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Galler A, Thönnes A, Joas J, Joisten C, Körner A, Reinehr T, Röbl M, Schauerte G, Siegfried W, Weghuber D, Weihrauch-Blüher S, Wiegand S, Holl RW, Prinz N. Clinical characteristics and outcomes of children, adolescents and young adults with overweight or obesity and mental health disorders. Int J Obes (Lond) 2024; 48:423-432. [PMID: 38195831 PMCID: PMC10896720 DOI: 10.1038/s41366-023-01449-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 11/25/2023] [Accepted: 12/12/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Mental disorders are important comorbidities in youth with obesity. Aim was to describe the clinical characteristics and outcome of youth with overweight or obesity having comorbid mental disorders. METHODS Data from children, adolescents, and young adults (age 6-30 years) with overweight or obesity and mental disorders (depression, anxiety disorder, eating disorder, attention deficit disorder (ADHD)) from 226 centers in Germany and Austria participating in the Adiposity Patient Registry (APV) were analyzed and compared with those without reported mental disorders using regression modeling. RESULTS Mental health comorbidity was reported in a total of 3969 out of 114,248 individuals with overweight or obesity: 42.5% had ADHD, 31.3% anxiety disorders, 24.3% depression, and 12.9% eating disorders. Being male (OR 1.39 (95%CI 1.27;1.52)), of older age (1.42 (1.25;1.62)), or with extreme obesity (1.45 (1.30;1.63)) were most strongly associated with mental health comorbidity. Regression analysis showed that mean BMI-SDS was significantly higher in the group of individuals with depression and eating disorders (BMI-SDS 2.13 (lower; upper mean:2.09;2.16) and 2.22 (2.17;2.26)) compared to those without reported mental health comorbidity (BMI-SDS 2.008 (2.005;2.011); p < 0.001). In youth with ADHD, BMI-SDS was lower compared to those without reported mental disorders (BMI-SDS 1.91 (1.89;1.93) vs 2.008 (2.005;2.011); p < 0.001). Proportion of severe obesity was higher in individuals with depression (23.7%), anxiety disorders (17.8%), and eating disorders (33.3%), but lower in ADHD (10.3%), compared to those without reported mental disorders (13.5%, p < 0.002). Proportions of dyslipidaemia and abnormal carbohydrate metabolism were not different in youth with and without reported mental health comorbidity. BMI-SDS change after one year of lifestyle intervention program ranged between -0.22 and -0.16 and was similar in youth without and with different mental disorders. CONCLUSION Health care professionals caring for youth with overweight or obesity should be aware of comorbid mental disorders and regular mental health screening should be considered.
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Affiliation(s)
- Angela Galler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Sozialpädiatrisches Zentrum, Paediatric Endocrinology and Diabetology, Berlin, Germany.
| | - Angelika Thönnes
- Universitätsklinikum des Saarlandes, Psychosomatische Medizin und Psychotherapie and Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Homburg, Germany
| | - Jens Joas
- Universitätsklinikum des Saarlandes, Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Homburg, Germany
| | - Christine Joisten
- Deutsche Sporthochschule Köln, Institut für Bewegungs- und Neurowissenschaft, Köln, Germany
| | - Antje Körner
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Kinder- und Jugendmedizin, Leipzig, Germany
| | | | - Markus Röbl
- Universitätsmedizin Göttingen, Georg-August-Universität, Klinik für Kinder und Jugendmedizin, Göttingen, Germany
| | | | | | | | | | - Susanna Wiegand
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Sozialpädiatrisches Zentrum, Paediatric Endocrinology and Diabetology, Berlin, Germany
| | - Reinhard W Holl
- University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Nicole Prinz
- University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
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Milligan MN, Duemling K, Radovanovic N, Alkozah M, Riblet N. Impacts of nutrition counseling on depression and obesity: A scoping review. Obes Rev 2023; 24:e13594. [PMID: 37357149 DOI: 10.1111/obr.13594] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 04/09/2023] [Accepted: 05/22/2023] [Indexed: 06/27/2023]
Abstract
This scoping review aims to evaluate the impact of nutrition counseling on mental health and wellbeing among people affected by obesity. Depression and obesity are major sources of morbidity and mortality worldwide. The prevalence of obesity is higher in patients with severe or suboptimally managed depression. Change in dietary quality prompted by nutrition counseling may pose a unique opportunity for intervention. Of the 1745 studies identified, 26 studies (total n = 6727) met inclusion criteria. Due to the heterogeneity of methods and outcome reporting, it was not possible to perform meta-analysis. Across all included studies, 34 different scales were used to quantify mental health/wellbeing. Eleven studies (42.3%) reported statistically significant findings between intervention and control groups. Only two of these studies assessed nutrition counseling independently rather than as part of a multidisciplinary intervention. Overall, many studies have examined the role of nutrition counseling on mental health/wellbeing in individuals affected by obesity. However, due to inconsistency in study methodologies and outcome measurement tools, it is challenging to draw robust or clinically meaningful conclusions about the effects of nutrition counseling on mental health in this population.
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Affiliation(s)
- Meredith N Milligan
- Leadership Preventive Medicine Residency, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
- Department of Family Medicine, Concord Hospital, Concord, New Hampshire, USA
| | - Kathleen Duemling
- Leadership Preventive Medicine Residency, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
- Department of Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Natasa Radovanovic
- Leadership Preventive Medicine Residency, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
- Department of Endocrinology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Maria Alkozah
- Leadership Preventive Medicine Residency, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
- Department of Infectious Disease, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Natalie Riblet
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
- Department of Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
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Liu Z, Sun L, Zhang Y, Wang J, Sun F, Zhang Z, Sun G, Sun L, Yang R. The prevalence of underweight and obesity in Chinese children and adolescents with major depressive disorder and relationship with suicidal ideation and attempted suicide. Front Psychiatry 2023; 14:1130437. [PMID: 37215666 PMCID: PMC10196048 DOI: 10.3389/fpsyt.2023.1130437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 04/17/2023] [Indexed: 05/24/2023] Open
Abstract
Background The high rates of obesity and suicide have become serious public health problems worldwide, especially in children and adolescents with major depressive disorder (MDD). This research aimed to explore the rates of underweight, overweight or obesity, suicidal ideation and attempted suicide in hospitalized children and adolescents with MDD. Then, we analyzed the correlation between underweight or obesity and suicidal ideation and attempted suicide, and finally obtained the independent influencing factors of underweight or obesity. Methods A total of 757 subjects in the Third People's Hospital of Fuyang from January 2020 to December 2021 were enrolled in this study. According to the underweight, overweight and obesity screening table for school-age children and adolescents published and implemented by the health industry standard of China, all subjects were divided into different body mass index (BMI) categories. We measured fasting blood glucose (FBG) and lipid levels in all subjects and assessed suicidal ideation, attempted suicide, and the severity of depressive symptoms. The socio-demographic and clinical data were collected and analyzed by SPSS 22.0. Results The rates of underweight, overweight, obesity, suicidal ideation and attempted suicide were 8.2% (62/757), 15.5% (117/757), 10.4% (79/757), 17.2% (130/757), and 9.9% (75/757), respectively. Correlation analysis indicated that BMIs level was positively correlated with age, age of first hospitalization, total duration of disease, number of hospitalizations, FBG, TG (triglyceride), TC (total cholesterol), LDL (low density lipoprotein), and negatively correlated with HDL (high density lipoprotein). Binary logistic regression analysis showed that male and high level of HDL were risk factors for MDD inpatients with underweight, while high level of TG was a protective factor. Meanwhile, higher levels of FBG, TG and CGI-S were risk factors and suicidal ideation and high dose of antidepressant drugs were protective factors for obesity in children and adolescents with MDD. Conclusion The prevalence of underweight, obesity, suicidal ideation and attempted suicide were high in children and adolescents with MDD, and severe depressive symptoms are independent risk factors for obesity, while suicidal ideation and high dose of antidepressants may be protective factors for obesity.
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Affiliation(s)
- Zhiwei Liu
- Department of Psychiatry, The Third People’s Hospital of Fuyang, Fuyang, China
- Department of Psychiatry, Fuyang Mental Health Center, Fuyang, China
| | - Liang Sun
- Department of Psychiatry, The Third People’s Hospital of Fuyang, Fuyang, China
- Department of Psychiatry, Fuyang Mental Health Center, Fuyang, China
| | - Yulong Zhang
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
| | - Juan Wang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
- Department of Psychiatry, The Fourth People’s Hospital of Chengdu, Chengdu, China
| | - Feng Sun
- Department of Psychiatry, The Third People’s Hospital of Fuyang, Fuyang, China
- Department of Psychiatry, Fuyang Mental Health Center, Fuyang, China
| | - Zhaokun Zhang
- Department of Psychiatry, The Third People’s Hospital of Fuyang, Fuyang, China
- Department of Psychiatry, Fuyang Mental Health Center, Fuyang, China
| | - Guangying Sun
- Department of Psychiatry, The Third People’s Hospital of Fuyang, Fuyang, China
- Department of Psychiatry, Fuyang Mental Health Center, Fuyang, China
| | - Longlong Sun
- Department of Psychiatry, The Third People’s Hospital of Fuyang, Fuyang, China
- Department of Psychiatry, Fuyang Mental Health Center, Fuyang, China
| | - Rongchun Yang
- Department of Psychiatry, The Third People’s Hospital of Fuyang, Fuyang, China
- Department of Psychiatry, Fuyang Mental Health Center, Fuyang, China
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Psychiatric Disorders and Obesity in Childhood and Adolescence-A Systematic Review of Cross-Sectional Studies. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020285. [PMID: 36832413 PMCID: PMC9955505 DOI: 10.3390/children10020285] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/18/2023] [Accepted: 01/28/2023] [Indexed: 02/04/2023]
Abstract
Obesity and psychiatric disorders have high prevalence and are both considered major health problems. Within the last decades, the rates of obesity have risen over 6%, while the prevalence of psychiatric disorders is over 12% for children and adolescents. The aim of this study was to systematically review the evidence regarding the relation of obesity and psychiatric disorders in childhood and adolescence. This review, based on the PRISMA guidelines, included cross-sectional studies published within the last decade, pertaining to the relation between psychiatric disorders and obesity in children and adolescents up to the age of 19 years. Studies on eating disorders were excluded. A total of 14 studies of 23,442 children and adolescents that investigated the relation of obesity with anxiety, mood disorders, and psychosis were included in this systematic review. Nine of the included studies reported a significant relationship between the psychiatric disorder under investigation and obesity. Understanding the nexus between obesity and psychiatric disorders in children and adolescents is of great importance, given the alarming increase in both conditions in youth. Such findings could facilitate the development and implementation of targeted interventions.
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5
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Gupte M, Tousif S, Lemon JJ, Toro Cora A, Umbarkar P, Lal H. Isoform-Specific Role of GSK-3 in High Fat Diet Induced Obesity and Glucose Intolerance. Cells 2022; 11:cells11030559. [PMID: 35159367 PMCID: PMC8834358 DOI: 10.3390/cells11030559] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/26/2022] [Accepted: 02/01/2022] [Indexed: 02/07/2023] Open
Abstract
Obesity-associated metabolic disorders are rising to pandemic proportions; hence, there is an urgent need to identify underlying molecular mechanisms. Glycogen synthase kinase-3 (GSK-3) signaling is highly implicated in metabolic diseases. Furthermore, GSK-3 expression and activity are increased in Type 2 diabetes patients. However, the isoform-specific role of GSK-3 in obesity and glucose intolerance is unclear. Pharmacological GSK-3 inhibitors are not isoform-specific, and tissue-specific genetic models are of limited value to predict the clinical outcome of systemic inhibiion. To overcome these limitations, we created novel mouse models of ROSA26CreERT2-driven, tamoxifen-inducible conditional deletion of GSK-3 that allowed us to delete the gene globally in an isoform-specific and temporal manner. Isoform-specific GSK-3 KOs and littermate controls were subjected to a 16-week high-fat diet (HFD) protocol. On an HFD, GSK-3α KO mice had a significantly lower body weight and modest improvement in glucose tolerance compared to their littermate controls. In contrast, GSK-3β-deletion-mediated improved glucose tolerance was evident much earlier in the timeline and extended up to 12 weeks post-HFD. However, this protective effect weakened after chronic HFD (16 weeks) when GSK-3β KO mice had a significantly higher body weight compared to controls. Importantly, GSK-3β KO mice on a control diet maintained significant improvement in glucose tolerance even after 16 weeks. In summary, our novel mouse models allowed us to delineate the isoform-specific role of GSK-3 in obesity and glucose tolerance. From a translational perspective, our findings underscore the importance of maintaining a healthy weight in patients receiving lithium therapy, which is thought to work by GSK-3 inhibition mechanisms.
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Affiliation(s)
- Manisha Gupte
- Department of Biology, Austin Peay State University, Clarksville, TN 37044, USA;
- Correspondence: (M.G.); (H.L.)
| | - Sultan Tousif
- Division of Cardiovascular Diseases, The University of Alabama at Birmingham (UAB), Birmingham, AL 35233, USA; (S.T.); (A.T.C.); (P.U.)
| | - Jacob J. Lemon
- Department of Biology, Austin Peay State University, Clarksville, TN 37044, USA;
| | - Angelica Toro Cora
- Division of Cardiovascular Diseases, The University of Alabama at Birmingham (UAB), Birmingham, AL 35233, USA; (S.T.); (A.T.C.); (P.U.)
| | - Prachi Umbarkar
- Division of Cardiovascular Diseases, The University of Alabama at Birmingham (UAB), Birmingham, AL 35233, USA; (S.T.); (A.T.C.); (P.U.)
| | - Hind Lal
- Division of Cardiovascular Diseases, The University of Alabama at Birmingham (UAB), Birmingham, AL 35233, USA; (S.T.); (A.T.C.); (P.U.)
- Correspondence: (M.G.); (H.L.)
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6
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Giusti L, Bianchini V, Aggio A, Mammarella S, Salza A, Necozione S, Alunno A, Ferri C, Casacchia M, Roncone R. Twelve-month outcomes in overweight/obese users with mental disorders following a multi-element treatment including diet, physical activity, and positive thinking: The real-world "An Apple a Day" controlled trial. Front Psychiatry 2022; 13:903759. [PMID: 36081460 PMCID: PMC9445251 DOI: 10.3389/fpsyt.2022.903759] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/27/2022] [Indexed: 11/15/2022] Open
Abstract
The present study aimed to evaluate the 12-month effectiveness of a real-world weight loss transdiagnostic intervention in overweight/obese participants affected by mental disorders under psychopharmacological treatment. We conducted a real-world, controlled, pragmatic outpatient trial. We allocated 58 overweight/obese adults under psychopharmacological treatment from a mental health outpatient unit and 48 overweight/obese adults from a cardiovascular prevention outpatient unit, and assigned them to an intervention or treatment usual as condition (TAU) enriched by life-style advice. Participants in both intervention groups took part in a diet programme (the modified OMNIHeart dietary protocol) and monitoring of regular aerobic activity. A brief group programme ("An Apple a Day" Metacognitive Training, Apple-MCT) was added in the intervention group of participants affected by mental disorders. The primary outcome was weight loss. Secondary outcomes included anthropometric, clinical, and metabolic variables. Psychopathology and health-related quality of life were also evaluated in the psychiatric sample. At 12 months, both intervention groups showed a more marked mean decrease in weight (6.7 kg, SD: 3.57) than the TAU group (0.32 kg, SD: 1.96), and a statistically significant improvement in metabolic variables compared with the control groups. Furthermore, the participants affected by mental disorders included in the intervention group reported improved health-related quality of life. Our findings suggest the need to implement integrated interventions based on a dietary protocol, physical activity, and modification of cognitive style in overweight/obese users with mental disorders.
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Affiliation(s)
- Laura Giusti
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Valeria Bianchini
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Annalisa Aggio
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Silvia Mammarella
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Anna Salza
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Stefano Necozione
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alessia Alunno
- Division of Internal Medicine and Nephrology, School of Internal Medicine-San Salvatore Hospital, Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Claudio Ferri
- Division of Internal Medicine and Nephrology, School of Internal Medicine-San Salvatore Hospital, Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Massimo Casacchia
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Rita Roncone
- University Unit Rehabilitation Treatment, Early Interventions in Mental Health-San Salvatore Hospital, Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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Stutzman DL. Long-term use of antidepressants, mood stabilizers, and antipsychotics in pediatric patients with a focus on appropriate deprescribing. Ment Health Clin 2021; 11:320-333. [PMID: 34824957 PMCID: PMC8582767 DOI: 10.9740/mhc.2021.11.320] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 08/09/2021] [Indexed: 11/13/2022] Open
Abstract
It is estimated that 8% to 12% of youth are prescribed psychotropic medications. Those in foster care, juvenile justice systems, residential treatment facilities, and with developmental or intellectual disabilities are more likely to be prescribed high-risk regimens. The use of psychotropic medications in this age group is often off-label and can be associated with significant risk, warranting critical evaluation of their role. Landmark trials, pediatric-specific guidelines, and state-driven initiatives play critical roles in supporting evidence-based use of psychotropic medications in children. Overall, there is a lack of literature describing the long-term use of psychotropic medications in youth—particularly with regard to neurobiological, physical, and social changes that occur throughout development. Deprescribing is an important practice in child and adolescent psychiatry, given concerns for over-prescribing, inappropriate polytherapy, and the importance of reevaluating the role of psychotropic medications as children develop.
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Bis-Humbert C, García-Cabrerizo R, García-Fuster MJ. Dose-dependent opposite effects of nortriptyline on affective-like behavior in adolescent rats: Comparison with adult rats. Eur J Pharmacol 2021; 910:174465. [PMID: 34464602 DOI: 10.1016/j.ejphar.2021.174465] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/27/2021] [Accepted: 08/27/2021] [Indexed: 11/19/2022]
Abstract
Antidepressant drugs elicit different behavioral and neurochemical responses with age. In fact, the use of antidepressants during adolescence is associated with an increased risk of suicidal thinking, being the best pharmacological treatment during this critical period a matter of constant debate in terms of its risk-benefit outcome. In this regard, the present study compared the effects of nortriptyline (3-10 mg/kg, 7 days) on regulating different aspects of affective-like behavior by screening adolescent and adult Sprague-Dawley rats through several consecutive tests (forced-swim, open field, sucrose preference). Brains were later collected to evaluate hippocampal neurogenesis and mBDNF protein content as potential molecular correlates of the observed behavioral responses. The main results in adolescent rats showed that nortriptyline induced dose-dependent opposite effects: while 3 mg/kg decreased immobility and increased mBDNF (indicative of an antidepressant-like response), 10 mg/kg decreased exploratory time in the open field and mBDNF (suggestive of an anxiogenic-like response). These effects were not associated with changes in neurogenesis regulation. In adult rats, nortriptyline failed to modulate affective-like behavior or the neuroplasticity markers evaluated at the doses tested. In conclusion, clear behavioral and neurochemical differences were observed between adolescent and adult rats in response to nortriptyline treatment. Interestingly, while nortriptyline displayed an antidepressant-like potential at the lowest dose examined in adolescence, a higher dose shifted these results towards a negative outcome, thus reinforcing the need to extreme caution when considering this treatment for our younger population.
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Affiliation(s)
- Cristian Bis-Humbert
- IUNICS, University of the Balearic Islands, Palma, Spain; Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Rubén García-Cabrerizo
- IUNICS, University of the Balearic Islands, Palma, Spain; Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - M Julia García-Fuster
- IUNICS, University of the Balearic Islands, Palma, Spain; Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain.
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Lewis-de los Angeles WW, Liu RT. History of Depression, Elevated Body Mass Index, and Waist-to-Height Ratio in Preadolescent Children. Psychosom Med 2021; 83:1075-1081. [PMID: 34267084 PMCID: PMC8578339 DOI: 10.1097/psy.0000000000000982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to evaluate whether a history of depression or self-injurious thoughts and behaviors predict elevated body mass index (BMI) and elevated waist-to-height ratio in preadolescents. METHODS Baseline data were evaluated from a large, nationally representative cohort study of 9- and 10-year-old children (unweighted n = 11,875), the Adolescent Brain and Cognitive Development study. RESULTS In the weighted sample, 10.6% of children had a history of depression, 7.0% had engaged in nonsuicidal self-injury, 13.1% had experienced suicidal ideation in their lifetime, and 1.1% had a history of attempted suicide. Among the children, 34.1% had an elevated BMI in the overweight or obese range and 31.9% had a waist-to-height ratio >0.5. In multivariate analyses, history of depression was associated with elevated BMI and waist-to-height ratio. Furthermore, interactions with sex were found; girls with a history of depression were more likely to have an elevated BMI (odds ratio = 1.47, 95% confidence interval = 1.24-1.74) and elevated waist-to-height ratio (odds ratio = 1.48, 95% confidence interval = 1.18-1.86) than girls without a history of depression, but no differences were observed between boys with and without a history of depression. Self-injurious thoughts and behaviors were not associated with elevated BMI or elevated waist-to-height. CONCLUSIONS In this study, 9- and 10-year-old girls with a history of depression were more likely to have an elevated BMI and elevated waist-to-height ratio than girls with no history of depression. These results provide important clinical context in caring for preadolescents with a history of depression.
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Affiliation(s)
- William W. Lewis-de los Angeles
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Pediatrics, Emma Pendleton Bradley Hospital, Riverside, Rhode Island
| | - Richard T. Liu
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
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Tagi VM, Samvelyan S, Chiarelli F. Treatment of Metabolic Syndrome in Children. Horm Res Paediatr 2021; 93:215-225. [PMID: 33017828 DOI: 10.1159/000510941] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 08/18/2020] [Indexed: 11/19/2022] Open
Abstract
Although metabolic syndrome (MetS) in children and adolescents is a frequently discussed topic in the literature, uniform guidelines on its definition and treatment are still lacking. Insulin resistance, central obesity, dyslipidaemia, and hypertension are commonly considered the main components of MetS. The first recommended approach to all these pathological conditions in children and adolescents is lifestyle intervention (diet and physical exercise); however, in some selected cases, a pharmacological or surgical treatment might prove useful for the prevention of metabolic and cardiovascular complications. The aim of this review is to present the more recent evidence about the treatment of the major components of MetS in children and adolescents, focussing on the current recommendations concerning lifestyle changes, available drugs, and bariatric surgery.
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Affiliation(s)
| | - Sona Samvelyan
- Department of Paediatrics, University of Chieti, Chieti, Italy
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Association of CNR1 and INSIG2 polymorphisms with antipsychotics-induced weight gain: a prospective nested case-control study. Sci Rep 2021; 11:15304. [PMID: 34315947 PMCID: PMC8316361 DOI: 10.1038/s41598-021-94700-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/07/2021] [Indexed: 02/07/2023] Open
Abstract
Weight gain is a frequent and severe adverse reaction in patients taking antipsychotics. The objective was to further investigate in a natural setting influential risk factors associated with clinically significant weight gain. An observational follow-up study was conducted. Patients when initiating treatment with whatever antipsychotic were included; a structured questionnaire was applied at baseline, 3 and 6 months later; a blood sample was obtained. In a nested case-control approach, patients with an increase ≥ 7% of their initial weight were considered as cases, the remaining, as controls. The results showed that, out of 185 patients, 137 completed the 6-month follow-up (cases, 38; controls, 99). Weight gain gradually and significantly increased in cases (baseline, 65.0 kg; 6 months, 74.0 kg) but not in controls (65.6 kg and 65.8 kg, respectively). Age (adjusted OR = 0.97, 95% CI = 0.96-0.99, p = 0.004), olanzapine (adjusted OR = 2.98, 95% CI = 1.13-7.80, p = 0.027) and quetiapine (adjusted OR = 0.25, 95% = 0.07-0.92, p = 0.037) significantly associated with weight gain. An association was also found for the CNR1 (rs1049353) and INSIG2 (rs7566605) polymorphisms. In conclusion, an increased risk of antipsychotics-induced weight gain was observed for younger age and olanzapine, and a relative lower risk for quetiapine. A potential role of CNR1 rs1049353 and INSIG2 rs7566605 polymorphisms is suggested.
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Gurka MJ, Siddiqi SU, Filipp SL, Mercado R, Thompson LA, Janicke DM, Shenkman EA. Attention deficit hyperactivity disorder medications and BMI trajectories: The role of medication type, sex and age. Pediatr Obes 2021; 16:e12738. [PMID: 33064373 PMCID: PMC8276278 DOI: 10.1111/ijpo.12738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/17/2020] [Accepted: 09/28/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Attention deficit hyperactivity disorder (ADHD) and the medications used to treat it are associated with obesity. Stimulants lead to weight loss, while antipsychotics and antidepressants lead to weight gain. Little is known, however, how alpha-2-agonists impact weight, or the independent effect on BMI of these four classes of medications, which are often prescribed concurrently. We aimed to estimate the proximal change in BMI associated with start of medication and to assess whether medication-specific departures in BMI varied by age and sex. STUDY DESIGN We analysed longitudinal electronic health records from children (4-19 years) with an ADHD diagnosis seen at one healthcare system (2011-2018). Their BMI z-scores were fit as a cubic function of age via a mixed model, separately by sex and adjusting for race/ethnicity. From this model, we estimated annual changes in BMI-z after medication, allowing changes to vary by age and sex. RESULTS Among the 22 714 children with ADHD (mean initial age = 10.0), 4335 (19.1%) were never prescribed ADHD medication. The others (80.9%) experienced departures in BMI-z after start of all four medication classes, which varied across age and sex (interaction P-values < .01). All medications had larger impacts at younger ages. As expected, decreased BMI-z was observed with stimulants, while antidepressants and antipsychotics led to BMI-z increases; alpha-agonists also were associated with BMI-z increases. CONCLUSIONS This longitudinal study revealed that ADHD medications are independently associated with proximal changes in BMI-z after initiation, significantly varying by sex and age. Future research should study further the interactions of these medications on long-term impacts on obesity.
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Affiliation(s)
- Matthew J. Gurka
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida,Institute for Child Health Policy, University of Florida, Gainesville, Florida,Department of Pediatrics, College of Medicine, University of Florida, Gainesville, Florida
| | - Siraj U. Siddiqi
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, Florida
| | - Stephanie L. Filipp
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida,Department of Pediatrics, College of Medicine, University of Florida, Gainesville, Florida
| | - Rebeccah Mercado
- Institute for Child Health Policy, University of Florida, Gainesville, Florida,Department of Pediatrics, College of Medicine, University of Florida, Gainesville, Florida
| | - Lindsay A. Thompson
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida,Institute for Child Health Policy, University of Florida, Gainesville, Florida,Department of Pediatrics, College of Medicine, University of Florida, Gainesville, Florida
| | - David M. Janicke
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Elizabeth A. Shenkman
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida,Institute for Child Health Policy, University of Florida, Gainesville, Florida
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Wang C, Shi W, Xu J, Huang C, Zhu J. Outcomes and safety of concomitant topiramate or metformin for antipsychotics-induced obesity: a randomized-controlled trial. Ann Gen Psychiatry 2020; 19:68. [PMID: 33302986 PMCID: PMC7727176 DOI: 10.1186/s12991-020-00319-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/25/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Although there are some existing data describing the usage of topiramate in patients with antipsychotic-induced obesity, study on its comparison with metformin is limited. This study aimed to explore the effectiveness and safety of concomitant topiramate on antipsychotic-induced obesity as well as its comparison with metformin. METHODS 62 stabilized outpatients with antipsychotic-induced obesity were randomized into the topiramate group and the metformin group with 16-week treatment. The patients' weight, body mass index (BMI), waist-hip ratio, and their side effects were assessed and compared. Intention-to-treat and completer analyses were performed. Meanwhile, covariance analysis was conducted to control the impact of the significant difference in BMI between the two groups. RESULTS The two groups had comparable characteristics, though their difference in baseline BMI was significant. (1) Intention-to-treat analyses: the random missing values were replaced using the last observation carried forward method when intention-to-treat analyses were conducted. Compared with the baseline, the weight, BMI, and waist-hip ratio in the topiramate group markedly decreased at each follow-up, whereas, in the metformin group, only waist-hip ratio significantly decreased at 4 weeks after treatment. Compared with the metformin, only weight and BMI in the topiramate group were significantly decreased at week 4 after treatment, and at week 8-16, weight, BMI and waist-hip ratio were remarkably declined. (2) Completer analyses: compared with the baseline, the weight, BMI, and waist-hip ratio in the topiramate group at week 4-16 were markedly decreased, whereas only waist-hip ratio with metformin was significantly decreased at week 4. Compared with the metformin, all BMI with topiramate were markedly decreased at week 4-16. Moreover, its weight and waist-hip ratio also were notably lowered at week 8. No significant differences in adverse events were found between the two groups. CONCLUSIONS Topiramate, similar to metformin in reducing obesity as previously reported, also significantly reduced body weight, BMI, and waist-hip ratio in patients with antipsychotic-induced obesity and demonstrated well tolerance in psychiatric patients. Trial registration The trial was registered at http://www.chictr.org.cn , and the number was ChiCTR-IPR-17013122.
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Affiliation(s)
- Congjie Wang
- Department of Psychiatry, Huai'an No. 3 People's Hospital, No.272 West Huaihai Rd., Huai'an, 223001, Jiangsu, China.
| | - Wenjie Shi
- Department of Psychiatry, Huai'an No. 3 People's Hospital, No.272 West Huaihai Rd., Huai'an, 223001, Jiangsu, China
| | - Jianyang Xu
- Department of Neurology, Huai'an No. 3 People's Hospital, No.272 West Huaihai Rd., Huai'an, 223001, Jiangsu, China.
| | - Chengbing Huang
- Department of Psychiatry, Huai'an No. 3 People's Hospital, No.272 West Huaihai Rd., Huai'an, 223001, Jiangsu, China
| | - Jiannan Zhu
- Department of Psychiatry, Huai'an No. 3 People's Hospital, No.272 West Huaihai Rd., Huai'an, 223001, Jiangsu, China
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Developmental-Behavioral Pediatricians' Diagnosis and Coding of Overweight and Obesity in Children with Autism Spectrum Disorder. J Dev Behav Pediatr 2020; 41:258-264. [PMID: 32040046 DOI: 10.1097/dbp.0000000000000783] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The prevalence of obesity in autism spectrum disorder (ASD) is high, and managing obesity in children with ASD can be challenging. The study's objective was to examine developmental-behavioral pediatricians' (DBPs) coding practices for overweight/obesity in children with ASD and patient characteristics associated with coding. METHODS We analyzed the clinical data on children with ASD with at least 1 visit at one of 3 developmental-behavioral pediatrics network sites between January 2010 and December 2011. Weight status was calculated using body mass index z-scores. For children meeting the criteria for overweight/obesity, we assessed the frequency of weight-related ICD-9 diagnosis codes at DBP visits, used multivariable logistic regression to determine characteristics associated with the presence of these codes, and examined the prevalence of weight-related codes relative to other diagnosis codes. RESULTS The sample included 4542 children, ages 2 to 19 years. 15.5% of children met the criteria for overweight, 14.7% for obesity, and 6.3% for severe obesity. Of children meeting the criteria for overweight/obesity/severe obesity, 7.5% had a weight-related code documented at their visits. Children with obesity or severe obesity and older children had higher odds of having a weight-related code. Compared with not being on medications, atypical antipsychotics use was significantly associated with increased odds of having a weight-related code. Of 3802 unique ICD-9 diagnosis codes documented at any visit during the study period, only 4% were related to weight. CONCLUSION Few children meeting the criteria for overweight/obesity had documented weight-related codes. Weight-related coding was more likely for children with obesity, who were older, and those taking atypical antipsychotics.
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Keast SL, Tidmore LM, Shropshire D, Nesser N, Lambert TL. Characterization of Chronic Multiclass Psychotropic Polypharmacy and Psychotherapy in Foster Care Youth in a State Medicaid Population. J Manag Care Spec Pharm 2020; 25:1340-1348. [PMID: 31778625 PMCID: PMC10397855 DOI: 10.18553/jmcp.2019.25.12.1340] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Foster youth have higher rates of psychotropic medication use and concurrent multiclass psychotropic polypharmacy compared with nonfoster youth. However, less is known about the extent of multiclass psychotropic polypharmacy after adjusting for patient factors associated with psychotropic medication use OBJECTIVES: To (a) compare psychotropic medication use and psychotherapy use by youth in foster care to those not in foster care in the Oklahoma Medicaid population across various sociodemographic and clinical factors, and (b) determine if patient-related characteristics are associated with high levels of concurrent multiclass psychotropic polypharmacy. METHODS This cross-sectional, retrospective analysis was conducted using paid prescription, outpatient, and inpatient Oklahoma Medicaid administrative claims from calendar year 2016. Foster youth and adolescents aged 20 years or younger were identified (n = 9,325) and compared with the general Oklahoma Medicaid population of the same age (n = 639,868). Descriptive statistics highlight baseline demographic and clinical differences between the 2 groups. Multivariable logistic regression was used to determine if covariates were associated with concurrent multiclass psychotropic polypharmacy. A subgroup analysis of foster youth taking at least 1 psychotropic medication was also performed to determine factors associated with the highest level of concurrent multiclass psychotropic polypharmacy. RESULTS Foster care was associated with higher odds of concurrent multiclass psychotropic polypharmacy regardless of presence of psychotherapy. Among the subgroup of foster youth taking at least 1 psychotropic medication, attention deficit hyperactivity disorder medications were the most commonly prescribed medication class, followed by antidepressants and anxiolytics when use was not chronic. However, at the highest level of chronic multiclass psychotropic polypharmacy (4-5 chronic concurrent medications), antipsychotics rose to the top, and anxiolytics were the least likely to be prescribed. Overall, the foster care population had the highest proportion of individuals with concurrent multiclass psychotropic polypharmacy (9.2% vs. 1.9%, P < 0.0001). The highest level of chronic multiclass psychotropic polypharmacy was more likely to occur in males (OR = 1.66, 95% CI = 1.40-1.96) and patients living in group homes (OR = 4.13, 95% CI = 2.02-8.44) or foster homes (OR = 1.66, 95% CI = 1.25-2.19). Being overweight or obese was associated with an 83% higher odds of being at the highest level of concurrent multiclass psychotropic polypharmacy (95% CI = 1.27-2.64). CONCLUSIONS Despite higher psychotherapy use, high rates of psychotropic medication use and concurrent multiclass psychotropic polypharmacy in foster youth remain a concern for policymakers. Patterns observed at different levels of concurrent multiclass psychotropic polypharmacy may be key to identifying youth who require additional monitoring. Future research exploring factors associated with higher levels of psychotropic concurrent multiclass psychotropic polypharmacy in foster youth can lead to actionable interventions and important policy changes. DISCLOSURES This project was funded through the CHIP Health Services Initiative. Keast, Tidmore, and Lambert report contractual employment for the Oklahoma Health Care Authority. Nesser is an employee of the Oklahoma Health Care Authority, and Shropshire is an employee of the Oklahoma Department of Human Services. Keast discloses unrelated research grant funding from AbbVie, Amgen, Otsuka, and Purdue Pharma. Tidmore discloses unrelated research grant funding from Amgen and Otsuka. The remaining authors have no relevant disclosures or conflicts of interest to declare. Posters based on this study were presented at AMCP Nexus 2017; October 16-19, 2017; Grapevine, TX, and at the AMCP Annual Meeting 2018; April 23-26, 2018; Boston, MA.
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Affiliation(s)
- Shellie L Keast
- University of Oklahoma College of Pharmacy and Pharmacy Management Consultants, Oklahoma City, Oklahoma
| | - Laura M Tidmore
- University of Oklahoma College of Pharmacy and Pharmacy Management Consultants, Oklahoma City, Oklahoma
| | | | | | - Tammy L Lambert
- University of Oklahoma College of Pharmacy and Pharmacy Management Consultants, Oklahoma City, Oklahoma
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Curtin C, Hyman SL, Boas DD, Hassink S, Broder-Fingert S, Ptomey LT, Gillette MD, Fleming RK, Must A, Bandini LG. Weight Management in Primary Care for Children With Autism: Expert Recommendations. Pediatrics 2020; 145:S126-S139. [PMID: 32238539 DOI: 10.1542/peds.2019-1895p] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2020] [Indexed: 11/24/2022] Open
Abstract
Research suggests that the prevalence of obesity in children with autism spectrum disorder (ASD) is higher than in typically developing children. The US Preventive Services Task Force and the American Academy of Pediatrics (AAP) have endorsed screening children for overweight and obesity as part of the standard of care for physicians. However, the pediatric provider community has been inadequately prepared to address this issue in children with ASD. The Healthy Weight Research Network, a national research network of pediatric obesity and autism experts funded by the US Health Resources and Service Administration Maternal and Child Health Bureau, developed recommendations for managing overweight and obesity in children with ASD, which include adaptations to the AAP's 2007 guidance. These recommendations were developed from extant scientific evidence in children with ASD, and when evidence was unavailable, consensus was established on the basis of clinical experience. It should be noted that these recommendations do not reflect official AAP policy. Many of the AAP recommendations remain appropriate for primary care practitioners to implement with their patients with ASD; however, the significant challenges experienced by this population in both dietary and physical activity domains, as well as the stress experienced by their families, require adaptations and modifications for both preventive and intervention efforts. These recommendations can assist pediatric providers in providing tailored guidance on weight management to children with ASD and their families.
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Affiliation(s)
- Carol Curtin
- Healthy Weight Research Network, University of Massachusetts Medical School, Worcester, Massachusetts; .,Eunice Kennedy Shriver Center, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Susan L Hyman
- Healthy Weight Research Network, University of Massachusetts Medical School, Worcester, Massachusetts.,University of Rochester Medical Center, Rochester, New York
| | - Diane D Boas
- Healthy Weight Research Network, University of Massachusetts Medical School, Worcester, Massachusetts.,The Barbara Bush Children's Hospital, Maine Medical Center, Portland, Maine
| | - Sandra Hassink
- Healthy Weight Research Network, University of Massachusetts Medical School, Worcester, Massachusetts.,Institute for Healthy Childhood Weight, American Academy of Pediatrics, Itasca, Illinois
| | - Sarabeth Broder-Fingert
- Healthy Weight Research Network, University of Massachusetts Medical School, Worcester, Massachusetts.,Boston Medical Center and School of Medicine, Boston University, Boston, Massachusetts
| | - Lauren T Ptomey
- Healthy Weight Research Network, University of Massachusetts Medical School, Worcester, Massachusetts.,University of Kansas Medical Center, Kansas City, Kansas
| | - Meredith Dreyer Gillette
- Healthy Weight Research Network, University of Massachusetts Medical School, Worcester, Massachusetts.,Children's Mercy Kansas City and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Richard K Fleming
- Healthy Weight Research Network, University of Massachusetts Medical School, Worcester, Massachusetts.,University of Massachusetts Boston, Boston, Massachusetts
| | - Aviva Must
- Healthy Weight Research Network, University of Massachusetts Medical School, Worcester, Massachusetts.,School of Medicine, Tufts University, Boston, Massachusetts; and
| | - Linda G Bandini
- Healthy Weight Research Network, University of Massachusetts Medical School, Worcester, Massachusetts.,Eunice Kennedy Shriver Center, University of Massachusetts Medical School, Worcester, Massachusetts.,Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts
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17
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Lindberg L, Hagman E, Danielsson P, Marcus C, Persson M. Anxiety and depression in children and adolescents with obesity: a nationwide study in Sweden. BMC Med 2020; 18:30. [PMID: 32079538 PMCID: PMC7033939 DOI: 10.1186/s12916-020-1498-z] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 01/16/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Anxiety and depression are more common in children with obesity than in children of normal weight, but it is unclear whether this association is independent of other known risk factors. Interpretation of results from previous studies is hampered by methodological limitations, including self-reported assessment of anxiety, depression, and anthropometry. The aim of this study was to investigate whether obesity increases the risk of anxiety or depression independently of other risk factors in a large cohort of children and adolescents, using robust measures with regard to exposure and outcome. METHODS Children aged 6-17 years in the Swedish Childhood Obesity Treatment Register (BORIS, 2005-2015) were included (n = 12,507) and compared with a matched group (sex, year of birth, and area of residence) from the general population (n = 60,063). The main outcome was a diagnosis of anxiety or depression identified through ICD codes or dispensed prescribed medication within 3 years after the end of obesity treatment. Hazard ratios (HRs) with 95% confidence intervals (CIs) from Cox proportional models were adjusted for several known confounders. RESULTS Obesity remained a significant risk factor for anxiety and depression in children and adolescents after adjusting for Nordic background, neuropsychiatric disorders, family history of anxiety/depression, and socioeconomic status. Girls in the obesity cohort had a 43% higher risk of anxiety and depression compared to girls in the general population (adjusted HR 1.43, 95% CI 1.31-1.57; p < 0.0001). The risk in boys with obesity was similar (adjusted HR 1.33, 95% CI 1.20-1.48; p < 0.0001). In sensitivity analyses, excluding subjects with neuropsychiatric disorders and a family history of anxiety/depression, the estimated risks in individuals with obesity were even higher compared with results from the main analyses (adjusted HR [95% CI]: girls = 1.56 [1.31-1.87], boys = 2.04 [1.64-2.54]). CONCLUSIONS Results from this study support the hypothesis that obesity per se is associated with risk of both anxiety and depression in children and adolescents.
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Affiliation(s)
- Louise Lindberg
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Blickagången 6A Novum, 141 57, Stockholm, Sweden.
| | - Emilia Hagman
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Blickagången 6A Novum, 141 57, Stockholm, Sweden
| | - Pernilla Danielsson
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Blickagången 6A Novum, 141 57, Stockholm, Sweden
| | - Claude Marcus
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Blickagången 6A Novum, 141 57, Stockholm, Sweden
| | - Martina Persson
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.,Department of Diabetes and Endocrinology, Sachsska Children's Hospital, Södersjukhuset, Stockholm, Sweden.,Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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Toscano CVA, Ferreira JP, Gaspar JM, Carvalho HM. Growth and weight status of Brazilian children with autism spectrum disorders: A mixed longitudinal study. J Pediatr (Rio J) 2019; 95:705-712. [PMID: 30071189 DOI: 10.1016/j.jped.2018.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 06/02/2018] [Accepted: 06/06/2018] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE This study examined the growth status and physical development of Brazilian children with autism spectrum disorders from 4 to 15 years of age. Furthermore, it was examined whether variation in growth patterns and weight status was influenced by the use of psychotropic medications. METHODS One-hundred and twenty children aged 3.6-12.1 years at baseline (average=7.2 years, SD=2.3 years) diagnosed with autism spectrum disorders were measured on three repeated occasions across a 4-year period. Stature, body mass, and body mass index were considered. Bayesian multilevel modeling was used to describe the individual growth patterns. RESULTS Growth in stature was comparable to the age-specific 50th percentile for Centers for Disease Control and Prevention reference data until approximately 8 years, but a substantial decrease in growth rate was observed thereafter, reaching the age-specific 5th percentile at 15 years of age. Both body mass and body mass index values were, on average, higher than both the Brazilian and Centers for Disease Control and Prevention age-specific 95th percentile reference until 8 years, but below the 50th specific-age percentile at the age of 15 years. CONCLUSIONS Brazilian boys with autism spectrum disorders between 4 and 15 years appear to have impaired growth in stature after 8-9 years of age, likely impacting pubertal growth. A high prevalence of overweight and obesity was observed in early childhood, although a trend of substantial decrease in body mass and body mass index was apparent when children with autism spectrum disorders entered the years of pubertal development.
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Affiliation(s)
- Chrystiane V A Toscano
- Universidade de Coimbra, Centro de Pesquisa em Esporte e Atividade Física, Coimbra, Portugal; Universidade Federal de Alagoas (UFAL), Maceió, AL, Brazil
| | - José P Ferreira
- Universidade de Coimbra, Centro de Pesquisa em Esporte e Atividade Física, Coimbra, Portugal
| | - Joana M Gaspar
- Universidade Federal de Santa Catarina, Centro de Ciências Biológicas, Departamento de Bioquímica, Programa de Pós-Graduação em Bioquímica, Florianópolis, SC, Brazil; Universidade Federal de Santa Catarina, Centro de Ciências Biológicas, Departamento de Bioquímica, Laboratório de Bioenergética e Estresse Oxidativo, Florianópolis, SC, Brazil.
| | - Humberto M Carvalho
- Universidade Federal de Santa Catarina, Centro Esportivo, Departamento de Educação Física, Florianópolis, SC, Brazil.
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McLennan JD. Deprescribing in a Youth with an Intellectual Disability, Autism, Behavioural Problems, and Medication-Related Obesity: A Case Study. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2019; 28:141-146. [PMID: 31798652 PMCID: PMC6863577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Vlad, not his real name, a 15 year old boy with an autism spectrum disorder and intellectual disability, was referred for psychiatric consultation due to aggression and other behavioural problems. He presented for initial psychiatric consultation on five psychotropic medications with associated severe obesity. A systematic deprescribing and cross-tapering plan was implemented, removing all five psychotropic medications (which included olanzapine and quetiapine) and introducing ziprasidone. These changes were associated with a 44.8kg weight loss with no behavioral deterioration and overall lower rates of aggression. Vlad's case may typify important deficiencies in the service system which create a context that allows for aggressive psychotropic polypharmacy without apparent concomitant increase in sophistication of behavioral management design and support, while also tolerating substantial treatment adverse effects (e.g., medication induced severe obesity) within a member of a vulnerable population (e.g., a youth with developmental disability in care). Suggestions to address some of these contextual factors are outlined.
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Affiliation(s)
- John D McLennan
- Children's Hospital of Eastern Ontario-Research Institute, Ottawa, Ontario
- Department of Pediatrics, University of Calgary, Alberta
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20
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Growth and weight status of Brazilian children with autism spectrum disorders: A mixed longitudinal study. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2018.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Risk Factors for Unhealthy Weight Gain and Obesity among Children with Autism Spectrum Disorder. Int J Mol Sci 2019; 20:ijms20133285. [PMID: 31277383 PMCID: PMC6650879 DOI: 10.3390/ijms20133285] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 07/01/2019] [Accepted: 07/03/2019] [Indexed: 02/06/2023] Open
Abstract
Autism Spectrum Disorder (ASD) is a developmental disorder characterized by social and communication deficits and repetitive behaviors. Children with ASD are also at a higher risk for developing overweight or obesity than children with typical development (TD). Childhood obesity has been associated with adverse health outcomes, including insulin resistance, diabetes, heart disease, and certain cancers. Importantly some key factors that play a mediating role in these higher rates of obesity include lifestyle factors and biological influences, as well as secondary comorbidities and medications. This review summarizes current knowledge about behavioral and lifestyle factors that could contribute to unhealthy weight gain in children with ASD, as well as the current state of knowledge of emerging risk factors such as the possible influence of sleep problems, the gut microbiome, endocrine influences and maternal metabolic disorders. We also discuss some of the clinical implications of these risk factors and areas for future research.
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The effects of antipsychotic medications on microbiome and weight gain in children and adolescents. BMC Med 2019; 17:112. [PMID: 31215494 PMCID: PMC6582584 DOI: 10.1186/s12916-019-1346-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 05/16/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Atypical antipsychotics, also known as second-generation antipsychotics, are commonly prescribed as treatment for psychotic disorders in adults, as well as in children and adolescents with behavioral problems. However, in many cases, second-generation antipsychotics have unwanted side effects, such as weight gain, potentially further increasing risk for morbidities including obesity, diabetes, and cardiovascular disease. While various mechanisms for this weight gain have been proposed, including effects on metabolic hormone signaling, recent evidence points to the importance of the gut microbiome in this process. The microbial communities residing within the gut are affected by second-generation antipsychotics and can confer weight gain. MAIN TEXT This review summarizes recent findings and presents data linking second-generation antipsychotics, gut microbiota alterations and weight gain. The review focuses on children and adolescent populations, which have not previously received much attention, but are of great interest because they may be most vulnerable to gut microbiome changes and may carry long-term metabolic effects into adulthood. CONCLUSIONS We present correlations between second-generation antipsychotics, gut microbiota alterations and weight gain, and suggest some mechanisms that may link them. A better understanding of the underlying mechanisms may lead to the design of improved treatments for psychotic disorders with fewer harmful side effects.
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Abstract
PURPOSE OF REVIEW This narrative review synthesized recent research related to obesity in adolescents with psychiatric disorders, with a focus on epidemiology, mechanisms, and weight management approaches. The paper reviews literature on depressive and anxiety disorders, bipolar disorder, and schizophrenia spectrum and other psychotic disorders. RECENT FINDINGS Depression has a bidirectional relationship with obesity. Bipolar disorder and schizophrenia spectrum disorders, and their treatments, increase the risk of developing obesity. Mechanisms underlying this weight gain include lifestyle and environmental factors and psychiatric medications, though emerging evidence has also suggested the role of genetic and neuroendocrine processes. Evidence about the most effective treatments for obesity in adolescents with psychiatric disorders remains limited. Adolescents with psychiatric disorders are at high risk for obesity. Close monitoring for increases in weight and cardiometabolic risk factors with use of antipsychotic and mood-stabilizing medications is recommended. Clinical trials are needed that test the efficacy of weight management strategies for this population.
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Affiliation(s)
- Ariana M. Chao
- University of Pennsylvania School of Nursing, Department of Biobehavioral Health Sciences;,Perelman School of Medicine at the University of Pennsylvania, Department of Psychiatry
| | - Thomas A. Wadden
- Perelman School of Medicine at the University of Pennsylvania, Department of Psychiatry
| | - Robert I. Berkowitz
- Perelman School of Medicine at the University of Pennsylvania, Department of Psychiatry;,Children’s Hospital of Philadelphia, Department of Child and Adolescent Psychiatry and Behavioral Sciences
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Waszak PM, Zagożdżon P, Pierucka M, Kubanek A. Antipsychotic Medication Prescribing Trends in a Pediatric Population in Northern Poland 2008-2012. J Child Adolesc Psychopharmacol 2018; 28:631-636. [PMID: 30048153 DOI: 10.1089/cap.2017.0154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES In recent years antipsychotics have been increasingly used in the population of children and adolescents. The objective of this article is to profile the use of antipsychotic medications in a pediatric population in Poland based on data from the Pomeranian region (Northern Poland). METHODS The study was based on National Health Fund data about prescription drug reimbursement between 2008 and 2012. A patient database was created using ID to analyze specific patterns and information about individuals using antipsychotics. Percentage population indicators were calculated using official demographic reports. RESULTS An increased number of overall prescriptions was observed since 2008, with a subsequent decline to its lowest number in 2012. The population with at least one antipsychotic-filled prescription per year has grown in the same time. The annual rate has increased from 0.26% to 0.31% of the general population between 0 and 17 years of age in the Pomeranian region. We observed an increasing number of females and the 0- to 4-year-old receiving antipsychotic prescriptions. The population share of prescribed first-generation antipsychotics exceeded the share of second-generation antipsychotics (SGAs). The use of SGAs increased from 38% to 44% of all prescriptions, during the observation period. The most frequently prescribed drugs were Risperidone (26.7%) and Chlorprothixene (21.7%). CONCLUSIONS The study revealed that the prescribing patterns of antipsychotics increased in the Polish pediatric population and concerned more patients from the youngest group. The high prevalence of such early exposure to antipsychotics should focus more attention on drug safety in this population.
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Affiliation(s)
- Przemysław M Waszak
- 1 Department of Hygiene and Epidemiology, Medical University of Gdansk , Gdansk, Poland .,2 Department of Developmental Psychiatry, Psychotic and Geriatric Disorders, Medical University of Gdansk , Gdansk, Poland
| | - Paweł Zagożdżon
- 1 Department of Hygiene and Epidemiology, Medical University of Gdansk , Gdansk, Poland
| | - Magdalena Pierucka
- 1 Department of Hygiene and Epidemiology, Medical University of Gdansk , Gdansk, Poland
| | - Alicja Kubanek
- 3 Department of Occupational, Metabolic, and Internal Diseases, Medical University of Gdansk , Gdansk, Poland
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Ameer B, Weintraub MA. Pediatric Obesity: Influence on Drug Dosing and Therapeutics. J Clin Pharmacol 2018; 58 Suppl 10:S94-S107. [DOI: 10.1002/jcph.1092] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 01/11/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Barbara Ameer
- Department of Medicine; Rutgers - Robert Wood Johnson Medical School; Piscataway NJ USA
| | - Michael A. Weintraub
- Department of Medicine; Thomas Jefferson University Hospitals; Philadelphia PA USA
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Baeza I, de la Serna E, Calvo-Escalona R, Merchán-Naranjo J, Rodríguez-Latorre P, Martínez-Cantarero MC, Andrés P, Alda JA, Muñoz-Samons D, Ilzarbe D, Arango C, Castro-Fornieles J. One-Year Prospective Study of Liver Function Tests in Children and Adolescents on Second-Generation Antipsychotics: Is There a Link with Metabolic Syndrome? J Child Adolesc Psychopharmacol 2018; 28:463-473. [PMID: 29975563 DOI: 10.1089/cap.2017.0117] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To analyze liver function tests (LFT), weight, metabolic syndrome (MetS) and at risk of meeting MetS criteria (AR-MetS) in children and adolescents on antipsychotics (AP) during a year-long follow-up. METHODS Two hundred sixteen patients, AP naïve or quasi-naïve (<30 days on AP), were included. Total bilirubin, the enzymes aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), weight and other parameters of MetS were measured at baseline, and at 3, 6 and 12 months, while patients remained on the same AP. RESULTS At baseline, patients (mean age: 14.1 ± 3.1 years; 60.2% male) were on risperidone (N = 143), olanzapine (N = 37), or quetiapine (N = 36), although the sample decreased over time to 67 patients at 12 months (risperidone N = 46, olanzapine N = 10, and quetiapine N = 11). Around 3% of patients had ALT/AST levels that were at least twice the upper limit of normal (ULN) at 3 and 6 months; whereas roughly 19% of patients had ALP levels that were at least twice the ULN in at least one assessment after baseline, but had no clinical symptoms. From baseline to 6 months, significant increases were observed in ALT levels in the whole sample (p = 0.005), whereas ALP increased only in patients on risperidone. Patients showed significant weight gain, and more individuals met criteria for MetS and AR-MetS over time (from baseline: 2.8% and 8.3%, to 1 year: 10.5% and 23.9%, respectively). There was a trend-level group effect in global ALT across time (p = 0.076). Patients with MetS showed higher ALT concentrations (28.9 [18.4-39.4] U/L) than AR-MetS (20.4 [8.5-32.2] U/L), and no-AR-MetS (19.2 [8.4-29.9] U/L). CONCLUSIONS Less than 3% of children and adolescents on AP during 1-year follow-up showed an increase in ALT or AST levels in one or more of the assessments, and none of these increases was of clinical significance. Patients with MetS and AR-MetS increased during this period, and the possible role of ALT levels to monitor these patients deserves further study.
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Affiliation(s)
- Inmaculada Baeza
- 1 Department of Child and Adolescent Psychiatry and Psychology, SGR-881, Institut Clinic of Neurosciences, Institut d'Investigacions Biomèdi ques August Pi Sunyer (IDIBAPS), Hospital Clínic Universitari of Barcelona , Barcelona, Spain .,2 Department of Medicine, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), University of Barcelona , Barcelona, Spain
| | - Elena de la Serna
- 1 Department of Child and Adolescent Psychiatry and Psychology, SGR-881, Institut Clinic of Neurosciences, Institut d'Investigacions Biomèdi ques August Pi Sunyer (IDIBAPS), Hospital Clínic Universitari of Barcelona , Barcelona, Spain .,2 Department of Medicine, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), University of Barcelona , Barcelona, Spain
| | - Rosa Calvo-Escalona
- 1 Department of Child and Adolescent Psychiatry and Psychology, SGR-881, Institut Clinic of Neurosciences, Institut d'Investigacions Biomèdi ques August Pi Sunyer (IDIBAPS), Hospital Clínic Universitari of Barcelona , Barcelona, Spain .,2 Department of Medicine, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), University of Barcelona , Barcelona, Spain
| | - Jessica Merchán-Naranjo
- 3 Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón , School of Medicine, Universidad Complutense, IISGM, CIBERSAM, Madrid, Spain
| | - Pamela Rodríguez-Latorre
- 3 Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón , School of Medicine, Universidad Complutense, IISGM, CIBERSAM, Madrid, Spain
| | | | - Patricia Andrés
- 4 Child and Adolescent Psychiatry Department, Hospital Infantil Universitario Niño Jesús , Madrid, Spain
| | - José Angel Alda
- 5 Child and Adolescent Psychiatry Department, Hospital Sant Joan de Déu , CIBERSAM, Barcelona, Spain
| | - Daniel Muñoz-Samons
- 5 Child and Adolescent Psychiatry Department, Hospital Sant Joan de Déu , CIBERSAM, Barcelona, Spain
| | - Daniel Ilzarbe
- 6 Department of Child and Adolescent Psychiatry, Institute of Psychiatry , Psychology and Neuroscience, King's College London, London, United Kingdom .,7 Faculty of Medicine, Universitat de Barcelona , Barcelona, Spain
| | - Celso Arango
- 3 Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón , School of Medicine, Universidad Complutense, IISGM, CIBERSAM, Madrid, Spain
| | - Josefina Castro-Fornieles
- 1 Department of Child and Adolescent Psychiatry and Psychology, SGR-881, Institut Clinic of Neurosciences, Institut d'Investigacions Biomèdi ques August Pi Sunyer (IDIBAPS), Hospital Clínic Universitari of Barcelona , Barcelona, Spain .,2 Department of Medicine, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), University of Barcelona , Barcelona, Spain
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Gezmen-Karadağ M, Çelik E, Kadayifçi FZ, Yeşildemir Ö, Öztürk YE, Ağagündüz D. Role of food-drug interactions in neurological and psychological diseases. Acta Neurobiol Exp (Wars) 2018. [DOI: 10.21307/ane-2018-017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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28
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Suglia SF, Koenen KC, Boynton-Jarrett R, Chan PS, Clark CJ, Danese A, Faith MS, Goldstein BI, Hayman LL, Isasi CR, Pratt CA, Slopen N, Sumner JA, Turer A, Turer CB, Zachariah JP. Childhood and Adolescent Adversity and Cardiometabolic Outcomes: A Scientific Statement From the American Heart Association. Circulation 2017; 137:e15-e28. [PMID: 29254928 DOI: 10.1161/cir.0000000000000536] [Citation(s) in RCA: 286] [Impact Index Per Article: 40.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Adverse experiences in childhood and adolescence, defined as subjectively perceived threats to the safety or security of the child's bodily integrity, family, or social structures, are known to be associated with cardiometabolic outcomes over the life course into adulthood. This American Heart Association scientific statement reviews the scientific literature on the influence of childhood adversity on cardiometabolic outcomes that constitute the greatest public health burden in the United States, including obesity, hypertension, type 2 diabetes mellitus, and cardiovascular disease. This statement also conceptually outlines pathways linking adversity to cardiometabolic health, identifies evidence gaps, and provides suggestions for future research to inform practice and policy. We note that, despite a lack of objective agreement on what subjectively qualifies as exposure to childhood adversity and a dearth of prospective studies, substantial evidence documents an association between childhood adversity and cardiometabolic outcomes across the life course. Future studies that focus on mechanisms, resiliency, and vulnerability factors would further strengthen the evidence and provide much-needed information on targets for effective interventions. Given that childhood adversities affect cardiometabolic health and multiple health domains across the life course, interventions that ameliorate these initial upstream exposures may be more appropriate than interventions remediating downstream cardiovascular disease risk factor effects later in life.
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Calarge CA, Mills JA, Janz KF, Burns TL, Coryell WH, Zemel BS. Body Composition in Adolescents During Treatment With Selective Serotonin Reuptake Inhibitors. Pediatrics 2017; 140:peds.2016-3943. [PMID: 28759400 PMCID: PMC5495528 DOI: 10.1542/peds.2016-3943] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To examine the independent contribution of major depressive disorder (MDD), generalized anxiety disorder (GAD), and selective serotonin reuptake inhibitors (SSRIs) to changes in body composition in older adolescents. METHODS Medically healthy 15- to 20-year-olds who were unmedicated or within 1 month of starting an SSRI were prospectively followed. Psychiatric functioning and medication treatment were assessed monthly. Body Mass Index (BMI) was measured every 4 months. Every 8 months, a whole-body dual-energy radiograph absorptiometry scan was obtained to determine lean BMI, fat mass index, and visceral fat mass. Linear mixed effects regression analysis examined associations between MDD, GAD, and SSRI use variables and body composition measures. RESULTS Over 1.51 ± 0.76 years of follow-up, 264 participants contributed 805 observations. After adjusting for age, sex, physical activity, dietary intake, and time in the study, MDD severity was inversely associated, prospectively, with BMI, fat mass index, and lean BMI z scores, whereas cumulative SSRI treatment duration and dose were positively associated with these outcomes. GAD severity and diagnosis were not significantly associated with any body composition outcome. Moreover, citalopram and escitalopram were most strongly associated with the increase in all body composition measures, including visceral fat mass, whereas the associations with fluoxetine were somewhat weaker. Sertraline was not different from no SSRI treatment. CONCLUSIONS Depression severity was associated with a decrease in measures of body composition in older adolescents over a mean of 1.5 years, whereas SSRI treatment was positively associated with these outcomes, with differential effects across treatment groups.
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Affiliation(s)
- Chadi A. Calarge
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | | | - Kathleen F. Janz
- Health and Human Physiology, College of Liberal Arts and Sciences, and
| | - Trudy L. Burns
- College of Public Health, The University of Iowa, Iowa City, Iowa; and
| | | | - Babette S. Zemel
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania
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Matheson BE, Douglas JM. Overweight and Obesity in Children with Autism Spectrum Disorder (ASD): a Critical Review Investigating the Etiology, Development, and Maintenance of this Relationship. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2017. [DOI: 10.1007/s40489-017-0103-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Brown JT, Eum S, Cook EH, Bishop JR. Pharmacogenomics of autism spectrum disorder. Pharmacogenomics 2017; 18:403-414. [PMID: 28244813 DOI: 10.2217/pgs-2016-0167] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Autism spectrum disorder (ASD) is characterized by persistent deficits in social communication and interactions as well as restricted, repetitive behaviors and interests. Pharmacologic interventions are often needed to manage irritability, aggressive behaviors and hyperactivity. Pharmacogenomic studies have investigated genetic associations with treatment response and side effects in an attempt to better understand drug mechanisms in hopes of optimizing the balance of symptom improvement versus side effects. The majority of pharmacogenomic studies to date have focused on antipsychotics, antidepressants and stimulants that are the most commonly utilized medication classes for ASD. This review is a comprehensive examination of the existing pharmacogenomic studies in ASD highlighting the current state of knowledge regarding genetic variation influencing pharmacokinetics and pharmacodynamics, and associated clinical outcomes.
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Affiliation(s)
- Jacob T Brown
- Department of Pharmacy Practice & Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Duluth, MN, USA
| | - Seenae Eum
- Department of Experimental & Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Edwin H Cook
- Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Jeffrey R Bishop
- Department of Experimental & Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA.,Department of Psychiatry, College of Medicine, University of Minnesota, Minneapolis, MN, USA
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Kumar S, Kelly AS. Review of Childhood Obesity: From Epidemiology, Etiology, and Comorbidities to Clinical Assessment and Treatment. Mayo Clin Proc 2017; 92:251-265. [PMID: 28065514 DOI: 10.1016/j.mayocp.2016.09.017] [Citation(s) in RCA: 794] [Impact Index Per Article: 113.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 09/12/2016] [Accepted: 09/21/2016] [Indexed: 12/11/2022]
Abstract
Childhood obesity has emerged as an important public health problem in the United States and other countries in the world. Currently 1 in 3 children in the United States is afflicted with overweight or obesity. The increasing prevalence of childhood obesity is associated with emergence of comorbidities previously considered to be "adult" diseases including type 2 diabetes mellitus, hypertension, nonalcoholic fatty liver disease, obstructive sleep apnea, and dyslipidemia. The most common cause of obesity in children is a positive energy balance due to caloric intake in excess of caloric expenditure combined with a genetic predisposition for weight gain. Most obese children do not have an underlying endocrine or single genetic cause for their weight gain. Evaluation of children with obesity is aimed at determining the cause of weight gain and assessing for comorbidities resulting from excess weight. Family-based lifestyle interventions, including dietary modifications and increased physical activity, are the cornerstone of weight management in children. A staged approach to pediatric weight management is recommended with consideration of the age of the child, severity of obesity, and presence of obesity-related comorbidities in determining the initial stage of treatment. Lifestyle interventions have shown only modest effect on weight loss, particularly in children with severe obesity. There is limited information on the efficacy and safety of medications for weight loss in children. Bariatric surgery has been found to be effective in decreasing excess weight and improving comorbidities in adolescents with severe obesity. However, there are limited data on the long-term efficacy and safety of bariatric surgery in adolescents. For this comprehensive review, the literature was scanned from 1994 to 2016 using PubMed using the following search terms: childhood obesity, pediatric obesity, childhood overweight, bariatric surgery, and adolescents.
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Affiliation(s)
- Seema Kumar
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, MN.
| | - Aaron S Kelly
- Department of Pediatrics and Department of Medicine, University of Minnesota, Minneapolis
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Affiliation(s)
- Shin-Hye Kim
- Department of Pediatrics, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Mi-Jung Park
- Department of Pediatrics, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Schwartz BS, Glass TA, Pollak J, Hirsch AG, Bailey-Davis L, Moran T, Bandeen-Roche K. Depression, its comorbidities and treatment, and childhood body mass index trajectories. Obesity (Silver Spring) 2016; 24:2585-2592. [PMID: 27804225 PMCID: PMC5125866 DOI: 10.1002/oby.21627] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 07/05/2016] [Accepted: 07/12/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE No prior studies have evaluated depression diagnoses and cumulative antidepressant use in relation to longitudinal body mass index (BMI) trajectories in a population-representative sample. METHODS Electronic health record data from 105,163 children ages 8 to 18 years with 314,648 BMI values were used. Depression diagnoses were evaluated as ever versus never, cumulative number of encounters with diagnoses, and total duration of diagnoses. Antidepressants were evaluated as months of use. Associations were evaluated with diagnoses alone, antidepressants alone, and then together, adjusting for covariates. RESULTS A total of 6,172 (5.9%) and 10,628 (10.1%) children had a diagnosis of depression or received antidepressant treatment, respectively. At all ages, children receiving Medical Assistance (30.9%) were more likely to be treated with antidepressants. Depression diagnosis and antidepressant use were each independently and positively associated with BMI trajectories; associations were stronger with longer durations of diagnosis and treatment. Among children who received 12 or more months of antidepressants (vs. none), the mean (95% CI) weight gain at 18 years associated with antidepressant use (all classes) was 2.10 (1.76-2.45) kg. CONCLUSIONS Depression and antidepressant use were both independently associated with increasing BMIs over time, suggesting an important unintended consequence of healthcare to the obesity epidemic.
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Affiliation(s)
- Brian S. Schwartz
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
- Center for Health Research, Geisinger Health System, Danville, PA
| | - Thomas A. Glass
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jonathan Pollak
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | | | - Timothy Moran
- Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD
| | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Allaire BT, Raghavan R, Brown DS. Morbid Obesity and Use of Second Generation Antipsychotics among Adolescents in Foster Care: Evidence from Medicaid. CHILDREN AND YOUTH SERVICES REVIEW 2016; 67:27-31. [PMID: 27990038 PMCID: PMC5157933 DOI: 10.1016/j.childyouth.2016.05.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Many adolescents enter foster care with high body mass index (BMI), and patterns of treatment further exacerbate the risk of morbid obesity. A principal risk factor for such exacerbation is the use of second generation antipsychotics (SGAs). We examine the association between receiving a morbid obesity diagnosis and SGA prescriptions among adolescents in foster care. METHODS We analyzed claims from 36 states' Medicaid Analytic Extract (MAX) files for 2000 through 2003. Obesity diagnoses were ascertained through a primary or secondary diagnosis claim of morbid obesity. Covariates included gender, race/ethnicity. age, insurance status, state obesity rate, and state fixed effects. We calculated relative risks of a diagnosis based upon four SGAs (clozapine, olanzapine, quetiapine, and risperidone) associated with obesity and a polypharmacy indicator. RESULTS Of the 1,261,806 foster care adolescent-years in the MAX files, 6,517 were diagnosed with morbid obesity, an annual prevalence of 0.5%. The risk of a morbid obesity diagnosis is much higher for female and non-white adolescents. The risk increases with age. Quetiapine and clozapine increased the risk of a morbid obesity diagnosis more than 2.5 times, and two or more psychotropic drugs (polypharmacy) increased the risk fivefold. CONCLUSIONS Adolescents in foster care are much more likely to be on SGA medications, and therefore may be more susceptible to weight gain and obesity. Given that SGA prescribing for younger populations has only expanded since these data were released, our study may actually understate the magnitude of the problem. Care is needed when prescribing SGAs for foster care adolescents.
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Affiliation(s)
- Benjamin T. Allaire
- RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC 27709, United States
| | - Ramesh Raghavan
- Washington University in St. Louis, Campus Box 1196, Goldfarb Hall, Room 229C, One Brookings Drive, St. Louis, MO 63130, United States
| | - Derek S. Brown
- Washington University in St. Louis, Campus Box 1196, Goldfarb Hall, Room 229C, One Brookings Drive, St. Louis, MO 63130, United States
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