PTSD會增加婦女的肥胖風險


  【24drs.com】創傷後壓力異常(PTSD)被認為與婦女過重及肥胖的風險增加有關。
  
  「護士健康研究」這項研究的最新結果顯示,在研究期間發生PTSD症狀的正常體重婦女,變得過重的風險比經歷創傷但無PTSD者增加36%。
  
  資深作者、紐約市Mailman公衛學院Karestan Koenen博士指出,PTSD不只是心智健康議題,除了心血管疾病和糖尿病,現在,PTSD的健康風險清單新增肥胖這項。
  
  這篇研究線上登載於11月20日的JAMA Psychiatry期刊。
  
  研究者指出,雖然PTSD被定義為肥胖的可能風險因素,但是不清楚PTSD是否改變了體重增加趨勢或者是共病症。
  
  為了探討這個問題,研究者進行了這篇首次探討PTSD和肥胖之關係的縱向研究。
  
  他們寫道,這篇研究首度檢視了曝露於民間情境下發生創傷事件的婦女,其PTSD症狀和BMI[身體質量指數]趨勢之間的前瞻式關係。
  
  為了研究,研究者分析了「護士健康研究 II」部分樣本的資料,該研究共包括1989年時、年紀22-44歲的54,224名研究對象,測量他們的創傷和PTSD症狀,追蹤這些研究對象到2005年。
  
  使用創傷與PTSD篩檢問卷測量PTSD症狀、發生時間、創傷情況;根據BMI值,超過25.0與30.0分別視為發生過重和肥胖;根據50,504名回覆者的資料進行最後分析。
  
  PTSD的閾值是在1個月以上持續有4個以上症狀,常見的症狀包括重複經歷創傷事件、感受處於威脅、迴避社交行為。
  
  結果顯示,1989年BMI正常的婦女中,在1989年發生至少4種PTSD症狀,和變得過重或肥胖的風險增加有關(勝算比1.36;95%信心區間[CI] 1.19 - 1.56)。
  
  即使是低於閾值症狀的婦女,風險也是較高的,校正憂慮這項也被視為肥胖的風險因素後,風險依舊。
  
  在1989年前開始有PTSD症狀的婦女,BMI比沒有PTSD的婦女增加更快速。
  
  研究者指出,PTSD對婦女體重之影響可能比一般族群更大。
  
  Koenen博士表示,護士相當適合進行這類研究,因為她們的BMI等健康測量相當準確;但是,她們也比較重視健康,所以可能比我們更不容易變肥胖,所以研究結果可能比原來預期的更保守。
  
  研究者推測,PTSD可能是因為刺激生物和行為機轉而影響體重,包括一些不健康的生活型態行為,例如不運動和吃垃圾食物,神經內分泌功能失調。
  
  研究者指出,研究結果認為PTSD婦女應監測或進行心臟代謝不良後果之篩檢。此外,他們認為,應將PTSD治療擴展納入飲食和運動之測量,以降低肥胖風險。目前,健康行為完全沒有在PTSD的治療範圍內。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=7032&x_classno=0&x_chkdelpoint=Y
  

PTSD Boosts Obesity Risk in Women

By Caroline Cassels
Medscape Medical News

Post-traumatic stress disorder (PTSD) has been linked to an increased risk for overweight and obesity in women.

The latest results from the Nurses Health Study show that women of normal weight who developed PTSD symptoms during the study period had 36% increased odds of becoming overweight compared with their counterparts who experienced trauma but had no PTSD symptoms.

"PTSD is not just a mental health issue. Along with cardiovascular disease and diabetes, we can now add obesity to the list of known health risks of PTSD," senior author Karestan Koenen, PhD, Mailman School of Public Health in New York City, said in a release.

The study was published online November 20 in JAMA Psychiatry.

First Study of Its Kind

Although it has been identified as a possible risk factor for obesity, it is unclear whether PTSD alters the trajectory of weight gain or whether it is a comorbid condition, the researchers note.

To examine this question, the researchers conducted what they report as the first longitudinal study to examine the relationship between PTSD and obesity.

"This study is the first to examine the prospective relation of PTSD symptoms to BMI [body mass index] trajectories and obesity in women exposed to a wide range of traumatic events occurring in civilian settings," they write.

For the study, the investigators analyzed data from a subsample of the Nurses Health Study II, which included 54,224 participants aged 22 to 44 years in 1989 and in whom trauma and PTSD symptoms were measured. Participants were followed-up until 2005.

Symptoms of PTSD, time of onset, and trauma were measured using the Trauma and PTSD Screening Questionnaire. The development of overweight and obesity was determined using BMI cut points of 25.0 and 30.0, respectively. The final analysis was based on data from 50,504 respondents.

The threshold for PTSD was the persistence of 4 or more symptoms duriong a period of 1 month or longer. Common symptoms included re-experiencing the traumatic event, feeling under threat, and social avoidance.

Risk Likely Underestimated

The results revealed that the onset of at least 4 PTSD symptoms in 1989 was associated with an increased risk of becoming overweight or obese (odds ratio, 1.36; 95% confidence interval [CI], 1.19 - 1.56) among women with normal BMI in 1989.

The higher risk was evident even for women with subthreshold symptom levels, and the risk remained after adjusting for depression, which is also thought to be a major risk factor for obesity.

Women with PTSD symptoms that began prior to 1989 experienced a more rapid increase in BMI than women without PTSD.

The researchers note that the impact of PTSD on women's weight may be even greater in the general population.

"Nurses are great for studies because they report health measures like BMI with a high degree of accuracy. But they are also more health conscious and probably less likely to become obese than most of us, which makes these results more conservative than they would otherwise be," said Dr. Koenen.

The investigators speculate that PTSD may influence weight gain through simultaneous biological and behavioral mechanisms, including unhealthy lifestyle behaviors, such as physical inactivity and consumption of junk food, and dysregulated neuroendocrine function.

According to investigators, the study's results suggest that women with PTSD should be monitored or undergo screening for adverse cardiometabolic outcomes.

In addition, they suggest that PTSD treatment should be expanded to include such measures as diet and exercise to mitigate the risk for obesity. They point out that currently, "health behaviors are completely outside the scope of PTSD treatments."

The authors report no relevant financial relationships.

JAMA Psychiatry. Published online November 20, 2013.

    
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