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Koning E, Grigolon RB, Breda V, Gomes FA, Zucatti KP, Teixeira PP, Colpani V, Gerchman F, Brietzke E. The effect of lifestyle interventions on depressive symptom severity in individuals with type-2 diabetes: A meta-analysis of randomized controlled trials. J Psychosom Res 2023; 173:111445. [PMID: 37579705 DOI: 10.1016/j.jpsychores.2023.111445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/10/2023] [Accepted: 08/02/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a severe metabolic condition which is commonly comorbid with depression. Lifestyle factors are involved in the pathophysiology of both conditions; however, the role of lifestyle interventions remains unclear. OBJECTIVE The objective of this study is to systematically review the literature on randomized controlled trials evaluating the effect of lifestyle interventions on depressive scores in patients with T2DM. METHODS A systematic search was conducted in computerized databases before October 2022. A random-effects model was used to investigate the effect of lifestyle interventions on depression scores and meta-regression was conducted to assess the influence of age and disease onset. RESULTS Six trials met the eligibility criteria for inclusion. A statistically significant reduction in depression scores was found for groups receiving lifestyle interventions compared to controls (SMD = -0.49 [95%CI -0.89 to -0.08]; p = 0.0269]). Interventions increased in efficacy with the age of the participants but no significant correlation was found with years since disease onset. Participants in a control group receiving a less intense lifestyle intervention demonstrated improved depression scores when compared to those who received standard care or no intervention at all. Trial design and outcome measurement tools were heterogeneous between studies and limited data on antidepressant use was available which may introduce bias into the results. CONCLUSION Lifestyle interventions were effective at improving depressive symptom severity in patients with T2DM.
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Affiliation(s)
- Elena Koning
- Centre for Neuroscience Studies (CNS), Queen's University, Kingston, ON, Canada.
| | | | - Vitor Breda
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada
| | - Fabiano A Gomes
- Centre for Neuroscience Studies (CNS), Queen's University, Kingston, ON, Canada; Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Kelly P Zucatti
- Programa de Pós-graduação emCiências Médicas: Endocrinologia, Universidade Federal do Rio Grandedo Sul, Porto Alegre, RS, Brasil
| | - Paula P Teixeira
- Programa de Pós-graduação emCiências Médicas: Endocrinologia, Universidade Federal do Rio Grandedo Sul, Porto Alegre, RS, Brasil
| | - Veronica Colpani
- Programa de Pós-graduação emCiências Médicas: Endocrinologia, Universidade Federal do Rio Grandedo Sul, Porto Alegre, RS, Brasil
| | - Fernando Gerchman
- Programa de Pós-graduação emCiências Médicas: Endocrinologia, Universidade Federal do Rio Grandedo Sul, Porto Alegre, RS, Brasil; Serviço de Endocrinologia e Metabologia do Hospital de Clínicas de PortoAlegre, Porto Alegre, RS, Brasil; Faculdade de Medicina, Universidade Federal do Rio Grandedo Sul, Porto Alegre, RS, Brasil
| | - Elisa Brietzke
- Centre for Neuroscience Studies (CNS), Queen's University, Kingston, ON, Canada; Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada
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Yeh EJ, Grigolon RB, Rodrigues SR, A Bueno AP. Systematic literature review and meta-analysis of cardiovascular risk factor management in selected Asian countries. J Comp Eff Res 2023; 12:e220085. [PMID: 36861459 PMCID: PMC10402804 DOI: 10.57264/cer-2022-0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 01/20/2023] [Indexed: 03/03/2023] Open
Abstract
Aim: There is a need to understand the management status of hypertension, dyslipidemia/hypercholesterolemia, and diabetes mellitus in the Asia-Pacific region (APAC). Methods: We conducted a systematic literature review and meta-analysis to summarize the awareness, treatment, and/or control rates of these risk factors in adults across 11 APAC countries/regions. Results: We included 138 studies. Individuals with dyslipidemia had the lowest pooled rates compared with those with other risk factors. Levels of awareness with diabetes mellitus, hypertension, and hypercholesterolemia were comparable. Individuals with hypercholesterolemia had a statistically lower pooled treatment rate but a higher pooled control rate than those with hypertension. Conclusion: The management of hypertension, dyslipidemia, and diabetes mellitus was suboptimal in these 11 countries/regions.
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Grigolon RB, Trevizol AP, Gerchman F, Bambokian AD, Magee T, McIntyre RS, Gomes FA, Brietzke E, Mansur RB. Is Obesity A Determinant Of Success With Pharmacological Treatment For Depression? A Systematic Review, Meta-Analysis And Meta-Regression. J Affect Disord 2021; 287:54-68. [PMID: 33773359 DOI: 10.1016/j.jad.2021.03.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The bidirectional association between Major Depressive Disorder (MDD) and obesity suggests that body mass index (BMI) at the baseline could influence remission rates (RR) with pharmacological treatment. We evaluated the influence of baseline BMI on the chances of remission among patients with MDD administered antidepressants. METHODS Based on the guidelines of the PRISMA statement, we conducted a systematic review on PubMed, Cochrane and Embase databases with subsequent meta-analysis and meta-regression. We included only randomized controlled trials evaluating the efficacy of antidepressants of different classes (monotherapy and combined therapies) that evidenced baseline BMI assessment. We created a model to describe the linear relationship between baseline BMI and RR. RESULTS Our systematic review yielded 70 studies with a total of 9,779 patients in the active group and 7,136 patients in the placebo group. In placebo controlled studies, BMI influenced the RR of patients randomized to active treatment. The RR for antidepressants in monotherapy was higher in normal weight to overweight patients rather than obese patients (33% vs 12%, respectively). Also in monotherapy, the RR is higher when the study is conducted on patients with a lower baseline BMI (p=0.029). For combined therapies, the pooled RR was higher in obese patients rather than in normal weight to overweight patients (75% vs 17%, respectively). LIMITATIONS BMI provides no information about body composition and obesity can be related to several potential confounders that potentially influence RR. CONCLUSION The RR with antidepressant therapy seems to be associated with baseline BMI in patients with MDD, although this simple variable was insufficiently explored so far.
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Affiliation(s)
- Ruth Bartelli Grigolon
- Post-Graduation Program in Psychiatry and Medical Psychology, Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil
| | - Alisson P Trevizol
- Temerty Centre for Therapeutic Brain Stimulation and the Mood and Anxiety Ambulatory Services at the Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Fernando Gerchman
- Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Service of Endocrinology and Metabology, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Taylor Magee
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit (MDPU), Toronto Western Hospital, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Brain and Cognition Discovery Foundation (BCDF), Toronto, ON, Canada
| | - Fabiano A Gomes
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada; Inpatient Psychiatric Unit, Kingston General Hospital, Kingston Health Science Centre, Kingston, ON, Canada; Centre for Neuroscience Studies (CNS), Queen's University, Kingston, ON, Canada
| | - Elisa Brietzke
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada; Inpatient Psychiatric Unit, Kingston General Hospital, Kingston Health Science Centre, Kingston, ON, Canada; Centre for Neuroscience Studies (CNS), Queen's University, Kingston, ON, Canada.
| | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit (MDPU), Toronto Western Hospital, University Health Network, Toronto, ON, Canada
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Dunker KLL, Alvarenga MDS, Teixeira PC, Grigolon RB. Effects of participation level and physical activity on eating behavior and disordered eating symptoms in the Brazilian version of the New Moves intervention: data from a cluster randomized controlled trial. SAO PAULO MED J 2021; 139:269-278. [PMID: 33978130 PMCID: PMC9625004 DOI: 10.1590/1516-3180.2020.0420.r2.04022021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/04/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Childhood and adolescent obesity is a worldwide public health concern. The New Moves program aims to change eating behavior (EB) and physical activity (PA). OBJECTIVE To evaluate the effectiveness of an intervention and predictors of better outcomes relating to EB and PA levels. DESIGN AND SETTING Secondary data from a cluster randomized controlled trial in 10 public schools in São Paulo, Brazil. METHODS 270 female adolescents, aged 12 to 14 years, were analyzed. Participation levels were categorized as presence in 1 to 9 sessions or 10 to 17 sessions, or control. Effectiveness was evaluated through improvement in disordered EB (DEB) and EB. Predictors of better outcomes relating to PA levels were evaluated through clustering of individual characteristics that affected changes in PA scores. RESULTS Participation level was not significantly associated with changes in DEB or EB. Girls with higher body mass index percentile (BMI-P) percentile tended to have increases in sedentary lifestyles through the program. Girls with less body image dissatisfaction presented higher increases in daily PA. Girls with higher BMI-P percentile and higher self-esteem showed reductions in sedentary lifestyles. The program seemed to have more effect on daily PA among older girls than among younger girls. CONCLUSIONS This program could be used as a structured action plan in schools, with the aims of improving eating behaviors and physical activity, in addition to promoting self-acceptance. The results indicate the importance of evaluating determinants of adherence, as these metrics might influence the effectiveness and future design of lifestyle programs.
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Affiliation(s)
- Karin Louise Lenz Dunker
- PhD. Nutritionist and Professor, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Marle dos Santos Alvarenga
- PhD. Nutritionist and Professor, Department of Nutrition, Faculdade de Saúde Pública (FSP), Universidade de São Paulo (USP), São Paulo (SP), Brazil.
| | - Paula Costa Teixeira
- PhD. Physical Educator and Professor, Institute of Psychiatry, Universidade de São Paulo (AMBULIM-IPq-HC-FMUSP), São Paulo (SP), Brazil.
| | - Ruth Bartelli Grigolon
- MSc. Nutritionist and Professor, Department of Psychiatry, Universidade Federal de São Paulo, São Paulo (SP), Brazil.
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Grigolon RB, Brietzke E, Trevizol AP, McIntyre RS, Mansur RB. Caloric restriction, resting metabolic rate and cognitive performance in Non-obese adults: A post-hoc analysis from CALERIE study. J Psychiatr Res 2020; 128:16-22. [PMID: 32485641 DOI: 10.1016/j.jpsychires.2020.05.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 05/18/2020] [Accepted: 05/22/2020] [Indexed: 12/22/2022]
Abstract
Physical activity (PA) has been proposed as a determinant of cognitive function and is one component of energy balance (EB). EB is the difference between energy intake (EI) and the total daily energy expenditure (TDEE). TDEE is a combination of resting metabolic rate (RMR), thermic effect of food and PA. The potential role of each of these components on cognitive function has not yet been systemically investigated. We aim to evaluate the association between each component of EB on cognition, using baseline and longitudinal data from a clinical trial of caloric restriction (CR). This is a parallel-group, randomized clinical trial comparing two years of 25% CR with two years of ad libitum diet (AL), with 220 healthy volunteers of both sex, aged between 21 and 50 years and initial BMI ≥ 22 kg/m2 and <28 kg/m2. Body weight, fat mass (FM), fat-free mass (FFM), and bone mineral content were evaluated, as well as RMR, TDEE, cognitive performance and baseline energy intake. A 30 min/day of a moderate level on a minimum of 5 days/week was advised as PA measure. Longitudinal analysis demonstrated that the influence of CR in the improvement of cognitive performance was moderated by changes in RMR, suggesting that in individuals submitted to CR, the cognitive performance and the RMR improved proportionally, independently of changes in EI and body mass. EB and homeostasis are crucial to modulate the RMR. Moreover, RMR presents an important influence on cognitive function in individuals submitted to CR in a long term.
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Affiliation(s)
- Ruth Bartelli Grigolon
- Post-Graduation Program in Psychiatry, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Elisa Brietzke
- Post-Graduation Program in Psychiatry, Universidade Federal de São Paulo, São Paulo, SP, Brazil; Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada; Centre for Neuroscience Studies (CNS), Queen's University, Kingston, ON, Canada
| | - Alisson Paulino Trevizol
- Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Brain and Cognition Foundation, Toronto, ON, Canada
| | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada.
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Trevizol AP, Brietzke E, Grigolon RB, Subramaniapillai M, McIntyre RS, Mansur RB. Peripheral interleukin-6 levels and working memory in non-obese adults: A post-hoc analysis from the CALERIE study. Nutrition 2019; 58:18-22. [DOI: 10.1016/j.nut.2018.06.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/08/2018] [Accepted: 06/11/2018] [Indexed: 12/14/2022]
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Osoegawa C, Gomes JS, Grigolon RB, Brietzke E, Gadelha A, Lacerda ALT, Dias ÁM, Cordeiro Q, Laranjeira R, de Jesus D, Daskalakis ZJ, Brunelin J, Cordes J, Trevizol AP. Non-invasive brain stimulation for negative symptoms in schizophrenia: An updated systematic review and meta-analysis. Schizophr Res 2018; 197:34-44. [PMID: 29397282 DOI: 10.1016/j.schres.2018.01.010] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 01/17/2018] [Accepted: 01/17/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Schizophrenia is a mental disorder with significant socioeconomic burden. Although current pharmacological treatments are effective for treating positive symptoms, medications have little-to-no effect in the treatment of negative symptoms. OBJECTIVE To assess the efficacy of non-invasive brain stimulation (NIBS) for negative symptoms in schizophrenia in randomized clinical trials (RCTs). METHODS A systematic review in Medline and Cochrane Library databases was performed up to May 31, 2017. The primary outcome was Hedges' g for continuous scores in a random-effects model. Heterogeneity was evaluated with the I2 and χ2 tests. Publication bias was assessed using Begg's funnel plot. RESULTS 31 RCTs (n = 1272) were included, most with small-to-modest sample sizes. Both repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) were superior to sham (Hedges' g = 0.19; 95% CI 0.07-0.32; and 0.5; 0.02-0.97, respectively). Only one study evaluated the use of transcutaneous auricular vagus nerve stimulation (taVNS). The funnel plot and Eggers test showed that the risk of publication bias was low. In relation to heterogeneity, we found an I2 of 0% (p = 0.749) and 51.3% (0.055) for rTMS and tDCS, respectively. CONCLUSION Both rTMS and tDCS were superior to sham stimulation for ameliorating negative symptoms in schizophrenia. We found no considerable heterogeneity or publication bias in our analysis, corroborating the strength of our findings. Not enough studies on other NIBS techniques, such as taVNS, were found for an isolated analysis. Further RCTs with larger sample sizes are needed to clarify the specific impact of NIBS on negative symptoms in schizophrenia.
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Affiliation(s)
| | - July Silveira Gomes
- Federal University of São Paulo, Brazil; Schizophrenia Program, Federal University of São Paulo (PROESQ), Brazil
| | | | - Elisa Brietzke
- Federal University of São Paulo, Brazil; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada; University of Toronto, Canada
| | - Ary Gadelha
- Federal University of São Paulo, Brazil; Schizophrenia Program, Federal University of São Paulo (PROESQ), Brazil
| | - Acioly L T Lacerda
- Federal University of São Paulo, Brazil; Center for Research and Clinical Trials Sinapse-Bairral, Instituto Bairral de Psiquiatria, Brazil
| | | | | | | | | | | | - Jerome Brunelin
- Lyon Neuroscience Research Center, Lyon 1 University, Lyon, France
| | - Joachim Cordes
- Department of Psychiatry and Psychotherapy, Heinrich-Heine University of Düsseldorf, Germany
| | - Alisson Paulino Trevizol
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada; University of Toronto, Canada.
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Abstract
A seletividade alimentar é caracterizada por recusa alimentar, pouco apetite e desinteresse pelo alimento. É um comportamento típico da fase pré-escolar, mas, quando presente em ambientes familiares desfavoráveis, pode acentuar-se e permanecer até a adolescência. Este artigo trata de um relato de caso em que o paciente, com diagnóstico de seletividade alimentar, inicia tratamento em serviço especializado de transtornos alimentares aos 14 anos. A particularidade deste caso é a rápida e boa evolução do quadro, possivelmente decorrente do desejo próprio de se tratar e do apoio recebido pela família. A análise do caso em questão aponta para a importância de identificar os casos de seletividade de forma correta e precoce para que eles sejam encaminhados o quanto antes a profissionais habilitados no tratamento de distúrbios alimentares nos diferentes estágios de desenvolvimento da infância e adolescência, resultando em melhor prognóstico do quadro.
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