limitation, medical comorbidity, cognitive impairment, caregiving burden, problem drinking, and low psychosocial support. Coprimary outcomes were incident major depressive disorder (MDD), adjudicated using DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition), and change in mood (Patient Health Questionnaire-9 [PHQ-9]). We used exact tests to determine treatment effects on MDD incidence and repeated-measures models to determine treatment effects on PHQ-9. Results: A total of 11.1% had subthreshold depression, 60.8% had ≥ 1 high-risk factor, MDD incidence was 4.7% (5.1% among completers), and mean PHQ-9 score change was 0.02 points. Among those with subthreshold depression, the MDD risk ratio (95% confidence interval) was 0.36 (0.06 to 1.28) for vitamin D3 and 0.85 (0.25 to 2.92) for omega-3s, compared to placebo; results were also null among those with ≥ 1 high-risk factor (vitamin D3 vs placebo: 0.63 [0.25 to 1.53]; omega-3s vs placebo: 1.08 [0.46 to 2.71]). There were no significant differences in PHQ-9 score change comparing either supplement with placebo. Conclusions: Neither vitamin D3 nor omega-3s showed benefits for indicated and selective prevention of late-life depression; statistical power was limited. Trial Registration: ClinicalTrials.gov identifier: NCT01696435.
Collapse
Affiliation(s)
- Chirag M Vyas
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Corresponding Author: Chirag M. Vyas, MBBS, MPH, Massachusetts General Hospital, One Bowdoin Sq, 7th Floor, Boston, MA 02114
| | - David Mischoulon
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Grace Chang
- Department of Psychiatry, VA Boston Healthcare System and Harvard Medical School, Boston, Massachusetts
| | - Nancy R Cook
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Alison Weinberg
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Jae H Kang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Vadim Bubes
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Georgina Friedenberg
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Meryl S LeBoff
- Division of Endocrinology, Diabetes and Hypertension Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - I-Min Lee
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Julie E Buring
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - JoAnn E Manson
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Charles F Reynolds
- Department of Psychiatry, UPMC and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (Reynolds)
| | - Olivia I Okereke
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
5
|
Vyas CM, Sadreyev RI, Gatchel JR, Kang JH, Reynolds CF, Mischoulon D, Chang G, Hazra A, Manson JE, Blacker D, Vivo ID, Okereke OI. Pilot Study of Second-Generation DNA Methylation Epigenetic Markers in Relation to Cognitive and Neuropsychiatric Symptoms in Older Adults. J Alzheimers Dis 2023; 93:1563-1575. [PMID: 37212116 PMCID: PMC10336852 DOI: 10.3233/jad-230093] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Associations between epigenetic aging with cognitive aging and neuropsychiatric measures are not well-understood. OBJECTIVE 1) To assess cross-sectional correlations between second-generation DNA methylation (DNAm)-based clocks of healthspan and lifespan (i.e., GrimAge, PhenoAge, and DNAm-based estimator of telomere length [DNAmTL]) and cognitive and neuropsychiatric measures; 2) To examine longitudinal associations between change in DNAm markers and change in cognition over 2 years. METHODS Participants were members of VITAL-DEP (VITamin D and OmegA-3 TriaL- Depression Endpoint Prevention) study. From previously ascertained cognitive groups (i.e., cognitively normal and mild cognitive impairment), we randomly selected 45 participants, aged≥60 years, who completed in-person neuropsychiatric assessments at baseline and 2 years. The primary outcome was global cognitive score (averaging z-scores of 9 tests). Neuropsychiatric Inventory severity scores were mapped from neuropsychiatric symptoms (NPS) from psychological scales and structured diagnostic interviews. DNAm was assayed using Illumina MethylationEPIC 850K BeadChip at baseline and 2 years. We calculated baseline partial Spearman correlations between DNAm markers and cognitive and NPS measures. We constructed multivariable linear regression models to examine longitudinal relations between DNAm markers and cognition. RESULTS At baseline, we observed a suggestive negative correlation between GrimAge clock markers and global cognition but no signal between DNAm markers and NPS measures. Over 2 years: each 1-year increase in DNAmGrimAge was significantly associated with faster declines in global cognition; each 100-base pair increase in DNAmTL was significantly associated with better global cognition. CONCLUSION We found preliminary evidence of cross-sectional and longitudinal associations between DNAm markers and global cognition.
Collapse
Affiliation(s)
- Chirag M. Vyas
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ruslan I. Sadreyev
- Department of Molecular Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jennifer R. Gatchel
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Geriatric Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA, USA
| | - Jae H. Kang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Charles F. Reynolds
- Department of Psychiatry, UPMC and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - David Mischoulon
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Grace Chang
- Department of Psychiatry, VA Boston Healthcare System and Harvard Medical School, Boston, MA, USA
| | - Aditi Hazra
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - JoAnn E. Manson
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Deborah Blacker
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Immaculata De Vivo
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Olivia I. Okereke
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
6
|
Jimenez DE, Park M, Rosen D, Joo JH, Garza DM, Weinstein ER, Conner K, Silva C, Okereke O. Centering Culture in Mental Health: Differences in Diagnosis, Treatment, and Access to Care Among Older People of Color. Am J Geriatr Psychiatry 2022; 30:1234-1251. [PMID: 35914985 PMCID: PMC9799260 DOI: 10.1016/j.jagp.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 01/25/2023]
Abstract
Mental healthcare disparities are routinely documented, yet they remain wider than in most other areas of healthcare services and common mental disorders (depression and anxiety) continue to be one of the highest health burdens for older people of color. To address disparities in mental health services for older people of color, the narrative must move beyond simply documenting these inequities and attain a better understanding of the internalized, interpersonal, systemic, and medical racism that have harmed these communities and excluded them from its services in the first place. It is imperative that researchers, clinicians, and policymakers acknowledge the realities of racism and discrimination as leading causes of mental healthcare disparities. Therefore, this review is a call-to-action. Authors adopt an antiracist and health equity lens in evaluating the differing needs of Blacks/African-Americans, Asian Americans, and Latinos by exploring psychiatric comorbidity, experiences with seeking, accessing, and engaging in treatment, and the unique cultural and psychosocial factors that affect treatment outcomes for these diverse groups. Further, authors offer researchers and practitioners tangible tools for developing and implementing culturally-sensitive, mental health focused interventions for older people of color with special attention placed on cultural adaptations, models of care, prevention, and practical strategies that can be implemented to reduce disparities and increase equity in mental healthcare.
Collapse
Affiliation(s)
- Daniel E Jimenez
- Department of Psychiatry and Behavioral Sciences (DEJ, DMG), University of Miami Miller School of Medicine, Miami, FL; Department of Family Health Care Nursing (MP), University of California San Francisco School of Nursing, San Francisco, CA; School of Social Work (DR), University of Pittsburgh, Pittsburgh, PA; Department of Psychiatry (JHJ, OO), Harvard Medical School, Boston, MA; Department of Psychology (ERW), University of Miami, Miami, FL; Department of Mental Health Law and Policy (KC), College of Behavioral and Community Sciences University of South Florida, Tampa, FL; Department of Psychiatry (CS), University of Rochester Medical Center, Rochester, NY.
| | - Mijung Park
- Department of Psychiatry and Behavioral Sciences (DEJ, DMG), University of Miami Miller School of Medicine, Miami, FL; Department of Family Health Care Nursing (MP), University of California San Francisco School of Nursing, San Francisco, CA; School of Social Work (DR), University of Pittsburgh, Pittsburgh, PA; Department of Psychiatry (JHJ, OO), Harvard Medical School, Boston, MA; Department of Psychology (ERW), University of Miami, Miami, FL; Department of Mental Health Law and Policy (KC), College of Behavioral and Community Sciences University of South Florida, Tampa, FL; Department of Psychiatry (CS), University of Rochester Medical Center, Rochester, NY
| | - Daniel Rosen
- Department of Psychiatry and Behavioral Sciences (DEJ, DMG), University of Miami Miller School of Medicine, Miami, FL; Department of Family Health Care Nursing (MP), University of California San Francisco School of Nursing, San Francisco, CA; School of Social Work (DR), University of Pittsburgh, Pittsburgh, PA; Department of Psychiatry (JHJ, OO), Harvard Medical School, Boston, MA; Department of Psychology (ERW), University of Miami, Miami, FL; Department of Mental Health Law and Policy (KC), College of Behavioral and Community Sciences University of South Florida, Tampa, FL; Department of Psychiatry (CS), University of Rochester Medical Center, Rochester, NY
| | - Jin Hui Joo
- Department of Psychiatry and Behavioral Sciences (DEJ, DMG), University of Miami Miller School of Medicine, Miami, FL; Department of Family Health Care Nursing (MP), University of California San Francisco School of Nursing, San Francisco, CA; School of Social Work (DR), University of Pittsburgh, Pittsburgh, PA; Department of Psychiatry (JHJ, OO), Harvard Medical School, Boston, MA; Department of Psychology (ERW), University of Miami, Miami, FL; Department of Mental Health Law and Policy (KC), College of Behavioral and Community Sciences University of South Florida, Tampa, FL; Department of Psychiatry (CS), University of Rochester Medical Center, Rochester, NY
| | - David Martinez Garza
- Department of Psychiatry and Behavioral Sciences (DEJ, DMG), University of Miami Miller School of Medicine, Miami, FL; Department of Family Health Care Nursing (MP), University of California San Francisco School of Nursing, San Francisco, CA; School of Social Work (DR), University of Pittsburgh, Pittsburgh, PA; Department of Psychiatry (JHJ, OO), Harvard Medical School, Boston, MA; Department of Psychology (ERW), University of Miami, Miami, FL; Department of Mental Health Law and Policy (KC), College of Behavioral and Community Sciences University of South Florida, Tampa, FL; Department of Psychiatry (CS), University of Rochester Medical Center, Rochester, NY
| | - Elliott R Weinstein
- Department of Psychiatry and Behavioral Sciences (DEJ, DMG), University of Miami Miller School of Medicine, Miami, FL; Department of Family Health Care Nursing (MP), University of California San Francisco School of Nursing, San Francisco, CA; School of Social Work (DR), University of Pittsburgh, Pittsburgh, PA; Department of Psychiatry (JHJ, OO), Harvard Medical School, Boston, MA; Department of Psychology (ERW), University of Miami, Miami, FL; Department of Mental Health Law and Policy (KC), College of Behavioral and Community Sciences University of South Florida, Tampa, FL; Department of Psychiatry (CS), University of Rochester Medical Center, Rochester, NY
| | - Kyaien Conner
- Department of Psychiatry and Behavioral Sciences (DEJ, DMG), University of Miami Miller School of Medicine, Miami, FL; Department of Family Health Care Nursing (MP), University of California San Francisco School of Nursing, San Francisco, CA; School of Social Work (DR), University of Pittsburgh, Pittsburgh, PA; Department of Psychiatry (JHJ, OO), Harvard Medical School, Boston, MA; Department of Psychology (ERW), University of Miami, Miami, FL; Department of Mental Health Law and Policy (KC), College of Behavioral and Community Sciences University of South Florida, Tampa, FL; Department of Psychiatry (CS), University of Rochester Medical Center, Rochester, NY
| | - Caroline Silva
- Department of Psychiatry and Behavioral Sciences (DEJ, DMG), University of Miami Miller School of Medicine, Miami, FL; Department of Family Health Care Nursing (MP), University of California San Francisco School of Nursing, San Francisco, CA; School of Social Work (DR), University of Pittsburgh, Pittsburgh, PA; Department of Psychiatry (JHJ, OO), Harvard Medical School, Boston, MA; Department of Psychology (ERW), University of Miami, Miami, FL; Department of Mental Health Law and Policy (KC), College of Behavioral and Community Sciences University of South Florida, Tampa, FL; Department of Psychiatry (CS), University of Rochester Medical Center, Rochester, NY
| | - Olivia Okereke
- Department of Psychiatry and Behavioral Sciences (DEJ, DMG), University of Miami Miller School of Medicine, Miami, FL; Department of Family Health Care Nursing (MP), University of California San Francisco School of Nursing, San Francisco, CA; School of Social Work (DR), University of Pittsburgh, Pittsburgh, PA; Department of Psychiatry (JHJ, OO), Harvard Medical School, Boston, MA; Department of Psychology (ERW), University of Miami, Miami, FL; Department of Mental Health Law and Policy (KC), College of Behavioral and Community Sciences University of South Florida, Tampa, FL; Department of Psychiatry (CS), University of Rochester Medical Center, Rochester, NY
| |
Collapse
|
7
|
Lampignano L, Sardone R, D’Urso F, Altamura M, Piccininni C, Griseta C, Bortone I, Castellana F, Zupo R, Donghia R, Guerra V, Resta E, Cisternino A, Caruso MG, Daniele A, De Pergola G, Bellomo A, Boeing H, Giannelli G, Panza F, Lozupone M. Processed meat consumption and the risk of incident late-onset depression: a 12-year follow-up of the Salus in Apulia Study. Age Ageing 2022; 51:6520507. [PMID: 35134842 DOI: 10.1093/ageing/afab257] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 10/14/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND the possible relationship between dietary habits and the incidence of late-onset depression (LOD), defined as first depression onset at later age, is unclear. OBJECTIVE to investigate the relationship between consumption of different food groups and incident LOD. DESIGN longitudinal population-based study with a 12-year follow-up. SETTING Castellana Grotte, Bari, Italy. SUBJECTS five hundred and forty-six older subjects from the Salus in Apulia Study. METHODS baseline data were recorded in 2003-06, and diagnostic data were recorded in 2013-18 at follow-up. Dietary intake was assessed with a food frequency questionnaire. Depressive disorders were assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders. Subjects who already suffered from depression or other psychiatric disorders at baseline were excluded from the analysis. The association between LOD and single dietary determinants was examined by Cox regression analysis and then applying the hazard ratio (HR). RESULTS subjects with incident LOD (n = 34) had lower global cognition and total cholesterol levels and a higher body mass index (BMI) at baseline. Only processed meat significantly increased the risk of incident LOD of about 10% by 5 g/day intake (HR adjusted for age, sex, education, multimorbidity and BMI: 1.13, 95% confidence intervals: 1.04-1.22). A similar relationship was found for single foods in the processed meat food group such as sausages, salami and mortadella and baked ham, but not for raw ham. CONCLUSIONS in midlife, a higher intake of processed meat was not only associated with an increased risk of cardiovascular- and metabolic-related chronic diseases in older age but also with an increased risk of developing LOD.
Collapse
Affiliation(s)
- Luisa Lampignano
- Population Health Unit – “Salus In Apulia Study”, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte (Bari) 70013, Italy
| | - Rodolfo Sardone
- Population Health Unit – “Salus In Apulia Study”, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte (Bari) 70013, Italy
| | - Francesca D’Urso
- Department of Clinical and Experimental Medicine, Psychiatric Unit, University of Foggia, Foggia 71121, Italy
| | - Mario Altamura
- Department of Clinical and Experimental Medicine, Psychiatric Unit, University of Foggia, Foggia 71121, Italy
| | - Carla Piccininni
- Department of Clinical and Experimental Medicine, Psychiatric Unit, University of Foggia, Foggia 71121, Italy
| | - Chiara Griseta
- Population Health Unit – “Salus In Apulia Study”, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte (Bari) 70013, Italy
| | - Ilaria Bortone
- Population Health Unit – “Salus In Apulia Study”, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte (Bari) 70013, Italy
| | - Fabio Castellana
- Population Health Unit – “Salus In Apulia Study”, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte (Bari) 70013, Italy
| | - Roberta Zupo
- Population Health Unit – “Salus In Apulia Study”, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte (Bari) 70013, Italy
| | - Rossella Donghia
- Population Health Unit – “Salus In Apulia Study”, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte (Bari) 70013, Italy
| | - Vito Guerra
- Population Health Unit – “Salus In Apulia Study”, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte (Bari) 70013, Italy
| | - Emanuela Resta
- Department of Cardiac, Thoracic, and Vascular Science, Institute of Respiratory Disease, University of Bari Aldo Moro, Bari 70121, Italy
- Translational Medicine and Management of Health Systems, University of Foggia, Foggia 71121, Italy
| | - Annamaria Cisternino
- Laboratory of Clinical Nutrition, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte (Bari) 70013, Italy
| | - Maria Gabriella Caruso
- Laboratory of Clinical Nutrition, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte (Bari) 70013, Italy
| | - Antonio Daniele
- Institute of Neurology, Catholic University of Sacred Heart, Rome 00187, Italy
- Institute of Neurology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 168, Italy
| | - Giovanni De Pergola
- Department of Biomedical Science and Human Oncology, School of Medicine, University of Bari, Bari 7012, Italy
| | - Antonello Bellomo
- Department of Clinical and Experimental Medicine, Psychiatric Unit, University of Foggia, Foggia 71121, Italy
| | - Heiner Boeing
- Population Health Unit – “Salus In Apulia Study”, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte (Bari) 70013, Italy
- Department of Epidemiology, German Institute of Human Nutrition, Nuthetal 14558, Germany
| | - Gianluigi Giannelli
- Population Health Unit – “Salus In Apulia Study”, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte (Bari) 70013, Italy
| | - Francesco Panza
- Population Health Unit – “Salus In Apulia Study”, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte (Bari) 70013, Italy
| | - Madia Lozupone
- Department of Basic Medicine, Neuroscience, and Sense Organs, Neurodegenerative Disease Unit, University of Bari Aldo Moro, Bari 70121, Italy
| |
Collapse
|
8
|
Okereke OI, Vyas CM, Mischoulon D, Chang G, Cook NR, Weinberg A, Bubes V, Copeland T, Friedenberg G, Lee IM, Buring JE, Reynolds CF, Manson JE. Effect of Long-term Supplementation With Marine Omega-3 Fatty Acids vs Placebo on Risk of Depression or Clinically Relevant Depressive Symptoms and on Change in Mood Scores: A Randomized Clinical Trial. JAMA 2021; 326:2385-2394. [PMID: 34932079 PMCID: PMC8693224 DOI: 10.1001/jama.2021.21187] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
IMPORTANCE Marine omega-3 fatty acid (omega-3) supplements have been used to treat depression but their ability to prevent depression in the general adult population is unknown. OBJECTIVE To test effects of omega-3 supplementation on late-life depression risk and mood scores. DESIGN, SETTING, AND PARTICIPANTS A total of 18 353 adults participated in the VITAL-DEP (Vitamin D and Omega-3 Trial-Depression Endpoint Prevention) ancillary study to VITAL, a randomized trial of cardiovascular disease and cancer prevention among 25 871 US adults. There were 16 657 at risk of incident depression (no previous depression) and 1696 at risk of recurrent depression (previous depression, but not for the past 2 years). Randomization occurred from November 2011 through March 2014; randomized treatment ended on December 31, 2017. INTERVENTIONS Randomized 2 × 2 factorial assignment to vitamin D3 (2000 IU/d), marine omega-3 fatty acids (1 g/d of fish oil, including 465 mg of eicosapentaenoic acid and 375 mg of docosahexaenoic acid) or placebo; 9171 were randomized to omega-3 and 9182 were randomized to matching placebo. MAIN OUTCOMES AND MEASURES Prespecified coprimary outcomes were risk of depression or clinically relevant depressive symptoms (total of incident + recurrent cases); mean difference in mood score (8-item Patient Health Questionnaire [PHQ-8] depression scale). RESULTS Among 18 353 participants who were randomized (mean age, 67.5 [SD, 7.1] years; 49.2% women), 90.3% completed the trial (93.5% among those alive at the end of the trial); the median treatment duration was 5.3 years. The test for interaction between the omega-3 and the vitamin D agents was not significant (P for interaction = .14). Depression risk was significantly higher comparing omega-3 (651 events, 13.9 per 1000 person-years) with placebo (583 events, 12.3 per 1000 person-years; hazard ratio [HR], 1.13; 95% CI, 1.01-1.26; P = .03). No significant differences were observed comparing omega-3 with placebo groups in longitudinal mood scores: the mean difference in change in PHQ-8 score was 0.03 points (95% CI, -0.01 to 0.07; P = .19). Regarding serious and common adverse events, the respective prevalence values in omega-3 vs placebo groups were major cardiovascular events (2.7% vs 2.9%), all-cause mortality (3.3% vs 3.1%), suicide (0.02% vs 0.01%), gastrointestinal bleeding (2.6% vs 2.7%), easy bruising (24.8% vs 25.1%), and stomach upset or pain (35.2% vs 35.1%). CONCLUSIONS AND RELEVANCE Among adults aged 50 years or older without clinically relevant depressive symptoms at baseline, treatment with omega-3 supplements compared with placebo yielded mixed results, with a small but statistically significant increase in risk of depression or clinically relevant depressive symptoms but no difference in mood scores, over a median follow-up of 5.3 years. These findings do not support the use of omega-3 supplements in adults to prevent depression. TRIAL REGISTRATION ClinicalTrials.gov Identifiers: NCT01696435 and NCT01169259.
Collapse
Affiliation(s)
- Olivia I. Okereke
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Chirag M. Vyas
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
| | - David Mischoulon
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Grace Chang
- Department of Psychiatry, VA Boston Healthcare System, Brockton, Massachusetts
| | - Nancy R. Cook
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Alison Weinberg
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Vadim Bubes
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Trisha Copeland
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Georgina Friedenberg
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - I-Min Lee
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Julie E. Buring
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Charles F. Reynolds
- Department of Psychiatry, UPMC and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - JoAnn E. Manson
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
9
|
Abstract
After participating in this activity, learners should be better able to:• Identify risk factors for late-life depression• Evaluate strategies to prevent late-life depression ABSTRACT: Late-life depression (LLD) is one of the major sources of morbidity and mortality in the world. Because LLD is related to increased public health burden, excess health care costs and utilization, reduced quality of life, and increased mortality, prevention is a priority. Older adults differ from younger adults with respect to key features, such as their chronicity and lifetime burden of depression and their constellation of comorbidities and risk factors. LLD likely arises from a complex interplay of risk factors, including medical, physiologic, psychosocial, behavioral, and environmental factors. Thus, a comprehensive understanding of LLD risk factors is necessary to inform prevention strategies. In this narrative literature review, we address both the risk architecture of LLD and several potential strategies for prevention. Our description of LLD risk factors and prevention approaches is informed by the framework developed by the National Academy of Medicine (formerly, Institute of Medicine), which includes indicated, selective, and universal approaches to prevention.
Collapse
|
10
|
Vyas CM, Ogata S, Reynolds CF, Mischoulon D, Chang G, Cook NR, Manson JE, Crous-Bou M, De Vivo I, Okereke OI. Telomere length and its relationships with lifestyle and behavioural factors: variations by sex and race/ethnicity. Age Ageing 2021; 50:838-846. [PMID: 33001148 DOI: 10.1093/ageing/afaa186] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Adherence to healthy lifestyles/behaviours promotes healthy ageing. However, little is known about whether age, sex and/or race/ethnicity moderate associations of lifestyle/behavioural factors with relative telomere length (RTL), a potential biomarker of ageing. METHODS We included 749 midlife to older non-Hispanic White (n = 254), Black (n = 248) and Hispanic (n = 247) US participants [mean (standard deviation) age = 69.3 (7.2) years; women: 50.5%]. We extracted genomic DNA from peripheral leucocytes. RTL was assayed using real-time quantitative polymerase chain reaction. Multivariable regression was used to examine associations between lifestyle/behavioural exposures (i.e. physical activity, alcohol consumption, smoking and depression) with RTL. RESULTS Increasing chronological age was associated with shorter RTL (P < 0.01). Higher physical activity was associated with longer RTL (P-trend = 0.03); daily versus never/rare alcohol consumption and 30+ versus <5 smoking pack-year were associated with shorter RTLs (P-trend = 0.02). Associations varied significantly by sex and race/ethnicity. The association between physical activity and longer RTL appeared strongest among non-Hispanic Whites (P-interaction = 0.01). Compared to men, women had stronger associations between heavy smoking and shorter RTLs (P-interaction = 0.03). Light/moderate alcohol consumption (monthly/weekly) was associated with longer RTL among non-Hispanic Whites, while daily consumption was related to shorter RTLs among Blacks and Hispanics (P-interactions < 0.01). Associations of daily alcohol and heavy smoking with shorter RTLs were particularly apparent among Black women. CONCLUSION We observed novel variations by sex and race/ethnicity in associations between lifestyle/behavioural factors and RTL. Further work is needed to replicate these findings and to address potential public health implications for modifying strategies by sex or across racial/ethnic groups to optimise lifestyles/behaviours for healthy ageing.
Collapse
Affiliation(s)
- Chirag M Vyas
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Soshiro Ogata
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Faculty of Nursing, School of Health Science, Fujita Health University, Toyoake, Japan
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Charles F Reynolds
- Department of Psychiatry, UPMC and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - David Mischoulon
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Grace Chang
- Department of Psychiatry, VA Boston Healthcare System and Harvard Medical School, Boston, MA, USA
| | - Nancy R Cook
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - JoAnn E Manson
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Marta Crous-Bou
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- BarcelonaBeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
- Department of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO) - Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Immaculata De Vivo
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Olivia I Okereke
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
11
|
Fouad S, El Shebini SM, Abdel-Moaty M, Ahmed NH, Hussein AMS, Essa HA, Tapozada ST. Menopause Anxiety and Depression; How Food Can Help? Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.5555] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Anxiety and depression are reported as two major frequent and chief complaints among peri-menopausal women in several societies.
AIM: The objective of the study was to study the effect of using two dietary supplements to beat depression and anxiety associated with menopause.
SUBJECTS AND METHODS: Sixty-six volunteers’ menopausal women participated on the study for 8 weeks, 35 subjects consumed daily cookies prepared mainly from soya flour and flaxseed, and 31 females consumed daily a blend composed mainly of raw unroasted peanut and raw sesame. Follow-up was performed with menopause rating scale, anxiety score, depression score, and biochemical parameters.
RESULTS: Soya cookies were rich in plant-based protein and total phenols while blend was a good source of unsaturated fatty acid. Blend consumers showed significant percentage reduction in beck anxiety score and beck depression score after intervention, more than cookies consumers group. The anthropometrics parameters were statistical significant changed on both groups, more on the group who consumed the soya cookies. Soya cookies demonstrated an anti-inflammatory effect, while blend had an antioxidant and anti-inflammatory effects as was shown on the serum assay of interleukin-6 and malondialdehyde as an inflammatory marker and an antioxidant marker, respectively.
CONCLUSION: From the results, it can be concluded that the supplementation of products enriched with unsaturated fatty acid was more beneficial to slow down the psychological menopause symptoms than natural estrogen rich product consumption.
Collapse
|
12
|
Kuszewski JC, Howe PRC, Wong RHX. An Exploratory Analysis of Changes in Mental Wellbeing Following Curcumin and Fish Oil Supplementation in Middle-Aged and Older Adults. Nutrients 2020; 12:nu12102902. [PMID: 32977404 PMCID: PMC7598152 DOI: 10.3390/nu12102902] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/14/2020] [Accepted: 09/21/2020] [Indexed: 12/20/2022] Open
Abstract
Curcumin has previously been shown to enhance mood in non-depressed older adults. However, observed benefits were limited to short-term supplementation (4 weeks). In a 16 week randomized, double-blind, placebo-controlled, 2 × 2 factorial design trial, we supplemented overweight or obese non-depressed adults (50–80 years) with curcumin (160 mg/day), fish oil (2000 mg docosahexaenoic acid +400 mg eicosapentaenoic acid/day), or a combination of both. Secondary outcomes included mental wellbeing measures (mood states and subjective memory complaints (SMCs)) and quality of life (QoL). Furthermore, plasma apolipoprotein E4 (APOE4) was measured to determine whether APOE4 status influences responses to fish oil. Curcumin improved vigour (p = 0.044) compared to placebo and reduced SMCs compared to no curcumin treatment (p = 0.038). Fish oil did not affect any mood states, SMCs or QoL; however, responses to fish oil were affected by APOE4 status. In APOE4 non-carriers, fish oil increased vigour (p = 0.030) and reduced total mood disturbances (p = 0.048) compared to placebo. Improvements in mental wellbeing were correlated with increased QoL. Combining curcumin with fish oil did not result in additive effects. This exploratory analysis indicates that regular supplementation with either curcumin or fish oil (limited to APOE4 non-carriers) has the potential to improve some aspects of mental wellbeing in association with better QoL.
Collapse
Affiliation(s)
- Julia C. Kuszewski
- Clinical Nutrition Research Centre, School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan 2308, Australia; (J.C.K.); (R.H.X.W.)
| | - Peter R. C. Howe
- Clinical Nutrition Research Centre, School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan 2308, Australia; (J.C.K.); (R.H.X.W.)
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central 4300, Australia
- UniSA Allied Health & Human Performance, University of South Australia, Adelaide 5000, Australia
- Correspondence: ; Tel.: +61-2-4921-7309
| | - Rachel H. X. Wong
- Clinical Nutrition Research Centre, School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan 2308, Australia; (J.C.K.); (R.H.X.W.)
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central 4300, Australia
| |
Collapse
|
13
|
Vyas CM, Ogata S, Reynolds CF, Mischoulon D, Chang G, Cook NR, Manson JE, Crous-Bou M, De Vivo I, Okereke OI. Lifestyle and behavioral factors and mitochondrial DNA copy number in a diverse cohort of mid-life and older adults. PLoS One 2020; 15:e0237235. [PMID: 32785256 PMCID: PMC7423118 DOI: 10.1371/journal.pone.0237235] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 07/02/2020] [Indexed: 01/15/2023] Open
Abstract
Mitochondrial DNA copy number (mtDNAcn) is a putative biomarker of oxidative stress and biological aging. Modifiable factors, including physical activity (PA), avoidance of heavy alcohol use and smoking, and maintaining good mental health, may reduce oxidative stress and promote healthy aging. Yet, limited data exist regarding how these factors are associated with mtDNAcn or whether age, sex or race/ethnicity moderate associations. In this cross-sectional study, we selected 391 adults (183 non-Hispanic White, 110 Black and 98 Hispanic; mean = 67 years) from the VITAL-DEP (VITamin D and OmegA-3 TriaL-Depression Endpoint Prevention) ancillary to the VITAL trial. We estimated associations between lifestyle and behavioral factors (PA, alcohol consumption, cigarette smoking and depression) and log-transformed mtDNAcn using multivariable linear regression models. MtDNAcn was not correlated with chronological age; women had ~17% higher mtDNAcn compared to men. There were no significant associations between PA measures (frequency, amount or intensity) or alcohol consumption with mtDNAcn. Cigarette smoking (per 5 pack-years) was significantly associated with mtDNAcn (percent difference = -2.9% (95% confidence interval (CI) = -5.4%, -0.4%)); a large contrast was observed among heavy vs. non-smokers (≥30 vs. 0 pack-years): percent difference = -28.5% (95% CI = -44.2%, -8.3%). The estimate of mtDNAcn was suggestively different for past vs. no depression history (percent difference = -15.1% 95% CI = -30.8%, 4.1%), but this difference was not statistically significant. The association between smoking and log-mtDNAcn varied by sex and race/ethnicity; it was stronger in men and Black participants. While chance findings cannot be excluded, results from this study support associations of smoking, but not chronological age, with mtDNAcn and suggest nuanced considerations of mtDNAcn as indicative of varying oxidative stress states vs. biological aging itself.
Collapse
Affiliation(s)
- Chirag M. Vyas
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Soshiro Ogata
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Charles F. Reynolds
- Department of Psychiatry, UPMC and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - David Mischoulon
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Grace Chang
- Department of Psychiatry, VA Boston Healthcare System, Brockton, Massachusetts, United States of America
| | - Nancy R. Cook
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - JoAnn E. Manson
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Marta Crous-Bou
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - Immaculata De Vivo
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Olivia I. Okereke
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| |
Collapse
|
14
|
Okereke OI, Reynolds CF, Mischoulon D, Chang G, Vyas CM, Cook NR, Weinberg A, Bubes V, Copeland T, Friedenberg G, Lee IM, Buring JE, Manson JE. Effect of Long-term Vitamin D3 Supplementation vs Placebo on Risk of Depression or Clinically Relevant Depressive Symptoms and on Change in Mood Scores: A Randomized Clinical Trial. JAMA 2020; 324:471-480. [PMID: 32749491 PMCID: PMC7403921 DOI: 10.1001/jama.2020.10224] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
IMPORTANCE Low levels of 25-hydroxyvitamin D have been associated with higher risk for depression later in life, but there have been few long-term, high-dose large-scale trials. OBJECTIVE To test the effects of vitamin D3 supplementation on late-life depression risk and mood scores. DESIGN, SETTING, AND PARTICIPANTS There were 18 353 men and women aged 50 years or older in the VITAL-DEP (Vitamin D and Omega-3 Trial-Depression Endpoint Prevention) ancillary study to VITAL, a randomized clinical trial of cardiovascular disease and cancer prevention among 25 871 adults in the US. There were 16 657 at risk for incident depression (ie, no depression history) and 1696 at risk for recurrent depression (ie, depression history but no treatment for depression within the past 2 years). Randomization occurred from November 2011 through March 2014; randomized treatment ended on December 31, 2017, and this was the final date of follow-up. INTERVENTION Randomized assignment in a 2 × 2 factorial design to vitamin D3 (2000 IU/d of cholecalciferol) and fish oil or placebo; 9181 were randomized to vitamin D3 and 9172 were randomized to matching placebo. MAIN OUTCOMES AND MEASURES The primary outcomes were the risk of depression or clinically relevant depressive symptoms (total of incident and recurrent cases) and the mean difference in mood scores (8-item Patient Health Questionnaire depression scale [PHQ-8]; score range, 0 points [least symptoms] to 24 points [most symptoms]; the minimal clinically important difference for change in scores was 0.5 points). RESULTS Among the 18 353 randomized participants (mean age, 67.5 [SD, 7.1] years; 49.2% women), the median treatment duration was 5.3 years and 90.5% completed the trial (93.5% among those alive at the end of the trial). Risk of depression or clinically relevant depressive symptoms was not significantly different between the vitamin D3 group (609 depression or clinically relevant depressive symptom events; 12.9/1000 person-years) and the placebo group (625 depression or clinically relevant depressive symptom events; 13.3/1000 person-years) (hazard ratio, 0.97 [95% CI, 0.87 to 1.09]; P = .62); there were no significant differences between groups in depression incidence or recurrence. No significant differences were observed between treatment groups for change in mood scores over time; mean change in PHQ-8 score was not significantly different from zero (mean difference for change in mood scores, 0.01 points [95% CI, -0.04 to 0.05 points]). CONCLUSIONS AND RELEVANCE Among adults aged 50 years or older without clinically relevant depressive symptoms at baseline, treatment with vitamin D3 compared with placebo did not result in a statistically significant difference in the incidence and recurrence of depression or clinically relevant depressive symptoms or for change in mood scores over a median follow-up of 5.3 years. These findings do not support the use of vitamin D3 in adults to prevent depression. TRIAL REGISTRATION ClinicalTrials.gov Identifiers: NCT01169259 and NCT01696435.
Collapse
Affiliation(s)
- Olivia I. Okereke
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Charles F. Reynolds
- Department of Psychiatry, UPMC and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - David Mischoulon
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Grace Chang
- Department of Psychiatry, VA Boston Healthcare System, Brockton, Massachusetts
| | - Chirag M. Vyas
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Nancy R. Cook
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Alison Weinberg
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Vadim Bubes
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Trisha Copeland
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Georgina Friedenberg
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - I-Min Lee
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Julie E. Buring
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - JoAnn E. Manson
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
15
|
Owens M, Watkins E, Bot M, Brouwer IA, Roca M, Kohls E, Penninx BWJH, Grootheest G, Hegerl U, Gili M, Visser M. Nutrition and depression: Summary of findings from the EU‐funded MooDFOOD depression prevention randomised controlled trial and a critical review of the literature. NUTR BULL 2020. [DOI: 10.1111/nbu.12447] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- M. Owens
- Department of Psychology University of Exeter Exeter UK
| | - E. Watkins
- Department of Psychology University of Exeter Exeter UK
| | - M. Bot
- Amsterdam UMC Vrije Universiteit, Psychiatry Amsterdam Public Health Research Institute GGZ in Geest Specialized Mental Health Care Amsterdam The Netherlands
| | - I. A. Brouwer
- Department of Health Sciences Faculty of Science Amsterdam Public Health Research Institute Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - M. Roca
- Institut Universitari d’ Investigació en Ciències de la Salut (IUNICS/IDISBA) Rediapp University of Balearic Islands Palma de Mallorca Spain
| | - E. Kohls
- Department of Psychiatry and Psychotherapy Medical Faculty University Leipzig Leipzig Germany
| | - B. W. J. H. Penninx
- Amsterdam UMC Vrije Universiteit, Psychiatry Amsterdam Public Health Research Institute GGZ in Geest Specialized Mental Health Care Amsterdam The Netherlands
| | - G. Grootheest
- Amsterdam UMC Vrije Universiteit, Psychiatry Amsterdam Public Health Research Institute GGZ in Geest Specialized Mental Health Care Amsterdam The Netherlands
| | - U. Hegerl
- Department of Psychiatry, Psychosomatics and Psychotherapy Goethe‐University Frankfurt Germany
| | - M. Gili
- Institut Universitari d’ Investigació en Ciències de la Salut (IUNICS/IDISBA) Rediapp University of Balearic Islands Palma de Mallorca Spain
| | - M. Visser
- Department of Health Sciences Faculty of Science Amsterdam Public Health Research Institute Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | | |
Collapse
|
16
|
Lyu H, Wang S, Jin Y, Shen R, Chen J, Zhu C, Chen B, Wu C. Simultaneous determination of VD2, VD3, 25(OH) D2, and 25(OH) D3 in human plasma using electrospray LC-MS/MS as well as its application to evaluate VD plasma levels in depressive, schizophrenic patients and healthy individuals. Biomed Chromatogr 2020; 34:e4932. [PMID: 32592191 DOI: 10.1002/bmc.4932] [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] [Received: 02/19/2020] [Revised: 06/17/2020] [Accepted: 06/24/2020] [Indexed: 11/08/2022]
Abstract
Vitamin D measurements in biological fluids by liquid chromatography-tandem mass spectrometry (LC-MS/MS) have been widely used but remain challenging at very low concentration levels. Rapid, high recovery, sensitive and reliable measurements of vitamin D, as well as its primary metabolites using LC-MS/MS are urgently needed for a routine clinical laboratory. Herein, we reported a novel electrospray LC-MS/MS method for determining vitamin D and its primary metabolites using the supported liquid extraction method to achieve higher recoveries, with optimized pH values to achieve optimal derivatization efficiency for higher sensitivity and selected chromatographic conditions to shorten the separation time. The method has been validated with respect to selectivity, recovery, matrix effects, accuracy and precision, stabilities, carryover and dilution effects. The method has been successfully applied to quantify the VD plasma concentrations of depressive, schizophrenic patients and healthy individuals. The result showed that there were significant differences in plasma VD levels between mental disorder patients with healthy individuals, and the total VD levels in mental disorder patients were much higher than healthy individuals, which might require larger clinical samples for validation.
Collapse
Affiliation(s)
- Haiyan Lyu
- Department of Pharmacy, Xiamen Xianyue Hospital, Xiamen 361012, China
| | - Suping Wang
- Fujian Provincial Key Laboratory of Innovative Drug Target Research and State Key Laboratory of Cell Stress Biology, School of Pharmaceutical Sciences, Xiamen University, Xiamen 361102, China
| | - Ying Jin
- The First Affiliated Hospital of Xiamen University, Xiamen 361003, China
| | - Rong Shen
- School of Medicine, Xiamen University, Xiamen 361102, China
| | - Jiayun Chen
- Fujian Provincial Key Laboratory of Innovative Drug Target Research and State Key Laboratory of Cell Stress Biology, School of Pharmaceutical Sciences, Xiamen University, Xiamen 361102, China
| | - Chunyan Zhu
- Fujian Provincial Key Laboratory of Innovative Drug Target Research and State Key Laboratory of Cell Stress Biology, School of Pharmaceutical Sciences, Xiamen University, Xiamen 361102, China
| | - Binbin Chen
- Department of Pharmacy, Xiamen Xianyue Hospital, Xiamen 361012, China
| | - Caisheng Wu
- Fujian Provincial Key Laboratory of Innovative Drug Target Research and State Key Laboratory of Cell Stress Biology, School of Pharmaceutical Sciences, Xiamen University, Xiamen 361102, China
| |
Collapse
|
17
|
Vyas CM, Donneyong M, Mischoulon D, Chang G, Gibson H, Cook NR, Manson JE, Reynolds CF, Okereke OI. Association of Race and Ethnicity With Late-Life Depression Severity, Symptom Burden, and Care. JAMA Netw Open 2020; 3:e201606. [PMID: 32215634 PMCID: PMC7325738 DOI: 10.1001/jamanetworkopen.2020.1606] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Importance Knowledge gaps persist regarding racial and ethnic variation in late-life depression, including differences in specific depressive symptoms and disparities in care. Objective To examine racial/ethnic differences in depression severity, symptom burden, and care. Design, Setting, and Participants This cross-sectional study included 25 503 of 25 871 community-dwelling older adults who participated in the Vitamin D and Omega-3 Trial (VITAL), a randomized trial of cancer and cardiovascular disease prevention conducted from November 2011 to December 2017. Data analysis was conducted from June to September 2018. Exposure Racial/ethnic group (ie, non-Hispanic white; black; Hispanic; Asian; and other, multiple, or unspecified race). Main Outcomes and Measures Depressive symptoms, assessed using the Patient Health Questionnaire-8 (PHQ-8); participant-reported diagnosis, medication, and/or counseling for depression. Differences across racial/ethnic groups were evaluated using multivariable zero-inflated negative binomial regression to compare PHQ-8 scores and multivariable logistic regression to estimate odds of item-level symptom burden and odds of depression treatment among those with diagnosed depression. Results There were 25 503 VITAL participants with adequate depression data (mean [SD] age, 67.1 [7.1] years) including 12 888 [50.5%] women, 17 828 [69.9%] non-Hispanic white participants, 5004 [19.6%] black participants, 1001 [3.9%] Hispanic participants, 377 [1.5%] Asian participants, and 1293 participants [5.1%] who were categorized in the other, multiple, or unspecified race group. After adjustment for sociodemographic, lifestyle, and health confounders, black participants had a 10% higher severity level of PHQ-8 scores compared with non-Hispanic white participants (rate ratio [RR], 1.10; 95% CI, 1.04-1.17; P < .001); Hispanic participants had a 23% higher severity level of PHQ-8 scores compared with non-Hispanic white participants (RR, 1.23; 95% CI, 1.10-1.38; P < .001); and participants in the other, multiple, or unspecified group had a 14% higher severity level of PHQ-8 scores compared with non-Hispanic white participants (RR, 1.14; 95% CI, 1.04-1.25; P = .007). Compared with non-Hispanic white participants, participants belonging to minority groups had 1.5-fold to 2-fold significantly higher fully adjusted odds of anhedonia (among black participants: odds ratio [OR], 1.76; 95% CI, 1.47-2.11; among Hispanic participants: OR, 1.96; 95% CI, 1.43-2.69), sadness (among black participants: OR, 1.31; 95% CI, 1.07-1.60; among Hispanic participants: OR, 2.09; 95% CI, 1.51-2.88), and psychomotor symptoms (among black participants: OR, 1.77; 95% CI, 1.31-2.39; among Hispanic participants: OR, 2.12; 95% CI, 1.28-3.50); multivariable-adjusted odds of sleep problems and guilt appeared higher among Hispanic vs non-Hispanic white participants (sleep: OR, 1.24; 95% CI, 1.01-1.52; guilt: 1.84; 95% CI, 1.31-2.59). Among those with clinically significant depressive symptoms (ie, PHQ-8 score ≥10) and/or those with diagnosed depression, black participants were 61% less likely to report any treatment (ie, medications and/or counseling) than non-Hispanic white participants after adjusting for confounders (adjusted OR, 0.39; 95% CI, 0.27-0.56). Conclusions and Relevance In this cross-sectional study, significant racial and ethnic differences in late-life depression severity, item-level symptom burden, and depression care were observed after adjustment for numerous confounders. These findings suggest a need for further examination of novel patient-level and clinician-level factors underlying these associations.
Collapse
Affiliation(s)
- Chirag M. Vyas
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - David Mischoulon
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Grace Chang
- Department of Psychiatry, VA Boston Healthcare System, Brockton, MA, USA
| | - Heike Gibson
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Nancy R. Cook
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - JoAnn E. Manson
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Charles F. Reynolds
- Department of Psychiatry, UPMC and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Olivia I. Okereke
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
18
|
Bazinet RP, Metherel AH, Chen CT, Shaikh SR, Nadjar A, Joffre C, Layé S. Brain eicosapentaenoic acid metabolism as a lead for novel therapeutics in major depression. Brain Behav Immun 2020; 85:21-28. [PMID: 31278982 DOI: 10.1016/j.bbi.2019.07.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/26/2019] [Accepted: 07/02/2019] [Indexed: 12/12/2022] Open
Abstract
The results of several meta-analyses suggest that eicosapentaenoic acid (EPA) supplementation is therapeutic in managing the symptoms of major depression. It was previously assumed that because EPA is extremely low in the brain it did not cross the blood-brain barrier and any therapeutic effects it exerted would be via the periphery. However, more recent studies have established that EPA does enter the brain, but is rapidly metabolised following entry. While EPA does not accumulate within the brain, it is present in microglia and homeostatic mechanisms may regulate its esterification to phospholipids that serve important roles in cell signaling. Furthermore, a variety of signaling molecules from EPA have been described in the periphery and they have the potential to exert effects within the brain. If EPA is confirmed to be therapeutic in major depression as a result of adequately powered randomized clinical trials, future research on brain EPA metabolism could lead to the discovery of novel targets for treating or preventing major depression.
Collapse
Affiliation(s)
- Richard P Bazinet
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada.
| | - Adam H Metherel
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Chuck T Chen
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, North Bethesda, MD 20852, United States
| | - Saame Raza Shaikh
- Department of Nutrition, Gillings School of Global Public Health & School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States
| | - Agnes Nadjar
- INRA, Nutrition et Neurobiologie Intégrée, UMR 1286, 33076 Bordeaux, France; Université de Bordeaux 2, 146 rue Léo Saignat, 33076 Bordeaux Cedex, France
| | - Corinne Joffre
- INRA, Nutrition et Neurobiologie Intégrée, UMR 1286, 33076 Bordeaux, France; Université de Bordeaux 2, 146 rue Léo Saignat, 33076 Bordeaux Cedex, France
| | - Sophie Layé
- INRA, Nutrition et Neurobiologie Intégrée, UMR 1286, 33076 Bordeaux, France; Université de Bordeaux 2, 146 rue Léo Saignat, 33076 Bordeaux Cedex, France
| |
Collapse
|
19
|
Mischoulon D, I Okereke O, Chang G. Commentary On: Serum 25-Hydroxyvitamin D Levels and Depression in Older Adults a Dose-Response Meta-analysis of Orospective Cohort Studies. Am J Geriatr Psychiatry 2019; 27:1203-1205. [PMID: 31327633 DOI: 10.1016/j.jagp.2019.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 06/18/2019] [Indexed: 10/26/2022]
Affiliation(s)
- David Mischoulon
- Depression Clinical and Research Program, Department of Psychiatry (DM), Massachusetts General Hospital, Boston, MA; Department of Psychiatry (DM), Harvard Medical School, Boston, MA.
| | - Olivia I Okereke
- Department of Psychiatry (OIO), Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Grace Chang
- VA Boston Healthcare System (GC), Brockton, MA; Harvard Medical School (GC), Boston, MA
| |
Collapse
|
20
|
Li H, Sun D, Wang A, Pan H, Feng W, Ng CH, Ungvari GS, Tao L, Li X, Wang W, Xiang YT, Guo X. Serum 25-Hydroxyvitamin D Levels and Depression in Older Adults: A Dose-Response Meta-Analysis of Prospective Cohort Studies. Am J Geriatr Psychiatry 2019; 27:1192-1202. [PMID: 31262683 DOI: 10.1016/j.jagp.2019.05.022] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/29/2019] [Accepted: 05/29/2019] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The association between serum vitamin D and risk of depression in older adults is controversial. We performed a dose-response meta-analysis of prospective cohort studies to examine the association between serum 25-hydroxyvitamin D [25(OH)D] concentrations and the risk of depression in older population. METHODS Studies published before February 2018 in the PubMed, Cochrane Library, Web of Science, PsycINFO, and EMBASE databases were systematically searched. Prospective cohort studies that examined the association between serum 25(OH)D levels and the risk of depression in older adults were included. A random-effects model was used to calculate the pooled hazard ratio and the corresponding 95% confidence intervals. A nonlinear dose-response association was examined using restricted cubic spline functions. RESULTS Six prospective studies covering 16,287 older adults with 1,157 cases of depression were included and analyzed. The pooled hazard ratio of depression for per 10-ng/mL increment in serum 25(OH)D was 0.88 (95% confidence intervals: 0.78-0.99, I2 = 79.0%, p <0.001 for heterogeneity). A linear dose-response association between serum 25(OH)D concentrations and incident depression was observed (p = 0.96 for nonlinearity). CONCLUSION Serum 25(OH)D concentration is negatively associated with the risk of depression in older adults. This meta-analysis suggests that increasing 25(OH)D levels may be a useful approach to reduce the risk of depression in older adults and highlights the need for further large-scale clinical studies.
Collapse
Affiliation(s)
- Haibin Li
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Dianqin Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Anxin Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Huiying Pan
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Wei Feng
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Gabor S Ungvari
- University of Notre Dame Australia, Fremantle, Australia; Division of Psychiatry, Medical School, University of Western Australia, Perth, Australia
| | - Lixin Tao
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Xia Li
- Department of Mathematics and Statistics, La Trobe University, Melbourne, Victoria, Australia
| | - Wei Wang
- Global Health and Genomics, School of Medical Sciences and Health, Edith Cowan University, Perth, Australia
| | - Yu-Tao Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China.
| | - Xiuhua Guo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China.
| |
Collapse
|
21
|
de Koning EJ, Lips P, Penninx BWJH, Elders PJM, Heijboer AC, den Heijer M, Bet PM, van Marwijk HWJ, van Schoor NM. Vitamin D supplementation for the prevention of depression and poor physical function in older persons: the D-Vitaal study, a randomized clinical trial. Am J Clin Nutr 2019; 110:1119-1130. [PMID: 31340012 PMCID: PMC6821546 DOI: 10.1093/ajcn/nqz141] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 06/14/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Depressive symptoms and impaired physical functioning are prevalent among older adults. Supplementation with vitamin D might improve both conditions, particularly in persons with low vitamin D status. OBJECTIVE The D-Vitaal study primarily aimed to investigate the effect of vitamin D supplementation on depressive symptoms, functional limitations, and physical performance in a high-risk older population with low vitamin D status. Secondary aims included examining the effect of vitamin D supplementation on anxiety symptoms, cognitive functioning, mobility, handgrip strength, and health-related quality of life. METHODS This study was a randomized placebo-controlled trial with 155 participants aged 60-80 y who had clinically relevant depressive symptoms, ≥1 functional limitations, and serum 25-hydroxyvitamin D [25(OH)D] concentrations of 15-50/70 nmol/L (depending on season). Participants received 1200 IU/d vitamin D3 (n = 77) or placebo tablets (n = 78) for 12 mo. Serum 25(OH)D was measured at baseline and 6 mo; outcomes were assessed at baseline, 6 mo, and 12 mo. Linear mixed-models analyses were conducted to assess the effect of the intervention. RESULTS The supplementation increased serum 25(OH)D concentrations in the intervention group to a mean ± SD of 85 ± 16 nmol/L compared with 43 ± 18 nmol/L in the placebo group after 6 mo (P < 0.001). No relevant differences between the treatment groups were observed regarding depressive symptoms, functional limitations, physical performance, or any of the secondary outcomes. CONCLUSIONS Supplementation with 1200 IU/d vitamin D for 12 mo had no effect on depressive symptoms and physical functioning in older persons with relatively low vitamin D status, clinically relevant depressive symptoms, and poor physical functioning. This trial is registered with the Netherlands Trial Register (www.trialregister.nl) under NTR3845.
Collapse
Affiliation(s)
- Elisa J de Koning
- Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands,Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Paul Lips
- Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands,Department of Internal Medicine, Endocrine Section, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Brenda W J H Penninx
- Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands,Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Petra J M Elders
- Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands,Department of General Practice and Elderly Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Annemieke C Heijboer
- Department of Clinical Chemistry, Endocrine Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Martin den Heijer
- Department of Internal Medicine, Endocrine Section, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Pierre M Bet
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Harm W J van Marwijk
- Department of General Practice and Elderly Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands,Division of Primary Care and Public Health, Brighton and Sussex Medical School, University of Brighton, Falmer, Brighton, United Kingdom
| | - Natasja M van Schoor
- Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands,Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands,Address correspondence to NMvS (E-mail: )
| |
Collapse
|
22
|
Fashanu OE, Zhao D, Schneider ALC, Rawlings AM, Sharrett AR, Lutsey PL, Gottesman RF, Gross AL, Guallar E, Alonso A, Mosley TH, Michos ED. Mid-life serum Vitamin D concentrations were associated with incident dementia but not late-life neuropsychological performance in the Atherosclerosis Risk in Communities (ARIC) Study. BMC Neurol 2019; 19:244. [PMID: 31640594 PMCID: PMC6805504 DOI: 10.1186/s12883-019-1483-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 10/09/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Activated Vitamin D has anti-inflammatory properties and adequate 25-hydroxyvitamin D [25(OH)D] concentrations may be important for neurocognitive function and protection against neurologic injury. We examined whether mid-life 25(OH) D concentrations were associated with later-life performance on neuropsychological testing, functional ability, depressive symptoms, and incident dementia. METHODS We studied 13,039 white and black ARIC participants who had serum 25(OH) D measured mid-life at visit 2 (1990-1992). Over the next ~ 20 years through visit 5 (2011-2013), participants underwent 3 additional in-person visits, annual telephone calls, and hospitalization surveillance. An extensive battery of neuropsychological outcomes were assessed at visit 5 using standardized protocols. Incident dementia was ascertained through a formal algorithm that included data from in-person cognitive testing, telephone interviews, hospital discharge codes, and death certificate codes. Diagnoses of dementia were adjudicated by expert clinician committee. For the primary cognitive analyses, we imputed for missing covariates and outcomes and used linear regression to evaluate non-concurrent cross-sectional associations of mid-life 25(OH) D (visit 2) with late-life neuropsychological outcomes (visit 5). We also used Cox regression models to examine associations of mid-life 25(OH) D and incident dementia. RESULTS In mid-life, the mean (SD) age of participants was 57 (6) years, 57% were women, and 24% black. Mean (SD) 25(OH) D was 24.3 (8.6) ng/mL; 33% had deficient (< 20 ng/mL), 44% intermediate (20- < 30 ng/mL), and 23% sufficient (≥30 ng/mL) 25(OH) D concentrations. Association between mid-life 25(OH) D and late-life performance on neuropsychological testing were mostly null. There was no significant association with functional ability or depressive symptoms. Results were similar in a sensitivity analysis using complete-case data (no imputation). However, after a median follow-up of 20 years, low 25(OH) D concentrations were associated with increased risk for incident dementia (p = 0.01 for trend across categories), with HR of 1.26 (95% CI 1.06, 1.49) for participants with deficient 25(OH) D, compared to sufficient concentrations. CONCLUSION In this community cohort, mid-life serum 25(OH) D concentrations were associated with incident dementia but not with performance on neuropsychological testing, functional ability, or depressive symptoms, 20 years later. Whether serum 25(OH) D concentrations are causally related to dementia or confounded by poorer health status remains uncertain. TRIAL REGISTRATION Registered on clinicaltrials.gov NCT00005131 .
Collapse
Affiliation(s)
- Oluwaseun E Fashanu
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Blalock 524-B, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
- Department of Medicine, Saint Agnes Hospital, Baltimore, MD, USA
| | - Di Zhao
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Blalock 524-B, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrea L C Schneider
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andreea M Rawlings
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- The School of Biological and Population Health Sciences, Oregon State University, Corvallis, OR, USA
| | - A Richey Sharrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Rebecca F Gottesman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center on Aging and Health, Johns Hopkins University, Baltimore, MD, USA
| | - Eliseo Guallar
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Blalock 524-B, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Thomas H Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Blalock 524-B, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| |
Collapse
|
23
|
A role for vitamin D and omega-3 fatty acids in major depression? An exploration using genomics. Transl Psychiatry 2019; 9:219. [PMID: 31488809 PMCID: PMC6728377 DOI: 10.1038/s41398-019-0554-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/21/2019] [Accepted: 06/20/2019] [Indexed: 01/08/2023] Open
Abstract
Trials testing the effect of vitamin D or omega-3 polyunsaturated fatty acid (n3-PUFA) supplementation on major depressive disorder (MDD) reported conflicting findings. These trials were inspired by epidemiological evidence suggesting an inverse association of circulating 25-hydroxyvitamin D (25-OH-D) and n3-PUFA levels with MDD. Observational associations may emerge from unresolved confounding, shared genetic risk, or direct causal relationships. We explored the nature of these associations exploiting data and statistical tools from genomics. Results from genome-wide association studies on 25-OH-D (N = 79 366), n3-PUFA (N = 24 925), and MDD (135 458 cases, 344 901 controls) were applied to individual-level data (>2000 subjects with measures of genotype, DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition) lifetime MDD diagnoses and circulating 25-OH-D and n3-PUFA) and summary-level data analyses. Shared genetic risk between traits was tested by polygenic risk scores (PRS). Two-sample Mendelian Randomization (2SMR) analyses tested the potential bidirectional causality between traits. In individual-level data analyses, PRS were associated with the phenotype of the same trait (PRS 25-OH-D p = 1.4e - 20, PRS n3-PUFA p = 9.3e - 6, PRS MDD p = 1.4e - 4), but not with the other phenotypes, suggesting a lack of shared genetic effects. In summary-level data analyses, 2SMR analyses provided no evidence of a causal role on MDD of 25-OH-D (p = 0.50) or n3-PUFA (p = 0.16), or for a causal role of MDD on 25-OH-D (p = 0.25) or n3-PUFA (p = 0.66). Applying genomics tools indicated that shared genetic risk or direct causality between 25-OH-D, n3-PUFA, and MDD is unlikely: unresolved confounding may explain the associations reported in observational studies. These findings represent a cautionary tale for testing supplementation of these compounds in preventing or treating MDD.
Collapse
|
24
|
Pilot study of DNA methylation, molecular aging markers and measures of health and well-being in aging. Transl Psychiatry 2019; 9:118. [PMID: 30886137 PMCID: PMC6423054 DOI: 10.1038/s41398-019-0446-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/07/2019] [Accepted: 02/16/2019] [Indexed: 12/18/2022] Open
Abstract
Relations of DNA methylation markers to other biological aging markers and to psychosocial, behavioral, and health measures remain unclear. The sample included 23 participants (n = 11 cases with psychiatric diagnoses and n = 12 controls without current or lifetime psychiatric disorder), balanced by age and sex. Genomic DNA was extracted from blood samples; the following were performed: genome-wide DNA methylation assay using Illumina 850k methylationEPIC; PCR assays for relative telomere length (RTL) and mitochondrial DNA copy number (mtCN). Exposures were: case status; depression and anxiety symptoms; psychosocial support; subjective and objective cognition. Outcomes were: DNA methylation age (DNAm age); RTL; mtCN; extrinsic and intrinsic epigenetic age acceleration (EEAA and IEAA). Stronger correlation with chronological age was observed for DNAm age (ρ = 0.86; p < 0.0001) compared to RTL (ρ = -0.53; p < 0.01); mtCN was not correlated with age. DNAm age was more strongly correlated with behavioral and health variables than RTL or mtCN; e.g., correlations with DNAm age: body mass index (ρ = 0.36; p = 0.10); smoking pack-years (ρ = 0.37; p = 0.08); physical activity (ρ = -0.56; p = 0.01); alcohol intake (ρ = 0.56; p = 0.01). DNAm age was inversely correlated with psychosocial support (ρ = -0.42; p = 0.048) and Modified Mini-Mental State score (ρ = -0.44; p = 0.01). Anxiety, psychosocial support, and objective cognition were significantly related to accelerated aging; depression and subjective cognition were not. In conclusion, DNAm age correlated more strongly with chronological age and key psychosocial, behavioral, and health variables than RTL or mtCN. Signals for associations with epigenetic aging were observed for psychosocial and neurobehavioral variables.
Collapse
|
25
|
Michaëlsson K, Melhus H, Larsson SC. Serum 25-Hydroxyvitamin D Concentrations and Major Depression: A Mendelian Randomization Study. Nutrients 2018; 10:nu10121987. [PMID: 30558284 PMCID: PMC6316636 DOI: 10.3390/nu10121987] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 12/13/2018] [Accepted: 12/14/2018] [Indexed: 11/16/2022] Open
Abstract
Whether vitamin D insufficiency is a contributing cause of depression remains unclear. We assessed whether serum 25-hydroxyvitamin D (S-25OHD) concentrations, the clinical marker of vitamin D status, were associated with major depression using Mendelian randomization. We used summary statistics data for six single-nucleotide polymorphisms significantly associated with S-25OHD concentrations in the Study of Underlying Genetic Determinants of Vitamin D and Highly Related Traits (SUNLIGHT) consortium and the corresponding data for major depression (n = 59,851 cases and 113,154 controls) from the Psychiatric Genomics Consortium. Genetically predicted S-25OHD concentrations were not associated with major depression. The odds ratio per genetically predicted one standard deviation decrease in S-25OHD concentrations was 1.02 (95% confidence interval 0.97⁻1.08; p = 0.44). The results of this study indicate that genetically lowered S-25OHD concentrations are not associated with increased risk of developing major depression.
Collapse
Affiliation(s)
- Karl Michaëlsson
- Department of Surgical Sciences, Uppsala University, SE-751 85 Uppsala, Sweden.
| | - Håkan Melhus
- Department of Medical Sciences, Uppsala University, SE-751 85 Uppsala, Sweden.
| | - Susanna C Larsson
- Department of Surgical Sciences, Uppsala University, SE-751 85 Uppsala, Sweden.
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
| |
Collapse
|
26
|
Cattelani L, Murri MB, Chesani F, Chiari L, Bandinelli S, Palumbo P. Risk Prediction Model for Late Life Depression: Development and Validation on Three Large European Datasets. IEEE J Biomed Health Inform 2018; 23:2196-2204. [PMID: 30507519 DOI: 10.1109/jbhi.2018.2884079] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Assessing the risk to develop a specific disease is the first step towards prevention, both at individual and population levels. The development and validation of risk prediction models (RPMs) is the norm within different fields of medicine but still underused in psychiatry, despite the global impact of mental disorders. In particular, there is a lack of RPMs to assess the risk of developing depression, the first worldwide cause of disability and harbinger of functional decline in old age. We present the depression risk assessment tool DRAT-up, the first prospective RPM to identify late-life depression among community-dwelling subjects aged 60-75. The development of DRAT-up was based on appraisal of relevant literature, extraction of robust risk estimates, and integration into model parameters. A unique feature is the ability to estimate risk even in the presence of missing values. To assess the properties of DRAT-up, a validation study was conducted on three European cohorts, namely, the English Longitudinal Study of Ageing, the Invecchiare nel Chianti, and the Irish Longitudinal Study on Ageing, with 20 206, 1359, and 3124 eligible samples, respectively. The model yielded accurate risk estimation in the three datasets from a small number of predictors. The Brier scores were 0.054, 0.133, and 0.041, respectively, while the values of area under the curve (AUC) were 0.761, 0.736, and 0.768, respectively. Sensitivity analyses suggest robustness to missing values: setting any individual feature to unknown caused the Brier scores to increase by 0.004 and the AUCs to decrease by 0.045 in the worst cases. DRAT-up can be readily used for clinical purposes and to aid policy-making in the field of mental health.
Collapse
|
27
|
Okereke OI. The Challenging Task of Addressing the Role of Vitamin D in Late-life Depression: Considerations of Measures, Confounders, Mediators, and Moderators. Am J Geriatr Psychiatry 2018; 26:1144-1146. [PMID: 30270131 PMCID: PMC6712573 DOI: 10.1016/j.jagp.2018.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 08/23/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Olivia I. Okereke
- Harvard T.H. Chan School of Public Health, 677 Huntington
Ave, Boston, MA 02115, USA,Channing Division of Network Medicine, Department of
Medicine, Brigham and Women’s Hospital and Harvard Medical School, 181
Longwood Avenue, Boston, MA, 02115, USA,Department of Psychiatry, Massachusetts General Hospital
and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| |
Collapse
|
28
|
Trump DL. Calcitriol and cancer therapy: A missed opportunity. Bone Rep 2018; 9:110-119. [PMID: 30591928 PMCID: PMC6303233 DOI: 10.1016/j.bonr.2018.06.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 05/07/2018] [Accepted: 06/05/2018] [Indexed: 12/31/2022] Open
Abstract
The vitamin D receptor is expressed in most tissues of the body - and the cancers that arise from those tissues. The vitamin D signaling pathway is active in those tissues and cancers. This is at least consistent with the hypothesis that perturbing this signaling may have a favorable effect on the genesis and growth of cancers. Epidemiologic data indicate that vitamin D signaling may be important in the initiation and outcome of a number of types of cancer. Many studies have shown that calcitriol (1,25 dihydroxycholecalciferol) and other vitamin D compounds have antiproliferative, pro-apoptotic, anti-cell migration and antiangiogenic activity in a number of preclinical studies in many different cancer types. Unfortunately, the assessment of the activity of calcitriol or other vitamin D analogues in the treatment of cancer, as single agents or in combination with other anticancer agents has been stymied by the failure to adhere to commonly accepted principles of drug development and clinical trials conduct.
Collapse
Affiliation(s)
- Donald L Trump
- Inova Schar Cancer Institute, Inova Health System, Fairfax, VA 22037, United States of America
| |
Collapse
|
29
|
Abstract
Depression remains difficult to manage, despite the many registered treatments available. For many depressed individuals, particularly those who have not responded to and/or had adverse effects from standard therapies, herbal and natural medications represent a potentially valuable alternative. This chapter will review several natural remedies used in the treatment of depression. Specific remedies covered include St. John's wort (SJW), S-adenosyl-L-methionine (SAMe), omega-3 fatty acids, rhodiola, and others. We will begin by providing some historical and social context about these remedies. Then we will review efficacy and safety data, as well as biological mechanisms of action of these therapies. Finally, we will discuss the limitations of the current state of knowledge and provide suggestions for a productive research agenda focused on natural remedies. While many questions about these treatments remain unanswered and much work needs to be done before we determine their place in the psychiatric armamentarium, we believe that this chapter will give psychiatrists a good perspective on the pros and cons of herbal and natural antidepressants as part of the pharmacological armamentarium and sensible guidelines on how and when they should be used.
Collapse
|