Association of metabolic syndrome with depression and anxiety in Japanese men

The Metabolic Syndrome, a Human Disease

This review focuses on the question of metabolic syndrome (MS) being a complex, but essentially monophyletic, galaxy of associated diseases/disorders, or just a syndrome of related but rather independent pathologies. The human nature of MS (its exceptionality in Nature and its close interdependence with human action and evolution) is presented and discussed. The text also describes the close interdependence of its components, with special emphasis on the description of their interrelations (including their syndromic development and recruitment), as well as their consequences upon energy handling and partition. The main theories on MS's origin and development are presented in relation to hepatic steatosis, type 2 diabetes, and obesity, but encompass most of the MS components described so far. The differential effects of sex and its biological consequences are considered under the light of human social needs and evolution, which are also directly related to MS epidemiology, severity, and relations with senescence. The triggering and maintenance factors of MS are discussed, with especial emphasis on inflammation, a complex process affecting different levels of organization and which is a critical element for MS development. Inflammation is also related to the operation of connective tissue (including the adipose organ) and the widely studied and acknowledged influence of diet. The role of diet composition, including the transcendence of the anaplerotic maintenance of the Krebs cycle from dietary amino acid supply (and its timing), is developed in the context of testosterone and β-estradiol control of the insulin-glycaemia hepatic core system of carbohydrate-triacylglycerol energy handling. The high probability of MS acting as a unique complex biological control system (essentially monophyletic) is presented, together with additional perspectives/considerations on the treatment of this 'very' human disease.

Metabolic syndrome and depression: evidence from a cross-sectional study of real-world data in Japan

BACKGROUND

Both metabolic syndrome (MetS) and depression are high priority health problems, especially for working age. Numerous studies have explored the link between metabolic syndrome and depression; however, not all of them have consistently demonstrated an association. The objective of this study was to determine whether there is an association between MetS and depression by analyzing extensive real-world data (RWD).

METHODS

Our data was drawn from insurance claims and health checkups of local government officials across all prefectures in Japan except for Tokyo in the 2019 fiscal year. According to the number of months with diagnosis of depression and prescription of antidepressants, the study participants were classified into the following categories: Certainly not Depression (CN), Possibly not Depression (PN), Possible Depression (PD), and Certain Depression (CD). Associations between MetS and its components-visceral obesity, hypertension, hyperlipidemia, and diabetes- and these categories of depression were analyzed by logistic regression.

RESULTS

The depression categories of the 130,059 participants were as follows: CN 85.2%; PN 6.9%; PD 3.9%; and CD 4.1%. For men, the adjusted odds ratio (AOR) for MetS were PN 0.94 (95% CI: 0.86-1.02), PD 1.31 (1.19-1.43), and CD 1.63 (1.50-1.76), with reference to CN. For women, AOR of MetS were PN 1.10 (0.91-1.32), PD 1.54 (1.24-1.91), and CD 2.24 (1.81-2.78). Among the MetS components, visceral obesity, hyperlipidemia, and diabetes were significantly associated with depression categories.

CONCLUSIONS

In this study, we found a significant association between MetS and depression, this association being similar to that previously reported. Our findings provide robust evidence for linkage between MetS and depression, suggesting that analysis of RWD is useful for providing concrete evidence.

A review on linking stress, depression, and insulin resistance via low-grade chronic inflammation

Stress is a disturbance in homeostasis caused by psychological, physiological, or environmental factors. Prolonged reactions to chronic stress can be detrimental, resulting in various metabolic abnormalities, referred to as metabolic syndrome (MS). There is a reciprocal increased risk between MS and major depressive disorder. Recent studies established an association between inflammation and insulin signaling in type 2 diabetes mellitus with depression. In the present review, we discuss chronic low-grade inflammation, pathways of insulin resistance, and brain glucose metabolism in the context of neuroinflammation and depression. Specific attention is given to psychotropic drugs such as bupropion, mirtazapine, and nefazodone, anti-inflammatory drugs like Celecoxib (COX-2 inhibitor), Etanercept, adalimumab, IL-4Ra antagonist, Anti-IL- 17A antibody (Ixekizumab) and lifestyle modifications including exercise, dietary changes, and sleep hygiene. These therapeutic solutions offer potential in treating depression by targeting metabolic conditions like insulin resistance and inflammatory pathways. The article further explains the significance of a nutrition and antioxidants-rich diet, emphasizing the role of omega-3 fatty acids, vitamin D, zinc, and polyphenols, to improve immunity and activate anti-inflammatory signaling pathways.

Metabolic syndrome among young adults at high and low familial risk for depression

BACKGROUND

Our study examined whether the early-onset depression phenotype among young adults (probands) is associated with the metabolic syndrome (MetS) and its components, and if MetS characterizes unaffected but high-risk siblings of probands.

METHODS

We studied three groups of young adults (Mage = 25 years, s.d. = 3.84 years): probands with histories of childhood onset depression - i.e. early-onset phenotype - (n = 293), their unaffected siblings (high-risk siblings, n = 273), and healthy controls (n = 171). Participants completed a full psychiatric interview, physical and laboratory assessments, and self-rating scales. MetS was defined using the criteria of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults ().

RESULTS

Early-onset depression phenotype and being a high-risk sibling were associated with higher MetS composite scores relative to that of controls, but did not differ from one another. With regard to MetS components: Probands and siblings had similarly larger waist circumference and lower HDL than did controls, while siblings and controls had lower triglyceride levels than did probands but did not differ from one another. Groups did not differ on glucose levels and SBP.

CONCLUSIONS

Our study extends the literature on the association between MetS and depression and underscores the importance of depression phenotypes: failure to account for the clinical heterogeneity of depression may partly underlie the inconsistent findings regarding its relation to MetS. The results also suggest that, in depression-prone populations, MetS may predate and possibly function as a risk factor for eventual depression.

Does Better Diet Quality Offset the Association between Depression and Metabolic Syndrome?

Several studies have shown that depression increases the risk of metabolic syndrome (MetS), which is often exacerbated by the fact that both exist concurrently. People with depression are more likely to have unhealthy eating habits, which can eventually trigger the development of MetS. This study was to investigate whether diet quality modifies the association between depression and MetS in a total of 13,539 Korean adults aged 19 to 80 from 2014, 2016 and 2018 Korean National Health and Nutrition Examination Surveys. Depression was assessed by the Patient Health Questionnaire-9 (PHQ-9) and subjects were divided into subgroups according to the PHQ-9 scores: normal (<5), mild (5-9), and moderate-to-severe (≥10) groups. Diet quality was measured by the Korean Healthy Eating Index (KHEI). A complex sample multiple logistic regression stratified by tertiles of KHEI scores was used to explore whether diet quality modifies an association between depression severity and metabolic syndrome. Depression severity was positively associated with the risk of MetS (p trend = 0.006) after adjustment for potential confounders. Only the lowest diet quality, moderately-to-severely depressed group, showed a higher risk of MetS (OR: 1.72, 95% CI: 1.24-2.40) compared to the normal group. Our results suggest that healthy diet quality could offset the positive relationship between depression and MetS in the general Korean adult population. Encouraging a healthy diet regime can improve not only physical health but also the mental state of the general public.

Association between anxiety and metabolic syndrome: An updated systematic review and meta-analysis

Objective

Previous studies have demonstrated an association between anxiety and metabolic syndrome (MetS). However, the association is still controversial. This updated meta-analysis aimed to reanalyze the association between anxiety and MetS.

Methods

We comprehensively searched PubMed, Embase and Web of Science for all related studies published before January 23, 2023. Observational studies that informed effect size with 95% confidence interval (CI) for the association between anxiety and MetS were included. According to heterogeneity between studies, fixed or random effects models were applied to calculate the pooled effect size. Publication bias was examined by funnel plots.

Results

The research included 24 cross-sectional studies: 20 studies used MetS as the dependent variable with a pooled OR of 1.07 (95% CI: 1.01-1.13) and four studies used anxiety as the dependent variable with a pooled OR of 1.14 (95% CI: 1.07-1.23). Three cohort studies were found: two studies detected the association of baseline anxiety with the risk of MetS, one of the studies demonstrated a significant association, but a similar result was not found in another study; one study showed no significant association between baseline MetS and the risk of anxiety.

Conclusion

Cross-sectional studies indicated an association between anxiety and MetS. The results from cohort studies are still inconsistent and limited. More large-scale prospective studies are needed to further reveal the causal relationship of anxiety with MetS.

The association of depression with metabolic syndrome parameters and malondialdehyde (MDA) in obese women: A case-control study

Background: There is evidence for a bidirectional association between obesity and depression, and obesity is the main risk factor for metabolic syndrome (MetS). This study aimed to compare oxidative stress and MetS features between depressed and non-depressed obese women and study the association of depressive symptoms, oxidative stress, and components of MetS.

Methods: In this case-control study conducted in Tabriz (East Azarbaijan, Iran), obese women (body mass index [BMI]: 30-40 kg/m² ) with a primary diagnosis of major depressive disorder (MDD; based on diagnostic interview with a psychiatrist; n=75) and their age-matched non-depressed controls (n=150) were enrolled. Beck Depression Inventory-version II (BDI-II) was used to assess depressive symptoms in both groups. Anthropometric parameters, blood pressure, fasting blood sugar (FBS), lipid profile and malondialdehyde (MDA) were measured.

Results: No significant differences in anthropometric parameters and blood pressure were observed between the two groups. However, FBS of the MDD group was significantly higher than the control (P <0.05). FBS was significantly correlated with BDI-II scores (r=0.158, P =0.017). No significant difference in lipid profile was observed between the groups. Serum MDA level was significantly lower in the MDD group and was inversely associated with BDI-II scores (r=-0.328, P <0.001). Overall, MDD was not significantly associated with MetS in our study (OR=0.848, 95% CI: 0.484, 1.487; P =0.566).

Conclusion: Although we found a correlation between higher depressive symptoms and some adverse metabolic outcomes, our findings do not support a significant association between MDD and MetS.

Are dentists more prone to metabolic syndrome and occupational stress?

OBJECTIVE

The aim of this study was to investigate the prevalence of metabolic syndrome (MS) among dentists in Riyadh, Saudi Arabia. The study also explored the causes of occupational stress among the participating dentists.

MATERIALS & METHODS

The participants included a conveniently selected sample of dentists (N = 126; Males = 65; Females = 61). The participants' anthropometric measurements/blood sample analysis were carried out and they completed a self-administered questionnaire. Data analysis included demographics, gender/age wise comparison using SPSS (p < 0.05). For the diagnosis of MS, updated criteria of the National Cholesterol Education Program was applied.

RESULTS

Participants diagnosed with MS were 13 (10.3%), Males = 11(8.7%) and Females = 2(1.5%). Physical activity of 6 (15.8%) with MS was only 0-2 hours/week. 9 (14.5%) participants with MS declared positive family history for MS. The average systolic (117.55±11.33) and diastolic blood pressure (71.9±9.34) of the participants was found to be normal with no gender wise statistical difference. No gender wise statistical differences (p > 0.05) were observed for cholesterol, triglycerides and HDL. However, significant difference (p = 0.00) was found for the fasting glucose level (Males = 5.69±1.49; Females = 4.94±0.42). Overall mean scoring (3.00±1.11) for the stress showed that the participants fall into the average/moderate level of stress category (Males = 3.16±1.02; Females = 2.83±1.08). Almost two third (68.26%) of the participant's responded that they were under some kind of stress.

CONCLUSIONS

MS was found to be less frequent among the dentists working in the city of Riyadh. Overall, the dentists were under moderate level of occupational stress, with male dentists being more prone to work related stress.

Non-Alcoholic Fatty Liver Disease (NAFLD) and Potential Links to Depression, Anxiety, and Chronic Stress

Non-alcoholic fatty liver disease (NAFLD) constitutes the most common liver disease worldwide, and is frequently linked to the metabolic syndrome. The latter represents a clustering of related cardio-metabolic components, which are often observed in patients with NAFLD and increase the risk of cardiovascular disease. Furthermore, growing evidence suggests a positive association between metabolic syndrome and certain mental health problems (e.g., depression, anxiety, and chronic stress). Given the strong overlap between metabolic syndrome and NAFLD, and the common underlying mechanisms that link the two conditions, it is probable that potentially bidirectional associations are also present between NAFLD and mental health comorbidity. The identification of such links is worthy of further investigation, as this can inform more targeted interventions for patients with NAFLD. Therefore, the present review discusses published evidence in relation to associations of depression, anxiety, stress, and impaired health-related quality of life with NAFLD and metabolic syndrome. Attention is also drawn to the complex nature of affective disorders and potential overlapping symptoms between such conditions and NAFLD, while a focus is also placed on the postulated mechanisms mediating associations between mental health and both NAFLD and metabolic syndrome. Relevant gaps/weaknesses of the available literature are also highlighted, together with future research directions that need to be further explored.

Emotional states of different obesity phenotypes: a sex-specific study in a west-Asian population

BACKGROUND

The present study aimed to investigate the associations of obesity phenotypes with depression, anxiety, and stress symptoms among adults in the Tehran Lipid and Glucose Study (TLGS).

METHODS

Depression, anxiety, and stress levels of participants from the TLGS were examined among different obesity phenotypes in this cross-sectional study. Obesity was defined as body mass index (BMI) ≥30 kg/m², and metabolically unhealthy status based on having metabolic syndrome (MetS) or type 2 diabetes. Four obesity phenotypes were defined: 1) Metabolically Healthy Non-Obese (MHNO), 2) Metabolically Healthy Obese (MHO) 3) Metabolically Unhealthy Non-Obese (MUNO), and 4) Metabolically Unhealthy Obese (MUO). Emotional states of different obesity phenotypes were assessed by the Persian version of depression, anxiety, and stress scale-21 items (DASS-21). Ordinal logistic regression analysis was used to compare sex-specific odds ratios of depression, anxiety, and stress in different obesity phenotypes.

RESULTS

The mean age of 2469 men and women was 46.2 ± 15.9 and 45.6 ± 14.7, respectively. In total, women were more likely to experience higher levels of depression (30.5%), anxiety (44.2%), and stress (43.5%) symptoms compared to men. After adjusting for potential confounders, compared to MHNO men, the odds of experiencing higher anxiety levels were significantly greater in metabolically unhealthy men whether they were obese (OR: 1.78, 95% CI: 1.25-2.54; P = < 0.001) or non-obese (OR: 1.61, 95% CI: 1.17-2.21; P = < 0.001), and also in MUO women (OR: 1.73, 95% CI: 1.28-2.34; P = < 0.001) compared to MHNO women. Moreover, the odds of experiencing higher stress levels were significantly greater in MUNO men (OR: 1.40, 95% CI: 1.02-1.90; P = 0.04) compared to MHNO men and in MUO women (OR: 1.45, 95% CI: 1.07-1.96; P = 0.02) compared to MHNO women. No difference in depression levels was observed in either sex.

CONCLUSIONS

Our results showed that men and women with various obesity phenotypes experienced different anxiety and stress levels. While MUO women and all metabolically unhealthy men experienced more anxiety and stress levels than MHNO individuals, none of the obesity phenotypes were associated with depression. These findings provide insight into recognizing the psychological consequences of different phenotypes of obesity in both sexes and utilizing future health promotion planning.

The relationship between depression and risk of metabolic syndrome: a meta-analysis of observational studies

INTRODUCTION

The link between metabolic syndrome and depression has always been controversial. Different studies that have examined the relationship between metabolic syndrome and depression have reported different results. Therefore, the goal of the present study was to examine the association between depression and MetS by meta-analysis.

METHODS

Embase, Scopus, PubMed, and ISI were searched for publications in English from January 1990 to February 2020. Search included cohort and cross-sectional studies aimed at examining the association between depression and MetS. The risk of bias was assessed by Newcastle-Ottawa Scale. Heterogeneity and publication bias were tested, subgroup analysis and meta-regression were conducted.

RESULTS

49 studies with total sample size 399,494 were analyzed. Results indicated the odds of MetS was higher in depressed compared to non-depressed individuals [OR: 1.48; 95 %CI: 1.33-1.64) vs. (OR: 1.38; 95 %CI: 1.17-1.64)]. For cross-sectional studies, depressed patients in Europe (OR = 1.35; 95 %CI: 1.47-1.99) were at higher odds of MetS compared to those in America and Asia. For cohort studies, depressed patients in America (OR = 1.46; 95 %CI: 1.16-1.84) were at higher odds of MetS than those in Europe. Cross-sectional studies indicated women with depression were at higher odds of MetS (OR = 1.95; 95 %CI: 1.38-2.74) compared to men. In both types of studies, the odds of MetS decreased with age.

CONCLUSIONS

Metabolic syndrome is more common in depressed compared to non-depressed individuals.

Associations of Body Weight and Waist Circumference with Psychopathology, Substance Use, and Well-Being in an Adult Transdiagnostic Sample

BACKGROUND

Prior studies have established inconsistent associations between body weight and mental health. However, most work has relied on body mass index (BMI) and examination of a single mental health variable. The present study examined associations of BMI and waist circumference with multiple mental health variables in a transdiagnostic psychiatric sample.

METHODS

Nursing staff measured waist circumference and calculated the BMI of 742 adults (54.6% female, 45.4% male) presenting for psychiatric treatment. Participants completed the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), Behavior and Symptom Identification Scale (BASIS-24), and Mental Health Continuum-Short Form (MHC-SF) as part of standard clinical monitoring. Suicide risk was assessed using the clinician-administered Mini International Neuropsychiatric Interview (M.I.N.I.). For curve fit estimation regression models, we entered BMI and waist circumference as independent variables separately; we entered seven dependent variables separately: 1) depression, 2) anxiety, 3) substance use, 4) self-harm, 5) interpersonal functioning, 6) well-being, and 7) suicide risk.

RESULTS

Increased BMI was associated with decreased well-being and increased depression. Increased waist circumference was associated with worse interpersonal functioning. Non-linear (quadratic) associations were observed between weight and depression, substance use, self-harm, and suicide.

LIMITATIONS

Most of the sample was White and only 2.6% was in the underweight category, limiting broad applicability of findings. Cross-sectional design precludes causal attributions.

CONCLUSIONS

Given associations between well-being, depression, interpersonal functioning, substance use, self-harm, and suicide with weight, findings may be used to inform mental health treatment, particularly by tailoring interventions to high-risk weight categories (underweight, obese) in psychiatric populations.

Anxiety, Depression, and Common Chronic Diseases, and Their Association With Social Determinants in Saudi Primary Care

INTRODUCTION

Patients with chronic diseases can experience psychological conditions, including anxiety and depression. However, the association between chronic diseases and these psychological conditions remains unclear. This study aimed to identify the relationship between anxiety, depression, and common chronic diseases (hypertension, type 2 diabetes, dyslipidemia, and rheumatoid arthritis), and their association with social determinants at an outpatient primary care setting.

METHODS

The validated hospital anxiety and depression scale was administered electronically to eligible participants. For each condition (anxiety and depression), participants were categorized as normal, borderline abnormal, and abnormal, according to their score out of 21 (≤7 = normal, 8-10 = borderline abnormal, ≥11 = abnormal). The scores and numbers of participants in each category were analyzed and compared with their demographic characteristics and chronic diseases for associations and relationships.

RESULTS

We recruited 271 participants (mean age of 51.65 + 11.71 years) attending primary care clinics. Of these patients, 17.7% and 8.9% had borderline abnormal and abnormal depression, respectively, and 10.3% and 8.9% of patients had borderline abnormal anxiety and abnormal anxiety. Common social determinants and lifestyle factors were examined. Age, gender, and sugary drinks' consumption significantly increased the odds of hypertension and type 2 diabetes; vigorous physical activity 3 times a week, decreased the odds of developing these chronic diseases. Adjusted regression models showed a statistically significant association between the hospital anxiety and depression scale score for borderline and abnormal anxiety and the presence of type 2 diabetes (OR 3.04 [95% CI 1.13, 8.19], P-value = .03 and OR 4.65 [95% CI 1.63,13.22], P-value <.03, respectively) and dyslipidemia (OR 5.93 [95% CI 1.54, 22.86], P-value = .01, and OR 4.70 [95% CI 0.78, 28.35], P-value = .09, respectively). The odds of developing depression were 4 times higher (P-value .04) in patients with rheumatoid arthritis.

CONCLUSION

Among patients attending primary care outpatient clinics, anxiety, and depression were significantly associated with type 2 diabetes and rheumatoid arthritis, respectively. Social determinants and lifestyle factors play a major role in the development of common chronic diseases in Saudi Arabia. Primary care physicians should consider the patients' psychological status, sociodemographic status, and lifestyle risks during the management of chronic diseases.

Prevalence and Associated Factors of Anxiety and Depression Among Patients with Type 2 Diabetes in Kerman, Southern Iran

PURPOSE

Depression and anxiety are common disorders in patients suffering from type 2 diabetes. These disorders can lead to premature morbidity, exacerbate disease complications, make patients suffer more, and increase health-care costs. As diabetes has increased worldwide recently, it is necessary to reduce the prevalence of factors that are associated with depression and anxiety in diabetes patients. This study aimed to assess the prevalence of anxiety and depression and to identify their associated factors, including metabolic components among people with type 2 diabetes.

PATIENTS AND METHODS

We performed a cross-sectional study in 1500 patients with type 2 diabetes in Kerman, in the southern part of Iran. The prevalence of depression and anxiety was estimated using the Beck Depression Inventory and the Hamilton Anxiety questionnaires, respectively. After calculating the proportions of depression and anxiety, univariate logistic regression was performed. Factors whose P-values were smaller than 0.2 in univariate logistic regression were included in multiple logistic regression for confounder adjustments. The analysis was performed using SPSS version 20.

RESULTS

The rates of depression and anxiety were 59% (95% CI: 54.48-63.12) and 62% (95% CI: 59.51-66.27), respectively. Factors found to be independently associated with anxiety were high FBS, high LDL-C, high TG, hypertension, complications, low physical activity. Factors found to be independently associated with depression were female gender, older age, high BMI, high FBS, high LDL-C, low HDL-C, high TG, high HbA1c, hypertension, and low physical activity. Complications were independently associated with anxiety but not with depression. Female gender, older age, high BMI, low HDL-C, and high HbA1c were independently associated with depression but not with anxiety.

CONCLUSION

Current findings demonstrated that a large proportion of patients with type 2 diabetes suffer from depression and anxiety. This study also identified factors associated with these disorders. Controlling some metabolic variables will decrease the prevalence of these disorders and improves clinical remedy and quality of life in patients with type 2 diabetes.

Preventive Effects of Escitalopram Against Anxiety-Like Depressive Behaviors in Monosodium Glutamate-Teated Rats Subjected to Partial Hepatectomy

The reasons for the relationship between depression and chronic liver disease (CLD) are complex and multifactorial. Further research is needed to decipher the etiology and establish an optimal management approach for depression in patients, including the potential role of non-pharmacological treatments. monosodium glutamate (MSG)-treated rats are more likely to develop anxiogenic- and depressive-like behaviors, which could be related to the dysfunction of serotonergic system. In this study, partial hepatectomy (PH) was performed in MSG-treated rats and the histopathological changes were observed in orbitofrontal cortex (OFC) and liver. The effect of escitalopram, a widely used antidepressant, on neural and liver injury in this model was also examined. The MSG + PH-treated rats displayed decreased distances traveled in total, in center arena, and in the left side of arena in inner open field test (OFT), as compared to saline, saline + PH, and MSG-treated animals. The present study established that PH aggravated anxiety-like depressive behaviors in MSG-treated rats, concordant with damaged Nissl bodies (and neurites), decreased IBA-1 and Sox-2 expression in OFC and neurotransmitter disorder. Escitalopram treatment could alleviate these pathological changes as well as reduce hepatic steatosis and lipid metabolism.

Clinical correlates and pharmacological management of Asian patients with concomitant diabetes mellitus and heart failure

Asia is the center of convergence of the twin epidemics of diabetes mellitus (DM) and heart failure (HF). The regional and ethnic diversity across Asia, along with a high prevalence of a young, lean diabetic phenotype, emphasizes the importance of targeted public health strategies that address the unique needs of Asian patients with DM and HF. This review discusses the epidemiology, clinical correlates, pharmacological management, and outcomes of Asian patients with concomitant DM and HF.

Metabolic Syndrome Is an Independent Risk Factor for Acquired Premature Ejaculation

Purpose

To determine the role of metabolic syndrome (MetS) as a risk factor for acquired premature ejaculation (PE) after considering the various risk factors, such as lower urinary tract symptoms, erectile dysfunction, hypogonadism, and prostatitis.

Materials and Methods

From January 2012 to January 2017, records of 1,029 men were analyzed. We performed multivariate analysis to identify risk factors for PE, including the covariate of age, marital status, International Prostate Symptom Score, International Index of Erectile Function (IIEF) score, National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) score, serum testosterone levels, and all components of MetS. Acquired PE was defined as self-reported intravaginal ejaculation latency time ≤3 minutes, and MetS was diagnosed using the modified National Cholesterol Education Program Adult Treatment Panel III criteria.

Results

Of 1,029 men, 74 subjects (7.2%) had acquired PE and 111 (10.8%) had MetS. Multivariate analysis showed that the IIEF overall satisfaction score (odds ratio [OR]=0.67, p<0.001), NIH-CPSI pain score (OR=1.07, p=0.035), NIH-CPSI voiding score (OR=1.17, p=0.032), and presence of MetS (OR=2.20, p=0.022) were significantly correlated with the prevalence of acquired PE. In addition, the Male Sexual Health Questionnaire for Ejaculatory Dysfunction scores and ejaculation anxiety scores progressively decreased as the number of components of MetS increased.

Conclusions

MetS may be an independent predisposing factor for the development of acquired PE. Effective prevention and treatment of MetS could also be important for the prevention and treatment of acquired PE.

Depression and metabolic syndrome in the older population: A review of evidence

BACKGROUND

Metabolic syndrome (MetS) has been shown to be associated with depression in older adults but the results are mixed. We summarized and evaluated the association between depression and MetS in people aged 60 years or over.

METHODS

Relevant published studies from January 1997 to July 2017 were identified by searching two electronic databases: PubMed/Medline and EMBASE. Observational studies were considered.

RESULTS

Twelve studies were included in the systematic review. Depression seemed to be related with MetS in the majority of the studies (10/12 = 83.3%). As far as the longitudinal studies are concerned, the onset of depression was related to MetS in 2 out of 3 studies (66.6%), while a relation between chronicity of depression and MetS was reported (1 study). Regarding cross-sectional studies, 7 out of 9 (77.7%) concluded that there was a positive association between depression and MetS. Mixed evidence was found among studies concerning the association between depression and the individual components of MetS. Four out of ten studies (40%) reported that depression was significantly associated with the waist circumference, a component of MetS.

LIMITATIONS

There was a high degree of heterogeneity between studies regarding their design. Only studies written in English, from peer-reviewed journals were included.

CONCLUSIONS

Depression seemed to be significantly associated with MetS in people aged 60 years or over. Among the components of MetS, abdominal obesity seemed to be associated more strongly and consistently with depression. The direction of the causality and mechanisms underlying the relationship are still largely unknown.

Impact of depression and/or anxiety on the presentation of cardiovascular events in a cohort with metabolic syndrome. StreX project: Five years of follow-up

OBJECTIVES

To determine the role of anxiety and depression on the incidence of cardiovascular events (CVE) in a Catalonian population with metabolic syndrome (MetS) over a five-year follow-up according to the number/type of MetS criteria.

METHODS

Prospective study to determine the incidence of CVE according to the presence of anxiety and depression disorders among individuals with different combinations of clinical traits of the MetS.

SETTING

Primary Care, Catalonia (Spain).

SUBJECTS

35-75 years old fulfilling MetS criteria without CVE at the initiation of follow-up (2009). We studied 16 MetS phenotypes [NCEP-ATPIII criteria] based on the presence of depression/anxiety. The primary endpoint was the incidence of CVE at five years.

RESULTS

We analyzed 401,743 people with MetS (17.2% of the population); 8.7% had depression, 16.0% anxiety and 3.8% both. 14.5% consumed antidepressants and 20.8% tranquilizers. At the 5-year follow-up, the incidence of CVE was 5.5%, being 6.4% in men and 4.4% in women. On comparing individuals with and without depression the incidence of CVE was 6.7% vs. 5.3%, respectively (p<0.01), being 5.5% in both groups in relation to anxiety.

CONCLUSION

Depression and anxiety play a role in the poor prognosis of patients with MetS. In Catalonia, the two predominant MetS phenotypes do not include obesity as a criterion.

Association Between Different Indicators of Obesity and Depression in Adults in Qingdao, China: A Cross-Sectional Study

Background: This study was designed to investigate the perceived relationship between body weight and depression risk in a Chinese population in Qingdao, China. Methods: A population-based cross-sectional survey was performed with 4,573 participants (between 35 and 74 years) from the year 2009 to 2012 in Qingdao, China. We applied the Zung self-rating depression scale to ascertain the level of depression in participants. The associations between different indicators of obesity [body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR)] and depression were assessed by logistic regression based on the Chinese criteria of obesity. Sensitivity analysis was done based on the Asian and WHO criteria of obesity. Results: The Zung scores for the 243 participants (5.2%) were over 45 and they were entitled as depression. Furthermore, multivariable logistic analyses revealed that being overweight [odds ratios (OR): 1.48, 95% confidence intervals [95% CI]: 1.08-2.03] and having abdominal obesity (WC category in Chinese criteria) (OR: 1.47, 95% CI: 1.08-2.00) were often associated with a higher risk for depression compared to normal weight subjects. Sensitivity analysis revealed that abdominal obesity (Asian criterion) (OR: 1.41, 95% CI: 1.03-1.91) was a significant risk factor for depression. Similarly, being overweight (WHO criterion) (OR: 1.39, 95% CI: 1.03-1.87) was an obvious risk factor for depression. Conclusion: Being overweight and having abdominal obesity (WC category) were found to be linked with a higher risk of depression. However, abdominal obesity (WHR category) was not associated with depression.

Increased prevalence of depression and anxiety among subjects with metabolic syndrome and known type 2 diabetes mellitus - a population-based study

OBJECTIVES

The metabolic syndrome (MetS) is a cluster of cardiovascular risk factors associated with high cardiovascular morbidity and mortality. The MetS and its elements have been linked to anxiety and depressive disorders. The aim of the current cross-sectional study was to assess the prevalence of depression and anxiety, measured by the Zung Self-Rating Scale in subjects with and without the metabolic syndrome and diabetes.

METHODS

A total of 2111 adults were included, 1155 female, age 47.6 (13.7) and 956 male, age 45.2 (13.5). All participants filled questionnaires covering current and past disorders and medication, smoking and family history. Zung self-rating depression and anxiety scales were completed. Body weight, height and waist circumference were measured, BMI was calculated, serum glucose and lipids were measured.

RESULTS

Depression (SDSi) and anxiety scores (SASi) were higher in the females and increased with age (p < 0.001). SDSi was higher in the females and males with metabolic syndrome (MetS) (50.9 ± 9.8 vs. 45.9 ± 8.9, p < 0.001 and 42.7 ± 9.2 vs. 40.5 ± 7.9 p < 0.001, respectively). SASi was higher in the MetS subjects (females 50.59 ± 11.35 vs. 45.97 ± 10.58, p < 0.001; males 40.48 ± 10.1 vs. 38.04 ± 8.42, p < 0.001). Both SDSi and SASi were higher in the subjects with known diabetes than in those with normal glucose tolerance (Mann-Whitney both p < 0,001). Positive depressive scores were more prevalent in subjects with MetS than those without (females 54% vs. 31.6%, p < 0.001; males 22.7% vs. 12.3%, p < 0.001). Depression and anxiety were more prevalent in the subjects with known diabetes than in those with normal glucose tolerance but not in the newly-diagnosed diabetes. The OR for depressiveness was 2.0 (1.3; 2.6) in subjects with MetS and 4.2 (2.3; 7.8) in those with known diabetes.

CONCLUSIONS

In conclusion, depressiveness and anxiety were associated positively with age and female gender and were more prevalent among subjects with MetS and known diabetes mellitus.

Prevalence of metabolic syndrome among patients with depressive disorder admitted to a psychiatric inpatient unit: A comparison with healthy controls

OBJECTIVE

This study aimed to compare the prevalence of metabolic syndrome (MS) among inpatients with depressive disorders and matched healthy controls.

METHOD

One hundred fifty eight patients with depressive disorders and 52 age and gender matched healthy controls were assessed for the prevalence of MS using Common Criteria for MS.

RESULTS

Prevalence of Metabolic syndrome among inpatients with depressive disorders was 44.3%, which was significantly higher than the healthy control group (17.3%). Increased waist circumference was the most common abnormality in both the groups. Prevalence of MS among patients with recurrent depression disorder (60.3%) was almost double that seen among those with first episode depression (32.6%). Compared to healthy controls, significantly greater proportion of patients with depressive disorders had increased blood pressure, abnormal fasting blood sugar, and HDL levels. Besides the prevalence of MS in 44.3% of patients with depressive disorders, another 46% of patients fulfilled one or two criteria of MS. Significant predictors of MS were being married, obese, greater age, higher weight, higher body mass index, and multiple episodes of depression.

CONCLUSIONS

Nearly two-fifth of depressed patients have MS and another two-fifth of patients had one or two abnormalities in the MS criteria. The prevalence of MS among patients with depressive disorders is significantly higher than the healthy controls. Hence, patients with depressive disorders should be regularly evaluated for the presence of MS and other cardiovascular risk factors and appropriate management strategies must be instituted at the earliest.

Association between anxiety and metabolic syndrome: A systematic review and meta-analysis of epidemiological studies

OBJECTIVE

Epidemiological studies have repeatedly investigated the association between anxiety and metabolic syndrome (MetS). However, the results have been inconsistent. We performed a meta-analysis of observational studies to summarize the evidence regarding the relation of anxiety and MetS risk.

METHODS

We performed a systematic literature search of all studies published in PubMed and EMBASE from its inception to June 2016. Cross-sectional and cohort studies that reported an association between the two conditions in adults were included. Data on prevalence, incidence, unadjusted or adjusted odds ratio (OR), and 95% CI were extracted or provided independently by the authors. Random effects model was used to report the pooled OR. The I² statistic was used to assess heterogeneity. Egger's test and Begger's test were used to evaluate the publication bias.

RESULTS

The search yielded 18 cross-sectional studies and two cohort studies. The pooled finding from cross-sectional studies showed that anxiety had a significant positive association with MetS (OR 1.07, 95% CI 1.01-1.12), with moderate heterogeneity (I²=45.7%, P=0.018). Findings from two cohort studies indicated that the association between anxiety and MetS was insignificant.

CONCLUSION

Our results suggest that there is an association between anxiety and MetS. In individuals with MetS anxiety should be detected and managed. Further prospective studies are needed to explore the bidirectional association between anxiety and MetS.

Metabolic syndrome and depressive symptoms among rural Northeast general population in China

Background

Previous researches aiming to estimate the association between metabolic syndrome and depressive symptoms come out with inconsistent results. Besides, most of them are conducted in the developed areas. There is lack of the data from rural China. The aim of this study is to confirm whether gender difference exists among the relationship between MetS, metabolic components and depressive symptoms in the rural Chinese population.

Methods

A cross-sectional analysis enrolled 11430 subjects’ aged ≥35 from rural Northeast China. Metabolic and anthropometric indicators were measured according to standard methods. Depressive symptoms were defined using the Patient Health Questionnaire-9 (PHQ-9).

Results

The prevalence of depressive symptoms was 6% among rural Northeast general population and the prevalence of MetS and its components were 39.0% for MetS, 42.9% for abdominal obesity, 67.1% for elevated blood pressure, 47.1% for hyperglycemia, 32.1% for hypertriglyceridemia, 29.5% for low HDL-C. Depressive symptoms were associated with triglyceride component (OR = 1.24, 95%CI: 1.05–1.46, P = 0.01) but not MetS (OR = 1.11, 95%CI: 0.94–1.30, P = 0.23). Moreover, depressive symptoms were associated with triglyceride component (OR = 1.21, 95% CI = 1.00–1.47, P = 0.05) in women only. But once adjusted for menopause status, depressive symptoms were no longer statically associated with triglyceride component (OR = 1.20, 95% CI = 0.99–1.46, P = 0.07).

Conclusions

Depressive symptoms were associated with triglyceride component but not MetS in rural Chinese population. Routine lipid screening should be recommended among rural depressed residents especially among female.

A Longitudinal Relationship Between Depressive Symptoms and Development of Metabolic Syndrome: The Coronary Artery Risk Development in Young Adults Study

OBJECTIVE

Despite variability in the burden of elevated depressive symptoms by sex and race and differences in the incidence of metabolic syndrome, few prior studies describe the longitudinal association of depressive symptoms with metabolic syndrome in a diverse cohort. We tested whether baseline and time-varying depressive symptoms were associated with metabolic syndrome incidence in black and white men and women from the Coronary Artery Risk Development in Young Adults study.

METHODS

Participants reported depressive symptoms using the Center for Epidemiologic Studies Depression Scale at four examinations between 1995 and 2010. At those same examinations, metabolic syndrome was determined. Cox proportional hazards models were used to examine the associations of depressive symptoms on the development of metabolic syndrome in 3208 participants without metabolic syndrome at baseline.

RESULTS

For 15 years, the incidence rate of metabolic syndrome (per 10,000 person-years) varied by race and sex, with the highest rate in black women (279.2), followed by white men (241.9), black men (204.4), and white women (125.3). Depressive symptoms (per standard deviation higher) were associated with incident metabolic syndrome in white men (hazard ratio = 1.25, 95% confidence interval = 1.08-1.45) and white women (hazard ratio = 1.17, 95% confidence interval = 1.00-1.37) after adjustment for demographic characteristics and health behaviors. There was no significant association between depression and metabolic syndrome among black men or black women.

CONCLUSIONS

Higher depressive symptoms contribute modestly to the onset of metabolic syndrome among white adults.

Metabolic syndrome and central obesity in depression: A cross-sectional study

INTRODUCTION

The current epidemiological data and meta-analyses indicate a bidirectional association between depression and metabolic syndrome (MetS).

AIMS

To assess the prevalence of metabolic syndrome and obesity in drug naïve patients (in current episode) having Recurrent Major Depressive Disorder and Bipolar Depression.

METHOD

This was a single point cross sectional observational study that involved administration of diagnostic and assessment tools and blood investigations. Recruitment for the study was done from a period of September 2008 to august 2009.

RESULTS

The prevalence of MetS was significantly more in the depression group when compared to healthy controls. The Bipolar depression group had 24% prevalence and recurrent depression group had 26% prevalence as opposed to none in the control group. The prevalence of MetS did not differ significantly amongst the both depression groups. Presence of central obesity was significantly more in the recurrent depression (30%) and Bipolar depression (24%) as compared to controls (8%). There was no statistically significant difference between the two depression subgroups.

DISCUSSION

Our study adds to the mounting evidence that links the presence of depression and metabolic syndrome. As we had ensured a drug free period of at least 3 months, the findings in our study indicate that the metabolic syndrome observed in our study is independent of drug exposure.

CONCLUSIONS

This study demonstrated significantly more incidence of metabolic syndrome and central obesity in patients of depression than age and sex matched controls.

The Relationship Between Depression and Metabolic Syndrome: Systematic Review and Meta-Analysis Study

Context

Several studies have been conducted on the relationship between depression and metabolic syndrome, which have had conflicting results. The purpose of this study was a meta-analysis of studies that have examined the relationship between these two variables.

Evidence Acquisition

This meta-analysis systematically reviewed the relationship between depression and metabolic syndrome. Scientific databases including IranMedex, SID, Magiran, Scopus, PubMed, Google Scholar, and Science Direct were searched and 17 articles were extracted from 2000 to 2014. Selected studies data were analyzed using meta-analysis and random effects model. Heterogeneity between the studies was examined using I2. Data were analyzed using STATA software version 12.1.

Results

Seventeen studies were analyzed with a sample size of 31880 people. Analysis by the type of studies showed that the relationship between the two variables in cross-sectional studies (OR = 1.51, CI 95% = 1.36 - 1.68) and cohort studies (OR = 1.6, CI 95% = 1.23 - 2.08) was significant. In general, the heterogeneity test results among the studies was not significant (P for heterogeneity = 0.08, I² = 39.8%).

Conclusions

There is a relationship between depression and metabolic syndrome.

Major depressive disorder and cardiometabolic disease risk among sub-Saharan African adults

OBJECTIVE

We sought to evaluate the extent to which major depressive disorder (MDD) is associated with cardiometabolic diseases and risk factors.

METHODS

This was a cross-sectional epidemiologic study of 1924 employed adults in Ethiopia. Structured interview was used to collect sociodemographic data, behavioral characteristics and MDD symptoms using a validated Patient Health Questionnaire-9 (PHQ-9) depression scale. Fasting blood glucose, insulin, C-reactive protein, and lipid concentrations were measured using standard approaches. Multivariate logistic regression models were fitted to estimate odds ratios (OR) and 95% confidence intervals (95% CI).

RESULTS

A total of 154 participants screened positive for MDD on PHQ-9 (8.0%; 95% CI: 6.7-9.2%). Among women, MDD was associated with more than 4-fold increased odds of diabetes (OR=4.14; 95% CI: 1.03-16.62). Among men the association was not significant (OR=1.12; 95% CI: 0.63-1.99). Similarly, MDD was not associated with metabolic syndrome among women (OR=1.51; 95% CI: 0.69-3.29) and men (OR=0.61; 95% CI: 0.28-1.34). Lastly, MDD was not associated with increased odds of systemic inflammation.

CONCLUSION

The results of our study do not provide convincing evidence that MDD is associated with cardiometabolic diseases among Ethiopian adults. Future studies need to evaluate the effect of other psychiatric disorders on cardiometabolic disease risk.

Waist-to-hip ratio, dyslipidemia, glycemic levels, blood pressure and depressive symptoms among diabetic and non-diabetic Chinese women: a cross-sectional study

OBJECTIVES

To explore the relationship between depressive symptoms and waist-to-hip ratio, dyslipidemia, glycemic levels or blood pressure among diabetic and non-diabetic Chinese women.

METHODS

11,908 women aged ≥40 years were enrolled in this cross-sectional study, including 2,511 with type 2 diabetes and 9,397 without. Depressive symptoms (defined as having mild-to-severe depressive symptoms) were assessed by the Patient Health Questionnaire-9 (PHQ-9) diagnostic algorithm. The prevalence and the odds ratios (ORs) with 95% confidence intervals (CIs) for having depressive symptoms were estimated using logistic regression analysis.

RESULTS

The age-adjusted prevalence of depressive symptoms was significantly higher in non-diabetic subjects with waist-to-hip ratio (WHR) ≥0.9 (8.6%, age-adjusted OR 1.51 [95% CI 1.17, 1.95]), total cholesterol (TC)>6.22 mmol/L (8.8%, 1.58 [1.16, 2.15]), and Hemoglobin A1c (HbA1c) ≥6.00 mmol/L (7.7%, 1.69 [1.34, 2.14]), while it was significantly lower in non-diabetic subjects with diastolic blood pressure (DBP) between 80 to 89 mmHg (6.2%, 0.78 [0.64, 0.95]). These relationships remained significant even after controlling for multiple factors (WHR ≥0.9: multivariable-adjusted OR 1.39 [95% CI 1.07, 1.80]; TC>6.22 mmol/L: 1.56 [1.14, 2.12]; HbA1c ≥6.00 mmol/L: 1.64 [1.30, 2.08]; DBP 80-89 mmHg: 0.78 [0.64, 0.95]). However, no significant trend between depressive symptoms and WHC, TC, HbA1c, DBP was observed in diabetic women, and no significant trend relationship between depressive symptoms and BMI, WC, TG, or SBP was observed in both non-diabetic and diabetic women. Moreover, the prevalence of depressive symptoms was significantly higher in previously-diagnosed diabetes, compared with non-diabetic subjects, while no significant differences were observed between newly-diagnosed diabetes and non-diabetic subjects.

CONCLUSION

The present study showed a relationship between WHR, TC, HbA1c, DBP and depressive symptoms among non-diabetic women, while no significant relationship between them was observed among diabetic women, even after controlling for multiple confounding factors.

Metabolic syndrome factors and risk of postoperative depression in high-grade glioma patients in a 1.5-year prospective study

To date, the relationship between metabolic syndrome factors and the risk of glioma-related depression is still unclear, and no study investigates this relationship. Our aim was to investigate the relationship between metabolic syndrome factors and the risk of postoperative depression in high-grade patients. A total of 386 high-grade glioma patients participated in blood sample collection for metabolic syndrome factors analysis and the hospital anxiety and depression scale testing. The association between metabolic syndrome factors and the risk of postoperative depression was assessed using Cox regression proportional hazards models, and Student's t tests were used to evaluate the differences in demographic variables and clinical characteristics in subgroups. The incidence of postoperative depression in our 1.5-year follow-up was 30.5%. We found the risk of postoperative depression was elevated with increased blood glucose level [hazard ratios (HR) 2.277, 95% confidence interval (CI) 1.201-4.320, top vs. bottom quartile]. The hazard ratio was increased for z-scores of blood glucose (HR 1.672 per unit standard deviation, 95% CI 1.311-2.133] and of the combined metabolic syndrome score (HR 1.080, 95% CI 1.000-1.167). In addition, risk of postoperative depression risk was increased in high-grade glioma patients with high blood glucose levels (≥6.0 mmol/l) (HR 2.084, 95% CI 1.235-3.515). However, we did not find significant associations between postoperative depression and other metabolic syndrome factors, including body mass index, systolic blood pressure, diastolic blood pressure, cholesterol, and triglycerides. Depression is prevalent among patients with high-grade glioma after operation. Blood glucose level is positively associated with the risk of postoperative depression, and might be involved in the etiology of postoperative depression, and may predict its development in high-grade glioma patients.

Joint effects of known type 2 diabetes susceptibility loci in genome-wide association study of Singapore Chinese: the Singapore Chinese health study

BACKGROUND

Genome-wide association studies (GWAS) have identified genetic factors in type 2 diabetes (T2D), mostly among individuals of European ancestry. We tested whether previously identified T2D-associated single nucleotide polymorphisms (SNPs) replicate and whether SNPs in regions near known T2D SNPs were associated with T2D within the Singapore Chinese Health Study.

METHODS

2338 cases and 2339 T2D controls from the Singapore Chinese Health Study were genotyped for 507,509 SNPs. Imputation extended the genotyped SNPs to 7,514,461 with high estimated certainty (r(2)>0.8). Replication of known index SNP associations in T2D was attempted. Risk scores were computed as the sum of index risk alleles. SNPs in regions ± 100 kb around each index were tested for associations with T2D in conditional fine-mapping analysis.

RESULTS

Of 69 index SNPs, 20 were genotyped directly and genotypes at 35 others were well imputed. Among the 55 SNPs with data, disease associations were replicated (at p<0.05) for 15 SNPs, while 32 more were directionally consistent with previous reports. Risk score was a significant predictor with a 2.03 fold higher risk CI (1.69-2.44) of T2D comparing the highest to lowest quintile of risk allele burden (p = 5.72 × 10(-14)). Two improved SNPs around index rs10923931 and 5 new candidate SNPs around indices rs10965250 and rs1111875 passed simple Bonferroni corrections for significance in conditional analysis. Nonetheless, only a small fraction (2.3% on the disease liability scale) of T2D burden in Singapore is explained by these SNPs.

CONCLUSIONS

While diabetes risk in Singapore Chinese involves genetic variants, most disease risk remains unexplained. Further genetic work is ongoing in the Singapore Chinese population to identify unique common variants not already seen in earlier studies. However rapid increases in T2D risk have occurred in recent decades in this population, indicating that dynamic environmental influences and possibly gene by environment interactions complicate the genetic architecture of this disease.

The relationship between abdominal obesity and depression in the general population: A systematic review and meta-analysis

SUMMARY

Obesity has been widely regarded as a public health concern because of its adverse impact on individuals' health. Systematic reviews have been published in examining the effect of obesity on depression, but with major emphasis on general obesity as measured by the body mass index. Despite a stronger effect of abdominal obesity on individuals' physical health outcomes, to our best knowledge, no systematic review was undertaken with regard to the relationship between abdominal obesity and depression. This paper reports the results of a systematic review and meta-analysis of cross-sectional studies examining the relationship between abdominal obesity and depression in a general population. Multiple electronic databases were searched until the end of September 2009. 15 articles were systematically reviewed and meta-analyzed. The analysis showed that the odds ratio of having depression for individuals with abdominal obesity was 1.38 (95% CI, 1.22-1.57) as compared to those who are not obese. Furthermore, it was found that this relationship did not vary with potential confounders including gender, age, measurement of depression and abdominal obesity, and study quality.:

Association between depressive symptoms and metabolic syndrome in Japanese community-dwelling older people: a cross-sectional analysis from the baseline results of the Fujiwara-kyo prospective cohort study

OBJECTIVE

Metabolic syndrome contains many risks for medical diseases such as cardiovascular disease and diabetes, which might precipitate depressive symptoms in the older people. However, the association between depressive symptoms and metabolic syndrome in Japanese community-dwelling older people is unclear. This study was performed to answer this important question.

METHODS

Cross-sectional analyses were performed on 3796 community-dwelling independent older people (≥ 65 years, 1911 men and 1885 women) from the 2007-2008 baseline examination of the Fujiwara-kyo study, a prospective cohort study on successful aging. Depressive symptoms were assessed using the 15-item short form of the Geriatric Depression Scale and metabolic syndrome was defined according to the 2005 International Diabetes Federation. Covariates were social supports, negative life events, health behavior, education, cognitive function, anthropometric status, and others. Multiple logistic regression analyses were performed to determine the relationships between depressive symptoms and these variables.

RESULTS

The prevalence of depressive symptoms (Geriatric Depression Scale-15 ≥ 6) and metabolic syndrome were 14.8% and 16.6%, respectively. Significant protective factors against depressive symptoms were higher education, more opportunity for drinking of alcohol, better social supports, and more walking daily. Metabolic syndrome was statistically associated with depressive symptoms (adjusted odds ratio = \ 1.32, 95% confidence interval = 1.03-1.68). Other risk factors significantly associated with depressive symptoms were sleep disturbance, visual or hearing impairment, and negative life events.

CONCLUSIONS

The present study showed an association between metabolic syndrome and depressive symptoms in ambulatory Japanese older people, as in western countries.

Understanding the somatic consequences of depression: biological mechanisms and the role of depression symptom profile

Depression is the most common psychiatric disorder worldwide. The burden of disease for depression goes beyond functioning and quality of life and extends to somatic health. Depression has been shown to subsequently increase the risk of, for example, cardiovascular, stroke, diabetes and obesity morbidity. These somatic consequences could partly be due to metabolic, immuno-inflammatory, autonomic and hypothalamic-pituitary-adrenal (HPA)-axis dysregulations which have been suggested to be more often present among depressed patients. Evidence linking depression to metabolic syndrome abnormalities indicates that depression is especially associated with its obesity-related components (for example, abdominal obesity and dyslipidemia). In addition, systemic inflammation and hyperactivity of the HPA-axis have been consistently observed among depressed patients. Slightly less consistent observations are for autonomic dysregulation among depressed patients. The heterogeneity of the depression concept seems to play a differentiating role: metabolic syndrome and inflammation up-regulations appear more specific to the atypical depression subtype, whereas hypercortisolemia appears more specific for melancholic depression. This review finishes with potential treatment implications for the downward spiral in which different depressive symptom profiles and biological dysregulations may impact on each other and interact with somatic health decline.

Metabolic Syndrome in Drug-naïve Patients with Depressive Disorders

BACKGROUND

The prevalence of metabolic syndrome (MS) is found to be higher in patients with depression than in the general population. As there is lack of data from India, this study aimed to assess the prevalence of MS in patients with depression who had never been treated with antidepressants for their depressive disorder and compare the same with a matched group of healthy controls.

MATERIALS AND METHODS

Forty-three drug-naïve patients with depressive disorders and 43 age- and gender-matched healthy controls were assessed for the prevalence of MS as per the consensus definition.

RESULTS

The prevalence of MS in patients with depression was 37.2% and was significantly higher than that seen in the healthy controls (16.3%). Increased waist circumference was the most common abnormality in both the study groups. Compared to healthy controls, a significantly higher proportion of patients with depression had abnormal waist circumference, systolic blood pressure, or high blood pressure. Besides 16 patients with depressive disorders having MS, another 53.5% of patients fulfilled one or two criteria of MS. None of the sociodemographic variables was associated with development of MS in patients with depression.

CONCLUSIONS

Slightly more than one-third of depressed patients who are drug-naïve have MS and this prevalence rate is significantly higher than in healthy controls.

Longitudinal relationship of depressive and anxiety symptoms with dyslipidemia and abdominal obesity

OBJECTIVE

Previous research indicates that patients with severe symptoms of depression or anxiety are prone toward the development of dyslipidemia and abdominal obesity. We sought to study these associations longitudinally.

METHODS

Among 2126 Netherlands Study of Depression and Anxiety participants, we studied whether severity of depressive (Inventory of Depressive Symptoms) or anxiety (Beck Anxiety Inventory) symptoms at baseline was associated with changes in lipids (i.e., total, high-density lipoprotein [HDL] or low-density lipoprotein cholesterol, and triglycerides) or waist circumference during a 2-year follow-up period. We also examined whether changes in severity of symptoms were associated with changes in lipid or waist circumference levels over these 2 years. Multivariate linear regression analyses were adjusted for age, sex, education, and tobacco consumption.

RESULTS

Baseline symptoms of depression or anxiety predicted a decrease in HDL cholesterol (adjusted β = -.062 [p = .003] and β = -.050 [p = .02], respectively) and an increase in waist circumference (adjusted β = .060 [p = .01] and β = .053 [p = .02], respectively) for 2 years. Reduction of symptoms of depression or anxiety over time did not coincide with an amelioration of lipid or waist circumference values.

CONCLUSIONS

People with initially severe symptoms of depression or anxiety showed a subsequent decrease in HDL cholesterol levels and an increase in abdominal obesity over time, independent of a potential reduction in symptom severity in this period. Therefore, such people are at elongated and increasing risk for dyslipidemia and obesity, predisposing them to cardiovascular disease.

Feeling refreshed by sleep can predict psychological wellbeing assessed using the general health questionnaire in male workers: a 3-year follow-up study

Prediction of psychological wellbeing based on several important predictors was conducted for ensuring maintenance of good mental health. A 3-year follow-up study to determine psychological well-being was conducted in 969 Japanese male workers. Age, body mass index, present history of medication and four lifestyle factors were used for the analysis. A logistic regression analysis revealed that the odds ratio (95% confidence interval) for obtaining a score of ≥4 in the General Health Questionnaire-12-item version, among the subjects who felt refreshed by sleep was 0.559 (0.415-0.753). None of the other factors showed any statistically significant association. Feeling refreshed by sleep was identified as a predictor of maintained psychological wellbeing in this 3-year follow-up study.

Mental disorders in patients with metabolic syndrome. The key role of central obesity

BACKGROUND

The Authors sought to evaluate current prevalence of mental disorders in patients affected by metabolic syndrome compared with patients affected by central obesity alone.

METHODS

186 (63.5%) patients affected by central obesity and 107 (36.5%) affected by metabolic syndrome according to ICF criteria were interviewed by means of SCID I.

RESULTS

Axis I current prevalence was respectively 45.7% and 44.9% among patients with central obesity and patients with metabolic syndrome, differences which were not significant. No statistically significant differences were found between groups as far as each single axis I diagnostic category was concerned. Moreover, current prevalence of any axis I, anxiety and mood disorders were independent of the number of components of metabolic syndrome.

CONCLUSION

metabolic syndrome is associated to an higher risk for current mental disorders, which seems to be mainly due to the strong association of central obesity to psychopathology.

Mental disorders in obese patients with and without metabolic syndrome

OBJECTIVE

The authors sought to evaluate lifetime prevalence of mental disorders in patients affected by metabolic syndrome compared with patients affected by central obesity alone.

METHODS

One hundred eighty-six (63.5%) patients affected by central obesity and 107 (36.5%) affected by metabolic syndrome according to ICF criteria were interviewed by means of SCID I and SCID II.

RESULTS

Axis I and axis II lifetime prevalence were respectively 53.8% and 30.1% among patients with central obesity, 50.5% and 28% among patients with metabolic syndrome, differences which were not significant. No statistically significant differences were found between groups as far as each single axis I and II diagnostic category was considered.

CONCLUSION

Metabolic syndrome is not associated with a higher risk of mental disorders compared to central obesity alone.

Type 2 diabetes and cardiovascular diseases: do they share a common soil? The Asian Indian experience

In India, diabetes and cardiovascular disease (CVD) are growing health problems. CVD accounts for much of the increased morbidity and premature mortality associated with type 2 diabetes. Moreover, CVD also occurs 2-3 decades earlier among diabetic subjects and runs a more aggressive course and has a worse prognosis. The pathophysiology of the link between diabetes and CVD is complex and multifactorial and understanding the mechanisms of the disease can help identify and treat CVD in patients with diabetes and vice versa. The current article reviews the common antecedents between type 2 diabetes and CVD including non-modifiable and modifiable risk factors and suggests that future research on diabetes and CVD should focus on searching for risk factors for CVD that may be more specific to diabetes, such as hypoglycaemia or medication related comorbidities. Also, the authors recommend research on common genetic variants which might have stronger effects and hence have a potential role in diabetes and CVD risk prediction. Finally, primary prevention trials trying to prevent both diabetes and CVD are the urgent need of the hour!

Presence of an interaction between smoking and being overweight increases risks of hypertension, diabetes, and cardiovascular disease in outpatients with mood disorders

OBJECTIVE

We aimed to evaluate the hypothesis that the presence of an interaction between smoking and being overweight increases the risks of lifestyle-related diseases (hypertension, diabetes mellitus, dyslipidemia, and cardiovascular disease) in outpatients with mood disorders.

METHODS

In this cross-sectional survey, using data from 213 outpatients with mood disorders (95 men, 118 women), we calculated the adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for each of hypertension, diabetes, dyslipedemia, and cardiovascular disease, using a binary logistic regression model; we then calculated the adjusted OR values for smokers and non-smokers with body mass indexes (BMIs) of <25 or ≥25 kg/m². Next, we examined the data for the presence of an interaction between smoking and being overweight, using three measures of additive interaction: relative excess risk due to the interaction (RERI), attributable proportion due to the interaction (AP), and the synergy index (S).

RESULTS

Smokers with BMI <25 kg/m² had a significantly lower risk of hypertension (OR 0.27, 95% CI 0.09-0.81) than non-smokers with BMI <25 kg/m² (reference group). Compared with the reference group, overweight non-smokers had a significantly higher risk (2.82, 1.34-6.19) of hypertension, and overweight smokers had a higher risk (4.43, 1.28-15.26) of hypertension and very high risks of diabetes (8.24, 2.47-27.42) and cardiovascular disease (13.12, 1.95-88.41). The highest RERI was derived from the relation with cardiovascular disease. The highest AP and S were derived from the relation with type 2 diabetes. There was no interaction of smoking and being overweight with dyslipidemia.

CONCLUSION

The presence of an interaction between smoking and being overweight exacerbates the risks of hypertension, diabetes, and cardiovascular disease in outpatients with mood disorders.

Chronic, noninvasive glucocorticoid administration suppresses limbic endocannabinoid signaling in mice

Limbic endocannabinoid signaling is known to be sensitive to chronic stress; however, studies investigating the impact of prolonged exposure to glucocorticoid hormones have been limited by the concurrent exposure to the stress of daily injections. The present study was designed to examine the effects of a noninvasive approach to alter plasma corticosterone (CORT) on the endocannabinoid system. More precisely, we explored the effects of a 4-week exposure to CORT dissolved in the drinking water of mice (100 μg/ml) and measured cannabinoid CB(1) receptor binding, endocannabinoid content, activity of the endocannabinoid degrading enzyme fatty acid amide hydrolase (FAAH), and mRNA expression of both the CB(1) receptor and FAAH in both the hippocampus and amygdala. Our data demonstrate that CORT decreases CB(1) receptor binding site density in both the hippocampus and amygdala and also reduced anandamide (AEA) content and increased FAAH activity within both structures. These changes in both CB(1) receptor binding and FAAH activity were not accompanied by changes in mRNA expression of either the CB(1) receptor or FAAH in either brain region. Interestingly, our CORT delivery regimen significantly increased 2-AG concentrations within the hippocampus, but not the amygdala. Collectively, these data demonstrate that the confounder of injection stress is sufficient to conceal the ability of protracted exposure to glucocorticoids to reduce CB(1) receptor density and augment AEA metabolism within limbic structures.

Waist circumference, abdominal obesity, and depression among overweight and obese U.S. adults: National Health and Nutrition Examination Survey 2005-2006

BACKGROUND

Obesity is associated with an increased risk of mental illness; however, evidence linking body mass index (BMI)-a measure of overall obesity, to mental illness is inconsistent. The objective of this study was to examine the association of depressive symptoms with waist circumference or abdominal obesity among overweight and obese U.S. adults.

METHODS

A cross-sectional, nationally representative sample from the 2005-2006 National Health and Nutrition Examination Survey was used. We analyzed the data from 2,439 U.S. adults (1,325 men and 1,114 nonpregnant women) aged ≥ 20 years who were either overweight or obese with BMI of ≥ 25.0 kg/m2. Abdominal obesity was defined as waist circumference of > 102 cm for men and > 88 cm for women. Depressive symptoms (defined as having major depressive symptoms or moderate-to-severe depressive symptoms) were assessed by the Patient Health Questionnaire-9 diagnostic algorithm. The prevalence and the odds ratios (ORs) with 95% confidence intervals (CIs) for having major depressive symptoms and moderate-to-severe depressive symptoms were estimated using logistic regression analysis.

RESULTS

After multivariate adjustment for demographics and lifestyle factors, waist circumference was significantly associated with both major depressive symptoms (OR: 1.03, 95% CI: 1.01-1.05) and moderate-to-severe depressive symptoms (OR: 1.02, 95% CI: 1.01-1.04), and adults with abdominal obesity were significantly more likely to have major depressive symptoms (OR: 2.18, 95% CI: 1.35-3.59) or have moderate-to-severe depressive symptoms (OR: 2.56, 95% CI: 1.34-4.90) than those without. These relationships persisted after further adjusting for coexistence of multiple chronic conditions and persisted in participants who were overweight (BMI: 25.0-< 30.0 kg/m2) when stratified analyses were conducted by BMI status.

CONCLUSION

Among overweight and obese U.S. adults, waist circumference or abdominal obesity was significantly associated with increased likelihoods of having major depressive symptoms or moderate-to-severe depressive symptoms. Thus, mental health status should be monitored and evaluated in adults with abdominal obesity, particularly in those who are overweight.

Lack of leisure-time physical activity in non-obese Japanese men with components of metabolic syndrome

A focus exclusively on waist circumference, the main component used in the diagnosis of metabolic syndrome (MetS), may lead to ignoring non-obese individuals with other MetS components, including high levels of blood pressure, fasting blood glucose, and triglycerides and low levels of high-density lipoprotein. This study investigated lifestyles and eating behaviors among non-obese individuals with components of MetS. Of the 918 Japanese male workers, 151 subjects (16.4%) had a waist circumference < 85 cm with more than one MetS component. This non-obese high-risk group for MetS gained weight in adulthood, consume alcohol, and engage in less leisure-time physical activity compared to 317 subjects (34.5%) with a waist circumference < 85 cm and without MetS components (p < 0.05). The remaining 450 subjects (49%) were obese with a waist circumference ≥ 85, including 93 men with MetS. A lack of leisure-time physical activity was associated with the non-obese high-risk group for MetS [odds ratio 1.59, 95% confidence interval 1.02 - 2.49] compared to the 317 non-obese men without MetS (reference group). Such a difference in physical activity was not found between the 450 obese subjects and the reference group. Instead, eating behaviors, such as eating rapidly, preference for fatty foods, and eating out for dinner, were significantly associated with MetS. Thus, men with smaller waist circumferences and any MetS component should be carefully monitored for physical activity to prevent further development of MetS, while men with larger waist circumferences including MetS need to be monitored for unfavorable eating behaviors.

Metabolic depression: a chronic depressive subtype? Findings from the InCHIANTI study of older persons

OBJECTIVE

Several studies report a cross-sectional association between metabolic syndrome and depression. Possibly, metabolic syndrome promotes onset or chronicity of depression. However, such a longitudinal link has not yet been confirmed. This study examines whether metabolic syndrome or its components are associated with onset and chronicity of depression.

METHOD

Secondary analyses were performed on data from 823 participants (≥ 65 years of age) in the InCHIANTI study, a prospective, population-based cohort study of older persons. From 1998 to 2000, the study sample was randomly selected from the population registry of 2 sites in Italy using a multistage stratified sampling method. Baseline data collection consisted of a home interview and a medical evaluation at the study clinic. Follow-up for each participant occurred after 3 years and 6 years. Metabolic syndrome at baseline was defined as ≥ 3 of the following: abdominal obesity, high triglycerides, low high-density lipoprotein cholesterol, high blood pressure, and high fasting glucose. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression scale (CES-D) at baseline and after 3 and 6 years. Sample characteristics were compared between persons with and without depression at baseline using χ² and t statistics. Logistic regression analyses were conducted separately in persons with and without depression at baseline to test whether metabolic syndrome at baseline could predict onset and chronicity of depression at follow-up.

RESULTS

At baseline, 235 persons had metabolic syndrome, and 168 were depressed (CES-D score ≥ 20). Among persons not depressed at baseline, 26.0% developed depression. Higher waist circumference increased the odds of depression onset (adjusted OR per SD increase = 1.28; 95% CI, 1.05-1.56), but there was no association between other metabolic syndrome components and onset of depression. Among persons depressed at baseline, depression had a chronic character in 69.0% of persons without and 88.5% of persons with metabolic syndrome. Metabolic syndrome was associated with an almost 3-fold increase in the odds of chronicity of depression (adjusted OR = 2.66; 95% CI, 1.01-7.00), with almost every metabolic syndrome component contributing to this association.

CONCLUSION

In late life, waist circumference, but not metabolic syndrome, predicted onset of depression. Depressed persons with metabolic syndrome were more likely to have persistent or recurrent depression. The latter may suggest that depression with metabolic abnormalities, which could be labeled metabolic depression, identifies a chronic subtype of depression.

Major depression and the metabolic syndrome

The aim of this study is to characterize the relationship between major depression and the metabolic syndrome in a large community based sample of Australian men and women aged 26-90 years. A lifetime history of major depression was assessed by telephone interview following the DSM-III-R. A current history of metabolic syndrome was assessed following the United States National Cholesterol Education Program Adult Treatment Panel III (NCEP AP-III) guidelines 1 to 3 years later. Logistic regression was used to estimate the association between depression and the metabolic syndrome, and its component criteria, controlling for age, sex and alcohol dependence. There was no association between a lifetime history of major depression and the presence of the metabolic syndrome. There was a weak association between depression and low high-density lipoprotein cholesterol but not with other component criteria of the metabolic syndrome. Despite calls for interventions directed at depression to reduce the onset of the metabolic syndrome there are important failures to replicate in large samples such as this, no consensus regarding the threshold at which depression may pose a significant risk even allowing for heterogeneity across populations, and no consensus regarding confounders that may explain inter-study differences. The absence of any dosage effect of depression on the associated risk for the metabolic syndrome in other unselected samples does not support a direct causal relationship. The call for intervention studies on the basis of the currently published evidence base is unwarranted.

Metabolic syndrome and depressive symptoms among Japanese men and women

OBJECTIVES

Evidence is limited on the relation between metabolic syndrome and depressive symptoms. The aim of this cross-sectional study was to investigate the association between metabolic syndrome and depressive symptoms in a Japanese working population.

METHODS

The study subjects comprised 458 municipal employees (age range 21-67 years) from two municipal offices in Japan. A modified version of the criteria of the National Cholesterol Education Program Adult Treatment Panel III was used to define metabolic syndrome. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES_D) scale.

RESULTS

Depressive symptoms (CES_D ≥ 16) in both the male and female subjects were not significantly associated with metabolic syndrome nor with each component of metabolic syndrome. In men, high fasting glucose was associated with increased prevalence of severe depressive state (CES_D ≥ 23).

CONCLUSIONS

Metabolic syndrome may not be associated with depressive status among Japanese employees.