Is there a relationship between PTSD and complicated obesity? A review of the literature

Nationwide Assessment of Chronic Pain among Hospitalized Individuals with Co-occurring Post Traumatic Stress Disorder and Substance Use Disorder in the United States

Objective: Chronic pain (CP) is independently associated with substance use disorders (SUD) and posttraumatic stress disorder (PTSD). However, little is known about factors associated with CP among patients with co-occurring PTSD and SUD. Patterns of hospital resource usage should also be explored further. Methods: Using the 2019 National Inpatient Sample (NIS), we identified 216,125 hospital discharges with co-occurring diagnoses of PTSD and SUD in 2019 and examined their association with CP. Multivariable logistic regression models were used to identify factors associated with an increased likelihood of CP in this cohort. Results: Among those with co-occurring PTSD and SUD (N = 216,125), 35,450 had associated CP, a prevalence of 164.02 cases per 1,000 discharges (95% CI [160.54, 167.52]). Individuals aged 55-64 with co-occurring PTSD and SUD were approximately 7.2 times more likely to experience CP, compared to those aged 16-24 (OR = 7.2; 95% CI [6.09, 8.60]). Being in the CP group was associated with 50% increased odds of insomnia and obesity (OR = 1.5; 95% CI [1.12, 2.03] and OR = 1.5; 95% CI [1.38, 1.55], respectively), 30% increased odds of anxiety (OR = 1.3; 95% CI [1.24, 1.38]), 20% increased odds of attention deficit disorder (ADD;OR = 1.2; 95% CI [1.12, 1.38]) and 10% increased odds of depression (OR = 1.1; 95% CI [1.01, 1.14]). Compared with females, being male was associated with slightly decreased odds of CP (OR = 0.9; 95% CI [0.84, 0.94]). Conclusions: Among hospitalized Americans with co-occurring PTSD and SUD, advanced age, being female, and the presence other mental health disorders were associated with an increased risk of CP. Providers treating co-occurring PTSD/SUD should evaluate for and consider evidence-based management of CP if present.

The relationship between nutrient intake and executive function in adults with post-traumatic stress disorder

BACKGROUND

Executive function (EF) deficits are common in adults with post-traumatic stress disorder (PTSD). Macro- and micronutrient intake are potential modifiable factors that may influence EF in PTSD.

OBJECTIVES

To explore the relationship between the daily dietary intake of ω-3 and ω-6 polyunsaturated fatty acids (PUFAs), vitamin C, vitamin E, vitamin D, vitamin B12 and folate, and EF in adults with PTSD.

METHODS

This was a cross-sectional observational study of adults with PTSD who completed neurocognitive assessments (n = 201). Digit span backwards, spatial span backwards, Stroop test and the Ruff Figural Fluency Task were used to assess EF. FoodFinder nutrient intake based on 24-h dietary recalls was used to calculate average daily nutrient intake. Multivariable linear regression models were used to regress EF on the nutrient variables.

RESULTS

Intake of vitamin E, ω-3 PUFAs, and ω-6 PUFAs were all positively associated with planning and set-shifting, with vitamin E (adjusted β = 0.20, p = 0.004) and ω-6 (adjusted β = 0.17, p = 0.01) remaining significant after adjustment for age; sex; education and body mass index. Vitamin D intake was negatively associated with interference (adjusted β = -0.21, p = 0.01). Vitamin C, vitamin B12 and folate intake were not associated with EF.

LIMITATIONS

24-h dietary recall data is limited by recall bias. Circulating nutrient levels were not measured.

CONCLUSIONS

Dietary intake of vitamins E, ω-3 and ω-6 may be important modifiable factors affecting EF in adults with PTSD. Randomised controlled trials are needed to investigate whether micro- and macronutrient interventions can improve EF and other outcomes in PTSD.

The neurohormone tyramine stimulates the secretion of an Insulin-Like Peptide from the intestine to modulate the systemic stress response in C. elegans

The DAF-2/insulin/insulin-like growth factor signaling (IIS) pathway plays an evolutionarily conserved role in regulating reproductive development, lifespan, and stress resistance. In C. elegans , DAF-2/IIS signaling is modulated by an extensive array of insulin-like peptides (ILPs) with diverse spatial and temporal expression patterns. However, the release dynamics and specific functions of these ILPs in adapting to different environmental conditions remain poorly understood. Here, we show that the ILP, INS-3, plays a crucial role in modulating the response to different types of stressors in C. elegans . ins-3 mutants display increased resistance to both heat and oxidative stress; however, under favorable conditions, this advantage is countered by slower reproductive development. ins-3 expression in both neurons and the intestine is downregulated in response to environmental stressors. Conversely, the neurohormone tyramine, which is released during the acute flight response, triggers an upregulation in ins-3 expression. Moreover, we found that tyramine negatively impacts environmental stress resistance by stimulating the release of INS-3 from the intestine. The subsequent release of INS-3 systemically activates the DAF-2 pathway, resulting in the inhibition of cytoprotective mechanisms mediated by DAF-16/FOXO and HSF-1. These studies offer mechanistic insights into the brain-gut communication pathway that weighs adaptive strategies to respond to acute and long-term stress scenarios.

The Search for Diagnostic Criteria to Divide the Wistar Rat Population into Phenotypes during Modeling of Post-Traumatic Stress Disorder

The levels of circulating hormones (corticosterone, testosterone, and leptin) and interleukins were studied in sexually mature male Wistar rats against the background of post-traumatic stress disorder (predator threat stress). It was found that in addition to the previously used anxiety index determined by animal behavior, the population of stressed individuals can be divided into stress-resistant and stress-sensitive phenotypes by the level of leptin and the index of anabolism (testosterone/corticosterone ratio). For the first time, it was determined that in stress-resistant rats, the levels of leptin and the testosterone/corticosterone index exceeds the control values, while in stress-sensitive individuals, these indicators are much lower.

Independent effects of posttraumatic stress disorder diagnosis and metabolic syndrome status on prefrontal cortical thickness and subcortical gray matter volumes

INTRODUCTION

Posttraumatic stress disorder (PTSD) and metabolic syndrome (MetS) are associated with overlapping brain structural differences. These often involve brain structures involved in the regulation of appetite, food intake, satiety, and reward processing. We examined the individual and interactive effects of PTSD diagnosis and MetS on cortical thickness and subcortical gray matter volumes in patients with PTSD (n = 104) compared to trauma-exposed controls (n = 97).

METHODS

Multivariate models were constructed for FreeSurfer-generated prefrontal cortical thickness and subcortical gray matter regions-of-interest (ROIs) to explore the effects of PTSD diagnosis and MetS as predictors, adjusting for relevant socio-demographic and clinical covariates. Individual prefrontal cortical and subcortical limbic ROIs were also selected based on a priori evidence of their involvement in both PTSD and MetS.

RESULTS

The mean age of the sample (n = 201; 78% female) was 41.6 (SD, 13.1) years. PTSD and MetS status showed independent associations with prefrontal cortical thickness and subcortical gray matter volumes across multiple ROIs, adjusting for age, sex, scanner sequence, alcohol, and tobacco use.

CONCLUSIONS

PTSD and MetS are independently associated with brain structural differences, including thinner prefrontal cortical thickness and smaller subcortical gray matter volumes, across multiple ROIs implicated in the hedonic and homeostatic regulation of food intake.

Investigating gender differences in the co-occurrence of PTSD and food addiction

OBJECTIVE

Post-traumatic stress disorder (PTSD) commonly co-occurs with substance use disorders (SUDs). Past studies suggest PTSD is also associated with food addiction (compulsive intake of highly processed foods containing refined carbohydrates and/or added fat). However, research investigating gender differences has been limited (e.g., restricted samples) and mixed. We aim to investigate the risk of co-occurring PTSD and food addiction in a community sample for all participants and stratified by gender. Additionally, we conducted risk ratios for problematic substance use and obesity to allow for within-sample comparisons.

METHOD

We utilized a sample of 318 participants recruited from Amazon Mechanical Turk (mean age = 41.2, 47.8% men, 78.0% white) to address existing gaps in the literature on PTSD and food addiction. We calculated risk ratios (adjusted for sociodemographic covariates) using modified Poisson regression with 95% confidence intervals. Results were also gender stratified.

RESULTS

Risk of food addiction (Risk Ratio (RR) = 6.42, 95% CI [4.10, 10.07], problematic alcohol use (RR) = 3.86, 95% CI [2.25,6.62], problematic smoking (RR) = 3.93, 95% CI [2.22, 6.97], and problematic nicotine vaping (RR) = 5.41, 95% CI [2.41, 11.14] were higher for those meeting criteria for PTSD. Risk of problematic cannabis use, and risk of obesity were not significantly higher for those meeting criteria for PTSD. Gender-stratified results suggest risk of food addiction may be higher for men (RR) = 8.54, 95% CI [4.49, 16.25] compared to women (RR) = 4.32, 95% CI [2.16, 8.62].

DISCUSSION

Food addiction, but not obesity, appears to co-occur with PTSD more strongly than other types of problematic substance use (alcohol, cannabis, cigarettes, nicotine vaping). This risk appears to be particularly high for men compared to women. Assessing for food addiction in those with PTSD, particularly in men, may assist in identifying high-risk groups.

360-Degree Perspectives on Obesity

Alarming statistics show that the number of people affected by excessive weight has surpassed 2 billion, representing approximately 30% of the world's population. The aim of this review is to provide a comprehensive overview of one of the most serious public health problems, considering that obesity requires an integrative approach that takes into account its complex etiology, including genetic, environmental, and lifestyle factors. Only an understanding of the connections between the many contributors to obesity and the synergy between treatment interventions can ensure satisfactory outcomes in reducing obesity. Mechanisms such as oxidative stress, chronic inflammation, and dysbiosis play a crucial role in the pathogenesis of obesity and its associated complications. Compounding factors such as the deleterious effects of stress, the novel challenge posed by the obesogenic digital (food) environment, and the stigma associated with obesity should not be overlooked. Preclinical research in animal models has been instrumental in elucidating these mechanisms, and translation into clinical practice has provided promising therapeutic options, including epigenetic approaches, pharmacotherapy, and bariatric surgery. However, more studies are necessary to discover new compounds that target key metabolic pathways, innovative ways to deliver the drugs, the optimal combinations of lifestyle interventions with allopathic treatments, and, last but not least, emerging biological markers for effective monitoring. With each passing day, the obesity crisis tightens its grip, threatening not only individual lives but also burdening healthcare systems and societies at large. It is high time we took action as we confront the urgent imperative to address this escalating global health challenge head-on.

The impact of PTSD on risk of cardiometabolic diseases: a national patient cohort study in Norway

BACKGROUND

Posttraumatic stress disorder (PTSD) is associated with cardiometabolic diseases, concurrent anxiety, alcohol use disorder and depression. The relationship between PTSD and cardiometabolic diseases are still unclear, and less is known about the effects of socioeconomic status, comorbid anxiety, comorbid alcohol use disorder and comorbid depression. The study, therefore, aims to examine the risk of developing cardiometabolic diseases including type 2 diabetes mellitus over time in PTSD patients, and to what extent socioeconomic status, comorbid anxiety, comorbid alcohol use disorder and comorbid depression attenuate associations between PTSD and risk of developing cardiometabolic diseases.

METHOD

A retrospective, register-based cohort study with 6-years follow-up of adult (> 18 years) PTSD patients (N = 7 852) compared with the general population (N = 4 041 366), was performed. Data were acquired from the Norwegian Patient Registry and Statistic Norway. Cox proportional regression models were applied to estimate hazard ratios (HRs) (99% confidence intervals) of cardiometabolic diseases among PTSD patients.

RESULTS

Significantly (p < 0.001) higher age and gender adjusted HRs were disclosed for all cardiometabolic diseases among PTSD patients compared to the population without PTSD, with a variation in HR from 3.5 (99% CI 3.1-3.9) for hypertensive diseases to HR = 6.5 (5.7-7.5) for obesity. When adjusted for socioeconomic status and comorbid mental disorders, reductions were observed, especially for comorbid depression, for which the adjustment resulted in HR reduction of about 48.6% for hypertensive diseases and 67.7% for obesity.

CONCLUSIONS

PTSD was associated with increased risk of developing cardiometabolic diseases, though attenuated by socioeconomic status and comorbid mental disorders. Health care professionals should be attentive towards the burden and increased risk that low socioeconomic status and comorbid mental disorders may represent for PTSD patients' cardiometabolic health.

The underlying mechanisms by which PTSD symptoms are associated with cardiovascular health in male UK military personnel: The ADVANCE cohort study

Post-Traumatic Stress Disorder (PTSD) has been identified as an independent risk factor for cardiovascular disease, but the mechanisms of this relationship are not well understood. This study investigates the associations between PTSD symptom clusters (hyperarousal, intrusive thoughts, avoidance behaviours and emotional numbing) and mechanisms of cardiovascular disease including cardiometabolic effects, inflammation, and haemodynamic functioning. In the ADVANCE study cohort of UK male military personnel, 1111 participants were assessed for PTSD via questionnaire and cardiovascular risk via venous blood sampling, pulse wave analysis and dual energy x-ray absorptiometry between 2015 and 2020. Variable selection procedures were conducted to assess which of the symptom clusters if any were associated with cardiovascular risk outcomes. Associations were confirmed via robust regression modelling. Avoidance behaviours were associated with greater systolic Blood Pressure (BP) (Adjusted Coefficient (AC) 0.640 (95% Confidence Interval (CI) 0.065, 1.149). Emotional numbing was associated with greater estimated glucose disposal rate (AC -0.021 (95%CI -0.036, -0.005). Hyperarousal was associated with greater levels of (log)triglycerides (exponentiated-AC 1.009 (95%CI 1.002, 1.017). Intrusive thoughts were associated with greater visceral adipose tissue (AC 0.574 (95%CI 0.020, 1.250). Nonlinear relationships were observed between emotional numbing with heart rate and intrusive thoughts with systolic BP. Limited evidence is present for symptom associations with lipoproteins and pulse wave velocity. No associations were observed between PTSD symptom clusters and high sensitivity c-reactive protein, diastolic BP, total cholesterol, or haemoglobin fasting glucose. In conclusion, symptom clusters of PTSD were associated with increased cardiovascular risk via cardiometabolic and haemodynamic functioning mechanisms, but not inflammation.

Ghrelin receptor agonist MK0677 and overnight fasting do not rescue deficient fear extinction in 129S1/SvImJ mice

The hunger hormone ghrelin has been implicated in the modulation of anxiety- and fear-related behaviors in rodents and humans, while its dysregulation may be associated with psychiatric illness. Along these lines, the ghrelin system has been suggested as a potential target to facilitate fear extinction, which is the main mechanism underlying cognitive behavioral therapy. So far, this hypothesis has not been tested in individuals that have difficulties to extinguish fear. Thus, we investigated pharmacological (ghrelin receptor agonist MK0677) and non-pharmacological (overnight fasting) strategies to target the ghrelin system in the 129S1/SvImJ (S1) mouse strain, which models the endophenotype of impaired fear extinction that has been associated with treatment resistance in anxiety and PTSD patients. MK0677 induced food intake and overnight fasting increased plasma ghrelin levels in S1 mice, suggesting that the ghrelin system is responsive in the S1 strain. However, neither systemic administration of MK0677 nor overnight fasting had an effect on fear extinction in S1 mice. Similarly, our groups previously reported that both interventions did not attenuate fear in extinction-competent C57BL/6J mice. In summary, our findings are in contrast to several studies reporting beneficial effects of GHSR agonism and overnight fasting on fear- and anxiety-related behaviors in rodents. Rather, our data agree with accumulating evidence of divergent behavioral effects of ghrelin system activation and underscore the hypothesis that potential benefits of targeting the ghrelin system in fear extinction may be dependent on factors (e.g., previous stress exposure) that are not yet fully understood.

Depression was associated with younger age, female sex, obesity, smoking, and physical inactivity, in 1027 patients with newly diagnosed type 2 diabetes: a Swedish multicentre cross-sectional study

BACKGROUND

Depression is a risk factor for type 2 diabetes (T2D) and cardiovascular disease (CVD). The aims were to explore the prevalence of depression, anxiety, antidepressant use, obesity, Hemoglobin A1c > 64 mmol/mol, life-style factors, pre-existing CVD, in patients with newly diagnosed T2D; to explore associations with depression; and to compare with Swedish general population data.

METHODS

Multicentre, cross-sectional study.

INCLUSION CRITERIA

adults with serologically verified newly diagnosed T2D. Included variables: age, sex, current depression and anxiety (Hospital Anxiety and Depression Scale), previous depression, antidepressant use, obesity (BMI ≥ 30 and ≥ 40 kg/m²), Hemoglobin A1c, pre-existing CVD. Logistic regression analyses were performed.

RESULTS

In 1027 T2D patients, aged 18-94 years, depression was associated with age (per year) (inversely) (odds ratio (OR) 0.97), anxiety (OR 12.2), previous depression (OR 7.1), antidepressant use (OR 4.2), BMI ≥ 30 kg/m² (OR 1.7), BMI ≥ 40 kg/m² (OR 2.3), smoking (OR 1.9), physical inactivity (OR 1.8), and women (OR 1.6) (all p ≤ 0.013). Younger women (n = 113), ≤ 59 years, compared to younger men (n = 217) had higher prevalence of current depression (31% vs 12%), previous depression (43 vs 19%), anxiety (42% vs 25%), antidepressant use (37% vs 12%), BMI ≥ 30 kg/m² (73% vs 60%) and BMI ≥ 40 kg/m²) (18% vs 9%), and smoking (26% vs 16%) (all p ≤ 0.029). Older women (n = 297), ≥ 60 years, compared to older men (n = 400) had higher prevalence of previous depression (45% vs 12%), anxiety (18% vs 10%), antidepressant use (20% vs 8%), BMI ≥ 30 kg/m² (55% vs 47%), BMI ≥ 40 kg/m² (7% vs 3%) (all p ≤ 0.048), but not of current depression (both 9%). Compared to the Swedish general population (depression (women 11.2%, men 12.3%) and antidepressant use (women 9.8%, men 5.3%)), the younger women had higher prevalence of current depression, and all patients had higher prevalence of antidepressant use.

CONCLUSIONS

In patients with newly diagnosed T2D, the younger women had the highest prevalence of depression, anxiety, and obesity. The prevalence of depression in young women and antidepressant use in all patients were higher than in the Swedish general population. Three risk factors for CVD, obesity, smoking, and physical inactivity, were associated with depression.

Cingulate and hippocampal subregion abnormalities in combat-exposed veterans with PTSD

BACKGROUND

The hippocampus and cingulate gyrus are strongly interconnected brain regions that have been implicated in the neurobiology of post-traumatic stress disorder (PTSD). These brain structures are comprised of functionally distinct subregions that may contribute to the expression of PTSD symptoms or associated cardio-metabolic markers, but have not been well investigated in prior studies.

METHODS

Two divisions of the cingulate cortex (i.e., rostral and caudal) and 11 hippocampal subregions were investigated in 22 male combat-exposed veterans with PTSD and 22 male trauma-exposed veteran controls (TC). Cardio-metabolic measures included cholesterol, body mass index, and mean arterial pressure.

RESULTS

Individuals with PTSD had less caudal cingulate area compared to TC even after controlling for caudal cingulate thickness. Total hippocampus volume was lower in PTSD compared to TC, accounted for by differences in CA1-CA4, granule cell layer of the dentate gyrus, molecular layer, and subiculum. Individuals with PTSD had higher mean arterial pressure compared to TC, which correlated with hippocampus volume only in the PTSD group.

LIMITATIONS

Sample size, cross-sectional analysis, no control for medications and findings limited to males.

CONCLUSIONS

These data demonstrate preferential involvement of caudal cingulate area (vs. thickness) and hippocampus subregions in PTSD. The inverse association between hippocampus volume and mean arterial pressure may contribute to accelerated aging known to be associated with PTSD.

Genetically regulated multi-omics study for symptom clusters of posttraumatic stress disorder highlights pleiotropy with hematologic and cardio-metabolic traits

Posttraumatic stress disorder (PTSD) is a psychiatric disorder that may arise in response to severe traumatic event and is diagnosed based on three main symptom clusters (reexperiencing, avoidance, and hyperarousal) per the Diagnostic Manual of Mental Disorders (version DSM-IV-TR). In this study, we characterized the biological heterogeneity of PTSD symptom clusters by performing a multi-omics investigation integrating genetically regulated gene, splicing, and protein expression in dorsolateral prefrontal cortex tissue within a sample of US veterans enrolled in the Million Veteran Program (N total = 186,689). We identified 30 genes in 19 regions across the three PTSD symptom clusters. We found nine genes to have cell-type specific expression, and over-representation of miRNA-families - miR-148, 30, and 8. Gene-drug target prioritization approach highlighted cyclooxygenase and acetylcholine compounds. Next, we tested molecular-profile based phenome-wide impact of identified genes with respect to 1678 phenotypes derived from the Electronic Health Records of the Vanderbilt University biorepository (N = 70,439). Lastly, we tested for local genetic correlation across PTSD symptom clusters which highlighted metabolic (e.g., obesity, diabetes, vascular health) and laboratory traits (e.g., neutrophil, eosinophil, tau protein, creatinine kinase). Overall, this study finds comprehensive genomic evidence including clinical and regulatory profiles between PTSD, hematologic and cardiometabolic traits, that support comorbidities observed in epidemiologic studies of PTSD.

Inpatients experiences about the impact of traumatic stress on eating behaviors: an exploratory focus group study

BACKGROUND

Unhealthy changes in eating behavior among people experiencing trauma have been observed. There is, however, a lack of in-depth knowledge regarding the impact of the after effects of traumatic life experiences on eating behavior. Because eating behavior represents important components for promotion and maintenance of good health throughout life, this study aimed to explore inpatients' lived experiences of the impact of traumatic stress on eating behavior.

METHOD

Thirteen female and two male inpatients (age range 28-62 years), recruited from a psychiatric clinic in Norway, participated in this qualitative explorative focus group study. The data analysis was performed using systematic text condensation.

RESULTS

The results in the present study describe the participants' experiences about the impact of traumatic stress on their eating behavior. Their discussions and descriptions disclosed problems that could be summarized into four main themes: "experiencing eating behaviors as coping strategies"; "experiencing being addicted to food and sweets"; "experiencing eating behaviors controlled by stress and emotions"; and "experiencing lack of appetite and reduced capacity to plan and prepare meals".

CONCLUSION

Traumatic stress can impact eating behavior in several complex ways that over time may cause adverse health consequences. The results add to an important understanding of changes in eating behavior that might appear in people struggling to cope with the after effects of traumatic life experiences to the existing literature. To better understand the complexity of how traumatic experiences may impact eating behavior, this knowledge is important and useful for health professionals offering support to those who experience struggling with eating behavior after traumatic experiences.

Post-traumatic stress disorder (PTSD) in mid-age and older adults differs by immigrant status and ethnicity, nutrition, and other determinants of health in the Canadian Longitudinal Study on Aging (CLSA)

PURPOSE

This study aimed to address knowledge gaps about post-traumatic stress disorder (PTSD) in mid-age and older adults, with particular attention to the relationship of PTSD with nutrition and with ethnicity and immigrant status.

METHODS

Binary logistic regression analysis of weighted comprehensive cohort data from the baseline Canadian Longitudinal Study on Aging (CLSA; n = 27,211) was conducted using the four-item Primary Care-PTSD tool (outcome) and immigrant status by ethnicity (Canadian-born white, Canadian-born minority, immigrant white, immigrant minority). Covariates included various social, economic, nutrition and health-related variables.

RESULTS

After controlling for socioeconomic and health variables, immigrants from minority groups had significantly higher odds of PTSD compared to their Canadian-born counterparts, whereas white immigrants had lower odds of PTSD. These relationships were significantly robust across seven cluster-based regression models. After adjusting for ethnicity/immigrant status, the odds of PTSD were higher among those earning lower household incomes, widowed, divorced, or separated respondents, ever smokers, and those who had multi-morbidities, chronic pain, high nutritional risk, or who reported daily consumptions of pastries, pulses and nuts, or chocolate. Conversely, those 55 years and over, who had high waist-to-height ratio, or who consumed 2-3 fiber sources daily had significantly lower odds of PTSD.

CONCLUSION

Interventions aimed at managing PTSD in mid-age and older adults should consider ethnicity, immigrant status, as well as socioeconomic, health, and nutrition status.

The association between body mass index and recovery from post-traumatic stress disorder after the nuclear accident in Fukushima

Post-traumatic stress disorder (PTSD) and obesity share common risk factors; however, the effect of obesity on recovery from PTSD has not been assessed. We examined the association between body mass index (BMI) and recovery from PTSD after the Great East Japan Earthquake. We analyzed 4356 men and women with probable PTSD aged ≥ 16 years who were living in evacuation zones owing to the radiation accident in Fukushima, Japan. Recovery from probable PTSD was defined as Post-traumatic Stress Disorder Checklist-specific scores < 44. Using Poisson regression with robust error variance adjusted for confounders, we compared the prevalence ratios (PRs) and 95% confidence intervals (CIs) for this outcome in 2013 and 2014. Compared with point estimates for normal weight (BMI: 18.5-24.9 kg/m2), especially in 2013, those for underweight (BMI: < 18.5 kg/m2) and obesity (BMI: ≥ 30.0 kg/m2) tended to slightly increase and decrease, respectively, for recovery from probable PTSD. The multivariate-adjusted PRs (95% CIs) for underweight and obesity were 1.08 (0.88-1.33) and 0.85 (0.68-1.06), respectively, in 2013 and 1.02 (0.82-1.26) and 0.87 (0.69-1.09), respectively, in 2014. The results of the present study showed that obesity may be a useful predictor for probable PTSD recovery. Obese victims with PTSD would require more intensive support and careful follow-up for recovery.

Prognostic factors of post-traumatic stress disorder risk in patients with surgical treatment of hip acetabular fracture. Original study

The aim of the study was to assess the risk of developing post-traumatic stress disorder in patients after hip acetabular fracture surgery. The study involved 42 patients fulfilling inclusion criteria. Physical ability levels of the patients were determined with the Harris Hip Score, and modified Merle d’Aubigné scale. High risk of post-traumatic stress disorder was assessed with the PTSD-C questionnaire. Patients had in PTSD-C questionnaire 42.86 ± 28,10 points. In Harris Hip Score 63.64 ± 16.06, in Merle scale 11.10 ± 2.82, that was poor results in both scales. Positive correlation with age reached the level of tendency (ρ = 0.294; p = 0.059). Patients at risk of PTSD were in worse functional state measured by HHS (U = 136.0; p = 0.034) and Merle scale (U = 132.0; p = 0.026) and they were older (U = 147.5; p = 0.068). The groups differed significantly in gender ratio (χ2 = 4.01; p = 0.045). Women (8/10) were more often than men (14/32) at risk of PTSD. Patients after surgical fixation of the acetabulum experience significant functional disability. Increased level of disability after fracture and surgery, older age and female sex make patients vulnerable to PTSD. It is advisable to make medical staff who treat accident victims aware towards aspects which may be related to disorders of the patients’ psychological health.

A lifestyle intervention randomized controlled trial in obese women with infertility improved body composition among those who experienced childhood adversity

Previous research indicates that tailoring lifestyle interventions to participant characteristics optimizes intervention effectiveness. Our objective was to assess whether the effects of a preconception lifestyle intervention in obese infertile women depended on women's exposure to adversity in childhood. A follow-up of a preconception lifestyle intervention randomized controlled trial (the LIFEstyle study) was conducted in the Netherlands among 577 infertile women (age 18-39 years) with a body mass index (BMI) ≥29 kg/m² at time of randomization; N = 110 (19%) consented to the follow-up assessment, 6 years later. A 6-month preconception lifestyle intervention aimed weight loss through improving diet and increasing physical activity. The control group received care as usual. Outcome measures included weight, BMI, waist and hip circumference, body fat percentage, blood pressure and metabolic syndrome. The potential moderator, childhood adversity, was assessed with the Life Events Checklist-5 questionnaire. Among the 110 women in our follow-up study, n = 65 (59%) reported no childhood adverse events, n = 28 (25.5%) reported 1 type of childhood adverse events and n = 17 (15.5%) reported ≥2 types of childhood adverse events. Regression models showed significant interactions between childhood adversity and effects of lifestyle intervention at the 6-year follow-up. Among women who experienced childhood adversity, the intervention significantly reduced weight (-10.0 [95% CI -18.5 to -1.5] kg, p = 0.02), BMI (-3.2 [-6.1 to -0.2] kg/m² , p = 0.04) and body fat percentage (-4.5 [95% CI -7.2 to -1.9] p < 0.01). Among women without childhood adversity, the intervention did not affect these outcomes (2.7 [-3.9 to 9.4] kg, p = 0.42), (0.9 [-1.4 to 3.3] kg/m² , p = 0.42) and (1.7 [95% CI -0.3 to 3.7] p = 0.10), respectively. Having a history of childhood adversity modified the effect of a preconception lifestyle intervention on women's body composition. If replicated, it may be important to consider childhood adversity as a determinant of lifestyle intervention effectiveness.

Broken Heartstrings—Post-Traumatic Stress Disorder and Psychological Burden after Acute Mitral Regurgitation Due to Chordae Tendineae Rupture

Chordae tendineae rupture (CTR) is a potentially life-threatening cardiac event often resulting in Acute mitral regurgitation (AMR). We assessed Post-traumatic stress disorder (PTSD), depression, and anxiety symptoms in n=21 CTR patients with AMR (age 82.3 ± 4.2 years; 66.7% men) and compared them to n=23 CTR patients with Chronic mitral regurgitation (CMR) and n=35 Myocardial infraction (MI) patients. Regression analyses revealed that PTSD scores were significantly higher in CTR patients with AMR than in CTR patients with CMR or MI patients. CTR patients with CMR had the lowest levels of PTSD-symptoms. Depression and anxiety scores were elevated across all three groups. Our results suggest that psychosocial factors need to be considered in CTR patients’ care.

The Good, the Bad and the Unknown Aspects of Ghrelin in Stress Coping and Stress-Related Psychiatric Disorders

Ghrelin is a peptide hormone released by specialized X/A cells in the stomach and activated by acylation. Following its secretion, it binds to ghrelin receptors in the periphery to regulate energy balance, but it also acts on the central nervous system where it induces a potent orexigenic effect. Several types of stressors have been shown to stimulate ghrelin release in rodents, including nutritional stressors like food deprivation, but also physical and psychological stressors such as foot shocks, social defeat, forced immobilization or chronic unpredictable mild stress. The mechanism through which these stressors drive ghrelin release from the stomach lining remains unknown and, to date, the resulting consequences of ghrelin release for stress coping remain poorly understood. Indeed, ghrelin has been proposed to act as a stress hormone that reduces fear, anxiety- and depression-like behaviors in rodents but some studies suggest that ghrelin may - in contrast - promote such behaviors. In this review, we aim to provide a comprehensive overview of the literature on the role of the ghrelin system in stress coping. We discuss whether ghrelin release is more than a byproduct of disrupted energy homeostasis following stress exposure. Furthermore, we explore the notion that ghrelin receptor signaling in the brain may have effects independent of circulating ghrelin and in what way this might influence stress coping in rodents. Finally, we examine how the ghrelin system could be utilized as a therapeutic avenue in stress-related psychiatric disorders (with a focus on anxiety- and trauma-related disorders), for example to develop novel biomarkers for a better diagnosis or new interventions to tackle relapse or treatment resistance in patients.

PTSD and obesity in U.S. military veterans: Prevalence, health burden, and suicidality

Post-traumatic stress disorder (PTSD) and obesity are prevalent among U.S. military veterans, though less is known about the mental and physical health burden and suicidality of co-occurring PTSD and obesity in this population. A nationally representative sample of the U.S. veterans was used to assess PTSD and obesity prevalence, co-occurrence and relationships with mental and physical health measures. A total of 16.4% of veterans screened positive for current PTSD, 32.7% for obesity, and 5.8% for co-occurring PTSD and obesity. Relative to obesity-only veterans, veterans with co-occurring PTSD and obesity had elevated likelihoods of mental and physical health concerns (most notably major depressive and generalized anxiety disorders), suicidality, and migraine headaches, and higher body mass indices. Relative to veterans with PTSD alone, individuals with comorbid PTSD and obesity had elevated likelihoods of suicidal ideation, nicotine dependence, mental health treatment, migraine headaches, diabetes, hypertension, and insomnia. A significant minority of U.S. veterans has co-occurring PTSD and obesity, which is associated with substantial mental and physical health burden, including elevated suicidality.  Results underscore the importance of integrative assessment, monitoring, and treatment approaches for PTSD and obesity in this population.

Effects of Psychological and Lifestyle Factors on Metabolic Syndrome Following the Fukushima Daiichi Nuclear Power Plant Accident: The Fukushima Health Management Survey

Aim: The Fukushima Daiichi Nuclear Power Plant accident dramatically changed the lifestyle of residents who lived near the plant. We evaluated the association of metabolic syndrome (MetS) with specific lifestyle- and disaster-related factors in residents following the accident.

Methods: This cross-sectional study included 20,920 residents who underwent both the Comprehensive Health Check and the Mental Health and Lifestyle Survey from June 2011 to March 2012. Associations between MetS and lifestyle- and disaster-related factors, including psychological distress (post-traumatic stress disorder [PTSD]), were estimated using logistic regression analysis, adjusted for demographic and lifestyle factors, in 2019.

Results: MetS was present in 30.4% of men and 11.5% of women. There were significant differences in smoking, drinking status, and PTSD prevalence between subjects with and without MetS. Multivariable logistic regression analysis showed that age, quitting smoking, and low physical activity were significantly associated with MetS. Moreover, PTSD and light to moderate drinking were also significantly associated with MetS in women.

Conclusions: Lifestyle- and disaster-related factors, including PTSD, were associated with MetS among subjects who lived near the Fukushima Daiichi Nuclear Power Plant accident.