The Associations of Fruit and Vegetable Intakes with Burden of Diseases: A Systematic Review of Meta-Analyses

Background

Low fruit and vegetable intakes are recognized risk factors for noncommunicable diseases. This systematic review summarizes published meta-analyses of global burden of diseases attributable to low fruit and vegetable intakes, and the best relative risk estimates.

Brain glucose metabolism difference between bipolar and unipolar mood disorders in depressed and euthymic states

Background

Functional brain imaging studies have consistently demonstrated abnormalities in regional cerebral glucose metabolism in the prefrontal cortex in patients with mood disorders (MD). These studies, however, have not clarified the differential characteristics of glucose metabolism between depressed and euthymic states, or between bipolar mood disorder (BP) and unipolar mood disorder (UP).

Methods

We used [¹⁸F]fluorodeoxyglucose (FDG) positron emission tomography (PET) to evaluate the differences in glucose metabolism at resting state. We compared 30 depressed and 17 euthymic female patients with mood disorders with age-, IQ-, and socioeconomically matched 20 healthy controls (HCs). Then, BP and UP patients were separately analyzed. The PET data were objectively analyzed by statistical parametric mapping (SPM).

Results

Compared with HCs, the depressed MD patients showed significantly lower glucose metabolism in the bilateral frontal gyri, left cingulate gyrus, bilateral temporal gyri, right insula, bilateral inferior parietal lobules, and right occipital gyrus. In contrast, the euthymic MD patients demonstrated fewer areas with significant reduction. When the depressed BP patients were separately compared with HCs, the glucose metabolism was found to be significantly lower in the bilateral frontal gyri, right cingulate gyrus, and bilateral inferior parietal lobules. Meanwhile, the depressed UP patients showed a significantly lower metabolism in the bilateral frontal gyri, left cingulate gyrus, bilateral temporal gyri, bilateral insulae, bilateral inferior parietal lobules, and right occipital gyrus.

Conclusions

The results of this study provide evidence of persistent hypometabolism in depressed MD patients, particularly in the frontal gyrus. Although the conclusions are limited in the cross-sectional study, these findings suggest that abnormalities in the right frontal gyrus, left temporal gyrus, and left cingulate gyrus tend to normalize as the depression symptoms improve, although those in the left frontal gyrus, right cingulate gyrus, and right temporal gyrus persist. This study also elucidated the cerebral hypofunction specific to each BP and UP. BP patients showed a decrease in glucose metabolism in the right anterior cingulate and UP patients did in the right temporal gyrus, right insula, and left posterior cingulate. This study clarified the differences between subtypes.     

Differential role of serotonergic polymorphisms in alcohol and heroin dependence

Background

Twin studies suggest that genetic factors account for 40–60% of the variance in alcohol dependence. It has been stated that different drug dependencies may have unique genetic influences. Alterations in serotonin availability and function can affect drinking behaviour. This study aimed to investigate whether three serotonergic polymorphisms (HTR2A A-1438G (rs6311), and SCL6A4 5-HTTLPR and STin2 VNTR) were associated with alcohol dependence, and, whether the serotonergic polymorphisms played a similar role in conferring vulnerability in alcohol and heroin dependence.

Methods

165 alcohol dependent patients, 113 heroin dependent patients, and 420 healthy controls from a homogeneous Spanish Caucasian population were genotyped using standard methods.

Results

Genotypic frequencies of the A-1438G, 5-HTTLPR, and STin2 VNTR polymorphisms did not differ significantly across the three groups. None of the three polymorphisms contributed to distinguishing alcoholic patients from healthy controls. There was an excess of −1438G and 5-HTTLPR L carriers in alcoholic patients in comparison to the heroin dependent group (OR (95% CI) = 1.98 (1.13–3.45) and 1.92 (1.07–3.44), respectively). The A-1438G and 5-HTTLPR polymorphisms also interacted in distinguishing alcohol from heroin dependent patients (Wald (df) = 10.21 (4), p = 0.037). The association of −1438A/G with alcohol dependence was especially pronounced in the presence of 5-HTTLPR S/S, less evident with 5-HTTLPR L/S and not present with 5-HTTLPR L/L. SCL6A4 polymorphism haplotypes were similarly distributed in all three groups.

Conclusions

Our data do not support a role of serotonergic polymorphisms in alcohol dependence but suggest a differential genetic background to alcohol and heroin dependence.     

A prediction rule for diagnosing hypomania

Background

Missing the diagnosis of past hypomania, and thus of bipolar II disorder, is common. Study aim was to find a ‘prediction rule’ for facilitating the diagnosis of past hypomania.

Methods

In an outpatient psychiatry private practice (non-tertiary care), a consecutive sample of 275 bipolar II disorder (BP-II) remitted patients, and consecutive, independent, sample of 138 major depressive disorder (MDD) remitted patients, had been interviewed for different study goals during follow-up visits by a senior bipolar-trained psychiatrist. Using the Structured Clinical Interview for DSM-IV, modified and validated by Benazzi and Akiskal [Benazzi F (2007). Lancet 369: 935–945] to improve the probing for past hypomania, patients had been questioned about the most common symptoms and duration of recent threshold and subthreshold hypomanic episodes. The sample was retrospective in nature. A prediction rule was tested. This is a score resulting from the sum of the weighted scores of each hypomanic symptom which was an independent predictor of hypomania. Its cutoff score for discriminating hypomania was based on the highest figure of correctly classified hypomanias and on the most balanced combination of sensitivity and specificity. A second, independent sample of 138 BP-II and 71 MDD remitted outpatients was tested to replicate the findings.

Results

By univariate logistic regression, hypomanic symptoms distinguishing BP-II and MDD included ‘increase in goal-directed activity’ (overactivity) (OR = 28.3), ‘elevated mood’ (OR = 14.9), ‘increased talkativeness’ (OR = 9.2), ‘inflated self-esteem’, ‘decreased need for sleep’, ‘excessive risky activities’, and ‘irritable mood’. By multivariable logistic regression, the independent predictors of hypomania resulted ‘increase in goal-directed activity’ (OR = 14.9, weighted score = 15), ‘elevated mood’ (OR = 7.5, weighted score = 7), ‘increased talkativeness’ (OR = 3.6, weighted score = 4); ‘irritable mood’, ‘inflated self-esteem’, ‘decreased need for sleep’, and ‘excessive risky activities’ had ORs between 2.04 and 2.39, with a weighted score = 2. The prediction rule showed that the cutpoint score ≥ 21 had the highest figure of correctly classified hypomanias (88%, ROC area = 0.94), showing the most balanced combination of sensitivity (87%) and specificity (89%). This prediction rule, tested on the second sample, found that the same cutoff score  ≥ 21 correctly classified the highest figure of hypomanias (94%, ROC area = 0.97), showing the most balanced combination of sensitivity (93%) and specificity (95%). To cross this cutoff score, overactivity was always required (as the sum of the scores of elevated mood and of the other symptoms did not reach this cutoff). However, scores 10 to 20 correctly classified only slightly lower figures of hypomanias.

Conclusions

A prediction rule for hypomania was tested. The scores of overactivity plus at least some hypomanic symptom (among elevated mood, irritability, inflated self-esteem, less sleep, talkativeness, excessive risky activities) correctly classified 88% of hypomanias. Instead, elevated mood without overactivity, plus even all the other symptoms, did not reach the best figure of correctly classified. However, lower cutoff scores, up to 10, classified slightly lower figures of hypomanias, but with less balanced combinations of sensitivity and specificity. These findings may have diagnostic utility, because BP-II versus MDD is likely to be a more severe disorder. This prediction rule, if replicated and fine-tuned in different settings, may help clinicians better probing past hypomania, thus reducing the common misdiagnosis of BP-II as MDD.     

The role of leptin and cortisol in hyperactivity in patients with acute and weight-recovered anorexia nervosa

Introduction

In food-restricted rats, leptin as well as corticotropin releasing factor attenuate semistarvation-induced hyperactivity (SIH). Results from studies in patients with anorexia nervosa (AN) showed an association between excessive physical activity (PA) and leptin. One recent report suggests a role for cortisol in PA. In this study, we assessed the relationships between PA and both, cortisol and leptin levels at the same time in patients with acute anorexia nervosa (acAN) in comparison to recovered patients (recAN).

Methods

Plasma leptin, plasma cortisol, body mass index (BMI), and expert-ratings of qualities of PA were assessed in 36 acAN patients, 27 recAN patients and 44 healthy control woman (HCW). Regression analyses were used to predict PA using BMI, leptin and cortisol levels as predictor variables.

Results

Leptin levels but not cortisol significantly contributed to the prediction of PA in acAN. In recAN PA was not elevated and not related to endocrine parameters but correlated positively with core eating disorder symptoms.

Conclusions

Our work lends support to the proposed inverse association between peripheral leptin levels and excessive physical activity in AN. This relationship is specific to the state of semistarvation. The role of additional mediators remains to be clarified.     

Volumetric differences in the pituitary between drug-naïve and medicated male patients with obsessive–compulsive disorder

Objective

Obsessive–compulsive symptoms are induced or aggravated by stress, and the pituitary is a key component of the hypothalamic-pituitary-adrenal axis. We examined pituitary volume in drug-naïve and medicated male patients with obsessive–compulsive disorder (OCD).

Methods

Volumetric magnetic resonance imaging studies were conducted on 62 male control subjects, medicated male patients (N = 50) and drug-naïve male patients (N = 12) with OCD.

Results

Pituitary volume was significantly smaller in drug-naïve patients with OCD (464.97 ± 55.82 mm³) compared to medicated patients (577.84 ± 129.11 mm³, P = 0.004) and control subjects (543.04 ±113.70 mm³, P = 0.027), and no difference between control subjects and medicated patients (P = 0.174).

Conclusion

The results indicate that drug-naïve male patients with OCD exhibit decreased pituitary volume. This finding suggests that dysregulation of the HPA axis in OCD may influence pituitary volume. In addition, the increased pituitary volume in medicated patients may reflect the effect of drugs on the pituitary.     

Insular cortex volume and impulsivity in teenagers with first-presentation borderline personality disorder

Fronto-limbic neural dysfunction has been implicated in the emotional dysregulation and impulsivity seen in borderline personality disorder (BPD). However, it remains unclear whether affected individuals exhibit morphologic changes of the insular cortex, a fronto-limbic integration cortex engaged in emotional regulation and impulse control. This magnetic resonance imaging study examined the insular cortex volume and its relationship to clinical characteristics in a first-presentation teenage BPD sample. No significant difference was found in the insular volume between 20 BPD participants (5 males) and 20 healthy control participants (5 males). There was no association between the insular volume and parasuicidal episodes, trauma exposure, or comorbid Axis I disorders, but the BPD participants with violent episodes during the previous 6 months had a smaller insular volume bilaterally compared with those without such episodes. Furthermore, right anterior insular volume in the BPD participants was negatively correlated with impulsivity score. These preliminary findings suggest that insular cortex volume does not significantly differ in early BPD, but that there might be a relationship with violent and impulsive behavior that is often seen in the disorder. Further studies are needed to clarify whether the potential relationship between the insular cortex volume and impulsivity is specific to BPD.     

老年期痴呆患者照料者负担及其相关因素调查

目的 调查老年期痴呆患者的基本情况、家庭关系、照料者的负担、躯体与心理状况. 方法采用统一自行设计的调查问卷及焦虑自评量表(SAS)、抑郁自评量表(SDS)、临床痴呆评定量表(CDR)由调查员入户调查.根据CDR评分分为轻度痴呆组(20例)、中度痴呆组(16例)、重度痴呆组(27例). 结果调查老年期痴呆患者63例.不同严重程度的老年期痴呆患者总经济损失(F=-15.40, P=0.00)、医疗护理费用(F=-14.48,P=0.00)、照料者经济损失(F=-13.57、P=0.00)、每日照料时间(F=-16.72,P=0.00)方面存在统计学差异.照料者的SAS得分平均(30.98±5.14)分,SDS得分平均为(32.27±5.39)分,不同严重程度的痴呆患者的照料者SAS(F=14.818,P=0.000)、SDS(F=5.592, P=0.040)得分有统计学差异. 结论不同严重程度的老年期痴呆患者的照料者的负担不同.痴呆的严重程度影响照料者的心理状况.     

Herpes zoster burden of illness and health care resource utilisation in the Australian population aged 50 years and older

Incidence of zoster and post-herpetic neuralgia (PHN) and associated health care resource utilisation were investigated in the Australian population aged ≥50 years, using general practice data from 2000 to 2006, and pharmaceutical prescribing, hospital morbidity and emergency department data from 1998 to 2005. Zoster and PHN incidence rates were estimated as ∼10/1000 and 1.45/1000 persons, respectively, with antivirals prescribed for 73.5% of zoster cases. Estimated hospitalisation and emergency department visit rates were 0.67/1000 and 0.38/1000 persons, respectively. Management of zoster (including PHN) involved ∼2.4 general practitioner consultations. Total costs to the health care system were estimated as ∼32.8 million per year. The substantial burden of zoster and PHN highlights the potential benefit of zoster vaccination.