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McLachlan C, Shelton R, Li L. Obesity, inflammation, and depression in adolescents. Front Psychiatry 2023; 14:1221709. [PMID: 37840796 PMCID: PMC10568138 DOI: 10.3389/fpsyt.2023.1221709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/14/2023] [Indexed: 10/17/2023] Open
Abstract
Background The prevalence of depression and obesity among adolescents has markedly increased over the last few decades. A bidirectional relationship has been proposed between depression and obesity in adolescence, but it remains poorly understood. Inflammation is a phenomenon that has been implicated in both disorders. Thus, a cross-sectional study was designed to investigate inflammation as a factor in the association between obesity and depression. The goal of this study is to better understand the interplay between these two disorders. Methods The study sample consisted of female and male, black and white adolescents aged 15-18 years. Participants were diagnosed with major depressive disorder (MDD) according to the Diagnostic and Statistical Manual of Mental Disorders-5. Depression severity was determined using the Quick Inventory of Depressive Symptomatology (QIDS). Participants completed the Childhood Trust Events Survey (CTES) and received an Early Life Stress (ELS) score based on the survey results. Those with a score of ≥4 were placed in the ELS group and those with a score ≤ 3 were placed in the non-ELS group. Anthropometric measures and a Dual Energy X-ray Absorptiometry (DEXA) scan were performed for body composition. Blood samples were collected to measure inflammatory factors. Results Adolescents with MDD (n = 47) had significantly elevated body mass index (BMI) percentiles compared to the controls (n = 47) (77.11 ± 3.58 vs. 59.63 ± 4.40), and increased adiposity measures, including total fat (p = 0.016), trunk fat (p = 0.016), and trunk/total fat ratio (p = 0.021). Levels of C-reactive protein, tumor necrosis factor-alpha, interleukin-6, leptin, and adiponectin varied significantly between the MDD and control groups, however, significance was not retained when BMI percentile and ELS score were controlled. There was a significant and positive relationship between QIDS and multiple measures of adiposity such as BMI percentile, visceral abdominal tissue, and trunk/total ratio. Depression severity was best predicted by ELS score, visceral adipose tissue, and adiponectin level. Conclusion Adolescents with MDD had increased levels of inflammatory factors and many measures of adiposity. Thus, the treatment of adolescent depression should include a focus on managing body composition and reducing chronic inflammation to potentially improve treatment outcomes.
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Affiliation(s)
| | | | - Li Li
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, United States
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Wang Y, Zhang X, Li Y, Gui J, Mei Y, Yang X, Liu H, Guo LL, Li J, Lei Y, Li X, Sun L, Yang L, Yuan T, Wang C, Zhang D, Li J, Liu M, Hua Y, Zhang L. Predicting depressive symptom by cardiometabolic indicators in mid-aged and older adults in China: a population-based cross-sectional study. Front Psychiatry 2023; 14:1153316. [PMID: 37351000 PMCID: PMC10282944 DOI: 10.3389/fpsyt.2023.1153316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 05/19/2023] [Indexed: 06/24/2023] Open
Abstract
Objective Depressive symptom is a serious mental illness often accompanied by physical and emotional problems. The prevalence of depressive symptom in older adults has become an increasingly important public health priority. Our study used cardiometabolic indicators to predict depressive symptom in middle-aged and older adults in China. Methods The data came from the China Health and Retirement Longitudinal Study 2011 (CHARLS2011), which was a cross-sectional study. The analytic sample included 8,942 participants aged 45 years or above. The study evaluated the relationship between cardiometabolic indicators and depression by measuring 13 indicators, including body mass index (BMI), waist circumference, waist-height ratio (WHtR), conicity index, visceral adiposity index (VAI), Chinese visceral adiposity index (CVAI), lipid accumulation product (LAP), a body shape index (ABSI), body roundness index (BRI), triglyceride glucose index (TyG-index) and its correlation index (TyG-BMI, TyG-waist circumference, TyG-WHtR). Binary logistic regression analysis was used to examine the association between thirteen cardiometabolic indicators and depressive symptom. In addition, the receiver operating characteristic (ROC) curve analysis and area under curve (AUC) were used to evaluate the predictive anthropometric index and to determine the optimum cut-off value. Results The study included 8,942 participants, of whom 4,146 (46.37%) and 4,796 (53.63%) were male and female. The prevalence of depressive symptom in mid-aged and older adults in China was 41.12% in males and 55.05% in females. The results revealed that BMI [AUC = 0.440, 95%CI: 0.422-0.457], waist circumference [AUC = 0.443, 95%CI: 0.425-0.460], WHtR [AUC = 0.459, 95%CI: 0.441-0.476], LAP [AUC = 0.455, 95%CI: 0.437-0.472], BRI [AUC = 0.459, 95%CI: 0.441-0.476], CVAI [AUC = 0.449, 95%CI: 0.432-0.467], TyG-BMI [AUC = 0.447, 95%CI: 0.429-0.465], and TyG-waist circumference [AUC =0.452, 95%CI: 0.434-0.470] were weak predictors of depressive symptom (p < 0.05) in males. In females, BMI [AUC = 0.470, 95%CI: 0.453-0.486], LAP [AUC = 0.484, 95%CI: 0.467-0.500], TyG-BMI [AUC = 0.470, 95%CI: 0.454-0.487], and TyG-waist circumference [AUC =0.481, 95%CI: 0.465-0.498] were weak predictors of depressive symptom (p < 0.05). On the other side, VAI, ABSI, conicity index and TyG index could not predict depressive symptom in middle-aged and older adults. Conclusion Most cardiometabolic indicators have important value in predicting depressive symptom. Our results can provide measures for the early identification of depressive symptom in middle-aged and older adults in China to reduce the prevalence of depressive symptom and improve health.
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Affiliation(s)
- Ying Wang
- Department of Graduate School, Wannan Medical College, Wuhu, An Hui, China
| | - Xiaoyun Zhang
- Department of Graduate School, Wannan Medical College, Wuhu, An Hui, China
| | - Yuqing Li
- Department of Graduate School, Wannan Medical College, Wuhu, An Hui, China
| | - Jiaofeng Gui
- Department of Graduate School, Wannan Medical College, Wuhu, An Hui, China
| | - Yujin Mei
- Department of Graduate School, Wannan Medical College, Wuhu, An Hui, China
| | - Xue Yang
- Department of Graduate School, Wannan Medical College, Wuhu, An Hui, China
| | - Haiyang Liu
- Student Health Center, Wannan Medical College, Wuhu, An Hui, China
| | - Lei-lei Guo
- Department of Surgical Nursing, School of Nursing, Jinzhou Medical University, Jinzhou, Liaoning, China
| | - Jinlong Li
- Department of Occupational and Environmental Health, Key Laboratory of Occupational Health and Safety for Coal Industry in Hebei Province, School of Public Health, North China University of Science and Technology, Tangshan, Hebei, China
| | - Yunxiao Lei
- Obstetrics and Gynecology Nursing, School of Nursing, Wannan Medical College, Wuhu, An Hui, China
| | - Xiaoping Li
- Department of Emergency and Critical Care Nursing, School of Nursing, Wannan Medical College, Wuhu, An Hui, China
| | - Lu Sun
- Department of Emergency and Critical Care Nursing, School of Nursing, Wannan Medical College, Wuhu, An Hui, China
| | - Liu Yang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, Wuhu, An Hui, China
| | - Ting Yuan
- Obstetrics and Gynecology Nursing, School of Nursing, Wannan Medical College, Wuhu, An Hui, China
| | - Congzhi Wang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, Wuhu, An Hui, China
| | - Dongmei Zhang
- Department of Pediatric Nursing, School of Nursing, Wannan Medical College, Wuhu, An Hui, China
| | - Jing Li
- Department of Surgical Nursing, School of Nursing, Wannan Medical College, Wuhu, An Hui, China
| | - Mingming Liu
- Department of Surgical Nursing, School of Nursing, Wannan Medical College, Wuhu, An Hui, China
| | - Ying Hua
- Rehabilitation Nursing, School of Nursing, Wanna Medical College, Wuhu, An Hui, China
| | - Lin Zhang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, Wuhu, An Hui, China
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Lee JI, Busler JN, Millett CE, Principe JL, Levin LL, Corrigan A, Burdick KE. Association between visceral adipose tissue and major depressive disorder across the lifespan: A scoping review. Bipolar Disord 2022; 24:375-391. [PMID: 34551182 DOI: 10.1111/bdi.13130] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Increasing evidence supports a bidirectional relationship between major depressive disorder (MDD) and obesity, but the role of visceral adipose tissue (VAT) as a measure of obesity in relation to MDD is not well understood. Here we review literature investigating the link between MDD and VAT in terms of biomarkers, sex differences, and aging. METHODS PubMed, EMBASE, PsycINFO, and CINAHL searches were conducted on December 11, 2020. No date or language limits were imposed. Major concepts searched were Depressive Disorder linked with Adipose Tissue, White, Hypothalmo-Hypophyseal System, and Pituitary-Adrenal System in addition to keywords. A final set of 32 items meeting criteria for inclusion. RESULTS Converging biological evidence suggests a significant bidirectional relationship between VAT and MDD across the lifespan. In adulthood, greater VAT was associated with increased risk for depression, especially in vulnerable groups such as individuals who are overweight/obese, postmenopausal women, and individuals with comorbid medical or psychiatric illness. In older adults, sarcopenia had an impact on the relationship between abnormal VAT and risk of depression. Additionally, sex differences emerged as a potential factor affecting the strength of the association between VAT and depression. CONCLUSIONS Elucidating the pathophysiological mechanisms associated with increased rates of depression in obese individuals will be crucial for developing specific treatment strategies that seek to improve outcomes in individuals with comorbid depression and obesity. Moreover, identifying age- and sex-specific risk factors may contribute to a more personalized medicine approach, thereby improving the quality of clinical care.
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Affiliation(s)
- Jia-In Lee
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jessica N Busler
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Caitlin E Millett
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Jessica L Principe
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Leonard L Levin
- Countway Library, Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Alexandra Corrigan
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Katherine E Burdick
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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4
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Cosan AS, Schweiger JU, Kahl KG, Hamann B, Deuschle M, Schweiger U, Westermair AL. Fat compartments in patients with depression: A meta-analysis. Brain Behav 2021; 11:e01912. [PMID: 33150726 PMCID: PMC7821617 DOI: 10.1002/brb3.1912] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 08/18/2020] [Accepted: 09/26/2020] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Depressive disorders are a common illness worldwide. Major depression is known as a significant predictor of the metabolic syndrome. However, the effects of depression on adipose tissue compartments are controversial. This meta-analysis aimed to evaluate the state of research on the relationship between patients with depression and adipose tissue compartments as compared to nondepressed individuals. METHODS The PubMed database was searched for human studies that measured adipose tissue compartments such as visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT) and/or organ-specific adipose tissue measurements using dual-energy X-ray absorptiometry, magnetic resonance imaging or computed tomography scan and reported the means and a measure of variance separately for depressed individuals and healthy controls. Twelve articles were identified, including a total of 1,141 depressed and 2,545 nondepressed individuals. RESULTS Major depressive disorder and self-reported depressive symptoms were associated with elevated visceral adipose tissue and elevated subcutaneous adipose tissue. Subanalyses for gender, age, method of adipose tissue measurement, and method of depression assessment showed elevated visceral adipose in depressed individuals. The results could be replicated when focussing on studies controlling for body mass index (BMI). Regarding other adipose tissue compartments, meta-analysis could not be carried out due to lack of studies. CONCLUSIONS Depression is associated with enlarged visceral and subcutaneous adipose tissue. Further, especially longitudinal, research is needed to identify the mechanism through which depressive disorders contribute to visceral adiposity.
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Affiliation(s)
- Alisa S Cosan
- Klinik für Psychiatrie und Psychotherapie, Universität zu Lübeck, Lubeck, Germany
| | | | - Kai G Kahl
- Klinik für Psychiatrie, Sozialpsychiatrie und Psychotherapie, Medizinische Hochschule Hannover, Hannover, Germany
| | | | - Michael Deuschle
- Zentralinstitut für Seelische Gesundheit, Fakultät für Medizin Mannheim, Universität Heidelberg, Mannheim, Germany
| | - Ulrich Schweiger
- Klinik für Psychiatrie und Psychotherapie, Universität zu Lübeck, Lubeck, Germany
| | - Anna L Westermair
- Klinik für Psychiatrie und Psychotherapie, Universität zu Lübeck, Lubeck, Germany
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Peters T, Nüllig L, Antel J, Naaresh R, Laabs BH, Tegeler L, Amhaouach C, Libuda L, Hinney A, Hebebrand J. The Role of Genetic Variation of BMI, Body Composition, and Fat Distribution for Mental Traits and Disorders: A Look-Up and Mendelian Randomization Study. Front Genet 2020; 11:373. [PMID: 32373164 PMCID: PMC7186862 DOI: 10.3389/fgene.2020.00373] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 03/26/2020] [Indexed: 12/22/2022] Open
Abstract
Anthropometric traits and mental disorders or traits are known to be associated clinically and to show genetic overlap. We aimed to identify genetic variants with relevance for mental disorders/traits and either (i) body mass index (or obesity), (ii) body composition, (and/or) (iii) body fat distribution. We performed a look-up analysis of 1,005 genome-wide significant SNPs for BMI, body composition, and body fat distribution in 15 mental disorders/traits. We identified 40 independent loci with one or more SNPs fulfilling our threshold significance criterion (P < 4.98 × 10-5) for the mental phenotypes. The majority of loci was associated with schizophrenia, educational attainment, and/or intelligence. Fewer associations were found for bipolar disorder, neuroticism, attention deficit/hyperactivity disorder, major depressive disorder, depressive symptoms, and well-being. Unique associations with measures of body fat distribution adjusted for BMI were identified at five loci only. To investigate the potential causality between body fat distribution and schizophrenia, we performed two-sample Mendelian randomization analyses. We found no causal effect of body fat distribution on schizophrenia and vice versa. In conclusion, we identified 40 loci which may contribute to genetic overlaps between mental disorders/traits and BMI and/or shape related phenotypes. The majority of loci identified for body composition overlapped with BMI loci, thus suggesting pleiotropic effects.
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Affiliation(s)
- Triinu Peters
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Lena Nüllig
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jochen Antel
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Roaa Naaresh
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Björn-Hergen Laabs
- Institute of Medical Biometry and Statistics, University of Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Lisa Tegeler
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Chaima Amhaouach
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Lars Libuda
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Anke Hinney
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Johannes Hebebrand
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Wang JY, Chang CC, Lee MC, Li YJ. Identification of psychiatric patients with high mortality and low medical utilization: a population-based propensity score-matched analysis. BMC Health Serv Res 2020; 20:230. [PMID: 32188440 PMCID: PMC7081626 DOI: 10.1186/s12913-020-05089-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/09/2020] [Indexed: 12/25/2022] Open
Abstract
Background The decreased life expectancy and care costs of mental disorders could be enormous. However, research that compares mortality and utilization concurrently across the major category of mental disorders is absent. This study investigated all-cause mortality and medical utilization among patients with and without mental disorders, with an emphasis on identifying the psychiatric category of high mortality and low medical utilization. Methods A total of 570,250 individuals identified from the 2002–2013 Taiwan National Health Insurance Reearch Database consistuted 285,125 psychiatric patients and 285,125 non-psychiatric peers through 1:1 dual propensity score matching (PSM). The expenditure survival ratio (ESR) was proposed to indicate potential utilization shortage. The category of mental disorders and 13 covariates were analyzed using the Cox proportional hazard model and general linear model (GLM) through SAS 9.4. Results PSM analyses indicated that mortality and total medical expenditures per capita were both significantly higher in psychiatric patients than those in non-psychiatric patients (all P <.0.0001). Patients with substance use disorders were reported having the youngest ages at diagnosis and at death, with the highest 25.64 of potential years of life loss (YPLL) and relevant 2904.89 of ESR. Adjusted Cox model and GLM results indicated that, compared with anxiety disorders, affective disorders and substance use disorders were significantly associated with higher mortality (HR = 1.246 and 1.064, respectively; all P < 0.05); schizophrenia was significantly associated with higher total medical expenditures per capita (P < 0.0001). Thirteen additional factors were significantly associated with mortality or utilization (all P < 0.05). Conclusion Substance use disorders are the category of highest YPLL but notably in insufficient utilization. Health care utilization in patients with substance use disorders should be augmented timely after the diagnosis, especially toward home and community care. The factors related to mortality and utilization identified by this study merit clinical attention.
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Affiliation(s)
- Jong-Yi Wang
- Department of Health Services Administration, China Medical University, No. 91, Xueshi Rd., North Dist, Taichung City, 40402, Taiwan
| | - Cheng-Chen Chang
- Department of Psychiatry, Changhua Christian Hospital, 135 Nanxiao St., Changhua City, Changhua County, 50006, Taiwan
| | - Meng-Chen Lee
- Department of Medical Affairs, Landseed International Hospital, No. 77, Guangtai Rd., Pingzhen Dist, Taoyuan City, 32449, Taiwan
| | - Yi-Jhen Li
- Department of Health Services Policy and Management, University of South Carolina, 915 Greene St, Columbia, SC, 29208, USA.
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7
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Coryell W. Impact, Diagnosis, Phenomenology, and Biology. Handb Exp Pharmacol 2019; 250:3-33. [PMID: 31004226 DOI: 10.1007/164_2018_156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This section provides summaries of the epidemiology, phenomenology, nosology, and the suspected biological substrates of the depressive disorders. It particularly emphasizes the historical evolution of the pertinent diagnostic constructs and the prognostic import both of the various diagnostic groupings and of the individual symptoms and symptom clusters.
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Affiliation(s)
- William Coryell
- Department of Psychiatry, Carver College of Medicine, University of Iowa Health Care, Iowa City, IA, USA.
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Dennison M, Sisson SB, Stephens L, Morris AS, Aston C, Dionne C, Knehans A, Dickens RD. Obesogenic Behaviors and Depressive Symptoms' Influence on Cardiometabolic Risk Factors in American Indian Children. JOURNAL OF ALLIED HEALTH 2019; 48:100-107. [PMID: 31167011 PMCID: PMC9558564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 09/18/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND American Indian (AI) populations suffer disproportionately from cardiovascular disease and depression as compared to other racial/ethnic groups. Behaviors that contribute to obesity are considered obesogenic and include poor diet, low physical activity, and high screen time. This study examined the relationship between depressive symptoms and obesogenic behaviors on cardiometabolic risk factors in AI youth. METHODS Participants (n=121) were evaluated for depressive symptoms, obesogenic behaviors, weight, blood pressure, lipids, and glucose levels. RESULTS All participants failed to meet guidelines for intake of sugar-sweetened beverages and fruits/vegetables, 74% did not meet physical activity guidelines, and 85% did not meet screen time guidelines. Lower physical activity was associated with higher body fat percentage (b=-4.20 ± 1.82, p=0.022). Elevated depressive symptoms and presence of at-risk cardiometabolic risk factors were found. Higher depressive symptoms were associated with higher blood glucose (random, fasting, and hemoglobin A1c). CONCLUSIONS Low physical activity, high screen time, and the presence of depressive symptomology heighten cardiometabolic risk factors in AI children. Associations between depressive symptoms and blood glucose underscore the impact of emotional health on cardiometabolic disease and emphasize need for proper depression assessment in chronic disease prevention efforts.
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Affiliation(s)
- Michelle Dennison
- Oklahoma City Indian Clinic, 4913 W. Reno, Oklahoma City, OK 73127, USA. Tel 405-948-4900 ext 660.
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Medrano L, Amatya K, Vizthum D, Fadrowski JJ, Brady TM. Association of mood disorders with cardiovascular disease risk factors in overweight and obese youth with elevated blood pressure. J Clin Hypertens (Greenwich) 2018; 20:1268-1275. [PMID: 30019457 PMCID: PMC6135674 DOI: 10.1111/jch.13348] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 05/31/2018] [Accepted: 06/07/2018] [Indexed: 01/05/2023]
Abstract
The American Heart Association defines mood disorders (MDO) as a tier-II cardiovascular disease risk factor in children. Cross-sectional analysis of overweight/obese children referred to an obesity hypertension clinic revealed 37% had a MDO (defined by clinical diagnosis or Patient Health Questionnaire-9/-A score ≥10), 55% had confirmed hypertension, and 75% left ventricular hypertrophy (LVH). Children with MDOs were older, had greater measures of adiposity, and had a greater prevalence of hypertension (78%) than those without MDOs (42%; P = .04). Hypertensive children were 2.8 times more likely to have a MDO than those without (52% vs 18%; P = .02). Multivariable logistic regression revealed a statistically significant independent association of MDOs with hypertension (Odds Ratio [OR] 6.3, P = .048), but not LVH (LVMI ≥ 51 g/m2.7 ; OR 1.13, P = .88). Overall, the prevalence of MDOs in this group of overweight/obese children with elevated blood pressure was well above national averages, suggesting that at-risk youth, particularly those with confirmed hypertension, should be regularly screened for MDOs.
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Affiliation(s)
- Leah Medrano
- Johns Hopkins University School of MedicineBaltimoreMDUSA
| | - Kaushalendra Amatya
- Division of Child and Adolescent PsychiatryChildren's National Medical CenterWashingtonDCUSA
| | - Diane Vizthum
- Institute for Clinical and Translational ResearchJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - Jeffrey J. Fadrowski
- Division of Pediatric NephrologyJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - Tammy M. Brady
- Division of Pediatric NephrologyJohns Hopkins University School of MedicineBaltimoreMDUSA
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10
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Kahl KG, Deuschle M, Stubbs B, Schweiger U. Visceral adipose tissue in patients with severe mental illness. Horm Mol Biol Clin Investig 2018; 33:hmbci-2018-0007. [PMID: 29547392 DOI: 10.1515/hmbci-2018-0007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 02/15/2018] [Indexed: 12/25/2022]
Abstract
Background Severe mental illnesses (SMIs), i.e. major depression, schizophrenia and bipolar disorder, are associated with an elevated risk for the development of type-2 diabetes mellitus and cardiovascular disorders. Several factors have been associated with increased cardiometabolic morbidity and mortality in SMI, including lifestyle factors (smoking, inactivity, unhealthy diet), endocrine and immunologic alterations; however, the underlying mechanisms remain to be fully uncovered. It is now well accepted that visceral adipose tissue (VAT) promotes the development of cardiometabolic disorders, at least in part by inflammatory and metabolic functions. Methods This paper reviews studies concerning VAT, with special focus on intra-abdominal and pericardial adipose tissue, in SMI. Results In patients with SMI, several studies have been performed concerning VAT. Most of these studies reported alterations of VAT particularly in patients with major depression and schizophrenia, independent of body weight and body mass index. Some of the studies also reported an increased cardiometabolic risk. Conclusion Patients with SMI are at increased risk of developing cardiometabolic disorders, and display increased amounts of VAT. As studies so far were mainly performed on patients before the onset of cardiometabolic disorders, VAT may serve as a biomarker for patients with SMI to assess cardiometabolic risks beyond established risk scores. Further, interventions aiming at reducing VAT in SMI are highly recommended in long-term multimodal treatment plans.
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Affiliation(s)
- Kai G Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany, Phone: +49 511-5322495, Fax: +49 511-5328573
| | - Michael Deuschle
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK.,Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK
| | - Ulrich Schweiger
- Department of Psychiatry and Psychotherapy, University of Lübeck Medical School, Lübeck, Germany
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11
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Comorbidity of Migraine, Major Depressive Disorder, and Generalized Anxiety Disorder in Adolescents and Young Adults. Int J Behav Med 2018; 24:528-534. [PMID: 28032323 DOI: 10.1007/s12529-016-9620-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE Depression and anxiety are highly comorbid psychiatric conditions and both are common in adult patients with migraine. This study aims to examine the unique associations between major depressive disorder (MDD) and generalized anxiety disorder (GAD) in a well-characterized group of older adolescents and college-age individuals with migraine. METHOD Participants (N = 227), between 15 and 20 years old, who were unmedicated or within 1 month of beginning antidepressant treatment underwent a comprehensive psychiatric assessment to establish the presence of MDD and GAD, according to the Diagnostic and Statistical Manual, Fourth Edition, Text Revision, and to rate their symptom severity using the Longitudinal Interval Follow-up Evaluation for Adolescents (A-LIFE). They then completed the ID-Migraine. The Student's t test and chi-square test were used to compare continuous and categorical variables, respectively, across participants with vs. without migraine. Logistic regression analysis examined the association between the presence of migraine and psychopathology. RESULTS A diagnosis of MDD was associated with significantly increased risk of having migraine. Moreover, more severe and persistent ratings of depression were associated with an even higher likelihood of having migraine. A diagnosis of GAD was also significantly associated with the presence of migraine. The prevalence of comorbid MDD and GAD was significantly higher in participants with migraine than those without migraine (55 vs. 22%, p < 0.0001). When examined concurrently, GAD remained significantly associated with migraine, with a statistical trend for MDD to be associated with it. CONCLUSION The comorbidity of migraine, MDD, and GAD has important clinical and research implications. Patients who suffer from any of these problems should be screened for all three in order to receive comprehensive care. Shared psychological and biological vulnerabilities may be involved in the three conditions. Greater understanding of the shared vulnerabilities can lead to unified treatments.
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Swardfager W, Hennebelle M, Yu D, Hammock BD, Levitt AJ, Hashimoto K, Taha AY. Metabolic/inflammatory/vascular comorbidity in psychiatric disorders; soluble epoxide hydrolase (sEH) as a possible new target. Neurosci Biobehav Rev 2018; 87:56-66. [PMID: 29407524 DOI: 10.1016/j.neubiorev.2018.01.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 01/17/2018] [Accepted: 01/21/2018] [Indexed: 02/06/2023]
Abstract
The common and severe psychiatric disorders, including major depressive disorder (MDD) and bipolar disorder (BD), are associated with inflammation, oxidative stress and changes in peripheral and brain lipid metabolism. Those pathways are implicated in the premature development of vascular and metabolic comorbidities, which account for considerable morbidity and mortality, including increased dementia risk. During endoplasmic reticulum stress, the soluble epoxide hydrolase (sEH) enzyme converts anti-inflammatory fatty acid epoxides generated by cytochrome p450 enzymes into their corresponding and generally less anti-inflammatory, or even pro-inflammatory, diols, slowing the resolution of inflammation. The sEH enzyme and its oxylipin products are elevated post-mortem in MDD, BD and schizophrenia. Preliminary clinical data suggest that oxylipins increase with symptoms in seasonal MDD and anorexia nervosa, requiring confirmation in larger studies and other cohorts. In rats, a soluble sEH inhibitor mitigated the development of depressive-like behaviors. We discuss sEH inhibitors under development for cardiovascular diseases, post-ischemic brain injury, neuropathic pain and diabetes, suggesting new possibilities to address the mood and cognitive symptoms of psychiatric disorders, and their most common comorbidities.
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Affiliation(s)
- W Swardfager
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada; Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Pharmacology & Toxicology, Faculty of Medicine, University of Toronto, Toronto, Canada; Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Canada; University Health Network Toronto Rehabilitation Institute, Toronto, Canada.
| | - M Hennebelle
- Department of Food Science and Technology, College of Agriculture and Environmental Sciences, University of California, Davis, CA, USA
| | - D Yu
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada; Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Pharmacology & Toxicology, Faculty of Medicine, University of Toronto, Toronto, Canada; Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Canada
| | - B D Hammock
- Department of Entomology and Nematology and Comprehensive Cancer Center UCDMC, University of California, Davis, CA, USA
| | - A J Levitt
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada; Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - K Hashimoto
- Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health, Chiba, Japan
| | - A Y Taha
- Department of Food Science and Technology, College of Agriculture and Environmental Sciences, University of California, Davis, CA, USA
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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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Goldstein BI, Blanco C, He JP, Merikangas K. Correlates of Overweight and Obesity Among Adolescents With Bipolar Disorder in the National Comorbidity Survey-Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry 2016; 55:1020-1026. [PMID: 27871636 DOI: 10.1016/j.jaac.2016.08.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 08/23/2016] [Accepted: 09/21/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Despite substantial evidence on the prevalence and correlates of overweight and obesity (OW/OB) in adults with bipolar disorder (BD), little is known about this topic in adolescents with BD. METHOD The method consisted of the National Comorbidity Survey-Adolescent Supplement, a face-to-face survey of mental disorders from 2001 through 2004, using a modified version of the fully structured World Health Organization Composite International Diagnostic Interview. Participants were adolescents 13 to 17 years of age, with bipolar disorder I or II (n = 295), major depressive disorder (n = 1,112), or controls with neither mood disorder (n = 8,716). Analyses examined for group differences in the prevalence of OW/OB and for correlates of OW/OB in the group with BD. RESULTS There were no significant differences in weight categories across groups. OW and OB in adolescents with BD were associated with significantly higher lifetime rates of suicide attempt (odds ratio 3.02, 95% CI 1.11-8.24), physical or sexual abuse (2.82, 1.20-6.60), binge eating or bulimia (2.66, 1.13-6.26), and conduct disorder (2.60, 1.10-6.13) in covariate-adjusted analyses. OW and OB also were significantly associated with seeing a professional for depression, being hospitalized overnight for depression, and receiving general medical treatment. CONCLUSION The similar prevalence of OW/OB in adolescents with and without BD suggests that this potent association in adults likely comprises a consequence of BD or its correlates. In contrast, the strong association of OW/OB with proxies for depression severity, including suicide attempts and hospitalization, is already evident even in this young, nonclinical sample. Studies are warranted to determine whether early intervention of OW/OB in BD might optimize physical and mental health.
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Affiliation(s)
- Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, and the University of Toronto, Toronto, Canada.
| | - Carlos Blanco
- National Institute on Drug Abuse and the Genetic Epidemiology Research Branch, National Institute of Mental Health, Bethesda, MD
| | - Jian-Ping He
- Genetic Epidemiology Research Branch and the Developmental Trajectories of Mental Disorders Branch, National Institute of Mental Health
| | - Kathleen Merikangas
- Genetic Epidemiology Research Branch and the Developmental Trajectories of Mental Disorders Branch, National Institute of Mental Health
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