Abdominal Adiposity Has Adverse Effects, Regardless of BMI

Posted on July 19, 2007 by Maurice Preter MD

Abdominal Adiposity Has Adverse Effects, Regardless of BMI

With fat distribution, it’s location, location, location.

In general, evidence implicates body-fat distribution as a risk factor for morbidity and mortality. To evaluate the link between abdominal adiposity and premature death in lean populations, trained interviewers measured baseline weight, height, and waist and hip circumferences (according to a standard protocol) for more than 72,000 nonsmoking participants in the Shanghai Women’s Health Study, a population-based, prospective cohort study (age range, 40–70). Mortality data were verified via registries and death certificates. Mean age at enrollment was 52. Mean BMI was normal (24 kg/m2); 35.2% were overweight or obese (BMI >=25), and 5% were obese (BMI >=30). Mean waist-hip ratio (WHR) was 0.81.

During a mean follow-up of 5.7 years, 1456 women died. WHR was positively associated, in dose-response fashion, with all-cause, cardiovascular, stroke, and diabetes mortality (P<0.01 for trend). After adjusting for BMI and other possible confounders, women in the highest WHR quintile had higher risks for death from all causes (relative risk, 1.79), cardiovascular disease (RR, 2.41), and stroke (RR, 2.23) compared with those in the lowest quintile. When stratified for BMI, women with lower BMIs had an even greater risk for death with increasing WHR.

Comment: In less than 6 years, WHR predicted higher mortality in this lean (compared with U.S. women) Chinese population. But an editorialist cautions that, because of time constraints, lack of standardization, and questions about whether abdominal obesity increases risk for all or some populations, fat-distribution measurement in clinical practice is unlikely to become part of routine clinical practice any time soon. What we can do is explain to our patients that BMI is not the whole story. Women with normal BMI but increased abdominal girth can be advised to exercise (which has been shown to decrease waist circumference [Journal Watch Women’s Health Jun 21 2007] and to improve on other modifiable risk factors.

— Diane E. Judge, APN/CNP

Published in Journal Watch Women’s Health June 21, 2007

Citations

Zhang X et al. Abdominal adiposity and mortality in Chinese women. Arch Intern Med 2007 May 14; 167:886-92. [Medline® abstract]

Hu FB. Obesity and mortality: Watch your waist, not just your weight. Arch Intern Med 2007 May 14; 167:875-6. [Medline® abstract]

Copyright © 2007. Massachusetts Medical Society. All rights reserved.

The above message comes from “Journal Watch“, who is solely responsible for its content.

Posted in Psychiatry/Neurology |

US veterans with migraine returning from combat in Iraq are more than twice as likely to have comorbid psychiatric conditions, including posttraumatic stress disorder (PTSD), depression, and anxiety, than their counterparts without migraine, a new study h

Posted on July 17, 2007 by Maurice Preter MD
 
May 9, 2007 — US veterans with migraine returning from combat in Iraq are more than twice as likely to have comorbid psychiatric conditions, including posttraumatic stress disorder (PTSD), depression, and anxiety, than their counterparts without migraine, a new study has shown.

Furthermore, based on the age and sex of the study cohort, which was predominantly male, investigators found there was a 2-fold increased prevalence of migraine among these veterans compared with the general population.

“These findings indicate soldiers with migraine are more likely to have symptoms of psychiatric conditions after a combat tour, with depression and PTSD being the most prevalent,” said the study’s principal investigator, Maj. Jay C. Erickson, MD, PhD, from the Madigan Army Medical Center, in Tacoma, Washington.

“This is the first study to examine the co-occurrence of migraines and psychiatric conditions in a military population. In addition, we think it may be the first study in any population to establish a possible link between migraine and PTSD,” he added.

The study was presented at American Academy of Neurology 59th Annual Meeting, in Boston, Massachusetts.

Migraine Prevalence 2-Fold Higher In Veterans

The cross-sectional study involved 3621 US soldiers who were asked to complete a voluntary migraine headache questionnaire based on International Headache Society criteria within 90 days of returning from a 1-year combat tour in Iraq. This screening instrument assessed headache frequency, severity, and duration in the last 3 months of deployment.

In addition, soldiers were asked to complete the Patient Health Questionnaire to screen for depression and anxiety and the Primary Care PTSD Screen to determine symptoms of PTSD.

In all, 2167 soldiers (60%) completed the questionnaire. Of the total study group, 19% screened positive for migraine, 32% screened positive for depression, 22% screened positive for PTSD, and 13% had anxiety. The average age of participants was 27 years and 96% were male.

Dr. Erickson pointed out that if this study had been conducted in an age- and sex-matched general population, the expected prevalence of migraine would be about 10%.

“What we have seen [in this study] is migraine prevalence that is 2-fold higher than you would expect in a general population based on age and gender,” he said.

When investigators compared the screening prevalence of each psychiatric condition in soldiers with migraine with nonmigraineurs they found individuals who screened positive for migraine were much more likely to have 1 or more psychiatric disorders. Overall, said Dr. Erickson, symptoms of 1 or more psychiatric conditions were present in 58% of soldiers with migraine vs 34% without migraine.

Prevalence of Psychiatric Disorders Among US Soldiers With Migraine vs Soldiers Without Migraine

Psychiatric Disorder
US Soldiers With Migraine (%)
US Soldiers Without Migraine (%)
Depression
50
27
PTSD
39
18
Anxiety
17
7
Migraine Indicator for Mental Health Screening

The study also found individuals with migraine and depression had more frequent headaches than those with migraine and no depression — an average of 3.5 headache days per month vs 2.5 days per month, respectively. The findings were similar for those with migraine and PTSD.

In contrast, said Dr. Erickson, anxiety did not affect headache frequency in subjects with migraine. In addition, neither pain severity or duration of migraines was significantly different among soldiers with and without symptoms of any of the study’s psychiatric conditions.

“These findings indicate that soldiers with migraine headaches are more likely to have certain psychiatric conditions following combat deployment. This knowledge should assist in the early diagnosis and treatment of soldiers with these health problems,” said Dr. Erickson.

He added that healthcare providers evaluating soldiers with migraine headaches should also perform mental health screening to ensure comorbid psychiatric disorders are identified and properly treated in this high-risk population.

Potential Shared Mechanism

At this point, the link between migraine and psychiatric disorders is not well understood. However, said Dr. Erickson, 1 possible shared biological mechanism may be altered signaling in the serotonin system as well as the norepinephrine system, both of which have been associated with migraine and the psychiatric disorders included in the study.

“Additional studies are needed to better understand the relationship between migraines and psychiatric conditions in military members. A better understanding of the shared mechanism could lead to improved prevention and treatment for migraines and psychiatric conditions in deployed military personnel,” he said.

American Academy of Neurology 59th Annual Meeting: Abstract P06.035. April 28 – May 5, 2007.

Posted in News | Tagged , , |

Anxiety disorders and depressive disorders preceding Parkinson’s disease: a case-control study.

Posted on July 16, 2007 by Maurice Preter MD
 
Mov Disord. 2000 Jul;15(4):669-77. Related Articles, Links
 
Anxiety disorders and depressive disorders preceding Parkinson’s disease: a case-control study.

Shiba M, Bower JH, Maraganore DM, McDonnell SK, Peterson BJ, Ahlskog JE, Schaid DJ, Rocca WA.

Department of Health Sciences Research, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.

We studied the association between preceding psychiatric disorders and Parkinson’s disease (PD) using a case-control design. We used the medical records-linkage system of the Rochester Epidemiology Project to identify 196 subjects who developed PD in Olmsted County, Minnesota, during the years 1976-1995. Each case was matched by age (+/-1 yr) and sex to a general population control. We reviewed the complete medical records of cases and control subjects to detect preceding psychiatric disorders. The frequency of psychiatric disorders was higher in cases than in control subjects; the odds ratio was 2.2 for anxiety disorders (95% confidence interval [95% CI] = 1.4-3.4; p = 0.0003), 1.9 for depressive disorders (95% CI = 1.1-3.2; p = 0.02), and 2.4 for both anxiety disorders and depressive disorders occurring in the same individual (95% CI = 1.2-4.8; p = 0.02). When we restricted analyses to disorders present 5 years or more before the onset of motor symptoms of PD, the association with depressive disorders lost statistical significance. However, the association with anxiety disorders remained significant for disorders present 5, 10, or 20 years before onset of motor symptoms. Our results suggest that anxiety disorders and depressive disorders are associated with PD and that the causative process or the risk factors underlying PD are present many years before the appearance of motor symptoms.

Publication Types:

PMID: 10928577 [PubMed – indexed for MEDLINE]

Posted in News | Tagged |

Migraine Strong Indicator of Comorbid Psychiatric Conditions in US Iraq Veterans.

Posted on July 16, 2007 by Maurice Preter MD

Migraine Strong Indicator of Comorbid Psychiatric Conditions in US Iraq Veterans

 

May 9, 2007 — US veterans with migraine returning from combat in Iraq are more than twice as likely to have comorbid psychiatric conditions, including posttraumatic stress disorder (PTSD), depression, and anxiety, than their counterparts without migraine, a new study has shown.

Furthermore, based on the age and sex of the study cohort, which was predominantly male, investigators found there was a 2-fold increased prevalence of migraine among these veterans compared with the general population.

“These findings indicate soldiers with migraine are more likely to have symptoms of psychiatric conditions after a combat tour, with depression and PTSD being the most prevalent,” said the study’s principal investigator, Maj. Jay C. Erickson, MD, PhD, from the Madigan Army Medical Center, in Tacoma, Washington.

“This is the first study to examine the co-occurrence of migraines and psychiatric conditions in a military population. In addition, we think it may be the first study in any population to establish a possible link between migraine and PTSD,” he added.

The study was presented at American Academy of Neurology 59th Annual Meeting, in Boston, Massachusetts.

Migraine Prevalence 2-Fold Higher In Veterans

The cross-sectional study involved 3621 US soldiers who were asked to complete a voluntary migraine headache questionnaire based on International Headache Society criteria within 90 days of returning from a 1-year combat tour in Iraq. This screening instrument assessed headache frequency, severity, and duration in the last 3 months of deployment.

In addition, soldiers were asked to complete the Patient Health Questionnaire to screen for depression and anxiety and the Primary Care PTSD Screen to determine symptoms of PTSD.

In all, 2167 soldiers (60%) completed the questionnaire. Of the total study group, 19% screened positive for migraine, 32% screened positive for depression, 22% screened positive for PTSD, and 13% had anxiety. The average age of participants was 27 years and 96% were male.

Dr. Erickson pointed out that if this study had been conducted in an age- and sex-matched general population, the expected prevalence of migraine would be about 10%.

“What we have seen [in this study] is migraine prevalence that is 2-fold higher than you would expect in a general population based on age and gender,” he said.

When investigators compared the screening prevalence of each psychiatric condition in soldiers with migraine with nonmigraineurs they found individuals who screened positive for migraine were much more likely to have 1 or more psychiatric disorders. Overall, said Dr. Erickson, symptoms of 1 or more psychiatric conditions were present in 58% of soldiers with migraine vs 34% without migraine.

Prevalence of Psychiatric Disorders Among US Soldiers With Migraine vs Soldiers Without Migraine

Psychiatric Disorder
US Soldiers With Migraine (%)
US Soldiers Without Migraine (%)
Depression
50
27
PTSD
39
18
Anxiety
17
7
Migraine Indicator for Mental Health Screening

The study also found individuals with migraine and depression had more frequent headaches than those with migraine and no depression — an average of 3.5 headache days per month vs 2.5 days per month, respectively. The findings were similar for those with migraine and PTSD.

In contrast, said Dr. Erickson, anxiety did not affect headache frequency in subjects with migraine. In addition, neither pain severity or duration of migraines was significantly different among soldiers with and without symptoms of any of the study’s psychiatric conditions.

“These findings indicate that soldiers with migraine headaches are more likely to have certain psychiatric conditions following combat deployment. This knowledge should assist in the early diagnosis and treatment of soldiers with these health problems,” said Dr. Erickson.

He added that healthcare providers evaluating soldiers with migraine headaches should also perform mental health screening to ensure comorbid psychiatric disorders are identified and properly treated in this high-risk population.

Potential Shared Mechanism

At this point, the link between migraine and psychiatric disorders is not well understood. However, said Dr. Erickson, 1 possible shared biological mechanism may be altered signaling in the serotonin system as well as the norepinephrine system, both of which have been associated with migraine and the psychiatric disorders included in the study.

“Additional studies are needed to better understand the relationship between migraines and psychiatric conditions in military members. A better understanding of the shared mechanism could lead to improved prevention and treatment for migraines and psychiatric conditions in deployed military personnel,” he said.

American Academy of Neurology 59th Annual Meeting: Abstract P06.035. April 28 – May 5, 2007.

Related Links

Online CME

Migraine With Aura Increases Suicide Risk in Adolescents

News

Migraine Linked to Greater Risk for Major Depression, Chronic Physical Symptoms

Resource Centers

Headache

External Links

American Academy of Neurology 59th Annual Meeting

Posted in News | Tagged |

Childhood sibling relationships as a predictor of major depression in adulthood: a 30-year prospective study.

Posted on July 16, 2007 by Maurice Preter MD
Am J Psychiatry. 2007 Jun;164(6):949-54. Related Articles, Links
 
Childhood sibling relationships as a predictor of major depression in adulthood: a 30-year prospective study.

Waldinger RJ, Vaillant GE, Orav EJ.

Department of Psychiatry, Brigham and Women’s Hospital and Harvard Medical School, 1249 Boylston St., Boston, MA 02215, USA. rwaldinger@partners.org

OBJECTIVE: The authors examined the quality of sibling relationships in childhood as a predictor of major depression in adulthood. METHOD: Study subjects were 229 men selected for mental and physical health and followed from ages 20 through 50 and beyond as part of a study of adult psychosocial development. Data were obtained from interviews with participants and their parents at intake and from follow-up interviews and self-report questionnaires completed by participants at regular intervals. These data were used to rate the quality of relationships with siblings, the quality of parenting received in childhood, and family history of depression as well as the occurrence, by age 50, of major depression, alcoholism, and use of mood-altering drugs (tranquilizers, sleeping pills, and stimulants). RESULTS: Poorer relationships with siblings prior to age 20 and a family history of depression independently predicted both the occurrence of major depression and the frequency of use of mood-altering drugs by age 50, even after adjustment for the quality of childhood relationships with parents. Poor relationships with parents in childhood did not predict the occurrence of depression by age 50 when family history of depression and the quality of relationships with siblings were taken into account. Quality of sibling relationships and family history of depression did not predict later alcohol abuse or dependence. CONCLUSIONS: Poor sibling relationships in childhood may be an important and specific predictor of major depression in adulthood. Further study of links between childhood sibling relationships and adult depression is warranted.

Publication Types:

PMID: 17541056 [PubMed – indexed for MEDLINE]

Posted in Aging |