Evan Atlantis

Obesity effects on depression: systematic review of epidemiological studies

Background:Obesity is a well-known cause of cardiovascular disease burden and premature death, but effects on psychological morbidity remain uncertain. This article reports findings following a systematic review of epidemiological studies to determine whether obesity causes depression.Methods:Multiple databases were searched for English-language studies of etiology of obesity (exposure variable, analyzed as an ordered category) on depression outcomes (dependent variables, continuous or categorical). Studies in children and in women during pregnancy or postpartum were excluded, as were nonrepresentative cross-sectional studies. Searches and identification of studies for inclusion were performed by EA, whereas a descriptive synthesis of important study characteristics was undertaken independently by us.Results:We reviewed 24 out of approximately 4500 potentially relevant studies; 4 were prospective cohort studies and 20 were cross-sectional studies (10 from the United States). Effect measures reported in all prospective cohort studies were consistent and suggested that obesity may increase the odds of future depression outcomes (symptoms or nonclinical diagnosis of depression). Effect measures reported in most cross-sectional studies from the United States supported the hypothesized association between obesity and prevalence of depression outcomes for women but not men, in contrast most cross-sectional studies from populations other than the United States consistently failed to find such associations.Conclusions:Overall, there is a weak level of evidence supporting the hypothesis that obesity increases the incidence of depression outcomes. Few high-quality prospective cohort studies exist, and cross-sectional studies account for the vast body of published evidence, and therefore firm conclusions for causality cannot yet be drawn. Our finding warrants additional high-quality etiological research on this topic.

Efficacy of exercise for treating overweight in children and adolescents: a systematic review

Background:Overweight prevalence among children/adolescents is increasing, while adult obesity may potentially cause a decline in life expectancy. More exercise is uniformly recommended, although treatment efficacy remains unclear.Objective:To determine the efficacy of exercise alone for treating overweight in children/adolescents.Design:A systematic review and meta-analysis of randomized trials published in English were completed following multiple database searches performed on December 10, 2004. Studies of isolated or adjunctive exercise/physical activity treatment in overweight/obese children or adolescents which reported any overweight outcome were included. Literature searches identified 645 papers which were manually searched, of which 45 were considered for inclusion, of which 13 papers which reported 14 studies were included (N=481 overweight boys and girls, aged ∼12 years). Two reviewers independently identified relevant papers for potential inclusion and assessed methodological quality. Principal measures of effects included the mean difference (MD) (between treatment and control groups), the weighted MD (WMD), and the standardized MD (SMD).Results:Few studies were of robust design. The pooled SMD was −0.4 (−0.7, −0.1, P=0.006) for percent body fat, and −0.2 (−0.6, 0.1, P=0.07) for central obesity outcomes, whereas the pooled WMD was −2.7 kg (−6.1 kg, 0.8 kg, P=0.07) for body weight, all of which favored exercise. Pooled effects on body weight were significant and larger for studies of higher doses, whereas nonsignificant and smaller effects were seen for studies of lower doses of exercise (155–180 min/weeks vs 120–150 min/weeks).Conclusions:Based on the small number of short-term randomized trials currently available, an aerobic exercise prescription of 155–180 min/weeks at moderate-to-high intensity is effective for reducing body fat in overweight children/adolescents, but effects on body weight and central obesity are inconclusive. Recommendations for future study designs are discussed.

Bidirectional Association Between Depression and Sexual Dysfunction: A Systematic Review and Meta-Analysis

INTRODUCTION Depression is frequently associated with sexual dysfunction in both men and women. AIM To examine whether depression predicts sexual dysfunction and, conversely, whether sexual dysfunction predicts depression. METHOD A systematic review and meta-analysis was conducted. PubMed and EMBASE biomedical answers electronic databases were searched for relevant studies up to November 2011. Reference lists of relevant articles were hand-searched and expert opinions were sought. Studies identified for inclusion had to be prospective cohort studies in adult populations that reported an association between depression and sexual dysfunction variables. MAIN OUTCOME MEASURES Odds ratios (ORs), prioritized where available, or relative risks (RRs) were pooled across studies using random-effects meta-analysis models. RESULTS Eight citations included for review yielded six studies on depression and risk of sexual dysfunction in 3,285 participants followed for 2-9 years, and six studies on sexual dysfunction and risk of depression in 11,171 participants followed for 1-10 years. Depression increased the risk of sexual dysfunction in pooled unadjusted (RR/OR 1.52 with 95% confidence intervals [1.02, 2.26]) and adjusted (RR/OR 1.71 [1.05, 2.78]) meta-analyses but not in the partially adjusted model (RR/OR 1.41 [0.90, 2.23]). There was significant heterogeneity between studies, but after removal of a single outlying study was diminished and the pooled partially adjusted, RR/OR increased to 1.69 (1.15, 2.47). Sexual dysfunction increased the odds of depression in the pooled unadjusted (OR 2.30 [1.74, 3.03]), adjusted (OR 3.12 [1.66, 5.85]), and partially adjusted (OR 2.71 [1.93, 3.79]) meta-analyses; heterogeneity was significant only in the adjusted model. Meta-regression analyses did not detect significant sources of heterogeneity in either examination. CONCLUSIONS Clinicians should be aware of a bidirectional association between depression and sexual dysfunction. Patients reporting sexual dysfunction should be routinely screened for depression, whereas patients presenting with symptoms of depression should be routinely assessed for sexual dysfunction.

Association between weight perception and psychological distress

Background:Obesity is a well-known cause of cardiovascular disease burden and premature death, but effects on depressive symptoms remain equivocal. Depressive symptoms may be more common among the obese individuals who perceive themselves as overweight, rather than those who perceive themselves as having an acceptable weight. Our aim was to determine whether weight status and weight perceptions are independently associated with psychological distress.Methods:We conducted a cross-sectional study using data from the Australian National Health Survey 2004–2005 (N=17 253). All variables were collected by self-report. Adjusted multinomial logistic regression analysis was conducted to generate prevalence odds ratios with 95% confidence intervals (95% CI) for medium (Kessler Psychological Distress Scale (K10) scores of 20–29) and high (K10 scores of 30–50) psychological distress (compared with K10 scores of 10–19 as the reference) associated with weight status (standard body mass index (BMI) cutoffs for underweight, overweight and obesity vs normal weight), weight perception (perceived underweight and overweight vs acceptable weight) and weight misperception (incorrect with BMI vs correct with BMI) adjusting for numerous important covariates.Results:Overweight and underweight perception increased the odds of medium (40 and 50%) and high (50 and 120%) psychological distress, whereas weight status and weight misperception were not associated with psychological distress in adjusted analysis. Gender, alcohol consumed per week and post-school education were not significant covariates (at P<0.10 level).Conclusions:Overweight and underweight perception rather than weight status or weight misperception are significant risk factors associated with medium and high psychological distress prevalence and effects appear to be uniform for men and women. Well-designed prospective studies are still needed to determine whether weight perceptions cause psychological distress, and if so, whether symptoms are significantly reduced following effective intervention.

Bidirectional Associations Between Clinically Relevant Depression or Anxiety and COPD: A Systematic Review and Meta-analysis

BACKGROUND The longitudinal associations between depression or anxiety and COPD, and their comorbid effect on prognosis, have not been adequately addressed by previous reviews. We aimed to systematically assess these associations to inform guidelines and practice. METHODS We searched electronic databases for articles published before May 2012. Longitudinal studies in adult populations that reported an association between clinically relevant depression or anxiety and COPD, or that reported their comorbid effect on exacerbation and/or mortality, were eligible. Risk ratios (RRs) were pooled across studies using random-effects models and were verified using fixed-effects models. Heterogeneity was explored with subgroup and metaregression analyses. RESULTS Twenty-two citations yielded 16 studies on depression or anxiety as predictors of COPD outcomes (incident COPD/chronic lung disease or exacerbation) and/or mortality, in 28,759 participants followed for 1 to 8 years, and six studies on COPD as a predictor of depression in 7,439,159 participants followed for 1 to 35 years. Depression or anxiety consistently increased the risk of COPD outcomes (RR, 1.43; 95% CI, 1.22-1.68), particularly in higher-quality studies and in people aged ≤ 66 years. Comorbid depression increased the risk of mortality (RR, 1.83; 95% CI, 1.00-3.36), particularly in men. Anxiety (or psychologic distress) increased the risk of COPD outcomes/mortality in most studies (RR, 1.27; 95% CI, 1.02-1.58). Finally, COPD consistently increased the risk of depression (RR, 1.69; 95% CI, 1.45-1.96). CONCLUSIONS Depression and anxiety adversely affect prognosis in COPD, conferring an increased risk of exacerbation and possibly death. Conversely, COPD increases the risk of developing depression. These bidirectional associations suggest potential usefulness of screening for these disease combinations to direct timely therapeutic intervention.

Weight status and perception barriers to healthy physical activity and diet behavior

Background:Physical inactivity and insufficient fruit and vegetable consumption are key risk factors for obesity and noncommunicable diseases. Weight perceptions may affect physical activity and diet behaviors. We report current prevalence estimates of Australian adults meeting recommended levels of leisure-time physical activity (LTPA) (⩾150 min/week or more of at least moderate-intensity physical activity (including walking) on ⩾5 days/week) and fruit (⩾2 servings/day) and vegetable (⩾5 servings/day) consumption for health benefits, by weight status and perceptions.Methods:We conducted a cross-sectional survey analysis of data for 16 314 adults from the Australian National Health Survey 2004–2005. All variables were collected by self-report. Weighted estimates were age- and gender-specific, and data were analyzed using logistic regression with acceptable weight referent categories, adjusting for covariates.Results:Among acceptable, overweight and obese adults, the prevalence of LTPA was 26.8, 26.1 and 19.3% for men, and 27.7, 23.7 and 19.7% for women, respectively. Approximately 55 and 15% of adults consumed sufficient fruit servings/day and vegetable servings/day, respectively, and less than 5% of adults met combined LTPA and diet guidelines. Overweight decreased the odds ratio for LTPA among women but not men, and obesity decreased the odds ratio for LTPA among both men and women. Overweight perception conferred odds ratios of 0.83 (95% CI 0.70–0.97, P=0.021) for overweight men, and of 0.74 (95% CI 0.62–0.88, P=0.001) and 0.69 (95% CI 0.59–0.80, P<0.001) for obese men and women, respectively; for LTPA, whereas no significant associations were found for acceptable weight perception. No consistent associations between weight status or perceptions and diet behaviors were found.Conclusions:Overweight perception may be another barrier to physical activity participation among men and women with excess body weight. Public health strategies might need to focus on overcoming weight perception as well as weight status barriers to adopting healthy physical activity behaviors.

A Review of the Association Between Depression and Insulin Resistance: Pitfalls of Secondary Analyses or a Promising New Approach to Prevention of Type 2 Diabetes?

We review the validity of the evidence for an association between depression and the risk of insulin resistance (IR). We describe the potentially plausible biological and behavioral mechanisms that explain how depression increases the risk of IR and consequent overt diabetes. We have identified gaps in the literature to guide future research. Evidence for bidirectional associations between depression and IR is inconsistent. Results showing positive associations between depression and IR are derived from cross-sectional studies, whereas negative findings are typically reported in cohort studies. On the other hand, tentative trial evidence suggests that the effective treatment of depression can improve IR, and that lifestyle programs improve IR and reduce depressive symptoms. These emerging themes could lead to potential new multidisciplinary approaches to preventing diabetes.

Efficacy and feasibility of a novel tri-modal robust exercise prescription in a retirement community: a randomized, controlled trial

OBJECTIVES: To test the feasibility and efficacy of current guidelines for multimodal exercise programs in older adults.

Collaborative care for comorbid depression and diabetes: a systematic review and meta-analysis

Objective The collaborative care model is recommended for depression in adults with a chronic physical health problem like diabetes. We sought to systematically assess the effect of collaborative care on depression and glycaemia in adults with comorbid depression and diabetes to inform guidelines and practice. Design Systematic review and meta-analysis. Data sources We searched PubMed, Scopus, Cochrane Library, CINAHL, Health Source Nursing, MEDLINE, PsychINFO and reference lists of retrieved articles published before August 2013. Inclusion criteria Randomised controlled trials (RCTs) on collaborative care (ie, coordinated multidisciplinary model of care) for depression that reported the effects on depression and glycaemic outcomes in adults with comorbid clinically relevant depression and diabetes were eligible. Data extraction and analysis Data on the mean difference in depression and glycaemic outcomes were extracted and pooled using random effects meta-analysis. Results Seven RCTs included for review reported effects on depression outcomes in 1895 participants, and glycated haemoglobin (HbA1c) level in 1556 participants. Collaborative care significantly improved the depression score (standardised mean difference was −0.32 (95% CI −0.53 to −0.11); I2=79%) and HbA1c level (weighted mean difference was −0.33% (95% CI −0.66% to −0.00%); I2=72.9%) compared with control conditions. Depression remission did not predict better glycaemic control across studies. Conclusions Limited evidence from short-to-medium term RCTs predominantly conducted in the USA suggests that collaborative care for depression significantly improves both depression and glycaemia outcomes, independently, in people with comorbid depression and diabetes.

Predictors of Sexual Dysfunction Incidence and Remission in Men

INTRODUCTION The progress and determinants of sexual dysfunction in middle-aged and elderly men remain unclear. AIM To describe the incidence or remission and biopsychosocial predictors of erectile dysfunction (ED) and low sexual desire (SD). MAIN OUTCOME MEASURES Erectile function (International Index of Erectile Function) and sexual desire (Sexual Desire Inventory 2) were assessed at follow-up. Sociodemographic, lifestyle, and health-related factors were examined in multivariate models of ED and low SD. METHODS Data were collected from 810 randomly selected men residing in northern and western Adelaide, Australia, and aged 35-80 years at baseline, who made clinic visits 5 years apart. RESULTS At baseline, 23.2% (n = 123) of men had ED. ED incidence and remission were observed in 31.7% (n = 179) and 29.0% (n = 71) of eligible men, respectively. At baseline, 19.2% (n = 165) had low solitary sexual desire, and 6.0% (n = 50) had low dyadic sexual desire; incidence of low sexual desire occurred in 17.6% (n = 83) (solitary) and 8.3% (n = 51) (dyadic), while remission occurred in 15.4% (n = 68) (solitary) and 22.6% (n = 40) (dyadic) of men. In the final regression models, predictors of incident ED were higher age, lower income, higher abdominal fat mass, low alcohol intake, higher risk of obstructive sleep apnea (OSA) risk, voiding lower urinary tract symptoms (LUTS), depression, and diabetes. Predictors of ED remission were lower age, current employment, and absence of voiding LUTS, angina, diabetes, and dyslipidemia. Predictors of low dyadic SD incidence included higher age, never having been married, widowhood, being unemployed, being retired, insufficient physical activity, and low alcohol intake. Predictors of low dyadic SD remission were being married, not being widowed, higher income, lower abdominal fat mass, lower OSA risk, and higher plasma testosterone. Predictors of low solitary SD included never having been married, being unemployed, low alcohol intake, lower testosterone, storage LUTS, and hypertension. Predictors of low solitary SD remission were being married, being employed, higher income, higher physical activity, moderate alcohol intake, and depression. CONCLUSIONS Sexual dysfunction in aging men is a dynamic disorder whose incidence and remission are predicted by a range of modifiable risk factors.