Hostility predicts metabolic syndrome risk factors in children and adolescents

Negative Emotional Reactivity and Somatic Symptoms during Adolescence Predict Adult Health and Wellbeing in Early and Middle Adulthood

Longitudinal research is lacking with respect to how negative emotional reactivity and somatic symptoms during adolescence set the stage for later health. The aim of this longitudinal study was to examine within-person associations between negative emotional reactivity and somatic symptoms during adolescence and their effects on health and wellbeing in adulthood. Participants (N = 1527; 48.3% female) were assessed annually at the age of 12 to 16 years and at the age of 35 and 45 years. Adolescents with frequent somatic symptoms reported higher reactivity. Individual differences in levels and changes of somatic symptoms and reactivity were independently associated with adult health and wellbeing decades later. The findings underscore the importance of considering how individual differences change during adolescent development.

Circulating serum vitamin D levels in relation to metabolic syndrome in children: A systematic review and dose-response meta-analysis of epidemiologic studies

Findings from epidemiologic studies that evaluated the relationship between serum vitamin D levels and metabolic syndrome (MetS) in children were contradictory. We conducted a systematic review and meta-analysis on the relation of serum 25(OH)D levels and MetS in children. A comprehensive search was conducted in electronic databases, up to November 2020. Eleven cross-sectional studies that reported the link between circulating vitamin D levels and MetS in children were included in the analysis. Combining 11 effect sizes from 11 cross-sectional studies with 22,196 participants revealed that highest versus lowest serum vitamin D concentration was significantly associated with a 50% reduced odds of MetS in children (OR: 0.50; 95%CI: 0.39, 0.64). Subgroup analysis by study location revealed decreased odds of MetS in both non-Asian (OR: 0.45; 95%CI: 0.33, 0.63) and Asian countries (OR: 0.54; 95%CI: 0.39, 0.76) with no heterogeneity in these subgroups. When we confined the studies to those with representative populations (n = 21,611), a significant inverse association was found between highest versus lowest circulating vitamin D level and MetS (OR: 0.55; 95%CI: 0.42, 0.71). Dose-response analysis showed that each 10 ng/ml (or 25 nmol/L) in serum vitamin D was linearly related to a 12% reduced odds of MetS (OR: 0.88; 95%CI: 0.78, 0.99) in children. A nonlinear association was also detected between serum 25(OH)D and MetS. This meta-analysis revealed that circulating vitamin D concentration was inversely associated with odds of MetS in children, in a dose-response fashion. The same finding was found in the studies with representative populations.

Hostile personality as a risk factor for hyperglycemia and obesity in adult populations: a systematic review

Purpose

Several studies have already provided valuable insights into the physiological and genetic causes of hyperglycemia and obesity. Concurrently, personality traits, such as hostility, have been suggested to have an impact on health and illness (i.e., self-reported general health, coronary artery disease, and overall mortality). The present systematic review investigated possible effects of hostility upon metabolic markers, such as high plasma glucose level and obesity among adults. We also attempted to reveal current gaps in knowledge and provide insights for future directions.

Methods

This systematic review was performed following the PRISMA 2009 guidelines to examine current evidence arising from observational studies regarding the potential impact of hostile behavior on hyperglycemia and obesity among adults. Of the initial 139 articles, 13 studies were included.

Results

The evidence supports an association between pre-diabetes and obesity with a hostile temperament in certain populations. The relationship between hostility and hyperglycemia was most common in African American women, in women with a family history of diabetes, in unmarried individuals, in White men, as well as in middle-aged and older people. Regarding obesity, high body mass index (BMI) was associated with a hostile personality, particularly among men. However, the paths by which hostile temperament affects glucose levels and BMI, as well as potential mediating and moderating mechanisms, are not entirely understood.

Conclusions

There is a need for research to enhance the understanding of biological, psychological and social factors related to hostility with a view to prevention and effective intervention.

Hostility Is Associated with Self-Reported Cognitive and Social Benefits Across Massively Multiplayer Online Role-Playing Game Player Roles

Massively Multiplayer Online Role-Playing Games (MMORPGs) can sometimes be associated with patterns of play that are harmful to health and well-being. Hazardous MMORPG play has been linked to hostility (toward other people). However, little is known about how hostility, as a risk factor, relates to players' choices within games, or players' experiences of the positive aspects of MMORPGs. In this study, we surveyed 5,847 players of Jagex's RuneScape to examine how trait hostility relates to player roles that prioritize skill acquisition/improvement (Skillers), combat (Killers), or narrative challenges (Questers). Killers reported modestly higher levels of trait hostility than Skillers and Questers. The most hostile players reported the strongest importance of in-game relative to offline achievements, possibly indicating hazardous involvement. Critically, hostile players also report the strongest cognitive and social benefits. These include (i) skills acquired through MMORPGs that help players to achieve things in their offline lives and (ii) online relationships that benefit offline relationships. These findings offer a new perspective on the way that a previously reported risk factor for harmful MMORPG play relates to player engagement, possibly by offering a helpful space for hostile individuals to develop problem solving and social skills. This suggests that some individuals who might be vulnerable to developing harmful patterns of MMORPG play may simultaneously experience greater tangible benefits.

Exercise effects on quality of life, mood, and self-worth in overweight children: the SMART randomized controlled trial

Overweight children are at risk for poor quality of life (QOL), depression, self-worth, and behavior problems. Exercise trials with children have shown improved mood and self-worth. Few studies utilized an attention control condition, QOL outcomes, or a follow-up evaluation after the intervention ends. The purpose is to test effects of an exercise program versus sedentary program on psychological factors in overweight children. One hundred seventy-five overweight children (87% black, 61% female, age 9.7 ± 0.9 years, 73% obese) were randomized to an 8 month aerobic exercise or sedentary after-school program. Depressive symptoms, anger expression, self-worth, and QOL were measured at baseline and post-test. Depressive symptoms and QOL were also measured at follow-up. Intent-to-treat mixed models evaluated intervention effects, including sex differences. At post-test, QOL, depression, and self-worth improved; no group by time or sex by group by time interaction was detected for QOL or self-worth. Boys' depressive symptoms improved more and anger control decreased in the sedentary intervention relative to the exercise intervention at post-test. At follow-up, depressive symptoms in boys in the sedentary group decreased more than other groups. Exercise provided benefits to QOL, depressive symptoms, and self-worth comparable to a sedentary program. Sedentary programs with games and artistic activities, interaction with adults and peers, and behavioral structure may be more beneficial to boys' mood than exercise. Some benefits of exercise in prior studies are probably attributable to program elements such as attention from adults. Trial Registration: Clinicaltrials.gov, NCT02227095.

The Development and Initial Validation of the Child Perceived Discrimination Questionnaire

Perceived discrimination can affect psychological and physical health, starting in childhood. Yet, the measures that exist for measuring perceived discrimination among children have methodological limitations and structural/theoretical inconsistencies. The Child Perceived Discrimination Questionnaire (CPDQ) fills the gaps of the current measures by assessing two dimensions of everyday discrimination from both child and adult sources. To assess the reliability and validity of the CPDQ, we examined data from 163 participants, aged 9-11, 52.15% female, 57.67% Black. Results indicated that the CPDQ has good to excellent internal consistency and provided preliminary support for an a priori hypothesized factor structure. The CPDQ also discriminated between different race groups and demonstrated construct validity. Future research should seek additional evidence of reliability and validity for the CPDQ, though this preliminary evidence suggests that the CPDQ is appropriate for assessing perceived discrimination in children.

Optimism predicts sustained vigorous physical activity in postmenopausal women

Optimism and cynical hostility are associated with health behaviors and health outcomes, including morbidity and mortality. This analysis assesses their association with longitudinal vigorous physical activity (PA) in postmenopausal women of the Women's Health Initiative (WHI). Subjects include 73,485 women nationwide without history of cancer or cardiovascular disease (CVD), and no missing baseline optimism, cynical hostility, or PA data. The Life Orientation Test-Revised Scale measured optimism. A Cook Medley questionnaire subscale measured cynical hostility. Scale scores were divided into quartiles. Vigorous PA three times or more per week was assessed via self-report at study baseline (1994–1998) and through follow-up year 6. Descriptive analysis mapped lifetime trajectories of vigorous PA (recalled at ages 18, 25, 50; prospectively assessed at baseline, and 3 and 6 years later). Hierarchical generalized linear mixed models examined the prospective association between optimism, cynical hostility, and vigorous PA over 6 years. Models adjusted for baseline sociodemographic variables, psychosocial characteristics, and health conditions and behaviors. Vigorous PA rates were highest for most optimistic women, but fell for all women by approximately 60% between age 50 and study baseline. In adjusted models from baseline through year 6, most vs. least optimistic women were 15% more likely to exercise vigorously (p < 0.001). Cynical hostility was not associated with lower odds of longitudinal vigorous PA after adjustment. Results did not differ by race/ethnicity or socioeconomic status. Higher optimism is associated with maintaining vigorous PA over time in post-menopausal women, and may protect women's health over the lifespan.

Healthy Families: A Family-Based Community Intervention To Address Childhood Obesity

The objective of this study was to determine the effectiveness of Healthy Families, a family-based community intervention, in improving the knowledge, self-efficacy, and health behaviors of overweight/obese children and their families as well as to explore the lessons learned. Results showed families who completed the program had significant improvements for children and parents in areas such as nutrition knowledge and self-efficacy in making healthy eating choices as well as participating in physical activity. Additionally, families reported decreasing their intake of sugar-sweetened beverages. Participating families and community partners provided valuable lessons for other communities seeking to implement a similar program.

Background lead and mercury exposures: Psychological and behavioral problems in children

BACKGROUND

The potential harm from exposure to nonessential metals, particularly mercury (Hg) and lead (Pb), has been the focus of research for years. Initial interest focused on relatively high exposures; however, recent evidence suggests that even background exposures might have adverse consequences for child development. Identifying the extent of these consequences is now a priority.

METHODS

We assessed blood Pb and Hg levels in a biracial sample of 9-11 year-old children (N = 203). Neurodevelopment and psychological functioning assessments included hostility, disruptive behaviors, emotion regulation, and autism spectrum disorder behaviors. Parasympathetic (vagal) responses to acute stress were indexed by heart rate variability (HRV) at rest and during stress.

RESULTS

With increasing Pb levels, children exhibit higher levels of hostile distrust and oppositional defiant behaviors, were more dissatisfied and uncertain about their emotions, and had difficulties with communication. These significant associations were found within a range of blood Pb levels from 0.19 to 3.25μg/dL, well below the "reference value" for children of >5μg/dL. Vagal reactivity interacted with Hg such that increasing Hg was associated with increasing autism spectrum behaviors for those children with sustained vagal tone during acute stress.

CONCLUSIONS

This study is the first to demonstrate an association between very low-level Pb exposure and fundamental psychological mechanisms that might explain prior associations with more complex outcomes such as delinquency. Analyses of vagal reactivity yielded entirely novel associations suggesting that Hg may increase autism spectrum behaviors in children with sustained vagal tone during acute stress. The novelty of these later findings requires additional research for confirmation and the cross-sectional nature of the data caution against assumptions of causality without further research.

Are Optimism and Cynical Hostility Associated with Smoking Cessation in Older Women?

BACKGROUND

Optimism and cynical hostility independently predict morbidity and mortality in Women's Health Initiative (WHI) participants and are associated with current smoking. However, their association with smoking cessation in older women is unknown.

PURPOSE

The purpose of this study is to test whether optimism (positive future expectations) or cynical hostility (mistrust of others) predicts smoking cessation in older women.

METHODS

Self-reported smoking status was assessed at years 1, 3, and 6 after study entry for WHI baseline smokers who were not missing optimism or cynical hostility scores (n = 10,242). Questionnaires at study entry assessed optimism (Life Orientation Test-Revised) and cynical hostility (Cook-Medley, cynical hostility subscale). Generalized linear mixed models adjusted for sociodemographics, lifestyle factors, and medical and psychosocial characteristics including depressive symptoms.

RESULTS

After full covariate adjustment, optimism was not related to smoking cessation. Each 1-point increase in baseline cynical hostility score was associated with 5% lower odds of cessation over 6 years (OR = 0.95, CI = 0.92-0.98, p = 0.0017).

CONCLUSIONS

In aging postmenopausal women, greater cynical hostility predicts lower smoking cessation over time. Future studies should examine whether individuals with this trait may benefit from more intensive cessation resources or whether attempting to mitigate cynical hostility itself may aid smoking cessation.

Frontal lobe regulation of blood glucose levels: support for the limited capacity model in hostile violence-prone men

Hostile men have reliably displayed an exaggerated sympathetic stress response across multiple experimental settings, with cardiovascular reactivity for blood pressure and heart rate concurrent with lateralized right frontal lobe stress (Trajanoski et al., in Diabetes Care 19(12):1412-1415, 1996; see Heilman et al., in J Neurol Neurosurg Psychiatry 38(1):69-72, 1975). The current experiment examined frontal lobe regulatory control of glucose in high and low hostile men with concurrent left frontal lobe (Control Oral Word Association Test [verbal]) or right frontal lobe (Ruff Figural Fluency Test [nonverbal]) stress. A significant interaction was found for Group × Condition, F (1,22) = 4.16, p ≤ .05 with glucose levels (mg/dl) of high hostile men significantly elevated as a function of the right frontal stressor (M = 101.37, SD = 13.75) when compared to the verbal stressor (M = 95.79, SD = 11.20). Glucose levels in the low hostile group remained stable for both types of stress. High hostile men made significantly more errors on the right frontal but not the left frontal stressor (M = 17.18, SD = 19.88) when compared to the low hostile men (M = 5.81, SD = 4.33). These findings support our existing frontal capacity model of hostility (Iribarren et al., in J Am Med Assoc 17(19):2546-2551, 2000; McCrimmon et al., in Physiol Behav 67(1):35-39, 1999; Brunner et al., in Diabetes Care 21(4):585-590, 1998), extending the role of the right frontal lobe to regulatory control over glucose mobilization.

Depressive symptoms, hostility, and hopelessness in inner-city adolescent health clinic patients: factor structure and demographic correlates

BACKGROUND

Depression, hostility, and hopelessness are risk factors for adult cardiovascular disease (CVD). People living in inner-city environments are particularly vulnerable. These associations may begin in adolescence, but research in this area is hampered by inadequate knowledge about how these negative psychological factors are related in teens and how they are affected by demographic characteristics. We hypothesized that depression, hostility, and hopelessness are one construct, and that this construct would be associated with race and gender in attendees at an inner-city adolescent health clinic.

METHODS

Two hundred and forty-six 15-18-year-old patients filled out instruments measuring depressive symptoms, hostility, and hopelessness. Confirmatory factor analysis was used to determine whether the negative psychological factors comprised a single construct or three separate ones. General linear modeling (GLM) was used to test the associations between demographic characteristics and the results of the factor analysis.

RESULTS

Depressive symptoms, hostility, and hopelessness were best characterized as three separate constructs, not one (root mean square error of approximation (RMSEA)=0.041, 90% confidence interval (CI)=(0.035, 0.047), comparative fit index (CFI)=0.98). There were no significant relationships between demographic variables and depressive symptoms or hostility. Six percent of the variance in hopelessness scores was accounted for by gender, race, and the interaction between the two (F=3.76; p=0.006), with White males, reporting the highest levels of hopelessness.

CONCLUSION

In an urban adolescent health clinic population, depressive symptoms, hostility, and hopelessness were best understood as three separate constructs. Hopelessness was significantly higher in White males. Implications for future clinical research on negative psychological factors in teens are discussed.

Cloninger’s Temperament Dimensions, Socio-economic and Lifestyle Factors and Metabolic Syndrome Markers at Age 31 Years in the Northern Finland Birth Cohort 1966

The aim of this study was to assess the association between temperament and metabolic syndrome markers. Cloninger’s Temperament and Character Inventory and clinical examination were carried out in 1997 in the Northern Finland Birth Cohort 1966 ( N = 4364 respondents). Novelty seeking was positively associated with waist circumference in both genders. Systolic blood pressure was highest in men with high harm avoidance and low persistence scores and lowest in women with high reward dependence and high persistence scores. Childhood socio-economic status did not confound these associations. Smoking and alcohol consumption were associated with higher novelty seeking. Our results suggest that temperament is associated with metabolic syndrome markers and this association may be partly mediated by lifestyle factors and socio-economic status in adulthood.

Quality of relationships with parents and friends in adolescence predicts metabolic risk in young adulthood

OBJECTIVE

This study was designed to examine whether family and peer relationships in adolescence predict the emergence of metabolic risk factors in young adulthood.

METHOD

Participants from a large, nationally representative cohort study (N = 11,617 for these analyses) reported on their relationship experiences with parents and close friends during adolescence. Fourteen years later, interviewers collected blood samples, as well as anthropometric and blood pressure measurements. Blood samples were analyzed for HbA1c.

RESULTS

Ordered logistic regressions revealed that for females, supportive parent-child relationships and close male friendships in adolescence were associated with reduced odds of having elevated metabolic risk markers in young adulthood. These effects remained significant even after controlling for baseline measures of body mass index (BMI) and health and demographic covariates. The protective effects of close relationships were not significant for males, however. Exploratory analyses with 2-parent families revealed that supportive father-child relationships were especially protective for females.

CONCLUSIONS

These findings suggest that, for females, close and supportive relationships with parents and male friends in adolescence may reduce the risk of metabolic dysregulation in adulthood.

Comparison of overweight and obese military-dependent and civilian adolescent girls with loss-of-control eating

OBJECTIVE

Limited data suggest that the children of U.S. service members may be at increased risk for disordered-eating. To date, no study has directly compared adolescent military-dependents to their civilian peers along measures of eating pathology and associated correlates. We, therefore, compared overweight and obese adolescent female military-dependents to their civilian counterparts along measures of eating-related pathology and psychosocial functioning.

METHOD

Adolescent females with a BMI between the 85th and 97th percentiles and who reported loss-of-control eating completed interview and questionnaire assessments of eating-related and general psychopathology.

RESULTS

Twenty-three military-dependents and 105 civilians participated. Controlling for age, race, and BMI-z, military-dependents reported significantly more binge episodes per month (p < 0.01), as well as greater eating-concern, shape-concern, and weight-concern (p's < 0.01) than civilians. Military-dependents also reported more severe depression (p < 0.05).

DISCUSSION

Adolescent female military-dependents may be particularly vulnerable to disordered-eating compared with civilian peers. This potential vulnerability should be considered when assessing military-dependents.

A Longitudinal Investigation of Race, Socioeconomic Status, and Psychosocial Mediators of Allostatic Load in Midlife Women: Findings From the Study of Women's Health Across the Nation

OBJECTIVES

This research sought to assess racial and socioeconomic status (SES) differences in level and change in allostatic load (AL) over time in midlife women and to test whether psychosocial factors mediate these relationships. These factors were discrimination, perceived stress, and hostility.

METHODS

Longitudinal data obtained from the Study of Women's Health Across the Nation were used (n = 2063; mean age at baseline = 46.0 years). Latent growth curve models evaluated the impact of demographic, menopausal, and psychosocial variables on level and change in AL for 8 years.

RESULTS

Direct effects: high levels of discrimination and hostility significantly predicted higher AL (path coefficients = 0.05 and 0.05, respectively). High perceived stress significantly predicted a faster rate of increase of AL (path coefficient = 0.06). Racial and SES differentials were present, with African American race (path coefficient = 0.23), low income (path coefficient = -0.15), and low education (path coefficient = -0.08) significantly predicting high AL level. Indirect effects: significant indirect effects were found for African American race, less income, and lower education through higher discrimination, perceived stress, and hostility on level and rate of AL.

CONCLUSIONS

This was one of the first studies that investigated AL over multiple periods, and results supported AL as a cumulative phenomenon, affected by multiple psychosocial and demographic factors. The results suggest the complex ways in which race, SES, and psychosocial factors operate to influence AL.

Positive attributes protect adolescents from risk for the metabolic syndrome

PURPOSE

Risk for cardiovascular disease develops as early as adolescence. The primary objective of the present study was to identify whether low levels of positive and high levels of negative emotions and attitudes are associated with the combination of cardiovascular risk factors known as the metabolic syndrome.

METHODS

Participants were 239 healthy adolescents (57% black; 53% female; mean age, 15.7 years) from a low-to-middle class community. They completed measures of negative and positive emotions and attitudes, which were factor analyzed and yielded two factors. Positive attributes included general positive affect, optimistic attitudes, subjective social status, and self-esteem. Negative emotions included cynical attitudes, depressive symptoms, trait anger, and general negative affect. Components of the metabolic syndrome (waist circumference, glucose, blood pressure, triglycerides, and high-density lipoprotein cholesterol) were standardized and averaged to create a metabolic syndrome composite risk score.

RESULTS

Linear regression analyses showed that the positive attributes factor was inversely associated with metabolic syndrome composite risk score, p < .01. The relationship remained significant after adjusting for age, sex, race, socioeconomic status, physical activity, smoking, and body mass index percentile. The negative emotion factor was unrelated to metabolic risk score.

CONCLUSIONS

Adolescents with more positive attributes had lower metabolic syndrome risk scores. This study emphasizes the importance of the development of psychosocial resources during the adolescent transition for potentially reducing future cardiovascular risk.

Metabolic syndrome and suicidal ideation in korean based on the 2010 korean national health and nutrition examination survey

The aim of this study was to investigate the relationship between metabolic syndrome and suicidal ideation in Korean. This study was based on the 2010 Korean National Health and Nutrition Examination Survey. A questionnaire was used to measure suicidal ideation and physical examination was performed to measure waist circumference, blood pressure, fasting glucose, cholesterol and triglyceride levels. Complex samples logistic regression was performed to estimate the relationship between metabolic syndrome and suicidal ideation among adults and adolescents. Subjects with metabolic syndrome were more likely to have suicidal ideation in adult. There would be essential needs to evaluate suicidal ideation in adult with metabolic syndrome and to follow up suicidal ideation in adolescents with metabolic syndrome.

Hostility modifies the association between TV viewing and cardiometabolic risk

BACKGROUND

It was hypothesized that television viewing is predictive of cardiometabolic risk. Moreover, people with hostile personality type may be more susceptible to TV-induced negative emotions and harmful health habits which increase occurrence of cardiometabolic risk.

PURPOSE

The prospective association of TV viewing on cardiometabolic risk was examined along with whether hostile personality trait was a modifier.

METHODS

A total of 3,269 Black and White participants in the coronary artery risk development in young adults (CARDIA) study were assessed from age 23 to age 35. A cross-lagged panel model at exam years 5, 10, 15, and 20, covering 15 years, was used to test whether hours of daily TV viewing predicted cardiometabolic risk, controlling confounding variables. Multiple group analysis of additional cross-lagged panel models stratified by high and low levels of hostility was used to evaluate whether the association was modified by the hostile personality trait.

RESULTS

The cross-lagged association of TV viewing at years 5 and 15 on clustered cardiometabolic risk score at years 10 and 20 was significant (B = 0.058 and 0.051), but not at 10 to 15 years. This association was significant for those with high hostility (B = 0.068 for exam years 5 to 10 and 0.057 for exam years 15 to 20) but not low hostility.

CONCLUSION

These findings indicate that TV viewing is positively associated with cardiometabolic risk. Further, they indicate that hostility might be a modifier for the association between TV viewing and cardiometabolic risk.

The metabolic costs of hostility in healthy adult men and women: cross-sectional and prospective analyses

BACKGROUND

Hostility is associated with altered metabolic activity but little research has examined sex and/or age differences using a global index of metabolic dysfunction or examined different aspects of hostility.

METHODS

The moderating effect of sex and age on the associations between three aspects of hostility (cynical attitude, angry affect, quarrelsome behavior in daily living) and metabolic burden (number of metabolic parameters in the higher quartile) were evaluated in 188 healthy men and women (M(age)=41; SD=11.34). Three years later, metabolic burden was measured again in 133 participants.

RESULTS

At study onset, quarrelsome behavior was associated with greater metabolic burden in men and women (Beta=.144; p<.05). After 3 yrs, cynical hostility predicted increased metabolic burden among mid-age and older individuals (b=.013 and .046 respectively; p<.001).

CONCLUSION

The aspect of hostility that is most closely associated with metabolic burden depends on the age of the participants and whether measures are concurrent or prospective.

Family-based models for childhood-obesity intervention: a systematic review of randomized controlled trials

Effective interventions are needed to address the growing epidemic of childhood obesity. In the past 35 years, family-based approach has gradually developed as a preferred intervention. This review aimed to examine the methodological rigour and treatment effectiveness of family-based interventions according to intervention types and theoretical orientations. A total of 15 randomized controlled trials (RCTs) of family-based lifestyle interventions for children and adolescents aged 2-19 years were included. The adapted Methodological Quality Rating Scales (MQRS) and a four-grade qualitative scoring scheme were adopted to evaluate the methodological rigour and the effectiveness of treatment, respectively. The average MQRS score was 7.93 out of 14 points. Ten of the 15 RCTs had well aligned their research questions with appropriate research methods. The overall short-term outcome of the15 RCTs were satisfactory with an average score of 3.1. Family-based interventions rooted in behaviour theory achieved better results than those theoretically connected to family systems theory in terms of treatment effectiveness. Results suggest future studies to improve the methodological design and continue to explore the potential of the family systems approach.

Personality as a risk factor for the metabolic syndrome: a systematic review

OBJECTIVE

The metabolic syndrome is a cluster of risk factors for the development of cardiovascular disease and/or type 2 diabetes. Personality can be defined as a stable set of behavioral characteristics of a person. In this review we systematically reviewed whether different personality characteristics are associated with the risk of having or developing the metabolic syndrome.

METHODS

Systematic review.

RESULTS

In total 18 studies were included. Thirteen cross-sectional analyses, and ten longitudinal analyses were grouped according to personality constructs: hostility, anger, and Type A behavior, temperament, neuroticism, and Type D personality. Conflicting evidence was reported on persons with high hostility, neuroticism, or Type D personality scores to be associated with an increased metabolic syndrome prevalence and development. All significant findings do point in the same direction: a more negative, or hostile personality type is associated with an increased prevalence of metabolic syndrome and its development over time.

CONCLUSION

There was no clear association between personality measures and the occurrence and development of the metabolic syndrome. There is, however, a cluster of risk factors that include the presence of the metabolic syndrome, as well as a more negative prone personality style, that both predispose to the development of coronary heart disease and diabetes. Future studies should investigate the role of personality measures in the development of these conditions, while taking into account metabolic syndrome, lifestyle and socio-demographic factors.

Mediation and moderation of the association between cynical hostility and systolic blood pressure in low-income women

Hostility may be related to risk factors for cardiovascular disease (CVD), such as blood pressure. However, the process by which hostility affects blood pressure is not fully understood. The current study sought to evaluate abdominal obesity (waist-to-hip ratio [WHR]) as a potential mediator and modifier of the relationship between cynical hostility and systolic blood pressure (SBP) in a group of disadvantaged women. Path analysis and multiple regression models were used to identify mediating and moderating pathways in the relationship between cynical hostility and SBP. Results indicate a significant interaction between WHR and cynical hostility. WHR was a partial mediator and significant moderator of the association between hostility and blood pressure. These findings highlight the potential importance of examining abdominal obesity and psychosocial factors as conjunctive determinants of CVD and risk factors for related metabolic conditions.

Relationship of insulin resistance to psychobehavioral characteristics of overweight and obese African American children

OBJECTIVES

The objective of this study was to evaluate the relationships of insulin resistance to positive as well as negative dimensions of the child's emotions, behavior and personality (hereafter referred to as "psychobehavioral characteristics") in a convenience sample of inner-city, overweight and obese, African American children.

METHODS

A secondary analysis was performed on a sample of 127 children ages 9-12 yr old who were participating in a community-based, Type 2 diabetes prevention program. Psychobehavioral characteristics of children were assessed using both child and parent ratings derived from the Behavioral Assessment for Children, 2nd edition (BASC-2). Body fatness was evaluated using anthropometric techniques, and insulin resistance (HOMA-IR) was calculated from fasting glucose and insulin concentrations. Hierarchical multiple linear regression models were employed with BASC scales as dependent variables and HOMA-IR as the independent variable of interest.

RESULTS

After adjusting for child age, pubertal stage, gender, family socioeconomic index, and intervention group assignment, child HOMA-IR was related at p<0.05 to less favorable scores for parent-report of behavioral symptoms and externalizing problems composites, and to content scales for bullying and negative emotionality. Additionally, child HOMA-IR was related at p<0.01 to less favorable scores for child-report inattention/hyperactivity composite. Body fatness suppressed the unfavorable relationship between HOMA-IR and these and other psychobehavioral characteristics as the degree of significance was higher following adjustment for body fatness in this cohort.

CONCLUSION

More than one psychobehavioral characteristic were associated with body fatness and insulin resistance in the overweight children of this study. Whether the associations are due to several, or only one, of these psychobehavioral characteristics could not be determined. A much larger and future study will be needed to determine which, if any, of these psychobehavioral characteristics are independently associated with insulin resistance in overweight children.

Mediators of the relationship between socioeconomic status and allostatic load in the Chicago Health, Aging, and Social Relations Study (CHASRS)

Low socioeconomic status (SES) has been associated with higher levels of allostatic load (AL). Posited mechanisms for this association include stress, personality, psychosocial variables, coping, social networks, and health behaviors. This study examines whether these variables explain the SES-AL relationship in a population-based sample of 208 51- to 69-year-old White, Black, and Hispanic adults in the Chicago Health, Aging, and Social Relations Study. AL was based on nine markers of physiological dysregulation. SES was inversely associated with a composite measure of AL; hostility and poor sleep quality helped to explain the association between AL and SES. Factor analyses revealed four AL components corresponding to the bodily systems of interest. SES was significantly associated with two AL components, suggesting that the effects of SES on physiological dysregulation are specific to certain systems in a middle to early old-age population.

Comparison of the established definition criteria for diagnosing metabolic syndrome between overweight and obese children in Vojvodina

Background/Aim. Metabolic syndrome is a clinical term which encompasses obesity, insulin resistance, dyslipidemia, hypertension, as well as an increased risk of the development of diabetes mellitus type 2 and cardiovascular disorders in early adulthood. The prevalence of metabolic syndrome is increasing and directly related to the obesity rate among children. The aim of the research was to compare the established definition of the criteria for diagnosing metabolic syndrome in a sample group consisting of overweight and obese children in Vojvodina. Methods. The research was performed as a cross study analysis of 206 examinees. In terms of the sample group (25% children and 75% adolescents), 74% were obese and 26% overweight according to the body mass index (BMI). Two sets of criteria for diagnosing metabolic syndrome were applied in the sample of adolescents: the criteria for adults, specifically adapted for children, and the criteria defined by the International Diabetes Federation (IDF) for children and adolescents. The research included the analysis of the following criteria: BMI, waist circumference, blood pressure, triglycerides, HDL cholesterol, glycemia and insulinemia during the oral glucose tolerance test (OGTT). Results. By applying the specific criteria for diagnosing the metabolic syndrome in children and adolescents on the whole sample, it was established that the metabolic syndrome was present in 41% of the examinees, while the application of the criteria defined by the IDF confirmed the diagnosis in 22% of the examinees. An analysis of the metabolic syndrome risk factors established that among the defined specific criteria the most frequent factors present were elevated BMI and the pathological results of the OGTT, while the least frequent was low HDL cholesterol. Among the criteria listed by the IDF, the most frequent metabolic syndrome factors were waist circumference and increased blood pressure, while the least frequent was elevated fasting glucose. Conclusion. Metabolic syndrome in overweight and obese children in Vojvodina was diagnosed much more often when the specific criteria for children and adolescents were applied than it was the case when the criteria defined by the International Diabetes Federation were applied.

The type B behavior pattern as a moderating variable of the relationship between stressor chronicity and health behavior

To test the hypotheses that Type B individuals would engage in more preventive and less risk-related behaviors under high stress than Type As, 155 students were administered questionnaires pertaining to the TABP, daily hassles, and health behavior. As predicted, in six out of seven regression analyses, Type Bs engaged in more preventive, and fewer risk-related behaviors under high stress, than those who self-reported as Type A. Self-regulation mechanisms are proposed to help account for these effects.

Hostility and adiposity mediate disparities in insulin resistance among adolescents and young adults

OBJECTIVE

This study explores whether the relationship between lower socioeconomic status and insulin resistance in adolescents is mediated by both physiological and psychological factors associated with increased cardiometabolic risk.

STUDY DESIGN

School-based longitudinal cohort study of 1222 healthy, non-Hispanic black and white teens. Parent education (PE), youth-specific Cook-Medley hostility scale, waist circumference, height, weight, pubertal status, and fasting plasma insulin (FPI) were measured and FPI reassessed 1 year later. Regression analyses utilizing bootstrapping (n=2000) were used to estimate the direct and indirect effects of PE on FPI and assess the role of hostility and adiposity while adjusting for covariates.

RESULTS

Lower PE predicted higher FPI (B=-1.52, P=.003), as did hostility (B=.19, P=.002) and adiposity (waist circumference B=.44, P<.001, BMI B=.98, P<.001). The effect of PE on FPI was mediated by both hostility and adiposity. When adiposity and hostility were accounted for, the effect of PE on FPI decreased by 32% (B=-1.04, P=.04); the total indirect estimate was -.485 (95% CI, -.652, -.041). Hostility accounted for 36% of the meditational effect.

CONCLUSIONS

Lower PE influences insulin resistance through adiposity and hostility. Thus, interventions to reduce health disparities associated with insulin resistance should consider both physiological and psychological approaches.

Impact of early psychosocial factors (childhood socioeconomic factors and adversities) on future risk of type 2 diabetes, metabolic disturbances and obesity: a systematic review

Background

Psychological factors and socioeconomic status (SES) have a notable impact on health disparities, including type 2 diabetes risk. However, the link between childhood psychosocial factors, such as childhood adversities or parental SES, and metabolic disturbances is less well established. In addition, the lifetime perspective including adult socioeconomic factors remains of further interest.

We carried out a systematic review with the main question if there is evidence in population- or community-based studies that childhood adversities (like neglect, traumata and deprivation) have considerable impact on type 2 diabetes incidence and other metabolic disturbances. Also, parental SES was included in the search as risk factor for both, diabetes and adverse childhood experiences. Finally, we assumed that obesity might be a mediator for the association of childhood adversities with diabetes incidence. Therefore, we carried out a second review on obesity, applying a similar search strategy.

Methods

Two systematic reviews were carried out. Longitudinal, population- or community-based studies were included if they contained data on psychosocial factors in childhood and either diabetes incidence or obesity risk.

Results

We included ten studies comprising a total of 200,381 individuals. Eight out of ten studies indicated that low parental status was associated with type 2 diabetes incidence or the development of metabolic abnormalities. Adjustment for adult SES and obesity tended to attenuate the childhood SES-attributable risk but the association remained. For obesity, eleven studies were included with a total sample size of 70,420 participants. Four out of eleven studies observed an independent association of low childhood SES on the risk for overweight and obesity later in life.

Conclusions

Taken together, there is evidence that childhood SES is associated with type 2 diabetes and obesity in later life. The database on the role of psychological factors such as traumata and childhood adversities for the future risk of type 2 diabetes or obesity is too small to draw conclusions. Thus, more population-based longitudinal studies and international standards to assess psychosocial factors are needed to clarify the mechanisms leading to the observed health disparities.

Psychological symptoms and insulin sensitivity in adolescents

PURPOSE

Symptoms of psychological distress have been linked to low insulin sensitivity in adults; however, little is known about this relationship in pediatric samples. We therefore examined symptoms of depression and anxiety in relation to insulin sensitivity in adolescents.

METHODS

Participants were 136 non-treatment-seeking, healthy adolescents (53.2% female) of all weight strata (BMI-z = 1.08 +/- 1.08) between the ages of 12 and 18 years (M = 15.16,SD = 1.55). Adolescents completed questionnaire measures assessing depression and anxiety symptoms. Fasting blood samples for serum insulin and plasma glucose were obtained to estimate insulin sensitivity with the quantitative insulin sensitivity check index. Fat mass and fat-free mass were measured with air displacement plethysmography or dual-energy X-ray absorptiometry.

RESULTS

Depressive symptoms were associated with higher fasting insulin and decreased insulin sensitivity even after controlling for fat mass, fat-free mass, height, age, pubertal status, race, and sex (p < 0.01).

CONCLUSIONS

As has been described for adults, depressive symptoms are associated with low insulin sensitivity among healthy adolescents. Further experimental and prospective studies are required to determine the directionality of this link.

Involvement of psychosocial factors in the association of obesity with periodontitis

The present case-control study of 79 subjects (19-69 yr) was designed to assess the relationship of several psychological determinants to periodontal disease and obesity. Periodontal clinical examinations were performed, and the subjects were asked to complete a set of questionnaires measuring Type A personality, anxiety, depression, dental anxiety, hopelessness, emotional intelligence, stress, self-esteem, optimism and satisfaction with life. In a bivariate analysis, overweight individuals presented higher levels of smoking exposure, anxiety and depression and lower levels of optimism and satisfaction with life. They were mainly females, with a higher number of sites and teeth with probing depth (PD) >6 mm and clinical attachment level (CAL) >5 mm. Patients with a mean PD exceeding 3 mm and a bleeding on probing index of >25% presented higher values of dental anxiety and lower levels of self-esteem. Multiple linear regression analyses revealed that dental anxiety was positively associated with the number of teeth with a PD of >6 mm and with reasons for visiting a dentist, while satisfaction with life was associated with flossing frequency. We conclude that there is an association between several psychological determinants, periodontitis, and body mass index.

Depressive symptoms and the metabolic syndrome in childhood and adulthood: a prospective cohort study

OBJECTIVE

To examine the reciprocal associations between depressive symptoms and clinical definitions of the metabolic syndrome in childhood and adulthood.

DESIGN

Population-based prospective cohort study of 921 participants (538 women and 383 men) in Finland. The components of the metabolic syndrome were measured in childhood (mean age 12 years) and again in adulthood (mean age 33 years). A revised version of the Beck Depression Inventory was used to assess depressive symptoms at the mean ages of 24 and 33.

MAIN OUTCOME MEASURES

Metabolic syndrome defined by the National Cholesterol Education Program Adult Treatment Panel III (NCEP), the European Group for the Study of Insulin Resistance, and the International Diabetes Federation criteria.

RESULTS

In women, depressive symptoms were associated with increased risk of the metabolic syndrome in adulthood (odds ratio for NCEP metabolic syndrome per 1 SD increase in depressive symptoms 1.40, 95% confidence interval 1.05-1.85). The metabolic syndrome in childhood, in turn, predicted higher levels of depressive symptoms in adulthood (p = .03). In men, no associations were found between depressive symptoms and the clinical definitions of the metabolic syndrome.

CONCLUSION

The process linking depressive symptoms with the metabolic syndrome may go into both directions and may begin early in life.

Defensiveness and metabolic syndrome: impact of sex and age

The association between defensiveness and metabolic burden, as well as the moderating effects of sex and age were evaluated in 199 healthy working men (N=81) and women (N=118), aged 20-64 years (M=41; S.D.=11.45). Defensiveness (Marlowe-Crowne Social Desirability Scale) and parameters of metabolic syndrome (MS; waist circumference, HDL, triglycerides, glucose, 24h ambulatory blood pressure) were obtained. In men, defensiveness was inversely related to MS burden (Beta=-.288; p=.001), as well as to individual measures of SBP, DBP, glucose and waist circumference (p<.05). In older women, high defensiveness was associated with a greater MS burden (p=.050) and glucose level (p=.005) while the reverse was true in younger women (p=.012). In conclusion, defensiveness was associated with a worse metabolic profile in older women but may be protective for men and younger women. Understanding the pathophysiological processes underlying these associations could elucidate sex and age differences and inform prevention efforts.

Aerobic exercise program reduces anger expression among overweight children

This study tested the effect of a structured aerobic exercise program on anger expression in healthy overweight children. Overweight sedentary children were randomly assigned to an aerobic exercise program or a no-exercise control condition. All children completed the Pediatric Anger Expression Scale at baseline and posttest. Anger Out and Anger Expression scores were lower for the exercise condition at posttest. Fitness improvements contributed significantly to final models, and points earned for adherence correlated negatively with posttest Anger Out. An aerobic exercise program might be an effective strategy to reduce anger expression, including reduction of aggressive behavior, in overweight children.

Mechanisms by Which Childhood Personality Traits Influence Adult Well-being

Children's personality traits have enduring effects that shape adult well-being. In particular, childhood conscientiousness influences core aspects of adult well-being: health, friendships, and mastery. Research is now examining the mechanisms by which early personality traits initiate and sustain particular life paths. These include mediating and moderating mechanisms that may operate during critical developmental periods or may build cumulatively over time. Future research would benefit from testing theoretically derived mechanisms for different traits, and examining variables as they change over time, using both short- and long-term longitudinal designs over different life stages.

Infant growth and hostility in adult life

OBJECTIVE

Hostility may confer a risk of cardiovascular disease and all-cause mortality, but why is uncertain. A common origin in suboptimal fetal and early postnatal life may lie beneath. This study tested whether prenatal and postnatal growth predicts hostility in adult life.

METHODS

Women (n = 939) and men (n = 740) born in Helsinki, Finland, from 1934 through 1944 filled out the Cook-Medley Hostility Scale at an average age of 63.4 years. Growth was estimated from birth, child welfare clinic, and school records. Adult body size was measured in a clinic.

RESULTS

Men and women who had higher levels of hostility in adulthood were born lighter and thinner, showed slower weight gain from birth to 6 months of age, were lighter throughout childhood (standardized regression coefficients (beta) <-0.05; 95% confidence intervals (95% CI), -0.14 to -0.00; p values <.05), but were heavier in adulthood (beta values > 0.06; 95% CIs, 0.02-0.14; p values <.01). They were also shorter from 6 months until the age of 1 year (beta values <-0.09; 95% CIs, -0.14 to -0.03; p values <.003), and tended to be shorter in adulthood (beta = -0.05; 95% CI, -0.09 to 0.00; p = .06). The latter effects were largely attributable to slower growth in stature from birth to 6 months (beta = -0.08; 95% CI, -0.14 to -0.02; p = .005). The associations were not explained by major confounders.

CONCLUSIONS

Our study suggests that slow prenatal and infant growth is linked with hostility in adult life.

[The HOMA and QUICKI indexes, and insulin and C-peptide levels in healthy children. Cut off points to identify metabolic syndrome in healthy children]

OBJECTIVE

The aim of this study was to establish the reference values of the Homeostasis Model Assessment (HOMA) and Quantitative Insulin Sensitivity Check (QUICKI) indexes, as well as those of insulin and C-peptide levels in healthy children and adolescents with a view to determining reference percentiles to detect those at cardiovascular risk.

MATERIAL AND METHODS

A total of 372 children boys and girls of different ages and at distinct pubertal stages with normal body mass index participated in the study. Fasting glucose, insulin and C-peptide values were measured by chemiluminescence and the HOMA and QUICKI indexes were calculated.

RESULTS

Fasting glucose levels were normal in all children. The mean values obtained for each variable were (mean (SD)): fasting glucose 87(7.75) mg/dL, insulin 7.74 (5.35) microU/mL, C-peptide: 1.76 (0.79) ng/mL, HOMA index 1.72 (1.27) and QUICKI index 0.72 (0.29). All the variables progressively increased with age, with statistically significant differences between prepubertal and pubertal children. The QUICKI index showed an inverse relationship. In addition, significant differences were found between sexes. The 90th percentile for all the variables was as follows: insulin 15.05 microU/mL, C-peptide: 2.85 ng/mL, HOMA index 3.43 and QUICKI index 1.10.

CONCLUSIONS

Values of fasting glucose, insulin, C-peptide and the HOMA index significantly increased with age and pubertal stage, while the QUICKI index decreased. We defined the 90th percentile for all the parameters studied as the cut-off point to identify children at cardiovascular risk in our population.

Cardiovascular disease risk factors in adolescents: do negative emotions and hypothalamic-pituitary-adrenal axis function play a role?

PURPOSE OF REVIEW

Negative emotions such as depression and hostility/anger are important risk factors for cardiovascular disease in adults, but are often neglected in treatment or prevention programs. Adolescence is a stage of life when negative emotions often first become problematic and is also a time when the pathogenesis of cardiovascular disease appears to accelerate. The literature on negative emotions and cardiovascular disease risk factors in adolescents is reviewed here.

RECENT FINDINGS

Research indicates that negative emotions are associated with cardiovascular disease risk factors in adolescence. Negative emotions are also associated with several types of hypothalamic-pituitary-adrenal axis dysregulation. Such dysregulation appears to have a facilitatory effect on cardiovascular disease development and progression in adults. Thus, it is possible that negative emotions in adolescents may be risk factors for the development of cardiovascular disease via dysregulation of the hypothalamic-pituitary-adrenal axis. Although this hypothesis has not been directly tested, some studies indirectly support the hypothesis.

SUMMARY

Negative emotions are associated with cardiovascular disease risk factors in adolescents; it is possible that hypothalamic-pituitary-adrenal axis dysregulation is an important mechanism. This hypothesis merits further research. If the hypothesis is valid, it has significant implications for early prevention of cardiovascular disease.

Instability in the diagnosis of metabolic syndrome in adolescents

BACKGROUND

Factor analyses suggest that the structure underlying metabolic syndrome is similar in adolescents and adults. However, adolescence is a period of intense physiological change, and therefore stability of the underlying metabolic structure and clinical categorization based on metabolic risk is uncertain.

METHODS AND RESULTS

We analyzed data from 1098 participants in the Princeton School District Study, a school-based study begun in 2001-2002, who were followed up for 3 years. We performed factor analyses of 8 metabolic risks at baseline and follow-up to assess stability of factor patterns and clinical categorization of metabolic syndrome. Metabolic syndrome was defined using the current American Heart Association/National Heart, Lung, and Blood Institute definition for adults (AHA), a modified AHA definition used in prior pediatric metabolic syndrome studies (pediatric AHA), and the International Diabetes Federation (IDF) guidelines. We found that factor structures were essentially identical at both time points. However, clinical categorization was not stable. Approximately half of adolescents with baseline metabolic syndrome lost the diagnosis at follow-up regardless of the definitions used: pediatric AHA=56% (95% confidence interval [CI], 42% to 69%), AHA=49% (95% CI, 32% to 66%), IDF=53% (95% CI, 38% to 68%). In addition to loss of the diagnosis, new cases were identified. Cumulative incidence rates were as follows: pediatric AHA=3.8% (95% CI, 2.8% to 5.2%); AHA=4.4% (95% CI, 3.3% to 5.9%); IDF=5.2% (95% CI, 4.0% to 6.8%).

CONCLUSIONS

During adolescence, metabolic risk factor clustering is consistent. However, marked instability exists in the categorical diagnosis of metabolic syndrome. This instability, which includes both gain and loss of the diagnosis, suggests that the syndrome has reduced clinical utility in adolescence and that metabolic syndrome-specific pharmacotherapy for youth may be premature.

Depressive symptoms and stressful life events predict metabolic syndrome among middle-aged women: a comparison of World Health Organization, Adult Treatment Panel III, and International Diabetes Foundation definitions

OBJECTIVE

We evaluated whether psychosocial factors that are related to cardiovascular disease and type 2 diabetes predict prospectively the risk for the metabolic syndrome using the different clinical criteria available for defining the syndrome.

RESEARCH DESIGN AND METHODS

Women were enrolled in a population-based prospective cohort study called the Healthy Women Study and were followed for an average of 15 years after baseline. Metabolic syndrome was defined via the World Health Organization, the National Cholesterol Education Program Adult Treatment Panel III, and the International Diabetes Foundation clinical criteria.

RESULTS

Among women who did not have the metabolic syndrome at the baseline, the risk for the metabolic syndrome defined in multiple ways varied from 1.21- to 2.12-fold ([95% CI 1.00-4.25], P < 0.05) for more severe depressive symptoms or very stressful life event(s). These associations were largely the same, regardless of the clinical criteria used to define the metabolic syndrome. Those who at the baseline reported feeling frequently and intensely angry, tense, or stressed also had an increased risk for developing the metabolic syndrome at least by one definition (relative risk 1.19-1.66 [1.00-2.39]).

CONCLUSIONS

These are the first data to demonstrate that psychosocial factors predict the risk for developing the metabolic syndrome by multiple definitions. Psychosocial factors may play a causal role in the chain of events leading to the metabolic syndrome.

Inflammation, cardiovascular disease, and metabolic syndrome as sequelae of violence against women: the role of depression, hostility, and sleep disturbance

Women who experience violence are significantly more likely to have serious health problems above and beyond any injuries they might incur. The intriguing question is why this is so. In this article, the author describes how three sequelae of violence against women-depression, hostility, and sleep disturbance-can increase the risk of disease. One possible mechanism by which these sequelae increase risk is by elevating levels of pro-inflammatory cytokines. These cytokines have an adaptive function in fighting infection and repairing injured tissues. However, chronically high levels of pro-inflammatory cytokines have been implicated in a wide range of diseases. The author focuses on two illnesses that have not received much attention in the violence against women (VAW) literature: cardiovascular disease and metabolic syndrome, the precursor to type 2 diabetes. Preliminary studies also suggest that treatments that can lower inflammation may be promising adjuncts for survivors of VAW.

Psychological underpinnings of metabolic syndrome

Metabolic syndrome (MS) is more common among socio-economically disadvantaged individuals and is associated with certain risky lifestyle practices. MS also appears to be triggered by adverse social circumstances and chronic stress. The present paper reviews accumulating evidence to imply that individuals who have certain personality and behaviour traits are particularly predisposed to develop MS, and brings together theories that relate to possible psychological mechanisms underlying MS. It considers how such factors might interact causally to encourage the development of MS. As part of the EU-funded LIPGENE Integrated Project, multi-level modelling will be undertaken to explore potential pathways to MS, taking into consideration the interplay between a range of psycho-social, demographic, cultural and lifestyle factors thought to contribute to the development of MS. Data will be gathered for this purpose from a representative sample of >50-year-olds living in Britain (n 1000) and Portugal (n 500). It is anticipated that this information will assist in the development and targetting of future intervention to prevent and treat MS in the normal population.

A quantitative analysis of the relationship between the Cook-Medley Hostility Scale and traditional coronary artery disease risk factors

One possible explanation for the association between Cook-Medley Hostility Scale (Ho Scale; W. W. Cook & D. M. Medley, 1954) scores and premature coronary artery disease (CAD) morbidity and mortality is that hostile persons also have elevations on CAD risk factors. Meta-analyses with fixed and random-effects models were used to evaluate the relationship between Ho Scale scores and CAD risk factors in the empirical literature. Ho Scale scores were significantly related to body mass index, waist-to-hip ratio, insulin resistance, lipid ratio, triglycerides, glucose, socioeconomic status (SES), alcohol consumption, and smoking. Although there was also heterogeneity among study outcomes, the results of conservative random effects models provide confidence in the obtained relationships. On the basis of available evidence, researchers might give attention to obesity, insulin resistance, damaging health behaviors, and SES as potential contributing factors in understanding the association between Ho Scale scores and CAD.

Fetal Origins of Stress-Related Adult Disease

During the past decade, a considerable body of evidence has emerged showing that circumstances during the fetal period may have lifelong programming effects on different body functions with a considerable impact on disease susceptibility. The purpose of this article is to provide a synopsis of these findings and their role in explaining the development of stress-related adult disease. In the context of Per Björntorp memorial symposium, stress-related disease will be interpreted broadly, including cardiovascular disease and components of the metabolic syndrome, for which the evidence of fetal origins is most abundant. It has however become evident that early-life programming has a much broader potential effect on an individual's health. For example, perinatal variables, such as low birth weight, have been associated with increased prevalence of depressive symptoms. Mechanistic studies in animals and humans have shown that lifelong programming of the hypothalamic-pituitary-adrenal axis (HPAA) function by fetal life conditions is likely to be a key factor in mediating associations with these disorders, which frequently are characterized by HPAA overactivity. Preliminary observations suggest a similar important role for early-life programming of sympathoadrenal function. Reduced HPAA activity is characteristic of a number of stress-related disorders, including posttraumatic stress disorder; chronic pain; fatigue; and atypical, melancholic depression. It is therefore highly plausible that susceptibility to these disorders originates in a similar manner during early life, although direct evidence is to a great deal lacking. Important targets for future research include distinction between the effects of different pregnancy conditions, such as maternal malnutrition, preeclampsia, and maternal infection, which may have dissimilar late-life consequences. This will be a crucial step when the associations that are currently emerging will be translated into disease prevention.

Hostility and urine norepinephrine interact to predict insulin resistance: the VA Normative Aging Study

OBJECTIVE

Previous research has produced mixed results pertaining to the association between hostility and insulin resistance. These inconsistent findings may be the result of a lack of studies examining potential moderators of this relationship and inconsistent measures of insulin resistance and/or hostility. We hypothesized that hostility may interact with circulating norepinephrine (NEPI) levels, indexed by 24-hour urine concentrations, to affect insulin resistance.

METHODS

Six hundred forty-three men (mean age = 63.1 years) free of diabetic medications completed the Minnesota Multiphasic Personality Inventory and participated in a laboratory assessment. The Cook-Medley Hostility (Ho) and 24-hour urine NEPI were used to predict insulin resistance defined by the homeostatic model assessment (HOMA) index, 2-hour postchallenge glucose (PCGL), and insulin levels (PCIL) after controlling for nine common covariates.

RESULTS

Multiple regression showed that the two-way interaction between Ho and NEPI significantly predicted HOMA and PCIL, but not PCGL, after controlling for covariates. Simple regression slopes of Ho on HOMA and PCIL were explored and indicated that, at higher levels of NEPI, higher Ho was associated with higher HOMA (beta = 0.14, p < .05). Ho was not a significant predictor of HOMA at mean and lower levels of NEPI. Similar results were obtained for PCIL, but not PCGL. Cynicism, but not other subscales of Ho, was similarly related to insulin resistance and NEPI.

CONCLUSION

Individuals with high stress and high hostility were more likely to have insulin resistance. It is important to study moderators in the relationship between hostility and insulin resistance.

Relation of childhood socioeconomic status and family environment to adult metabolic functioning in the CARDIA study

OBJECTIVE

Low SES and a conflict-ridden, neglectful, or harsh family environment in childhood have been linked to a high rate of physical health disorders in adulthood. The objective of the present investigation was to evaluate a model of the pathways that may help to explain these links and to relate them to metabolic functioning (MF) in the Coronary Artery Risk Development In Young Adults (CARDIA) dataset.

METHODS

Participants (n = 3225) in the year 15 assessment of CARDIA, age 33 to 45 years, completed measures of childhood socioeconomic status (SES), risky early family environment (RF), adult psychosocial functioning (PsyF, a latent factor measured by depression, hostility, positive and negative social contacts), and adult SES. Indicators of the latent factor MF were assessed, specifically, cholesterol, insulin, glucose, triglycerides, and waist circumference.

RESULTS

The overall prevalence of metabolic syndrome was 9.7%. Structural equation modeling indicated that childhood SES and RF are associated with MF via their association with PsyF (standardized path coefficients: childhood SES to RF -0.13, RF to PsyF 0.44, PsyF to MF 0.09, all p < .05), but also directly (coefficient from childhood SES to MF -0.12, p < .05), with good overall model fit. When this model was tested separately for race-sex subgroups, it fit best for white women, fit well for African-American women and white men, but did not fit well for African-American men.

CONCLUSIONS

These results indicate that childhood SES and early family environment contribute to metabolic functioning through pathways of depression, hostility, and poor quality of social contacts.

Temperament in childhood predicts body mass in adulthood: the Cardiovascular Risk in Young Finns Study

This study examined associations of temperament at ages 6 to 12 with body-mass index (BMI) and waist circumference (WC) at ages 24 to 30 years. The participants were 619 men and women derived from the population-based Cardiovascular Risk in Young Finns Study. Temperament was operationalized as (negative) emotionality, sociability, and activity. High emotionality predicted increased BMI, independently of WC, and independently of childhood and adulthood risk factors for adult obesity. None of the temperament dimensions had any associations with WC after controlling for BMI. The findings suggest that temperamental difficulty in childhood may be a useful risk indicator for general body mass in adulthood, and the mechanisms relating temperament with body mass should be further explored.

Exciting discoveries on the health effects of family violence: where we are, where we need to go

In the 20 years since the founding of the Journal of Interpersonal Violence, there have been exciting new discoveries on the long-term physical health effects of family violence. As exciting as these discoveries have been, we still know little about why the experience of family violence makes people sick. Some of the most promising areas of study on this topic will be in neuroscience, sleep studies, and cognitive variables such as hostility. Once we understand mechanisms, we can design interventions that can ameliorate these effects.