Depressive symptoms and metabolic risk in adult male twins enrolled in the National Heart, Lung, and Blood Institute twin study

Familial confounding of internalising symptoms and obesity in adolescents and young adults; a co-twin analysis

BACKGROUND

Obesity and internalising disorders, including depression and anxiety, often co-occur. There is evidence that familial confounding contributes to the co-occurrence of internalising disorders and obesity in adults. However, its impact on this association among young people is unclear. Our study investigated the extent to which familial factors confound the association between internalising disorders and obesity in adolescents and young adults.

SUBJECTS/METHODS

We used a matched co-twin design to investigate the impact of confounding by familial factors on associations between internalising symptoms and obesity in a sample of 4018 twins aged 16 to 27 years.

RESULTS

High levels of internalising symptoms compared to low levels increased the odds of obesity for the whole cohort (adjusted odds ratio [AOR] = 3.1, 95% confidence interval [CI]: 1.5, 6.8), and in females (AOR = 4.1, 95% CI 1.5, 11.1), but not in males (AOR = 2.8 95% CI 0.8, 10.0). We found evidence that internalising symptoms were associated with an increased between-pair odds of obesity (AOR 6.2, 95% CI 1.7, 22.8), using the paired analysis but not using a within-pair association, which controls for familial confounding. Sex-stratified analyses indicated high internalising symptoms were associated with increased between-pair odds of obesity for females (AOR 12.9, 95% CI 2.2, 76.8), but this attenuated to the null using within-pair analysis. We found no evidence of between or within-pair associations for males and weak evidence that sex modified the association between internalising symptoms and obesity (likelihood ratio test p = 0.051).

CONCLUSIONS

Some familial factors shared by twins confound the association between internalising symptoms and obesity in adolescent and young adult females. Internalising symptoms and obesity were not associated for adolescent and young adult males. Therefore, prevention and treatment efforts should especially address familial shared determinants of obesity, particularly targeted at female adolescents and young adults with internalising symptoms and those with a family history of these disorders.

Higher metabolic variability increases the risk of depressive disorder in type 2 diabetes mellitus: a longitudinal nationwide cohort study

BACKGROUND AND OBJECTIVES

While variabilities in metabolic parameters (METv) have been linked to adverse health outcomes in type 2 DM, their association with depression is yet to be studied. This research aimed to investigate the association between METv and depressive disorder in patients with type 2 DM.

METHODS

The study involved a nationwide cohort of 1,119,631 type 2 DM patients who had undergone three or more serial health examinations between 2005 and 2012. At each visit, body mass index (BMI), fasting glucose (FG), systolic blood pressure (BP), and total cholesterol (TC) were measured and stratified into quartiles, with Q4 being the highest and Q1 the lowest. The risk of depressive disorder was evaluated using Cox proportional hazard regression models, which accounted for METs in the indexes, after adjusting for sex, income status, lifestyle habits, medical comorbidities, DM severity, and baseline levels of BMI, FG, BP, and TC.

RESULTS

During a mean follow-up period of 6.00 ± 2.42 years, 239,477 (21.4%) cases of type 2 DM patients developed depressive disorder. The risk of developing depressive disorder was gradually increased as the number of METv increased (HR 1.18; 95% CI 1.13, 1.23 for the group with the highest METv in all parameters compared to those with the lowest METv in all parameters). In the subgroup analysis, the risk of developing depressive disorder was 43% higher in men (HR 1.43; 95% CI 1.34, 1.51), and 31% higher in those younger than 65 years of age (HR 1.31; 95% CI 1.23, 1.39) in the group with the highest number of METv compared to the group with the lowest number of METv.

CONCLUSION

In type 2 DM, higher METv was an independent risk factor for depressive disorder. This risk is notably elevated in men and individuals under the age of 65 years.

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.

Anxiety disorders and age-related changes in physiology

BACKGROUND

Anxiety disorders are leading contributors to the global disease burden, highly prevalent across the lifespan and associated with substantially increased morbidity and early mortality.

AIMS

The aim of this study was to examine age-related changes across a wide range of physiological measures in middle-aged and older adults with a lifetime history of anxiety disorders compared with healthy controls.

METHOD

The UK Biobank study recruited >500 000 adults, aged 37-73, between 2006 and 2010. We used generalised additive models to estimate non-linear associations between age and hand-grip strength, cardiovascular function, body composition, lung function and heel bone mineral density in a case group and in a control group.

RESULTS

The main data-set included 332 078 adults (mean age 56.37 years; 52.65% females). In both sexes, individuals with anxiety disorders had a lower hand-grip strength and lower blood pressure, whereas their pulse rate and body composition measures were higher than in the healthy control group. Case-control group differences were larger when considering individuals with chronic and/or severe anxiety disorders, and differences in body composition were modulated by depression comorbidity status. Differences in age-related physiological changes between females in the anxiety disorder case group and healthy controls were most evident for blood pressure, pulse rate and body composition, whereas this was the case in males for hand-grip strength, blood pressure and body composition. Most differences in physiological measures between the case and control groups decreased with increasing age.

CONCLUSIONS

Findings in individuals with a lifetime history of anxiety disorders differed from a healthy control group across multiple physiological measures, with some evidence of case-control group differences by age. The differences observed varied by chronicity/severity and depression comorbidity.

Depression and Metabolic Syndrome: A Narrative Review

We reviewed the literature to investigate the relationship between depression and metabolic syndrome. Major depressive disorder is characterized by a low mood or a loss of interest for longer than two weeks. Metabolic syndrome describes multiple metabolic risk factors including obesity, insulin resistance, dyslipidemia, and hypertension. We divided our findings into environmental, genetic, epigenetic, and biological pathway links between depression and the different aspects of metabolic syndrome. We found various sources linking obesity and metabolic syndrome genetically, environmentally, biological pathway-wise, and, while not fully explored, epigenetically. Diabetes and depression were also found to be linked environmentally with both conditions increasing the risk of the other. Depression was also shown to be linked to cardiovascular complications as it increased the risk of occurrence of such complications in healthy people. These findings have led us to believe that there is a link between depression and metabolic syndrome on various levels, especially obesity.

Epigenetic age is associated with baseline and 3-year change in frailty in the Canadian Longitudinal Study on Aging

BACKGROUND

The trajectory of frailty in older adults is important to public health; therefore, markers that may help predict this and other important outcomes could be beneficial. Epigenetic clocks have been developed and are associated with various health-related outcomes and sociodemographic factors, but associations with frailty are poorly described. Further, it is uncertain whether newer generations of epigenetic clocks, trained on variables other than chronological age, would be more strongly associated with frailty than earlier developed clocks. Using data from the Canadian Longitudinal Study on Aging (CLSA), we tested the hypothesis that clocks trained on phenotypic markers of health or mortality (i.e., Dunedin PoAm, GrimAge, PhenoAge and Zhang in Nat Commun 8:14617, 2017) would best predict changes in a 76-item frailty index (FI) over a 3-year interval, as compared to clocks trained on chronological age (i.e., Hannum in Mol Cell 49:359-367, 2013, Horvath in Genome Biol 14:R115, 2013, Lin in Aging 8:394-401, 2016, and Yang Genome Biol 17:205, 2016).

RESULTS

We show that in 1446 participants, phenotype/mortality-trained clocks outperformed age-trained clocks with regard to the association with baseline frailty (mean = 0.141, SD = 0.075), the greatest of which is GrimAge, where a 1-SD increase in ΔGrimAge (i.e., the difference from chronological age) was associated with a 0.020 increase in frailty (95% CI 0.016, 0.024), or ~ 27% relative to the SD in frailty. Only GrimAge and Hannum (Mol Cell 49:359-367, 2013) were significantly associated with change in frailty over time, where a 1-SD increase in ΔGrimAge and ΔHannum 2013 was associated with a 0.0030 (95% CI 0.0007, 0.0050) and 0.0028 (95% CI 0.0007, 0.0050) increase over 3 years, respectively, or ~ 7% relative to the SD in frailty change.

CONCLUSION

Both prevalence and change in frailty are associated with increased epigenetic age. However, not all clocks are equally sensitive to these outcomes and depend on their underlying relationship with chronological age, healthspan and lifespan. Certain clocks were significantly associated with relatively short-term changes in frailty, thereby supporting their utility in initiatives and interventions to promote healthy aging.

Impact of metabolic syndrome on patient outcomes of supination-external rotation ankle fracture

Metabolic syndrome has been known as a risk factor for morbidity following orthopedic procedures, yet its impact on surgical treatment of ankle fractures remains unclear. The aim of this study was to compare the patient outcomes of surgical treatment of supination-external rotation ankle fractures in patients with and without metabolic syndrome. This study was designed as a retrospective matched case-control study. Forty-nine patients with supination-external rotation ankle fracture and metabolic syndrome were age-, sex-, and fracture type-matched with 49 controls without metabolic syndrome. Olerud-Molander Ankle Score (OMAS), Visual Analog Scale (VAS), Kellgren and Lawrence (K&L) scale, and complications were assessed at final follow-up. The mean postoperative follow-up was 19.5 months (range, 13-44). The OMAS measurements in the metabolic syndrome group were lower than those in the control group (p = 0.006) and the VAS for pain measurements in the metabolic syndrome group were greater than those in the control group (p < 0.001). The K&L scale and complications did not differ significantly between the two groups. Patients with metabolic syndrome are at risk for higher pain scores and lower functional outcomes after surgical treatment for supination-external rotation ankle fracture. These results suggest that metabolic syndrome should be treated together with ankle fractures.

The Role of Microbiome in Insomnia, Circadian Disturbance and Depression

Good sleep and mood are important for health and for keeping active. Numerous studies have suggested that the incidence of insomnia and depressive disorder are linked to biological rhythms, immune function, and nutrient metabolism, but the exact mechanism is not yet clear. There is considerable evidence showing that the gut microbiome not only affects the digestive, metabolic, and immune functions of the host but also regulates host sleep and mental states through the microbiome-gut-brain axis. Preliminary evidence indicates that microorganisms and circadian genes can interact with each other. The characteristics of the gastrointestinal microbiome and metabolism are related to the host's sleep and circadian rhythm. Moreover, emotion and physiological stress can also affect the composition of the gut microorganisms. The gut microbiome and inflammation may be linked to sleep loss, circadian misalignment, affective disorders, and metabolic disease. In this review article, we discuss various functions of the gut microbiome and how its activities interact with the circadian rhythms and emotions of the host. Exploring the effects of the gut microbiome on insomnia and depression will help further our understanding of the pathogenesis of mental disorders. It is therefore important to regulate and maintain a normal gastrointestinal micro-ecological environment in patients when treating mental disorders.

Factors related to metabolic parameters in medicated patients with major depressive disorder--a naturalistic study

The aim of this study was to examine the metabolic parameters, including body mass index (BMI), homeostasis model assessment-estimated insulin resistance (HOMA-IR), homeostasis model assessment-estimated pancreatic β-cell function (HOMA-β), and lipid plasma level, in medicated patients with major depressive disorder (MDD) and to assess factors related to metabolic parameters in patients with MDD. 121 patients with MDD and 63 controls were recruited. The Hamilton Depression Rating Scale (HDRS), Wisconsin Card Sorting Test (WCST), Continuous Performance Test (CPT), and Finger-Tapping Test (FTT), were administered. BMI, HOMA-IR, and HOMA-β were calculated as modifiable metabolic parameters. The FTT results and BMI in depressed patients were significantly poorer and lower, respectively, than those of the controls. However, no significant differences were noted between MDD patients and controls included metabolic parameters and other neuropsychological tests. Among depressed patients, higher BMI is significantly related with lower education, no tobacco use, and male. The result demonstrated metabolic parameters could be neutral among medicated patients with MDD, particularly in non-elderly Asian individuals. The deficits of psychomotor speed could be more prominent than other cognitive alterations in patient with MDD.

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.

Anxiety but not depression is associated with metabolic syndrome: The Isfahan Healthy Heart Program

Background:

Only a few studies have carried out to evaluate the association of depression and anxiety with metabolic syndrome (MetS). The aim of this study was to investigate whether the depression and anxiety are associated with MetS and its different components.

Materials and Methods:

This cross-sectional study forms part of the prospective Isfahan Cohort Study. A total of 470 participants were chosen. Anxiety and depression symptoms were measured using hospital anxiety and depression scale (HADS). The MetS was diagnosed according to the American Heart Association and National Heart, Lung, and Blood Institute. One-way analysis of variance and binary logistic regression were used.

Results:

The mean age of participants was 55.7 ± 9.3. The prevalence of MetS in female participants with symptoms of depression (P < 0.0001), concurrent anxiety and depression (P = 0.004), anxiety (P < 0.0001), and asymptomatic individuals (P = 0.001) was significantly different when compared to male participants. Moreover, the analysis showed that having anxiety symptoms is in a negative relationship with MetS (odds ratio [OR] = 0.31; 95% confidence interval [CI] = 0.12–0.78). In addition, with each 10-year increase in age, the probability of MetS will decrease 40% (OR = 0.59; 95%Cl = 0.53–0.72). Body mass index (OR = 1.29; 95%CI = 1.21–1.37), and gender (higher age for women) (OR = 0.34; 95%CI = 0.11–0.98) had positive relationship with MetS.

Conclusion:

The study findings revealed that the prevalence of MetS in patients with anxiety was lower than the healthy subjects, while no significant association was found between depression, concurrent depression, an anxiety with MetS.

Treatment with Rhodiola crenulata root extract ameliorates insulin resistance in fructose-fed rats by modulating sarcolemmal and intracellular fatty acid translocase/CD36 redistribution in skeletal muscle

Background

Rhodiola species have been used for asthenia, depression, fatigue, poor work performance and cardiovascular diseases, all of which may be associated with insulin resistance. To disclose the underlying mechanisms of action, the effect of Rhodiola crenulata root (RCR) on insulin resistance was investigated.

Methods

Male Sprague-Dawley rats were treated with liquid fructose in their drinking water over 18 weeks. The extract of RCR was co-administered (once daily by oral gavage) during the last 5 weeks. The indexes of lipid and glucose homeostasis were determined enzymatically and/or by ELISA. Gene expression was analyzed by Real-time PCR, Western blot and/or confocal immunofluorescence.

Results

RCR extract (50 mg/kg) suppressed fructose-induced hyperinsulinemia and the increases in the homeostasis model assessment of insulin resistance index and the adipose tissue insulin resistance index in rats. Additionally, this treatment had a trend to restore the ratios of glucose to insulin and non-esterified fatty acids (NEFA) to insulin. Mechanistically, RCR suppressed fructose-induced acceleration of the clearance of plasma NEFA during oral glucose tolerance test (OGTT), and decreased triglyceride content and Oil Red O staining area in the gastrocnemius. Furthermore, RCR restored fructose-induced sarcolemmal overexpression and intracellular less distribution of fatty acid translocase/CD36 that contributes to etiology of insulin resistance by facilitating fatty acid uptake.

Conclusion

These results suggest that RCR ameliorates insulin resistance in fructose-fed rats by modulating sarcolemmal and intracellular CD36 redistribution in the skeletal muscle. Our findings may provide a better understanding of the traditional use of Rhodila species.

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.

Association between major depression and type 2 diabetes in midlife: findings from the Screening Across the Lifespan Twin Study

OBJECTIVE

Cohort studies suggest that the relationship between major depression (MD) and Type 2 diabetes (T2DM) is bidirectional. However, this association may be confounded by shared genetic or environmental factors. The objective of this study was to use a twin design to investigate the association between MD and T2DM.

METHODS

Data come from the Screening Across the Lifespan Twin Study, a sample of monozygotic and dizygotic twins 40 years or older sampled from the Swedish Twin Registry (n = 37,043). MD was assessed by using the Composite International Diagnostic Inventory. Structural equation twin modeling and Cox proportional hazards modeling were used to assess the relationship between MD and T2DM.

RESULTS

Approximately 19% of respondents had a history of MD and 5% had a history of T2DM. MD was associated with 32% increased likelihood of T2DM (95% confidence interval = 1.00-1.80) among twins aged 40 to 55 years, even after accounting for genetic risk, but was not associated with T2DM among twins older than 55 years. T2DM was associated with 33% increased likelihood of MD (95% confidence interval = 1.02-1.72) among younger, but not older twins. Cholesky decomposition twin modeling indicated that common unique environmental factors contribute to the association between MD and T2DM.

CONCLUSIONS

Environmental factors that are unique to individuals (i.e., not shared within families) but common to both MD and T2DM contribute to their co-occurrence in midlife. However, we cannot exclude the possibility of bidirectional causation as an alternate explanation. It is likely that multiple processes are operating to effect the relation between psychiatric and medical conditions in midlife.

Social and behavioral risk marker clustering associated with biological risk factors for coronary heart disease: NHANES 2001-2004

BACKGROUND

Social and behavioral risk markers (e.g., physical activity, diet, smoking, and socioeconomic position) cluster; however, little is known whether clustering is associated with coronary heart disease (CHD) risk. Objectives were to determine if sociobehavioral clustering is associated with biological CHD risk factors (total cholesterol, HDL cholesterol, systolic blood pressure, body mass index, waist circumference, and diabetes) and whether associations are independent of individual clustering components.

METHODS

Participants included 4,305 males and 4,673 females aged ≥ 20 years from NHANES 2001-2004. Sociobehavioral Risk Marker Index (SRI) included a summary score of physical activity, fruit/vegetable consumption, smoking, and educational attainment. Regression analyses evaluated associations of SRI with aforementioned biological CHD risk factors. Receiver operator curve analyses assessed independent predictive ability of SRI.

RESULTS

Healthful clustering (SRI = 0) was associated with improved biological CHD risk factor levels in 5 of 6 risk factors in females and 2 of 6 risk factors in males. Adding SRI to models containing age, race, and individual SRI components did not improve C-statistics.

CONCLUSIONS

Findings suggest that healthful sociobehavioral risk marker clustering is associated with favorable CHD risk factor levels, particularly in females. These findings should inform social ecological interventions that consider health impacts of addressing social and behavioral risk factors.

Psychological functioning in adolescents with obesity co-morbidities

BACKGROUND

An understanding of the relationships among obesity severity, medical co-morbidities, and psychological complications is important in the design of interventions to encourage overweight youth and families to accomplish healthy lifestyle changes.

METHODS

We evaluated associations among psychological status, diagnosed medical co-morbidities consistent with components of the metabolic syndrome, and BMI among 166 obese adolescents (11-18 years) referred for endocrinology consultation. We hypothesized that there would be higher levels of psychological distress among youth with more diagnosed components of the metabolic syndrome (i.e., more medical co-morbidities associated with obesity).

RESULTS

Contrary to expectation, we found that meeting criteria for extreme obesity alone was more predictive of psychological difficulties.

CONCLUSIONS

The degree of obesity may be more relevant than the number of associated medical co-morbidities in impacting psychological health. It is important to recognize individual differences between patients in terms of identifying motivating goals for accomplishing weight management.

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.

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.

Ambulatory blood pressure and the metabolic syndrome in normotensive and untreated hypertensive men

BACKGROUND

Components of the metabolic syndrome are typically intercorrelated in epidemiologic studies and, when combined, predict type 2 diabetes and cardiovascular diseases. However, it remains unclear whether a single construct underlies the various components and which of the components are most closely associated with the underlying syndrome. Here, we use our confirmatory factor analytic model of the metabolic syndrome to examine the extent to which measures of ambulatory blood pressure, reflecting blood pressure variability throughout the day and night, may strengthen the association between blood pressure and the other components of the syndrome.

METHODS

Participants were a community sample of 358 men (248 with hypertension), ages 40-70, not receiving antihypertensive medications. Confirmatory factor analysis was employed to examine model fit and the strength of association between clinic and ambulatory blood pressure and the metabolic syndrome.

RESULTS

The blood pressure factor loaded significantly on the underlying metabolic syndrome but the strength of association was not as great (loading = 0.34, p < 0.01) as those observed for the obesity, insulin resistance and lipid factors. The factor loadings for the ambulatory measures (awake loading = 0.19; sleep loading = 0.16, p values < 0.01) were significant but smaller in magnitude than the loadings for clinic blood pressure.

CONCLUSIONS

Both clinic and ambulatory measures of blood pressure are significantly associated with the underlying metabolic syndrome using confirmatory factor analytic methods. However, the strength of association appears greater for the clinic measures relative to the ambulatory measures in this study.

Rhodiola crenulata root ameliorates derangements of glucose and lipid metabolism in a rat model of the metabolic syndrome and type 2 diabetes

ETHNOPHARMACOLOGICAL RELEVANCE

Rhodiola species are traditionally used as tonics and stimulants to treat asthenia, suggesting their possible regulatory effect on energy metabolism. Clinical trials have demonstrated their glucose-lowering effect in type 2 diabetes.

AIM OF THE STUDY

To examine the effects of Rhodiola on glucose and lipid metabolism in the metabolic syndrome and type 2 diabetes.

MATERIALS AND METHODS

Zucker diabetic fatty (ZDF) rats were treated with Rhodiola crenulata root (RCR) powder (100 and 500 mg/kg, by gavage, once daily for 4 weeks). In addition, the effects of RCR on sucrose-induced acute hyperglycemia in mice and olive oil-induced hypertriglyceridemia in rats were also examined. Biochemical variables were determined enzymatically or by ELISA.

RESULTS

In ZDF rats, RCR treatment decreased the increased plasma insulin and triglyceride concentrations at baseline, the index of the homeostasis model assessment of insulin resistance (HOMA-IR) and excessive hepatic triglyceride accumulation. This treatment also inhibited abnormal increases in plasma glucose and insulin concentrations during oral glucose tolerance test. Furthermore, RCR reversed the increased adipose insulin resistance index, and accelerated the decline of plasma concentrations of non-esterified fatty acids after exogenous glucose stimulation. However, RCR minimally affected sucrose-induced acute hyperglycemia in mice and olive oil-induced acute hypertriglyceridemia in rats.

CONCLUSIONS

The present results demonstrate that RCR treatment improves metabolic derangements in animal model of the metabolic syndrome and type 2 diabetes. Our findings may provide new pharmacological basis of therapeutics for the adaptogenic plants to treat metabolic derangements-associated disorders, such as asthenia.

Interrelationships among physical activity, depression, homocysteine, and metabolic syndrome with special considerations by sex

OBJECTIVE

Examine the interrelationships among physical activity, depression, homocysteine and metabolic syndrome, and to examine the association between physical activity and the simultaneous presence of metabolic syndrome, depression, and high homocysteine.

METHODS

Data from the 2005-2006 National Health and Nutrition Examination Survey were used. 1146 participants were included in the analyses. Physical activity was objectively measured using accelerometry.

RESULTS

With respect to the association between physical activity and the simultaneous presence of these three co-morbidities, women, compared to men, had a greater strength of association. For women, compared to those participants not having metabolic syndrome or at least mild depression or high homocysteine (reference groups), the odds ratio values for participants with 1) only depression, 2) only metabolic syndrome, 3) only high homocysteine, 4) metabolic syndrome and mild depression, and 5) metabolic syndrome, mild depression and high homocysteine, respectively, were 0.74 (95% confidence interval: 0.57-0.96, 0.77 (95% confidence interval: 0.61-0.97), 1.08 (95% confidence interval: 0.66-1.76), 0.43 (95% confidence interval: 0.32-0.58), and 0.15 (95% confidence interval: 0.05-0.44), respectively.

CONCLUSION

Promotion of physical activity in the adult population, especially among women, who were found to be less moderately- to vigorously-physically active than their male counterparts, may play an important role in reducing these deleterious conditions.

Persistent heavy smoking as risk factor for major depression (MD) incidence--evidence from a longitudinal Canadian cohort of the National Population Health Survey

BACKGROUND

Reports of bidirectional associations between smoking and major depression (MD) have been interpreted as providing evidence for confounding by shared-vulnerability factors (SV) that predispose individuals to both conditions. If this is true, then smoking cessation may not reduce the risk of MD. From clinical practice and public health perspectives, the long-term outcomes associated with smoking persistence and cessation are potentially important and deserve exploration. To this end, the 12-year risk of MD in persistent heavy smokers and abstainers who were former-heavy smokers with and without adjustment for potential confounders were compared.

METHODS

Follow-up data from the National Population Health Survey (NPHS) was used. Multinomial logistic (ML) models were fit to identify potential confounders. Using proportional hazard (PH) models, unadjusted and adjusted hazard ratios (HRs) for MD outcome were estimated for different smoking patterns.

RESULTS

The unadjusted HR relating the risk of MD among current-heavy versus former-heavy smokers was 4.3 (95% CI: 2.6-6.9, p < 0.001). Current-heavy smoking predicted onset of MD (HR = 3.1, 95% CI: 1.9-5.2, p < 0.001) even after adjustment for age, sex and stress - the main confounders. However, this was not the case for the never, former-light, and current-light categories. Evidence of decreased risk of MD among former-heavy relative to current-heavy smokers as function of smoking cessation maintenance time was also found.

CONCLUSIONS

Contrary to common beliefs about the benefits of smoking for mental health, our results suggest that current-heavy rather than ever-heavy smoking is a major determinant of MD risk and point towards the benefits of smoking cessation maintenance.

Depressive symptoms and serum lipid levels in young adult women

Accumulating data suggest that depression is associated with risk factors for cardiovascular disease, but few studies have investigated potential behavioral mediators of such associations, particularly among women. In this study of healthy young adult women (n = 225), we examined associations among depressive symptoms, health behaviors, and serum lipid levels. Depressive symptoms were assessed with the 20-item Center for Epidemiologic Studies-Depression scale, and a fasting blood sample was obtained for serum lipid levels, including total cholesterol, high-density lipoprotein (HDL-C) and low-density lipoprotein (LDL-C). Diet was measured using 24-h recalls, and other health behaviors (physical activity, smoking) were assessed via self-report questionnaire. Results indicated a modest negative association between depressive symptoms and LDL-C levels. Higher levels of depressive symptoms were also associated with lower total and insoluble dietary fiber intake, both of which were associated with HDL-C and LDL-C. Mediational analyses indicated a significant indirect effect of depressive symptoms on LDL-C via total and insoluble dietary fiber in unadjusted analyses, but not in adjusted analyses. The present findings suggest that depressive symptoms are inversely associated with serum LDL-C levels in young adult women, but that these associations are not likely mediated by adverse lifestyle behaviors.

The Taipei Adolescent Twin/Sibling Family Study II: Depression, Insulin Resistance, and Hormonal Factors

In this ongoing longitudinal study of adolescent twins/sibling pairs and their parents in Taipei, we aimed to investigate the genetic and environmental influences on adolescent behavioral development, metabolic risk factors, and the associations between the two. Special focus is on anxious depression, metabolic profile, and hormonal factors such as cortisol and leptin. The first wave of assessment was completed during the period of 2002 to 2005 and included 192 twin pairs, 6 triplets, 56 sibling pairs and their first-degree relatives (484 parents and 142 siblings). We are currently in the process of a second wave assessment as follow-up. Dimensional psychological assessments using self-report questionnaires, as well as categorical assessments based on semistructured clinical interviews, were performed. All subjects received a 2-hour oral glucose tolerance test at the examination site. The metabolic phenotypes including body mass index, blood pressure, levels of glucose, insulin, and lipid profile as well as related hormonal levels were measured. Zygosity was determined using DNA, except for a few twins whose DNA was not available. Such a combination of detailed psychological assessments and metabolic function tests is expected to help shed light on the interrelation of psychological well-being and metabolic functioning.

Update on the NAS-NRC Twin Registry

The National Academy of Sciences-National Research Council (NAS-NRC) Twin Registry is one of the oldest, national population-based twin registries in the United States. It consists of 15,924 white male twin pairs born in the years 1917 to 1927 (inclusive), both of whom served in the armed forces, mostly during World War II. This article updates activity in this registry since the earlier 2002 article in Twin Research. The results of clinically based studies on dementia, Parkinson's disease, age-related macular degeneration, and primary osteoarthritis were published, as well as articles based on previously collected questionnaire data on chronic fatigue syndrome, functional limitations, and healthy aging. In addition, risk factor studies are being planned to merge clinical data with earlier collected risk factor data from questionnaires. Examination data from the subset of National Heart, Lung, and Blood Institute (NHLBI) twins resulted in a number of articles, including the relationship of endogenous sex hormones to coronary heart disease and morphological changes in aging brain structures. The NEO Five-Factor Personality Inventory (a paper-and-pencil self-administered questionnaire) has been fielded for the first time. A push to consolidate the various data holdings of the registry is being made.

Association between depressive symptoms and metabolic syndrome in police officers: results from two cross-sectional studies

Policing is one of the most dangerous and stressful occupations and such stress can have deleterious effects on health. The purpose of this study was to examine the association between depressive symptoms and metabolic syndrome (MetSyn) in male and female police officers from two study populations, Buffalo, NY and Spokane, WA. Depressive symptoms were measured using the Center for Epidemiologic Studies-Depression (CES-D) scale. MetSyn was defined using the 2005 AHA/NHBLI guidelines. Analysis of covariance was used to describe differences in number of MetSyn components across depressive symptom categories. The number of MetSyn components increased significantly across categories of CES-D for Spokane men only (p-trend = 0.003). For each 5-unit increase in CES-D score, odds increased by 47.6% for having hypertriglyceridemia, by 51.8% for having hypertension, and by 56.7% for having glucose intolerance. Exploring this association is important since both are predictors of future chronic health problems and the results could be helpful in developing future gender-specific prevention and intervention efforts among police officers.

Increased health burden associated with comorbid depression in older Brazilians with diabetes

BACKGROUND

The health burden associated with comorbid depression and diabetes in older community residents in middle income countries is unclear.

METHODS

Data came from a statewide representative sample (N = 6963, age ≥ 60) in Brazil. Controlled polytomous logistic regression was used to determine whether four mutually exclusive groups (all possible combinations of the presence or absence of depression and diabetes) differed in sociodemographic characteristics, social resources, health behaviors, and selected health conditions.

RESULTS

While 2.37% were expected to have comorbid depression/diabetes given sample base rates (depression: 20.92% [1457/6963]; diabetes: 11.35% [790/6959]), comorbidity was present in 3.62% (52.5% beyond expectation; P<0.0001; OR = 1.58, 95% Confidence Interval 1.29-1.95). Depression without diabetes was reported by 17.3%, and diabetes without depression by 7.7%. In controlled analyses, the depression group had poorer socioeconomic status and health behaviors, and a greater likelihood of vascular, respiratory, and musculoskeletal problems than the diabetes group. Vascular, respiratory, and urinary problems were exacerbated in comorbid depression/diabetes; the comorbid group was also more likely to be female and younger.

LIMITATIONS

Cross-sectional design.

CONCLUSIONS

To our knowledge, this is the first study that explicitly reports on all four possible depression/diabetes combinations in an older representative community-resident sample, using controlled analyses to identify unique associations with sociodemographic characteristics and other health conditions. The burden of comorbid depression/diabetes in Brazil, a middle income country, appears to be comparable to that found in higher income countries. So, similarly, depression without diabetes had a greater odds of adverse sociodemographic and health conditions than diabetes without depression; comorbid depression/diabetes was more likely in women and young elderly, and the odds of vascular, respiratory, and urinary conditions was increased significantly. Attention to comorbid depression/diabetes as a unique entity is needed.

Depression trajectories and obesity among the elderly in Taiwan

BACKGROUND

The present study aimed to (a) characterize 10-year trajectory patterns of depressive symptoms and (b) investigate the association between depressive trajectory and subsequent obesity, metabolic function and cortisol level.

METHOD

In a prospective study of Taiwanese adults aged ≥60 years (n=3922) between 1989 and 1999, depression was assessed using a 10-item short-form of the Center for Epidemiologic Studies Depression Scale and information on body mass index (BMI) was collected by self-report. A subsample (n=445) of the original cohort in 1989 was drawn to assess metabolic variables and cortisol levels in a 2000 follow-up. After trajectory analyses were performed, multinomial logistic regression analyses were used to estimate the association estimates.

RESULTS

We identified four distinctive trajectories of depressive symptoms: class 1 (persistent low, 41.8%); class 2 (persistent mild, 46.8%); class 3 (late peak, 4.2%); and class 4 (high-chronic, 7.2%). The results from both complete cases and multiple imputation analyses indicated that the odds of obesity were lower in the class 2, 3 or 4 elderly, as compared with those in class 1, while the odds of underweight were higher. The classes of older adults with more and persistent depressive symptoms showed a trend toward having both a lower BMI (p=0.01) and a higher cortisol level (p=0.04) compared with those with low depressive symptoms.

CONCLUSIONS

Incremental increases in depressive symptoms over time were associated with reduced risk of obesity and higher cortisol levels.

Vital exhaustion, depressive symptoms and serum triglyceride levels in high-risk middle-aged men

The role of elevated serum triglyceride level as a risk factor of coronary artery disease is well established. Previous results have also indicated that depression or depressive symptoms and vital exhaustion correlate with triglyceride levels. The aim of this study was to investigate the associations of depressive symptoms, vital exhaustion, and health behavior with serum triglyceride levels. The study sample comprised 444 high-risk middle-aged men. Participants completed self-report questionnaires before laboratory tests. Triglyceride concentrations were measured by the enzymatic method. Vital exhaustion and depression were associated with unhealthy lifestyles and triglycerides. Vital exhaustion and depression were closely correlated constructs with comparable relations with known coronary artery disease risk factors. When comparing vital exhaustion (VE) to Beck Depression Inventory (BDI), however, the first one had a stronger correlation with triglycerides (TG), and also, path analyses showed a direct link from vital exhaustion to body mass index but not from depression. Both vital exhaustion and depression are related to triglyceride levels. The relations are partly mediated by unfavorable lifestyles. Although vital exhaustion is not so commonly assessed as depression, results of this study support the importance of vital exhaustion as a health-related psychological risk factor.

A test for common genetic and environmental vulnerability to depression and diabetes

Molecular genetic research has provided some evidence for the association between depression and metabolic disorders. We sought to determine if molecular findings are reflected in twin analyses testing if common genetic and environmental risk factors contribute to the co-occurrence of diabetes and depression. Data to derive depression and diabetes were collected from 1,237 male-male twins who participated in the 2005 Vietnam Era Twin Study of Aging (VETSA). The 1,237 twins were comprised of 347 MZ pairs, 3 MZ singletons, 267 DZ pairs and 6 unpaired twins. Depression was defined as a score below 46 on the Short Form-36 mental component summary score. Diabetes was defined by self report, use of anti-diabetic medications and insulin. Twin models were fit to estimate the correlation of genetic and environmental contributions to depression and diabetes. Consistent with other studies these data support the association between depression and diabetes (OR = 1.7; 95%CI: 1.1-2.7). Genetic vulnerability accounted for 50% (95%CI: 32%-65%) of the variance in risk for depression and 69% (95%CI: 52%-81%) of the variance in risk for diabetes. The genetic correlation between depression and diabetes was r = 0.19 (95%CI: 0-0.46) and the non-shared environmental correlation was r = 0.09 (95% CI: 0-0.45). Overall there is little evidence that common genetic and environmental factors account for the co-occurrence of depression and diabetes in middle aged men. Further research in female twins and larger cohorts is warranted.

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.

Posttraumatic stress disorder, cardiovascular, and metabolic disease: a review of the evidence

BACKGROUND

Posttraumatic stress disorder (PTSD) is a significant risk factor for cardiovascular and metabolic disease.

PURPOSE

The purpose of the current review is to evaluate the evidence suggesting that PTSD increases cardiovascular and metabolic risk factors, and to identify possible biomarkers and psychosocial characteristics and behavioral variables that are associated with these outcomes.

METHODS

A systematic literature search in the period of 2002-2009 for PTSD, cardiovascular disease, and metabolic disease was conducted.

RESULTS

The literature search yielded 78 studies on PTSD and cardiovascular/metabolic disease and biomarkers.

CONCLUSIONS

Although the available literature suggests an association of PTSD with cardiovascular disease and biomarkers, further research must consider potential confounds, incorporate longitudinal designs, and conduct careful PTSD assessments in diverse samples to address gaps in the research literature. Research on metabolic disease and biomarkers suggests an association with PTSD, but has not progressed as far as the cardiovascular research.

Depression, coronary artery disease, type 2 diabetes, metabolic syndrome and quality of life in Taiwanese adults from a cardiovascular department of a major hospital in Southern Taiwan

AIMS

To examine the relationships between depression, coronary artery disease, type 2 diabetes, metabolic syndrome and quality of life in Taiwanese adults from a cardiovascular department of a major hospital in Taiwan.

BACKGROUND

Research suggests associations between depression, metabolic syndrome and quality of life. Despite this fact, few studies have investigated these relationships among Taiwanese.

DESIGN

A cross-sectional descriptive correlational design was used to conduct this study.

METHODS

A convenience sample of 140 adults participated in the study. Data were analysed with descriptive statistics, Pearson's correlations, hierarchical regression and t-tests.

RESULTS

Almost a half of the subjects (46.5%) had metabolic syndrome. The most common combination of metabolic syndrome criteria was elevated blood glucose, central obesity and high blood pressure (23.7%). A greater number of individuals had coronary artery disease (72.9%), type 2 diabetes (35%) and/or depression (21.4%). Type 2 diabetes and depression were significant predictors of overall quality of life (β = -0.16, p < 0.01 and β = -0.63, p < 0.001, respectively). In addition, there were significant differences between individuals with and without type 2 diabetes and/or depression regarding overall quality of life scores; t (138) = 3.50, p < 0.01); and t (138) = 7.80, p < 0.001), respectively.

CONCLUSIONS

Coronary artery disease, type 2 diabetes and depression were common among our sample of individuals with metabolic syndrome. Those with diabetes and/or depression had worse quality of life than those without those diseases.

RELEVANCE TO CLINICAL PRACTICE

Nurses need to be prepared to assess and intervene in preventing or treating depression among patients with chronic diseases, especially those with coronary artery disease, type 2 diabetes and metabolic syndrome. When individuals are treated for depression, they are more likely to engage in self-management of their diseases, which will prevent complications and improve their quality of life.

Protein and lipid oxidative damage in streptozotocin-induced diabetic rats submitted to forced swimming test: the insulin and clonazepam effect

Diabetes may modify central nervous system functions and is associated with moderate cognitive deficits and changes in the brain, a condition that may be referred to as diabetic encephalopathy. The prevalence of depression in diabetic patients is higher than in the general population, and clonazepam is being used to treat this complication. Oxidative stress may play a role in the development of diabetes complications. We investigated oxidative stress parameters in streptozotocin-induced diabetic rats submitted to forced swimming test (STZ) and evaluated the effect of insulin (STZ-INS) and/or clonazepam (STZ-CNZ and STZ-INS-CNZ) acute treatment on these animal model. Oxidative damage to proteins measured as carbonyl content in plasma was significantly increased in STZ group compared to STZ treated groups. Malondialdehyde plasma levels were significantly reduced in STZ-INS and STZ-INS-CNZ groups when compared to STZ rats, being significantly reduced in STZ-INS-CNZ than STZ-INS rats. The activities of the antioxidant enzymes catalase, superoxide dismutase and glutathione peroxidase showed no significant differences among all groups of animals. These findings showed that protein and lipid damage occurs in this diabetes/depression animal model and that the associated treatment of insulin and clonazepam is capable to protect against oxidative damage in this experimental model.

The association between conventional antidepressants and the metabolic syndrome: a review of the evidence and clinical implications

Major depressive disorder is a prevalent recurrent medical syndrome associated with inter-episodic dysfunction. The metabolic syndrome is comprised of several established risk factors for cardiovascular disease (i.e. abdominal obesity, dyslipidaemia, dysglycaemia and hypertension). The criterion items of the metabolic syndrome collectively represent a multi-dimensional risk factor for cardiovascular disease and type 2 diabetes mellitus. Extant evidence indicates that both major depressive disorder and the metabolic syndrome, albeit distinct, often co-occur and are possibly subserved by overlapping pathophysiology and causative mechanisms. Conventional antidepressants exert variable effects on constituent elements of the metabolic syndrome, inviting the need for careful consideration prior to treatment selection and sequencing. Initiating and maintaining antidepressant therapy should include routine surveillance for clinical and/or biochemical evidence suggestive of the metabolic syndrome.

Genetic vulnerability and phenotypic expression of depression and risk for ischemic heart disease in the Vietnam era twin study of aging

OBJECTIVE

To determine if depression contributes to incident heart disease after accounting for genetic, behavioral, and medical factors associated with both conditions.

METHODS

We used a prospective twin study with a 12-year follow-up. In 1992, lifetime diagnosis of depression was assessed in 1159 male-male twins and merged with longitudinal health data from the Vietnam Era Twin Registry Study of Aging. Incident heart disease was defined as having myocardial infarction, heart surgery, or angina at 12-year follow-up when twins were 55.4 years (standard deviation, 2.5 years) of age. Risks for heart disease were computed in a logistic regression model that included comparing twins at different levels of phenotypic expression of depression and varying levels of genetic vulnerability at the same time adjusting for pertinent covariates.

RESULTS

After adjusting for sociodemographics, co-occurring psychopathology, smoking, obesity, diabetes, hypertension, and social isolation, twins at high genetic risk and exposed to depression remained at greater risk of developing ischemic heart disease (IHD) (odds ratio, 2.55; 95% confidence interval, 1.44-4.49) compared with those at low genetic risk and without phenotypic expression of depression. Odds ratios suggest that twins at genetic liability but without phenotypic expression were at risk of IHD, but the effect was not statistically significant.

CONCLUSIONS

A history of depression is a risk factor for incident heart disease after adjusting for numerous covariates. Twins with both high genetic vulnerability and phenotypic expression of depression were at greatest risk of IHD. Trends suggest the genetic contribution to IHD that overlaps with depression may partly explain this association, but studies in larger samples are warranted.

Sex-specific associations of depressive symptoms and cardiovascular risk factors in older adults

OBJECTIVES

To examine sex-specific associations between depressive symptoms and cardiovascular risk factors in older men and women.

METHOD

One hundred and thirty-one healthy, community-dwelling older adults [mean age = 66(6.59), 63% male] completed the Beck depression inventory, and engaged in assessment of systolic and diastolic blood pressure, body mass index (BMI), waist circumference (WC), fasting total, low- and high-density lipoprotein cholesterol (TC, LDL-C, and HDL-C), triglycerides, glucose, insulin, and maximal aerobic capacity (Vo2max). Sex-stratified hierarchical regression analyses examined the association between depressive symptoms and each risk factor adjusting for age, education, and BMI (select models).

RESULTS

Significant associations were found between higher levels of depressive symptoms and greater BMI, WC, insulin, LDL-C, and lower Vo2max in women only (p < 0.05). The insulin association was partially mediated by BMI.

CONCLUSION

In healthy older women, but not men, higher levels of depressive symptoms were associated with greater CVD risk factors. Depressive symptoms may confer biobehavioral risk for cardiovascular and metabolic diseases in older women in part via their association with pertinent biomedical risk factors.

Cholesterol, triglycerides, and the Five-Factor Model of personality

Unhealthy lipid levels are among the leading controllable risk factors for coronary heart disease. To identify the psychological factors associated with dyslipidemia, this study investigates the personality correlates of cholesterol (total, LDL, and HDL) and triglycerides. A community-based sample (N=5532) from Sardinia, Italy, had their cholesterol and triglyceride levels assessed and completed a comprehensive personality questionnaire, the NEO-PI-R. All analyses controlled for age, sex, BMI, smoking, drinking, hypertension, and diabetes. Low Conscientiousness and traits related to impulsivity were associated with lower HDL cholesterol and higher triglycerides. Compared to the lowest 10%, those who scored in top 10% on Impulsivity had a 2.5 times greater risk of exceeding the clinical threshold for elevated triglycerides (OR=2.51, CI=1.56-4.07). In addition, sex moderated the association between trait depression (a component of Neuroticism) and HDL cholesterol, such that trait depression was associated with lower levels of HDL cholesterol in women but not men. When considering the connection between personality and health, unhealthy lipid profiles may be one intermediate biomarker between personality and morbidity and mortality.

Depressive symptoms and metabolic syndrome: selective association in older women

The metabolic syndrome (MetS) is being increasingly found in older populations. Depressive symptoms are prevalent in elderly populations, and they are associated with adverse outcomes, chiefly cardiovascular. The aim of this study was to evaluate the association of the 30-item geriatric depression scale (GDS) score with MetS, as defined according to the National Cholesterol Education Program's Adult Treatment Panel III (ATP-III) criteria, in all 353 participants aged 75+ years living in Tuscania (Italy). Metabolic syndrome was associated with the GDS score in a multivariable linear regression analysis in women (beta s= 2.14, 95% CI = 0.14 to 4.14; P = .036), but not in men (beta = -.84, 95% CI = -3.17 to 1.49; P = .476), after adjusting. Analysis of the interaction term confirmed (P = .022) that such an association differed according to sex. Metabolic syndrome is independently associated with depressive symptoms in community-dwelling older women. Older women with depression should be prompted to undergo screening for MetS. Conversely, elderly women with MetS should be assessed for affective disorders.

Depressive symptoms and metabolic risk: effects of cortisol and gender

We examined gender effects and the role of cortisol in the association between depressive symptoms and metabolic risk in the Stress, Atherosclerosis, and ECG Study (STRATEGY). In 215 healthy adults from the general population (n=107 men, n=108 women, distributed equally across four age groups, 30-70 years), we assessed depressive symptoms by the Patient Health Questionnaire (PHQ score >10) and measured variables of the metabolic syndrome: high-density lipoprotein (HDL), triglycerides, systolic and diastolic blood pressure, fasting blood glucose and waist circumference. Salivary cortisol was assessed at 08:00, 12:00, 16:00 and 22:00 h. Depressive symptoms were not associated with the metabolic syndrome as entity in the total sample or in men and women separately. However, women with depressive symptoms had larger waist circumferences, higher fasting blood glucose, lower HDL-cholesterol, higher diastolic blood pressure, and higher 16:00 and 22:00 h salivary cortisol compared to women without depressive symptoms. These results persisted after adjusting for age, education, smoking, and physical activity. In adjusted regression analyses, inclusion of cortisol attenuated the association between depressive symptoms and waist, fasting glucose, HDL and diastolic blood pressure in women. In men, we did not find an association between depressive symptoms and variables of the metabolic syndrome. In women, depressive symptoms are associated with several variables of the metabolic syndrome. Elevated afternoon and evening cortisol appear to partially mediate this association.

Generalized anxiety disorder is associated with metabolic syndrome in the Vietnam experience study

BACKGROUND

Few studies have explored the relationship between major mental health disorders and metabolic syndrome (MetS), although both have been linked to cardiovascular disease. The present study examined the cross-sectional associations of major depressive disorder (MDD) and generalized anxiety disorder (GAD) with MetS in a large study of male US veterans.

METHODS

The analyses were cross-sectional. Participants (n = 4256) were drawn from the Vietnam Experience Study. From military service files, telephone interviews, and a medical examination, occupational, socio-demographic, and health data were collected. One-year prevalence of MDD and GAD was determined with DSM-III criteria. Metabolic syndrome was ascertained from data on: body mass index, fasting blood glucose or a diagnosis of diabetes, blood pressure, high-density lipoprotein cholesterol, and triglyceride levels.

RESULTS

In models that adjusted for age (p = .01) and additionally for place of service, ethnicity, marital status, smoking, alcohol consumption, IQ at enlistment, household income in midlife, and education grade achieved (p = .02), GAD was positively associated with MetS. Major depressive disorder was not related to MetS.

CONCLUSIONS

Depression has very much been the focal condition for studies on mental health and physical health outcomes. The current data suggest that future research should perhaps pay equal attention to GAD.

Lifetime history of major depression predicts the development of the metabolic syndrome in middle-aged women

OBJECTIVE

To prospectively examine the association of major depression with incidence of the metabolic syndrome in women.

METHODS

Data were drawn from one of seven sites of the Study of Women's Health Across the Nation (SWAN), a prospective cohort study of the menopausal transition. Participants were 429 (34.5% African-American) women. Major depression and comorbid diagnoses were assessed via the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition Axis I Disorders at baseline and seven annual follow-up evaluations. The metabolic syndrome was measured at baseline and each follow-up evaluation (except the second) based on National Cholesterol Education Program (NCEP) criteria.

RESULTS

Longitudinal generalized estimating equations (GEE) models indicated that, in women who were free of the metabolic syndrome at baseline, a lifetime major depression history or current major depressive episode at baseline was significantly associated with the onset and presence of the metabolic syndrome during the follow-up (odds ratio = 1.82; 95% Confidence Interval (CI) = 1.06-3.14). Survival analyses showed that, in women who were free of the metabolic syndrome at baseline, a lifetime major depression history or current major depressive episode at baseline predicted increased risk of developing the metabolic syndrome during the follow-up (hazard ratio = 1.66; 95% CI = 0.99-3.75). Lifetime history of alcohol abuse or dependence predicted incident metabolic syndrome and attenuated the association between depression and the metabolic syndrome in both models.

CONCLUSIONS

This study documents that major depression is a significant predictor of the onset of the metabolic syndrome. Intervention studies targeting depression may prevent the development of the metabolic syndrome in women.