Francisca Lahortiga

Association of the Mediterranean Dietary Pattern With the Incidence of Depression: The Seguimiento Universidad de Navarra/University of Navarra Follow-up (SUN) Cohort

CONTEXT Adherence to the Mediterranean dietary pattern (MDP) is thought to reduce inflammatory, vascular, and metabolic processes that may be involved in the risk of clinical depression. OBJECTIVE To assess the association between adherence to the MDP and the incidence of clinical depression. DESIGN Prospective study that uses a validated 136-item food frequency questionnaire to assess adherence to the MDP. The MDP score positively weighted the consumption of vegetables, fruit and nuts, cereal, legumes, and fish; the monounsaturated- to saturated-fatty-acids ratio; and moderate alcohol consumption, whereas meat or meat products and whole-fat dairy were negatively weighted. SETTING A dynamic cohort of university graduates (Seguimiento Universidad de Navarra/University of Navarra Follow-up [SUN] Project). PARTICIPANTS A total of 10 094 initially healthy Spanish participants from the SUN Project participated in the study. Recruitment began on December 21, 1999, and is ongoing. MAIN OUTCOME MEASURE Participants were classified as having incident depression if they were free of depression and antidepressant medication at baseline and reported a physician-made diagnosis of clinical depression and/or antidepressant medication use during follow-up. RESULTS After a median follow-up of 4.4 years, 480 new cases of depression were identified. The multiple adjusted hazard ratios (95% confidence intervals) of depression for the 4 upper successive categories of adherence to the MDP (taking the category of lowest adherence as reference) were 0.74 (0.57-0.98), 0.66 (0.50-0.86), 0.49 (0.36-0.67), and 0.58 (0.44-0.77) (P for trend <.001). Inverse dose-response relationships were found for fruit and nuts, the monounsaturated- to saturated-fatty-acids ratio, and legumes. CONCLUSIONS Our results suggest a potential protective role of the MDP with regard to the prevention of depressive disorders; additional longitudinal studies and trials are needed to confirm these findings.

Validity of a self-reported diagnosis of depression among participants in a cohort study using the Structured Clinical Interview for DSM-IV (SCID-I)

BackgroundDepression assessment in population studies is usually based on depressive symptoms scales. However, the use of scales could lead to the choice of an arbitrary cut-off point depending on the sample characteristics and on the patient diagnosis. Thus, the use of a medical diagnosis of depression could be a more appropriate approach.ObjectiveTo validate a self-reported physician diagnosis of depression using the Structured Clinical Interview for DSM-IV (SCID-I) as Gold Standard and to assess the factors associated to a valid self-reported diagnosis.MethodsThe SUN Project is a cohort study based on university graduates followed-up through postal questionnaires. The response to the question included in the questionnaire: Have you ever been diagnosed of depression by a physician? was compared to that obtained through the SCID-I applied by a psychiatrist or a clinical psychologist. The percentages of confirmed depression and non-depression were assessed for the overall sample and according to several characteristics. Logistic regression models were fitted to ascertain the association between different factors and a correct classification regarding depression status.ResultsThe percentage of confirmed depression was 74.2%; 95% confidence interval (95% CI) = 63.3–85.1. Out of 42 participants who did not report a depression diagnosis in the questionnaire, 34 were free of the disease (%confirmed non-depression = 81.1%; 95% CI = 69.1–92.9). The probability of being a true positive was higher among ex-smokers and non-smokers and among those overweight or obese but the differences were not statistically significant.ConclusionThe validity of a self-reported diagnosis of depression in the SUN cohort is adequate. Thus, this question about depression diagnosis could be used in further investigations regarding this disease in this graduate cohort study.

Prevalencia de trastornos de la conducta alimentaria en las adolescentes navarras.

Fundamento A pesar de la alarma social que se ha levantado en torno a los trastornos de laconducta alimentaria (TCA), solo existe una informacion limitada en Espana acerca de su prevalencia.Son necesarios estudios realizados en la comunidad que evaluen la frecuencia deeste problema en muestras representativas de la poblacion. Sujetos y metodos Con el objetivo de estimar la prevalencia de anorexia nerviosa (AN), bulimianerviosa (BN) y de cuadros parciales o incompletos del tipo «trastornos de la conducta alimentariano especificados» (TCANE), se selecciono una muestra representativa de la poblacion femeninaadolescente navarra por un procedimiento de seleccion aleatoria multietapica. Se estudiouna muestra de 2.862 participantes de entre 12 y 21 anos. El proceso de cribado serealizo mediante el cuestionario Eating Attitudes Test (EAT) (considerando positivos valores superioresa 30) y el diagnostico se confirmo mediante una entrevista semiestructurada realizadapor un psiquiatra (ajustandose a los criterios DSM-IV). Resultados La prevalencia global de TCA en esta poblacion femenina adolescente fue del4,1% (IC del 95%: 3,45–4,95), siendo del 3,1% (IC del 95%: 2,5–3,8) para TCANE, del O,8%(IC del 95%: 0,5–1,2) para BN y del 0,3% (IC del 95%: 0,1–0,6) para AN. Conclusiones La prevalencia de TCA en Navarra es ligeramente inferior a la de otros trabajos deautores espanoles, aunque se constata la mayor frecuencia de cuadros incompletos. La elevadaprevalencia global del problema en cifras absolutas apoya la necesidad de desarrollar estrategiasde prevencion primaria.

Longitudinal relationship of diet and oxidative stress with depressive symptoms in patients with metabolic syndrome after following a weight loss treatment: The RESMENA project

BACKGROUND & AIM Metabolic syndrome and depression seem to share some common underlying mechanisms, although less is known about the impact of metabolic syndrome dietary treatments on depression. This study examined the association between a hypocaloric treatment designed to reduce metabolic syndrome features in self-perceived depression and the potential involvement of dietary components and oxidative stress changes. METHODS Analyses were based on volunteers (n = 55) with metabolic syndrome (age 50 ± 1 y.o.; 38M/17F), where depressive symptoms were assessed using the Beck Depression Inventory. Participants followed two hypocaloric diets (control diet and RESMENA diet) with the same energy restriction (-30% TCV) for six months. Depressive symptoms, dietary records, anthropometrical measurements, biochemical parameters and oxidative stress levels were analysed. RESULTS Both diets improved self-perceived depression similarly (p = 0.528). Participants with lower depressive symptoms at baseline reported a significantly higher intake of omega-3 polyunsaturated fatty acids (p trend = 0.002). Interestingly, after adjusting for potential confounders, the increase in folate consumption (p = 0.011) and the decrease in plasma malondialdehyde levels (p = 0.012) throughout the intervention, were associated with the improvement in depressive symptoms. CONCLUSIONS A higher intake of folate and a decline in malondialdehyde plasma levels during a weight loss intervention, were related to improvements in manifestations of depression (www.clinicaltrials.gov; NCT01087086).

The Association Between the Mediterranean Lifestyle and Depression

This research assessed the association between the adherence to a Mediterranean lifestyle beyond the Mediterranean diet and the risk of depression in a prospective cohort of Spanish university graduates. Through a dynamic cohort study method, diet was assessed with a validated semiquantitative food-frequency questionnaire. The baseline assessment included a validated questionnaire on physical activity and average time spent with friends (socializing). Mediterranean lifestyle was defined as the joint exposure to Mediterranean diet, level of physical activity, and level of socializing. After a median follow-up of 8.5 years, 806 cases of depression among 11,800 participants were observed. Participants with the highest adherence to the Mediterranean lifestyle showed a 50% relative risk reduction in depression risk as compared to those participants with the lowest adherence (multivariable hazard ratio = 0.50; 95% confidence interval = [0.32, 0.81]). The Mediterranean lifestyle might reduce depression risk in the Seguimiento Universidad de Navarra cohort study beyond the known effects of the Mediterranean diet.

Cardiovascular risk and incidence of depression in young and older adults: evidence from the SUN cohort study

ANCOVA analysis, which included age and education as covariates. The model also remained significant in a follow-up analysis in which participants who identified as AfricanAmerican (N515) were excluded. Carriers of the 5HTTLPR-S’ allele had increased PTSD symptoms compared to individuals homozygous for the L’ allele (IES mean score: L’L’547.3 6 5.3, S559.8 6 4.1). For DISC1, individuals homozygous for the T allele had increased PTSD symptoms compared to A carriers (A545.3 6 2.8, TT561.9 6 7.2). In ANCOVA analysis of symptom sub-factors, 5-HTTLPR and DISC1 selectively influenced intrusion and hypervigilance symptoms, but did not affect avoidance symptoms. PTSD symptom severity (total IES scores) increased by an average of 40% with each risk genotype (none538.4, one5 54.5, two565.6). These data support prior observations of 5-HTTLPR effects on PTSD symptoms in military veterans. Although 5-HTTLPR has been identified as a potential contributor to PTSD susceptibility in civilian-based populations, its effect may be less robust in those populations, due to lower overall level of trauma exposure. The effects of 5-HTTLPR on PTSD in military veterans after deployment to a war zone may be more robust because of a universal and constant exposure to threat, military training, and/or separation from family and home social support. In addition to 5-HTTLPR, genetic variation in DISC1, a gene associated with susceptibility to multiple mental disorders, was found to contribute to PTSD symptom severity. Possessing both DISC1 and 5-HTTLPR risk genotypes resulted in a 1.7fold increase in PTSD symptoms. Although this is the first report of DISC1 S704C TT allele as a risk factor for PTSD, the finding is not surprising, considering that this allele has been identified as a risk factor for major depression. DISC1 variants interfere with a protein complex important for organelle transport and in tethering of mitochondria, interfering with dendritic development and reducing densities of dendritic spines in the frontal cortex, paralleling our recent report of spine density reductions in the frontal cortex in PTSD. This study was powered to screen for candidate genes with relatively large effect sizes on PTSD symptoms in combat veterans, which may be different from sets of genes affecting PTSD in civilian populations. Study of the serotonin system in PTSD is motivated in large part by the therapeutic utility of serotonin uptake inhibitors to treat symptoms of PTSD. Our data provide additional impetus for continued study of this system in PTSD pharmacotherapy. In addition, antipsychotics such as risperidone have been shown to reverse DISC1-related behavioral deficits and pathophysiology in animal models, suggesting the possibility that such agents could be re-examined for use as alternative pharmacotherapies for PTSD. Keith A. Young, Sandra B. Morissette, Robert Jamroz, Eric C. Meyer, Matthew S. Stanford, Li Wan, Nathan A. Kimbrel Central Texas Veterans Health Care System, Temple, TX, USA; Department of Veterans Affairs VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA; Department of Psychiatry and Behavioral Science, Texas A&M Health Science Center, Temple, TX, USA; University of Texas at San Antonio, San Antonio, TX, USA; Hope and Healing Center & Institute, Houston, TX, USA; Durham Veterans Affairs Medical Center, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Duke University Medical Center, Durham, NC, USA