一般的心智健康異常與肥胖風險有關


  August 14, 2009 — 一篇新研究認為,一般的心智健康異常,如憂鬱和焦慮,與肥胖風險增加有強烈關聯,且此關聯隨著年紀而增加。
  
  在一篇大型、族群基礎、縱向研究中,英國倫敦大學院的研究者發現,在40歲時,6%的研究對象為肥胖,而且此一年紀時,肥胖者的心智健康異常比率與那些心智健康異常者沒有差別。
  
  然而,在70歲時,35%的研究對象有一般的心智健康異常且肥胖,那些無心智異常者則有27%為肥胖(勝算比為1.46)。性別、種族、社會經濟狀態等因素不會影響肥胖風險。
  
  作者們寫道,本研究強調一般的心智異常在年老時的肥胖風險。需要更詳細的臨床指引來幫助醫師預防和治療心智健康異常成人的肥胖,促進肥胖年長者有更好的心智健康。
  
  這項研究發表於8月的英國精神病學期刊(British Journal of Psychiatry)。
  
  此研究包括10,166名年紀在35至55歲的公務員,研究者將他們分類為肥胖(身體質量指數≧30 kg/m2)或不肥胖。這些研究對象也完成一般健康問卷(General Health Questionnaire),聚焦在自我報告的焦慮、憂鬱症狀和相關的社會心理失能。在19年的追蹤期間內,另外重複這些檢測3次。
  
  作者們報告指出,出現心智異常者,隨著年紀增加而有較高的肥胖風險(P = .004)。40歲時,不論是否有心智異常,肥胖的比率估計為5.7%,但是在70歲時,有心智異常者與無心智異常者的肥胖比率分別是34.6%和27.1%。
  
  【推論到較年經的族群?】
  俄亥俄州辛辛那提醫學院的Susan L. McElroy醫師接受Medscape Psychiatry邀請,對該文獻進行評論時表示,該研究對於心智疾病與肥胖之間的關聯來說,是一篇有重要貢獻的文獻。
  
  McElroy醫師表示,這或許是提及肥胖和一般心智異常之關聯性的最大型與期間最久的研究。不過,研究開始時納入之世代的平均年紀為40歲出頭到45歲左右,這些發現無法推論到可能也有肥胖-精神病理學關係的較年輕世代。
  
  McElroy醫師指出,研究者認為,此一差異意味著一般心智健康問題可能是肥胖的一個原因,體重增加可能是憂鬱藥物的副作用之一,肥胖者可能認為自己有不佳的身體意象(body image),且有較高風險發生心智健康問題,老化相關的健康問題也可能造成體重增加和憂鬱或焦慮。
  
  【老化的問題依舊未能解決】
  華盛頓西雅圖團體醫療保險合作醫院的研究員、精神科醫師Gregory Simon向Medscape Psychiatry表示,此研究確認許多之前的研究結果且一致指出,肥胖和顯露憂鬱及焦慮症狀的心理壓力之間有強烈關聯。
  
  不過,Simon醫師表示,雖然Kivimaki醫師的研究,並未發現年輕族群的此一關聯,而是隨著年紀增加風險,但他的資料顯示,憂鬱和肥胖在年輕和年長者之間有類似的關聯。
  
  Simon醫師表示,研究發現中的差異可能是因為研究方法不同。舉例來說,Kivimaki醫師的研究使用一般健康問卷,而其他研究使用不同的方法。人們對於這些不同的心理壓力或憂鬱之測量方法的回應,可能因為年紀而有不同。
  
  他指出,此時,我認為老化問題(肥胖和憂鬱之間的關係會因為年紀而改變嗎?)依舊未能解決。但是本研究與其他許多研究顯示,一般而言,肥胖和憂鬱有強烈關聯。
  
  Simon醫師表示,對於醫師的意義,包括需將肥胖視為憂鬱病患的常見問題,憂鬱治療也須考量對肥胖的影響,包括藥物對體重的可能影響。
  
  他表示,憂鬱在過重或肥胖者之間特別常見,所以醫師應有能力分辨憂鬱且討論治療選項。
  
  醫學研究委員會、英國心臟基金會、英國健康與安全執行委員會、國家心臟肺臟與血液研究中心、國家老化研究中心、健康照護政策研究局以及麥克阿瑟基金會(John D. and Catherine T. MacArthur Foundation)等資助本研究。作者們宣告沒有相關財務關係。
  

Common Mental Health Disorders Strongly Linked to Obesity Risk

By Janis Kelly
Medscape Medical News

August 14, 2009 — Common mental health disorders such as depression and anxiety are strongly linked to an increased risk for obesity — an association that grows stronger as individuals age, new research suggests.

In a large, population-based, longitudinal study, investigators from University College London in the United Kingdom found that at that age 40 years, 6% of subjects were obese, and that at this age, there no differences in the proportion of mentally healthy subjects who were obese in comparison with those who had mental health disorders.

However, at age 70 years, 35% of participants who had common mental health disorders were obese compared with 27% of those without mental disorders (odds ratio, 1.46). The risk of being obese did not vary by sex, ethnic background, or socioeconomic status.

"This study emphasizes the role of common mental disorders in the risk of obesity at older ages. There is a need for more detailed clinical guidelines to help doctors prevent and treat obesity among adults with mental health disorders, and promote better mental health among older people who are obese," the authors write.

The study is published in the August issue of the British Journal of Psychiatry.

The study included 10,166 civil servants aged 35 to 55 years. Each was classified as obese (body mass index ? 30 kg/m2) or nonobese. Participants also completed a General Health Questionnaire, which focuses on self-reported symptoms of anxiety and depression and associated psychosocial dysfunction. These tests were repeated another 3 times during a 19-year follow-up period.

The authors report that the excess risk for obesity in the presence of mental disorders increased with age (P = .004). The estimated proportion of individuals who were obese was 5.7% at age 40 years, both in the presence and absence of mental disorders, but the corresponding figures were 34.6% and 27.1%, respectively, at age 70 years.

Generalizeable to Younger Populations?

Asked by Medscape Psychiatry to comment on the article, Susan L. McElroy, MD, from the University of Cincinnati College of Medicine, Ohio, said the study makes "an important contribution to the literature on the relationship between mental illness and obesity."

"This is probably the largest and longest study to show that age affects the relationship between obesity and common mental disorders," Dr. McElroy said. "However, as the mean age of the cohort was in the early [to] mid-40s at study initiation, these findings cannot be generalized to younger cohorts, where there may also be obesity–psychopathology relationships," she said.

The researchers suggested that this difference might mean that common mental health problems could be a cause of obesity, that weight gain might be in part a result of side effects from medications for depression, that obese individuals may have a poor self-body image and be at greater risk of developing mental health problems, or that concomitant health problems associated with aging might cause both weight gain and depression or anxiety, Dr. McElroy added.

Question of Age Still Unsettled

Gregory Simon, MD, psychiatrist and researcher at Group Health Cooperative in Seattle, Washington, told Medscape Psychiatry that this study confirms and is consistent with the results of many previous studies indicating that there is a strong association between obesity and psychological distress that manifests as symptoms of depression and anxiety.

However, Dr. Simon said that although the Kivimaki study found that this association was absent in younger people and increased with age, his data show that depression and obesity were similarly associated in younger and older people.

"This difference in findings may be due to differences in study methods. For example, the Kivimaki study used the General Health Questionnaire, while other studies have used different measures. It's possible that there are age differences in how people respond to these different measures of psychological distress or depression," said Dr. Simon.

"At this point, I would say the age question (does the relationship between obesity and depression vary by age?) is still unsettled. But this study adds to many others showing that, in general, obesity and depression are strongly related," he added.

Dr. Simon said the implications for clinicians include the need to consider that obesity is very common among people with depression and that treatment for depression will often need to consider the challenges of obesity and the possible effects of medications on weight.

"Depression is especially common among people who are overweight or obese, so clinicians should be prepared to identify depression and discuss treatment options," he said.

The study was funded by the Medical Research Council, British Heart Foundation, UK Health and Safety Executive, National Heart Lung and Blood Institute, National Institute on Aging, Agency for Health Care Policy Research, and the John D. and Catherine T. MacArthur Foundation. The authors have disclosed no relevant financial relationships.

Br J Psychiatry. 2009;195:149–155.

    
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