Neutrophil-to-lymphocyte ratio (NLR) variations in relationship with childhood maltreatment in patients with anorexia nervosa: a retrospective cohort study

PURPOSE

Anorexia nervosa (AN) is a serious mental illness. It is frequently accompanied by a history of childhood maltreatment (CM) that may constitute a specific ecophenotype in patients with eating disorders necessitating special assessment and management. This retrospective study tested whether in patients with AN, CM-related chronic stress may manifest through low-grade inflammation reflected by an increase in white blood cell ratios (neutrophil-to-lymphocyte ratio, NLR, platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio).

METHODS

Participants (N = 206) were enrolled at an eating disorder daycare unit in Montpellier, France, from March 2013 and January 2020. CM was assessed using the childhood trauma questionnaire (CTQ). The Eating Disorder Examination Questionnaire (EDE-Q) and the MINI were used to assess AN severity and the other clinical characteristics, respectively.

RESULTS

NLR was higher in patients with AN and history of CM (p = 0.029) and in patients with AN and history of emotional abuse (p = 0.021), compared with patients with AN without history of CM. In multivariate analysis, emotional abuse (β = 0.17; p = 0.027) contributed significantly to NLR variability.

CONCLUSION

In patients with AN, NLR is a low-grade inflammation marker that is influenced by various sociodemographic, clinical and biological factors. It is more directly affected by some CM types, especially emotional abuse, than by the presence/absence of CM history. Future studies should focus on mediators between CM and increased inflammation, such as interoceptive awareness, emotional dysregulation, food addiction, and stress sensitization.

LEVEL OF EVIDENCE

III. Evidence obtained from well-designed cohort or case-control analytic studies.

Impact of bipolar disorder on eating disorders severity in real-life settings

BACKGROUND

Comorbidity of bipolar disorder (BD) and eating disorders (ED) is common and increases the course and severity of BD. However, the impact of comorbid BD on the clinical profile of ED patients remains unclear. Most studies have focused on patients primarily assessed for BD and data on patients with a primary diagnosis of ED are sparse. We investigated the association between a dual diagnosis and severity in terms of clinical, neuropsychological dimensions and daily functioning.

METHOD

Two hundred and sixty-one patients with ED were consecutively recruited. BD was screened with the MINI and further confirmed in the French expert centre network. The severity of ED symptoms was assessed with the EDE-Q and EDI-2, daily functioning with the FAST. The neurocognitive assessment targeted attention, set-shifting and decision-making.

RESULTS

Forty-nine patients screened positive for BD, but diagnosis was confirmed in only thirty patients (11.5% of the cohort). After multiple adjustments, comorbidity was associated with greater severity on the total score and three subscales of the EDE-Q and on four of the ten dimensions of the EDI-2. Comorbid BD was associated with lower daily functioning but not with lower neuropsychological performance.

LIMITATIONS

Sample referred to specialist clinics not large enough to authorize an analysis by subtype and cross-sectional evaluation.

CONCLUSION

The association between ED and BD increases ED severity for most of these core features. It negatively impacts daily functioning. The results also highlight issues about the validity of screening tools to detect BD in patients with ED.

Effect of a 6-Month Brisk Walking Program on Walking Endurance in Sedentary and Physically Deconditioned Women Aged 60 or Older: A Randomized Trial

BACKGROUND

Walking endurance is a predictor of healthy ageing.

OBJECTIVE

To examine if a 6-month brisk walking program can increase walking endurance in sedentary and physically deconditioned older women.

TRIAL DESIGN

Randomized controlled trial.

SETTING

Women recruited from public meetings aimed at promoting physical activity in women aged 60 or older.

SUBJECTS

121 women aged 65.7 ± 4.3 years, with sedentary lifestyle (Physical Activity Questionnaire for the Elderly score < 9.4), and a 6-minute walking distance (6MWD) below normal value based on their gender, age, and body weight, and weight.

METHODS

Women were randomly assigned to a 150 min/week brisk walking program (two supervised sessions and one session on their own per week) for six months (exercisers) (n=61) or a control group with physical activity allowed freely (n=60).

OUTCOME

The primary outcome was relative change in 6MWD.

RESULTS

54/61 exercisers and 55/60 control subjects completed the program and data analysis was possible for 51 exercisers and 47 controls. At baseline, 6MWD was on average 23.1% and 22.5% below age-matched norms in exercisers and controls, respectively. Attendance rate for supervised sessions was 92% in exercisers. The 6MWD increased more significantly in exercisers than in controls (mean increase of 41.5% vs 11.0 %; p<0.0001). Over the 6-month program, 38 exercisers (74.5%) vs 5 controls (10.6%) had a 6MWD over the age-matched norm (p<0.0001). Exercisers with the highest tertile of 6MWD improvement (>46%) were those with baseline lowest values of 6MWD (p=0.001) and highest values of body mass index (BMI) (p<0.01).

CONCLUSION

Present results support recommendation that brisk walking programs should be encouraged to improve walking endurance in physically deconditioned women aged 60 or older, especially in those with high BMI.

Maximal oxygen uptake and power of lower limbs during a competitive season in triathletes

BACKGROUND

In order to study the effect of a competitive triathlon season on maximal oxygen uptake (VO2max), aerobic power (AeP) and anaerobic performance (AnP) of the lower limbs, eight triathletes performed exercise tests after: (1) a pre-competition period (Pre-COMP) (2) a competitive period (COMP), and (3) a low (volume and intensity) training period (Post-COMP). The tests were a vertical jump-and-reach test and an incremental exercise test on a cycle ergometer. Ventilatory data were collected every minute during the incremental test with an automated breath-by-breath system and the heart-rate was monitored using a telemetric system.

RESULTS

No changes in VO2max were observed, whereas AeP decreased after Post-COMP compared to Pre-COMP and COMP and AnP decreased during COMP compared to Pre-COMP and Post-COMP. In addition, second ventilatory threshold (VT2) and power output at first ventilatory threshold (VT1) and VT2 decreased after Post-COMP.

CONCLUSION

This study showed that six weeks of low volume and intensity of training is too long a period to preserve adaptations to training, although a stable maximal oxygen uptake throughout the triathlon season was observed. Moreover, the AnP decrease during COMP was probably in relation with the repetitive nature of the training mode and/or triathlon competitions.

Carbohydrate dependence during hard-intensity exercise in trained cyclists in the competitive season: importance of training status

To test the hypothesis that intensive endurance training increases CHO utilisation during hard-intensity exercise, seven competitive road cyclists (Cy) performed three 50-min steady-state exercise tests on a cycle ergometer above their ventilatory threshold (+ 15 %) over the course of a cycling season (January [ET1], May [ET2] and September [ET3]). We compared the data with the baseline values of seven sedentary controls (Sed). CHO oxidation in Cy was higher in ET2 and ET3 than in ET1 (p < 0.05), was lower in ET3 than in ET2 (p < 0.05) and was higher in Cy than in Sed only in ET2 (p < 0.05). Lactate kinematics were lower in Cy than in Sed in all conditions (p < 0.05), but in Cy they were lower in ET2 than in ET1 and higher in ET3 than in ET2 (p < 0.05). Race performance was impaired and the overtraining score was increased at ET3 in comparison with ET2 (p < 0.05). We conclude that competitive cyclists increase CHO oxidation during hard-intensity exercise over the course of a season, but show a decline by the end of the season in association with the appearance of an overtraining state. Thus, well-trained cyclists develop a CHO dependence, which is modified with training status.