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Pichardo MS, Ferrucci LM, Molina Y, Esserman DA, Irwin ML. Structural Racism, Lifestyle Behaviors, and Obesity-related Cancers among Black and Hispanic/Latino Adults in the United States: A Narrative Review. Cancer Epidemiol Biomarkers Prev 2023; 32:1498-1507. [PMID: 37650844 PMCID: PMC10872641 DOI: 10.1158/1055-9965.epi-22-1147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 05/02/2023] [Accepted: 08/29/2023] [Indexed: 09/01/2023] Open
Abstract
One in three adults in the United States has obesity; a chronic disease that is implicated in the etiology of at least 14 cancers. Cancer is the leading cause of death among U.S. Hispanic/Latino adults and the second most common cause of death, after cardiovascular disease, for Black adults. Our country's legacy in overt discrimination (e.g., slavery, segregation) generated inequities across all spheres in which people function as defined by the socioecological model-biological, individual, community, structural-and two of the many areas in which it manifests today are the disproportionate burden of obesity and obesity-related cancers in populations of color. Inequities due to environmental, social, and economic factors may predispose individuals to poor lifestyle behaviors by hindering an individual's opportunity to make healthy lifestyles choices. In this review, we examined the evidence on obesity and the lifestyle guidelines for cancer prevention in relation to cancer risk and outcomes for Black and Hispanic/Latino adults. We also discussed the role of structural and societal inequities on the ability of these two communities to adopt and maintain healthful lifestyle behaviors in accordance with the lifestyle guidelines for cancer prevention and control.
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Affiliation(s)
- Margaret S. Pichardo
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, 06520
- Department of Surgery, Hospital of the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, PA 19104
| | - Leah M. Ferrucci
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, 06520
- Yale Cancer Center, New Haven, CT 06520
| | - Yamile Molina
- School of Public Health, University of Illinois Chicago and Cancer Center University of Illinois Chicago, 60607
| | - Denise A. Esserman
- Department of Biostatistics, Yale School of Public Health, New Haven, CT 06520
| | - Melinda L. Irwin
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, 06520
- Yale Cancer Center, New Haven, CT 06520
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2
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Ballantyne JC, Sullivan MD. Is Chronic Pain a Disease? THE JOURNAL OF PAIN 2022; 23:1651-1665. [PMID: 35577236 DOI: 10.1016/j.jpain.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/24/2022] [Accepted: 05/06/2022] [Indexed: 11/30/2022]
Abstract
It was not until the twentieth century that pain was considered a disease. Before that it was managed medically as a symptom. The motivations for declaring chronic pain a disease, whether of the body or of the brain, include increasing its legitimacy as clinical problem and research focus worthy of attention from healthcare and research organizations alike. But 1 problem with disease concepts is that having a disease favors medical solutions and tends to reduce patient participation. We argue that chronic pain, particularly chronic primary pain (recently designated a first tier pain diagnosis in International Diagnostic Codes 11), is a learned state that is not intransigent even if it has biological correlates. Chronic pain is sometimes a symptom, and may sometimes be its own disease. But here we question the value of a disease focus for much of chronic pain for which patient involvement is essential, and which may need a much broader societal approach than is suggested by the disease designation. PERSPECTIVE: This article examines whether designating chronic pain a disease of the body or brain is helpful or harmful to patients. Can the disease designation help advance treatment, and is it needed to achieve future therapeutic breakthrough? Or does it make patients over-reliant on medical intervention and reduce their engagement in the process of recovery?
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Affiliation(s)
- Jane C Ballantyne
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington.
| | - Mark D Sullivan
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
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3
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XENOHORMESIS UNDERLYES THE ANTI-AGING AND HEALTHY PROPERTIES OF OLIVE POLYPHENOLS. Mech Ageing Dev 2022; 202:111620. [PMID: 35033546 DOI: 10.1016/j.mad.2022.111620] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 12/08/2021] [Accepted: 01/05/2022] [Indexed: 02/08/2023]
Abstract
The paper provides a comprehensive and foundational mechanistic framework of hormesis that establishes its centrality in medicine and public health. This hormetic framework is applied to the assessment of olive polyphenols with respect to their capacity to slow the onset and reduce the magnitude of a wide range of age-related disorders and neurodegenerative diseases, including Alzheimer's Disease and Parkinson's Disease. It is proposed that olive polyphenol-induced anti-inflammatory protective effects are mediated in large part via the activation of AMPK and the upregulation of Nrf2 pathway. Consistently, herein we also review the importance of the modulation of Nrf2-related stress responsive vitagenes by olive polyphenols, which at low concentration according to the hormesis theory activates this neuroprotective cascade to preserve brain health and its potential use in the prevention and therapy against aging and age-related cognitive disorders in humans.
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4
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Ballantyne JC, Koob GF. Allostasis theory in opioid tolerance. Pain 2021; 162:2315-2319. [PMID: 33769368 DOI: 10.1097/j.pain.0000000000002280] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/17/2021] [Indexed: 01/29/2023]
Affiliation(s)
- Jane C Ballantyne
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - George F Koob
- National Institute of Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, United States
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5
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Maternal protein malnutrition prolongs sickness behavior in male offspring. J Neuroimmunol 2020; 341:577169. [DOI: 10.1016/j.jneuroim.2020.577169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 01/23/2020] [Accepted: 01/23/2020] [Indexed: 01/01/2023]
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6
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Giurgescu C, Nowak AL, Gillespie S, Nolan TS, Anderson CM, Ford JL, Hood DB, Williams KP. Neighborhood Environment and DNA Methylation: Implications for Cardiovascular Disease Risk. J Urban Health 2019; 96:23-34. [PMID: 30635842 PMCID: PMC6430282 DOI: 10.1007/s11524-018-00341-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Exposure to chronic stress such as living in disadvantaged neighborhoods has been related to cardiovascular disease (CVD). Chronic stress may increase the risk for CVD by increasing levels of systemic inflammation (e.g., higher levels of pro-inflammatory cytokines). Differential DNA methylation of inflammation-related candidate genes is also related to higher risk for CVD. Thus, the purpose of this review was to examine the association of neighborhood disadvantage with DNA methylation. A search of literature was conducted using Scopus, CINAHL, PubMed, Medline, and Embase databases. The keywords neighborhood, neighborhood disorder, neighborhood crime, neighborhood violence, neighborhood safety, built environment, and housing vacancy were combined with the keywords DNA methylation and epigenetics. Five studies were included in this review (n = 3 adult blood samples and n = 2 fetal blood samples). Four of the five studies reported an association of neighborhood socioeconomic status, social environment, and crime with either global or gene-specific DNA methylation. Only two studies examined the association of neighborhood disadvantage with inflammation-related candidate genes. One of these studies found a significant association of neighborhood socioeconomic disadvantage and social environment with DNA methylation in inflammation-related candidate genes. Thus, data are limited on the association between neighborhood disadvantage and DNA methylation of inflammation-related candidate genes, as well as genes in other potential mechanistic pathways including psychosocial stress, toxin response, and adiposity. Future studies should examine these associations and the potential epigenetic mechanisms by which neighborhood disadvantage increases the risk for CVD.
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Affiliation(s)
- Carmen Giurgescu
- College of Nursing, The Ohio State University, Columbus, OH, USA.
| | | | | | - Timiya S Nolan
- College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Cindy M Anderson
- College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Jodi L Ford
- College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Daryl B Hood
- College of Public Health, The Ohio State University, Columbus, OH, USA
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Messerli-Bürgy N, Arhab A, Stülb K, Kakebeeke TH, Zysset AE, Leeger-Aschmann CS, Schmutz EA, Ehlert U, Kriemler S, Jenni OG, Munsch S, Puder JJ. Physiological stress measures in preschool children and their relationship with body composition and behavioral problems. Dev Psychobiol 2018; 60:1009-1022. [DOI: 10.1002/dev.21782] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 07/26/2018] [Accepted: 08/06/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Nadine Messerli-Bürgy
- Department of Clinical Psychology and Psychotherapy; University of Fribourg; Fribourg Switzerland
- Department of Psychology; University of Fribourg; Fribourg Switzerland
- Endocrinology, Diabetes & Metabolism Service; Centre Hospitalier Universitaire Vaudois (CHUV); Lausanne Switzerland
| | - Amar Arhab
- Endocrinology, Diabetes & Metabolism Service; Centre Hospitalier Universitaire Vaudois (CHUV); Lausanne Switzerland
| | - Kerstin Stülb
- Department of Clinical Psychology and Psychotherapy; University of Fribourg; Fribourg Switzerland
| | - Tanja H. Kakebeeke
- Child Development Center; University Children's Hospital Zurich; Zurich Switzerland
- Children's Research Center; University Children's Hospital Zurich; Zurich Switzerland
| | - Annina E. Zysset
- Child Development Center; University Children's Hospital Zurich; Zurich Switzerland
| | | | - Einat A. Schmutz
- Epidemiology, Biostatistics and Prevention Institute; University of Zurich; Zurich Switzerland
| | - Ulrike Ehlert
- Department of Psychology - Clinical Psychology and Psychotherapy; University of Zurich; Zurich Switzerland
| | - Susi Kriemler
- Epidemiology, Biostatistics and Prevention Institute; University of Zurich; Zurich Switzerland
| | - Oskar G. Jenni
- Child Development Center; University Children's Hospital Zurich; Zurich Switzerland
- Children's Research Center; University Children's Hospital Zurich; Zurich Switzerland
| | - Simone Munsch
- Department of Clinical Psychology and Psychotherapy; University of Fribourg; Fribourg Switzerland
| | - Jardena J. Puder
- Endocrinology, Diabetes & Metabolism Service; Centre Hospitalier Universitaire Vaudois (CHUV); Lausanne Switzerland
- Division of Pediatric Endocrinology, Diabetology and Obesity; Centre Hospitalier Universitaire Vaudois (CHUV); Lausanne Switzerland
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Mechanisms of cortisol - Substance use development associations: Hypothesis generation through gene enrichment analysis. Neurosci Biobehav Rev 2018; 92:128-139. [PMID: 29802855 DOI: 10.1016/j.neubiorev.2018.05.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 04/18/2018] [Accepted: 05/15/2018] [Indexed: 11/21/2022]
Abstract
There are many theories about the mechanisms of associations between hypothalamic-pituitary-adrenal (HPA) function (indexed by cortisol) and substance use. However, the potential for genes that contribute to both HPA function and substance use to confound the association (e.g., genetic confounding) has largely been ignored. We explore the potential role of genetics in cortisol-substance use associations, build a conceptual framework placing theories and mechanisms for how cortisol and substance use are related into a developmental progression, and develop new hypotheses based on our findings. We conclude that the relationship between cortisol function and substance use is complex, occurs at multiple levels of analysis, and is bidirectional at multiple phases of the substance use progression. Additionally, there is potential for genetic confounding in cortisol-substance use associations, and thus a need for genetically informed designs to investigate how and why cortisol function is associated with substance use phenotypes from initiation through disorder. Gene-environment interplay and developmental context are likely to impact the effectiveness of prevention and intervention efforts to reduce substance use problems.
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9
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Jay GW, Barkin RL. Primary Headache Disorders Part I- Migraine and the Trigeminal Autonomic Cephalalgias. Dis Mon 2017; 63:308-338. [DOI: 10.1016/j.disamonth.2017.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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10
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Freese J, Klement RJ, Ruiz-Núñez B, Schwarz S, Lötzerich H. The sedentary (r)evolution: Have we lost our metabolic flexibility? F1000Res 2017; 6:1787. [PMID: 29225776 DOI: 10.12688/f1000research.12724.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2017] [Indexed: 12/19/2022] Open
Abstract
During the course of evolution, up until the agricultural revolution, environmental fluctuations forced the human species to develop a flexible metabolism in order to adapt its energy needs to various climate, seasonal and vegetation conditions. Metabolic flexibility safeguarded human survival independent of food availability. In modern times, humans switched their primal lifestyle towards a constant availability of energy-dense, yet often nutrient-deficient, foods, persistent psycho-emotional stressors and a lack of exercise. As a result, humans progressively gain metabolic disorders, such as the metabolic syndrome, type 2 diabetes, non-alcoholic fatty liver disease, certain types of cancer, cardiovascular disease and Alzheimer´s disease, wherever the sedentary lifestyle spreads in the world. For more than 2.5 million years, our capability to store fat for times of food shortage was an outstanding survival advantage. Nowadays, the same survival strategy in a completely altered surrounding is responsible for a constant accumulation of body fat. In this article, we argue that the metabolic disease epidemic is largely based on a deficit in metabolic flexibility. We hypothesize that the modern energetic inflexibility, typically displayed by symptoms of neuroglycopenia, can be reversed by re-cultivating suppressed metabolic programs, which became obsolete in an affluent environment, particularly the ability to easily switch to ketone body and fat oxidation. In a simplified model, the basic metabolic programs of humans' primal hunter-gatherer lifestyle are opposed to the current sedentary lifestyle. Those metabolic programs, which are chronically neglected in modern surroundings, are identified and conclusions for the prevention of chronic metabolic diseases are drawn.
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Affiliation(s)
- Jens Freese
- Institute of Outdoor Sports and Environmental Science, German Sports University Cologne, Cologne, 50933, Germany
| | - Rainer Johannes Klement
- Department of Radiotherapy and Radiation Oncology, Leopoldina Hospital Schweinfurt, Schweinfurt, 97422, Germany
| | - Begoña Ruiz-Núñez
- Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9713, Netherlands
| | - Sebastian Schwarz
- University College Physiotherapy Thim van der Laan,, Landquart, 7302, Switzerland
| | - Helmut Lötzerich
- Institute of Outdoor Sports and Environmental Science, German Sports University Cologne, Cologne, 50933, Germany
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11
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Freese J, Klement RJ, Ruiz-Núñez B, Schwarz S, Lötzerich H. The sedentary (r)evolution: Have we lost our metabolic flexibility? F1000Res 2017; 6:1787. [PMID: 29225776 PMCID: PMC5710317 DOI: 10.12688/f1000research.12724.2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2018] [Indexed: 12/18/2022] Open
Abstract
During the course of evolution, up until the agricultural revolution, environmental fluctuations forced the human species to develop a flexible metabolism in order to adapt its energy needs to various climate, seasonal and vegetation conditions. Metabolic flexibility safeguarded human survival independent of food availability. In modern times, humans switched their primal lifestyle towards a constant availability of energy-dense, yet often nutrient-deficient, foods, persistent psycho-emotional stressors and a lack of exercise. As a result, humans progressively gain metabolic disorders, such as the metabolic syndrome, type 2 diabetes, non-alcoholic fatty liver disease, certain types of cancer, cardiovascular disease and Alzheimer´s disease, wherever the sedentary lifestyle spreads in the world. For more than 2.5 million years, our capability to store fat for times of food shortage was an outstanding survival advantage. Nowadays, the same survival strategy in a completely altered surrounding is responsible for a constant accumulation of body fat. In this article, we argue that the metabolic disease epidemic is largely based on a deficit in metabolic flexibility. We hypothesize that the modern energetic inflexibility, typically displayed by symptoms of neuroglycopenia, can be reversed by re-cultivating suppressed metabolic programs, which became obsolete in an affluent environment, particularly the ability to easily switch to ketone body and fat oxidation. In a simplified model, the basic metabolic programs of humans’ primal hunter-gatherer lifestyle are opposed to the current sedentary lifestyle. Those metabolic programs, which are chronically neglected in modern surroundings, are identified and conclusions for the prevention of chronic metabolic diseases are drawn.
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Affiliation(s)
- Jens Freese
- Institute of Outdoor Sports and Environmental Science, German Sports University Cologne, Cologne, 50933, Germany
| | - Rainer Johannes Klement
- Department of Radiotherapy and Radiation Oncology, Leopoldina Hospital Schweinfurt, Schweinfurt, 97422, Germany
| | - Begoña Ruiz-Núñez
- Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9713, Netherlands
| | - Sebastian Schwarz
- University College Physiotherapy Thim van der Laan,, Landquart, 7302, Switzerland
| | - Helmut Lötzerich
- Institute of Outdoor Sports and Environmental Science, German Sports University Cologne, Cologne, 50933, Germany
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12
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Sagner M, McNeil A, Puska P, Auffray C, Price ND, Hood L, Lavie CJ, Han ZG, Chen Z, Brahmachari SK, McEwen BS, Soares MB, Balling R, Epel E, Arena R. The P4 Health Spectrum – A Predictive, Preventive, Personalized and Participatory Continuum for Promoting Healthspan. PROGRESS IN PREVENTIVE MEDICINE 2017. [DOI: 10.1097/pp9.0000000000000002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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13
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Sealy-Jefferson S, Giurgescu C, Slaughter-Acey J, Caldwell C, Misra D. Neighborhood Context and Preterm Delivery among African American Women: the Mediating Role of Psychosocial Factors. J Urban Health 2016; 93:984-996. [PMID: 27704384 PMCID: PMC5126020 DOI: 10.1007/s11524-016-0083-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Preterm delivery (PTD), or birth before 37 completed weeks of gestation, is a serious public health issue, and racial disparities persist. In a recently published study, perceptions of the residential environment (or neighborhood context) were associated with PTD rates among urban African American women with low educational attainment (≤12 years); however, the mechanisms of these associations are unknown. Given this gap in the literature, we used data from the Life Influences on Fetal Environments Study of postpartum African American women from Metropolitan Detroit, Michigan (2009-2011; n = 399), to examine whether psychosocial factors (depressive symptomology, psychological distress, and perceived stress) mediate associations between perceptions of the neighborhood context and PTD. Validated scales were used to measure women's perceptions of their neighborhood safety, walkability, healthy food availability (higher=better), and social disorder (higher=more disorder). The psychosocial indicators were measured with the Center for Epidemiologic Studies-Depression Scale, Kessler's Psychological Distress Scale (K6), and Cohen's Perceived Stress Scale. Statistical mediation was assessed using an unadjusted logistic regression-based path analysis for estimating direct and indirect effects. The associations between perceived walkability, food availability, and social disorder were not mediated by psychosocial factors. However, perceptions of neighborhood safety were inversely associated with depressive symptoms which were positively associated with PTD rates. Also, higher perceived neighborhood social disorder was associated with higher PTD rates, net of the indirect paths through psychosocial factors. Future research should identify other mechanisms of the perceived neighborhood context-PTD associations, which would inform PTD prevention efforts among high-risk groups.
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Affiliation(s)
| | | | | | | | - Dawn Misra
- Wayne State University, Detroit, MI, USA
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14
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Pellissier S, Bonaz B. The Place of Stress and Emotions in the Irritable Bowel Syndrome. VITAMINS AND HORMONES 2016; 103:327-354. [PMID: 28061975 DOI: 10.1016/bs.vh.2016.09.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Our emotional state can have many consequences on our somatic health and well-being. Negative emotions such as anxiety play a major role in gut functioning due to the bidirectional communications between gut and brain, namely, the brain-gut axis. The irritable bowel syndrome (IBS), characterized by an unusual visceral hypersensitivity, is the most common disorder encountered by gastroenterologists. Among the main symptoms, the presence of current or recurrent abdominal pain or discomfort associated with bloating and altered bowel habits characterizes this syndrome that could strongly alter the quality of life. This chapter will present the physiopathology of IBS and explain how stress influences gastrointestinal functions (permeability, motility, microbiota, sensitivity, secretion) and how it could be predominantly involved in IBS. This chapter will also describe the role of the autonomic nervous system and the hypothalamic-pituitary axis through vagal tone and cortisol homeostasis. An analysis is made about how emotions and feelings are involved in the disruption of homeostasis, and we will see to what extent the balance between vagal tone and cortisol may reflect dysfunctions of the brain-gut homeostasis. Finally, the interest of therapeutic treatments focused on stress reduction and vagal tone enforcement is discussed.
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Affiliation(s)
- S Pellissier
- Laboratoire Interuniversitaire de Psychologie, Personnalité, Cognition, Changement Social, Université Savoie Mont-Blanc, Chambéry, France.
| | - B Bonaz
- Clinique Universitaire d'Hépato-Gastroentérologie, CHU de Grenoble, Grenoble 09, France; Université Grenoble Alpes, Grenoble Institut des Neurosciences, Fonctions Cérébrales et Neuromodulation, INSERM, Grenoble 09, France
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15
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Sagner M, McNeil A, Puska P, Auffray C, Price ND, Hood L, Lavie CJ, Han ZG, Chen Z, Brahmachari SK, McEwen BS, Soares MB, Balling R, Epel E, Arena R. The P4 Health Spectrum - A Predictive, Preventive, Personalized and Participatory Continuum for Promoting Healthspan. Prog Cardiovasc Dis 2016; 59:506-521. [PMID: 27546358 DOI: 10.1016/j.pcad.2016.08.002] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 08/10/2016] [Indexed: 02/06/2023]
Abstract
Chronic diseases (i.e., noncommunicable diseases), mainly cardiovascular disease, cancer, respiratory diseases and type-2-diabetes, are now the leading cause of death, disability and diminished quality of life on the planet. Moreover, these diseases are also a major financial burden worldwide, significantly impacting the economy of many countries. Healthcare systems and medicine have progressively improved upon the ability to address infectious diseases and react to adverse health events through both surgical interventions and pharmacology; we have become efficient in delivering reactive care (i.e., initiating interventions once an individual is on the verge of or has actually suffered a negative health event). However, with slowly progressing and often 'silent' chronic diseases now being the main cause of illness, healthcare and medicine must evolve into a proactive system, moving away from a merely reactive approach to care. Minimal interactions among the specialists and limited information to the general practitioner and to the individual receiving care lead to a fragmented health approach, non-concerted prescriptions, a scattered follow-up and a suboptimal cost-effectiveness ratio. A new approach in medicine that is predictive, preventive, personalized and participatory, which we label here as "P4" holds great promise to reduce the burden of chronic diseases by harnessing technology and an increasingly better understanding of environment-biology interactions, evidence-based interventions and the underlying mechanisms of chronic diseases. In this concept paper, we propose a 'P4 Health Continuum' model as a framework to promote and facilitate multi-stakeholder collaboration with an orchestrated common language and an integrated care model to increase the healthspan.
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Affiliation(s)
- Michael Sagner
- College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA; SARENA Clinic, Medical Center and Research Institute.
| | - Amy McNeil
- College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Pekka Puska
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Charles Auffray
- European Institute for Systems Biology and Medicine, Paris and Lyon, France
| | | | - Leroy Hood
- Institute for Systems Biology, Seattle, WA, USA
| | - Carl J Lavie
- Department of Cardiovascular Diseases, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA, USA
| | - Ze-Guang Han
- Key Laboratory of Systems Biomedicine (Ministry of Education), Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhu Chen
- Key Laboratory of Systems Biomedicine (Ministry of Education), Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, Shanghai, China
| | - Samir Kumar Brahmachari
- Academy of Scientific and Innovative Research, CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Bruce S McEwen
- Harold and Margaret Milliken Hatch Laboratory of Neuroendocrinology, The Rockefeller University, New York, NY, USA
| | | | - Rudi Balling
- Luxembourg Centre for Systems Biomedicine (LCSB), Esch-sur-Alzette, Luxembourg
| | - Elissa Epel
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA
| | - Ross Arena
- College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA; SARENA Clinic, Medical Center and Research Institute
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16
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Messerli-Bürgy N, Kakebeeke TH, Arhab A, Stülb K, Zysset AE, Leeger-Aschmann CS, Schmutz EA, Fares F, Meyer AH, Munsch S, Kriemler S, Jenni OG, Puder JJ. The Swiss Preschoolers' health study (SPLASHY): objectives and design of a prospective multi-site cohort study assessing psychological and physiological health in young children. BMC Pediatr 2016; 16:85. [PMID: 27390933 PMCID: PMC4939002 DOI: 10.1186/s12887-016-0617-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 06/29/2016] [Indexed: 11/15/2022] Open
Abstract
Background Children’s psychological and physiological health can be summarized as the child’s thinking, feeling, behaving, eating, growing, and moving. Children’s psychological and physiological health conditions are influenced by today’s life challenges: Thus, stress exposure and lack of physical activity represent important health challenges in older children. However, corresponding evidence for young children is scarce. The aim of Swiss Preschoolers’ Health Study (SPLASHY) is to examine the role of stress and physical activity on children’s psychological and physiological health, particularly on cognitive functioning, psychological well-being, adiposity and motor skills in children at an early stage of childhood. We will also assess the role of child and environmental characteristics and aim to define sensitive time points. Methods/design In a total of 84 child care centers, children at preschool age (2–6 years) are recruited and are assessed immediately and one year later. Assessments include direct measurements of the children in the child care centers and at home as well as assessments of children’s behavior and environmental factors through informants (parents and child care educators). Discussion SPLASHY is one of the first studies in early childhood aiming to investigate the influence of stress and physical activity on children’s psychological and physiological health in a community-based longitudinal design. Trial registration Current Controlled Trials ISRCTN41045021 (date of registration: 21.03.14)
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Affiliation(s)
- Nadine Messerli-Bürgy
- Endocrinology, Diabetes & Metabolism Service, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland. .,Department of Clinical Psychology and Psychotherapy, University of Fribourg, Fribourg, Switzerland.
| | - Tanja H Kakebeeke
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Amar Arhab
- Endocrinology, Diabetes & Metabolism Service, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Kerstin Stülb
- Department of Clinical Psychology and Psychotherapy, University of Fribourg, Fribourg, Switzerland
| | - Annina E Zysset
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
| | | | - Einat A Schmutz
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Fady Fares
- Endocrinology, Diabetes & Metabolism Service, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Andrea H Meyer
- Department of Psychology, University of Basel, Basel, Switzerland
| | - Simone Munsch
- Department of Clinical Psychology and Psychotherapy, University of Fribourg, Fribourg, Switzerland
| | - Susi Kriemler
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Oskar G Jenni
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Jardena J Puder
- Endocrinology, Diabetes & Metabolism Service, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.,Division of Pediatric Endocrinology, Diabetology and Obesity, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
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17
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Peters A, McEwen BS. Stress habituation, body shape and cardiovascular mortality. Neurosci Biobehav Rev 2015; 56:139-50. [DOI: 10.1016/j.neubiorev.2015.07.001] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 06/30/2015] [Accepted: 07/01/2015] [Indexed: 12/21/2022]
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18
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Burstein R, Noseda R, Borsook D. Migraine: multiple processes, complex pathophysiology. J Neurosci 2015; 35:6619-29. [PMID: 25926442 PMCID: PMC4412887 DOI: 10.1523/jneurosci.0373-15.2015] [Citation(s) in RCA: 457] [Impact Index Per Article: 50.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 03/09/2015] [Accepted: 03/20/2015] [Indexed: 12/29/2022] Open
Abstract
Migraine is a common, multifactorial, disabling, recurrent, hereditary neurovascular headache disorder. It usually strikes sufferers a few times per year in childhood and then progresses to a few times per week in adulthood, particularly in females. Attacks often begin with warning signs (prodromes) and aura (transient focal neurological symptoms) whose origin is thought to involve the hypothalamus, brainstem, and cortex. Once the headache develops, it typically throbs, intensifies with an increase in intracranial pressure, and presents itself in association with nausea, vomiting, and abnormal sensitivity to light, noise, and smell. It can also be accompanied by abnormal skin sensitivity (allodynia) and muscle tenderness. Collectively, the symptoms that accompany migraine from the prodromal stage through the headache phase suggest that multiple neuronal systems function abnormally. As a consequence of the disease itself or its genetic underpinnings, the migraine brain is altered structurally and functionally. These molecular, anatomical, and functional abnormalities provide a neuronal substrate for an extreme sensitivity to fluctuations in homeostasis, a decreased ability to adapt, and the recurrence of headache. Advances in understanding the genetic predisposition to migraine, and the discovery of multiple susceptible gene variants (many of which encode proteins that participate in the regulation of glutamate neurotransmission and proper formation of synaptic plasticity) define the most compelling hypothesis for the generalized neuronal hyperexcitability and the anatomical alterations seen in the migraine brain. Regarding the headache pain itself, attempts to understand its unique qualities point to activation of the trigeminovascular pathway as a prerequisite for explaining why the pain is restricted to the head, often affecting the periorbital area and the eye, and intensifies when intracranial pressure increases.
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Affiliation(s)
- Rami Burstein
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, Harvard Medical School, Boston, Massachusetts 02115
| | - Rodrigo Noseda
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, Harvard Medical School, Boston, Massachusetts 02115
| | - David Borsook
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts 02115, and Harvard Medical School, Boston, Massachusetts 02115
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19
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Ramsay DS, Al-Noori S, Shao J, Leroux BG, Woods SC, Kaiyala KJ. Predicting addictive vulnerability: individual differences in initial responding to a drug's pharmacological effects. PLoS One 2015; 10:e0124740. [PMID: 25880426 PMCID: PMC4400068 DOI: 10.1371/journal.pone.0124740] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 03/04/2015] [Indexed: 12/31/2022] Open
Abstract
Considerable data suggest that individuals who appear minimally disrupted during an initial drug administration have elevated risk for abusing the drug later. A better understanding of this association could lead to more effective strategies for preventing and treating drug addiction. To investigate this phenomenon using a rigorous experimental model, we first administered the abused inhalant nitrous oxide (N2O) to rats in a total calorimetry and temperature system to identify groups that were sensitive or insensitive to the drug’s hypothermic effect. We then enrolled the two groups in a novel N2O self-administration paradigm. The initially insensitive rats self-administered significantly more N2O than sensitive rats, an important step in the transition to addiction. Continuous non-invasive measurement of core temperature and its underlying determinants during screening revealed that both groups had similarly increased heat loss during initial N2O administration, but that insensitive rats generated more heat and thereby remained relatively normothermic. Calorimetry testing conducted after self-administration revealed that whereas N2O’s effect on heat loss persisted comparably for both groups, initially insensitive rats actually over-responded by generating excess heat and becoming hyperthermic. Thus, rats with the greatest initial heat-producing compensatory response(s) appeared initially insensitive to N2O-induced hypothermia, subsequently self-administered more N2O, and developed hyperthermic overcompensation during N2O inhalation, consistent with increased abuse potential and an allostatic model of addictive vulnerability.
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Affiliation(s)
- Douglas S. Ramsay
- Department of Oral Health Sciences, University of Washington, Seattle, WA, United States of America
- * E-mail:
| | - Salwa Al-Noori
- Department of Oral Health Sciences, University of Washington, Seattle, WA, United States of America
| | - Jason Shao
- Department of Biostatistics, University of Washington, Seattle, WA, United States of America
| | - Brian G. Leroux
- Department of Oral Health Sciences, University of Washington, Seattle, WA, United States of America
- Department of Biostatistics, University of Washington, Seattle, WA, United States of America
| | - Stephen C. Woods
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, United States of America
| | - Karl J. Kaiyala
- Department of Oral Health Sciences, University of Washington, Seattle, WA, United States of America
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20
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Nederhof E, Marceau K, Shirtcliff EA, Hastings PD, Oldehinkel AJ. Autonomic and Adrenocortical Interactions Predict Mental Health in Late Adolescence: The TRAILS Study. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2014; 43:847-61. [DOI: 10.1007/s10802-014-9958-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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21
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Pellissier S, Dantzer C, Mondillon L, Trocme C, Gauchez AS, Ducros V, Mathieu N, Toussaint B, Fournier A, Canini F, Bonaz B. Relationship between vagal tone, cortisol, TNF-alpha, epinephrine and negative affects in Crohn's disease and irritable bowel syndrome. PLoS One 2014; 9:e105328. [PMID: 25207649 PMCID: PMC4160179 DOI: 10.1371/journal.pone.0105328] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 07/20/2014] [Indexed: 12/27/2022] Open
Abstract
Crohn's disease (CD) and irritable bowel syndrome (IBS) involve brain-gut dysfunctions where vagus nerve is an important component. The aim of this work was to study the association between vagal tone and markers of stress and inflammation in patients with CD or IBS compared to healthy subjects (controls). The study was performed in 73 subjects (26 controls, 21 CD in remission and 26 IBS patients). The day prior to the experiment, salivary cortisol was measured at 8:00 AM and 10:00 PM. The day of the experiment, subjects completed questionnaires for anxiety (STAI) and depressive symptoms (CES-D). After 30 min of rest, ECG was recorded for heart rate variability (HRV) analysis. Plasma cortisol, epinephrine, norepinephrine, TNF-alpha and IL-6 were measured in blood samples taken at the end of ECG recording. Compared with controls, CD and IBS patients had higher scores of state-anxiety and depressive symptomatology. A subgroup classification based on HRV-normalized high frequency band (HFnu) as a marker of vagal tone, showed that control subjects with high vagal tone had significantly lower evening salivary cortisol levels than subjects with low vagal tone. Such an effect was not observed in CD and IBS patients. Moreover, an inverse association (r = -0.48; p<0.05) was observed between the vagal tone and TNF-alpha level in CD patients exclusively. In contrast, in IBS patients, vagal tone was inversely correlated with plasma epinephrine (r = -0.39; p<0.05). No relationship was observed between vagal tone and IL-6, norepinephrine or negative affects (anxiety and depressive symptomatology) in any group. In conclusion, these data argue for an imbalance between the hypothalamus-pituitary-adrenal axis and the vagal tone in CD and IBS patients. Furthermore, they highlight the specific homeostatic link between vagal tone and TNF-alpha in CD and epinephrine in IBS and argue for the relevance of vagus nerve reinforcement interventions in those diseases.
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Affiliation(s)
- Sonia Pellissier
- Grenoble Institut des Neurosciences (GIN), Centre de Recherche INSERM 836 Equipe : Stress et Interactions Neuro-Digestives (EA3744), Université Joseph Fourier, Grenoble, France
- Département de Psychologie, Université de Savoie, Chambéry, France
| | - Cécile Dantzer
- Laboratoire Interuniversitaire de Psychologie: Personnalité, Cognition, Changement social (LIP/PC2S), Université de Savoie, Chambéry, France
| | - Laurie Mondillon
- Laboratoire de Psychologie Sociale et Cognitive (LAPSCO, CNRS UMR6024), Université Blaise Pascal, Clermont-Ferrand, France
| | - Candice Trocme
- Institut de Biologie, Centre Hospitalo-Universitaire de Grenoble, Grenoble, France
| | - Anne-Sophie Gauchez
- Institut de Biologie, Centre Hospitalo-Universitaire de Grenoble, Grenoble, France
| | - Véronique Ducros
- Institut de Biologie, Centre Hospitalo-Universitaire de Grenoble, Grenoble, France
| | - Nicolas Mathieu
- Clinique Universitaire d’Hépato-Gastroentérologie, Centre Hospitalo-Universitaire de Grenoble, Grenoble, France
| | - Bertrand Toussaint
- Institut de Biologie, Centre Hospitalo-Universitaire de Grenoble, Grenoble, France
- Laboratoire TIMC/TheREx UMR 5525, Université Joseph Fourier, Grenoble, France
| | - Alicia Fournier
- Laboratoire de Psychologie Sociale et Cognitive (LAPSCO, CNRS UMR6024), Université Blaise Pascal, Clermont-Ferrand, France
| | - Frédéric Canini
- Unité de Neurophysiologie du Stress, Institut de Recherche Biomédicale des Armées (IRBA), Brétigny-sur-Orge, France
- Ecole du Val de Grâce, Paris, France
| | - Bruno Bonaz
- Grenoble Institut des Neurosciences (GIN), Centre de Recherche INSERM 836 Equipe : Stress et Interactions Neuro-Digestives (EA3744), Université Joseph Fourier, Grenoble, France
- Clinique Universitaire d’Hépato-Gastroentérologie, Centre Hospitalo-Universitaire de Grenoble, Grenoble, France
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Kinser PA, Lyon DE. A conceptual framework of stress vulnerability, depression, and health outcomes in women: potential uses in research on complementary therapies for depression. Brain Behav 2014; 4:665-74. [PMID: 25328843 PMCID: PMC4107381 DOI: 10.1002/brb3.249] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 05/07/2014] [Accepted: 06/09/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Depression is a chronic mental health condition that affects millions of individuals worldwide. It is well-established that psychological stress plays an integral role in depression and that depression has numerous negative health outcomes. However, a closer look at components of stress vulnerabilities and depression is required to allow for the development and testing of appropriate interventions. AIMS AND DISCUSSION This article describes a conceptual framework about the complex and bidirectional relationship between stress vulnerability, depression, and health outcomes in women. The authors elucidate how the framework can be applied in clinical research about cellular aging and on the mechanisms of complementary and alternative medicine (CAM) for depression, using yoga as an example of a CAM modality. CONCLUSION The proposed conceptual framework may be helpful for adding depth to the body of knowledge about the use of mind-body therapies for individuals at high risk of stress vulnerability and/or depression.
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Affiliation(s)
- Patricia A Kinser
- Department of Family and Community Health Nursing, School of Nursing, Virginia Commonwealth University PO Box 980567, Richmond, Virginia, 23298-0567
| | - Debra E Lyon
- School of Nursing, University of Florida PO Box 100197, Gainesville, Florida, 32610-0197
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Abstract
Homeostasis, the dominant explanatory framework for physiological regulation, has undergone significant revision in recent years, with contemporary models differing significantly from the original formulation. Allostasis, an alternative view of physiological regulation, goes beyond its homeostatic roots, offering novel insights relevant to our understanding and treatment of several chronic health conditions. Despite growing enthusiasm for allostasis, the concept remains diffuse, due in part to ambiguity as to how the term is understood and used, impeding meaningful translational and clinical research on allostasis. Here, we provide a more focused understanding of homeostasis and allostasis by explaining how both play a role in physiological regulation, and a critical analysis of regulation suggests how homeostasis and allostasis can be distinguished. Rather than focusing on changes in the value of a regulated variable (e.g., body temperature, body adiposity, or reward), research investigating the activity and relationship among the multiple regulatory loops that influence the value of these regulated variables may be the key to distinguishing homeostasis and allostasis. The mechanisms underlying physiological regulation and dysregulation are likely to have important implications for health and disease.
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Affiliation(s)
- Douglas S. Ramsay
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, USA
- Department of Orthodontics, University of Washington, Seattle, Washington, USA
- Department of Pediatric Dentistry, University of Washington, Seattle, Washington, USA
| | - Stephen C. Woods
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
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Relationship of serum carotenoid concentrations with allostatic load as a measure of chronic stress among middle-aged adults in the USA. Public Health Nutr 2014; 18:313-21. [PMID: 24513032 DOI: 10.1017/s1368980014000056] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Chronic stress and repeated physiological attempts at stress adaptation may result in 'fatigue' and suboptimal performance of multiple physiological systems, i.e. allostatic load (AL). Although carotenoids have been linked with individual cardiovascular, metabolic and inflammatory biomarkers, little is known about the relationship of carotenoids with the multi-system biomarker measure of stress, AL. The present study examined the association of serum concentrations of carotenoids with AL among middle-aged adults. DESIGN Cross-sectional. AL score was calculated based on nine risk-rated indicators (systolic and diastolic blood pressure, pulse rate, total and HDL-cholesterol, glycosylated Hb, sex-specific waist-to-hip ratio, albumin and C-reactive protein). SUBJECTS Middle-aged (45-64 years, n 3387) men and women participants in the Third National Health and Nutrition Examination Survey, NHANES III (1988-1994). RESULTS Serum β-carotene concentration was inversely associated with high AL after adjusting for age, education, race/ethnicity, serum cotinine, alcohol consumption, physical activity and other carotenoids (α-carotene, β-cryptoxanthin, lycopene, lutein/zeaxanthin). Females in the lowest β-carotene quartile were 2·94 (95 % CI 1·74, 4·94) times and males 2·90 (95 % CI 1·43, 5·89) times as likely to have high AL, compared with peers in the highest quartile (P for linear trend 0·001 and 0·018 for females and males, respectively). Mean serum β-carotene concentrations were also inversely associated with the number of 'high-risk' AL components (P for linear trend <0·001 and 0·004 for females and males, respectively). CONCLUSIONS Our study adds to evidence linking low β-carotene levels with unfavourable health outcomes.
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25
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Poole L, Leigh E, Kidd T, Ronaldson A, Jahangiri M, Steptoe A. The combined association of depression and socioeconomic status with length of post-operative hospital stay following coronary artery bypass graft surgery: data from a prospective cohort study. J Psychosom Res 2014; 76:34-40. [PMID: 24360139 PMCID: PMC3991423 DOI: 10.1016/j.jpsychores.2013.10.019] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 10/24/2013] [Accepted: 10/29/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To understand the association between pre-operative depression symptoms, including cognitive and somatic symptom subtypes, and length of post-operative stay in patients undergoing coronary artery bypass graft (CABG) surgery, and the role of socioeconomic status (SES). METHODS We measured depression symptoms using the Beck Depression Inventory (BDI) and household income in the month prior to surgery in 310 participants undergoing elective, first-time, CABG. Participants were followed-up post-operatively to assess the length of their hospital stay. RESULTS We showed that greater pre-operative depression symptoms on the BDI were associated with a longer hospital stay (hazard ratio=0.978, 95% CI 0.957-0.999, p=.043) even after controlling for covariates, with the effect being observed for cognitive symptoms of depression but not somatic symptoms. Lower SES augmented the negative effect of depression on length of stay. CONCLUSIONS Depression symptoms interact with socioeconomic position to affect recovery following cardiac surgery and further work is needed in order to understand the pathways of this association.
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Affiliation(s)
- Lydia Poole
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, UK.
| | - Elizabeth Leigh
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, UK
| | - Tara Kidd
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, UK
| | - Amy Ronaldson
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, UK
| | - Marjan Jahangiri
- Department of Cardiac Surgery, St George's Hospital, University of London, Blackshaw Road, London, UK
| | - Andrew Steptoe
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, UK
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Giurgescu C, Engeland CG, Zenk SN, Kavanaugh K. Stress, Inflammation and Preterm Birth in African American Women. ACTA ACUST UNITED AC 2013. [DOI: 10.1053/j.nainr.2013.09.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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27
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Peters A, Kubera B, Hubold C, Langemann D. The corpulent phenotype-how the brain maximizes survival in stressful environments. Front Neurosci 2013; 7:47. [PMID: 23565074 PMCID: PMC3613700 DOI: 10.3389/fnins.2013.00047] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 03/13/2013] [Indexed: 11/14/2022] Open
Abstract
The reactivity of the stress system may change during the life course. In many—but not all—humans the stress reactivity decreases, once the individual is chronically exposed to a stressful and unsafe environment (e.g., poverty, work with high demands, unhappy martial relationship). Such an adaptation is referred to as habituation. Stress habituation allows alleviating the burden of chronic stress, particularly cardiovascular morbidity and mortality. Interestingly, two recent experiments demonstrated low stress reactivity during a mental or psychosocial challenge in subjects with a high body mass. In this focused review we attempt to integrate these experimental findings in a larger context. Are these data compatible with data sets showing a prolonged life expectancy in corpulent people? From the perspective of neuroenergetics, we here raise the question whether “obesity” is unhealthy at all. Is the corpulent phenotype possibly the result of “adaptive phenotypic plasticity” allowing optimized survival in stressful environments?
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Affiliation(s)
- Achim Peters
- Clinical Research Group: Brain Metabolism, Neuroenergetics, Obesity and Diabetes, University of Luebeck Luebeck, Germany
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28
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Stress and obesity as risk factors in cardiovascular diseases: a neuroimmune perspective. J Neuroimmune Pharmacol 2013; 8:212-26. [PMID: 23329173 DOI: 10.1007/s11481-012-9432-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 12/28/2012] [Indexed: 01/09/2023]
Abstract
Obesity is now growing at an alarming rate reaching epidemic proportions worldwide thus increasing morbidity and mortality rates for chronic disease. But although we have ample information on the complications associated with obesity, precisely what causes obesity remains poorly understood. Some evidence attributes a major role to a low-grade chronic inflammatory state (neurogenic inflammation) induced in obesity by inflammatory mediators produced and secreted within the expanded activated adipocyte pool. Adipose tissue is an endocrine organ that secretes numerous adipose tissue-specific or enriched hormones, known as adipokines, cytokine-like molecules thought to play a pathogenic role in cardiovascular diseases. The imbalance between increased inflammatory stimuli and decreased anti-inflammatory mechanisms may depend on chronic stress. Hence the positive correlation found between stress, obesity and cardiovascular diseases. The chronic inflammatory state associated with insulin resistance and endothelial dysfunction is highly deleterious for vascular function. This review focuses on the proposed neuroimmunodulatory mechanisms linking chronic (psychological) stress, obesity and cardiovascular diseases.
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29
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Kubera B, Hubold C, Zug S, Wischnath H, Wilhelm I, Hallschmid M, Entringer S, Langemann D, Peters A. The brain's supply and demand in obesity. FRONTIERS IN NEUROENERGETICS 2012; 4:4. [PMID: 22408618 PMCID: PMC3297086 DOI: 10.3389/fnene.2012.00004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 02/24/2012] [Indexed: 11/13/2022]
Abstract
During psychosocial stress, the brain demands extra energy from the body to satisfy its increased needs. For that purpose it uses a mechanism referred to as "cerebral insulin suppression" (CIS). Specifically, activation of the stress system suppresses insulin secretion from pancreatic beta-cells, and in this way energy-particularly glucose-is allocated to the brain rather than the periphery. It is unknown, however, how the brain of obese humans organizes its supply and demand during psychosocial stress. To answer this question, we examined 20 obese and 20 normal weight men in two sessions (Trier Social Stress Test and non-stress control condition followed by either a rich buffet or a meager salad). Blood samples were continuously taken and subjects rated their vigilance and mood by standard questionnaires. First, we found a low reactive stress system in obesity. While obese subjects showed a marked hormonal response to the psychosocial challenge, the cortisol response to the subsequent meal was absent. Whereas the brains of normal weight subjects demanded for extra energy from the body by using CIS, CIS was not detectable in obese subjects. Our findings suggest that the absence of CIS in obese subjects is due to the absence of their meal-related cortisol peak. Second, normal weight men were high reactive during psychosocial stress in changing their vigilance, thereby increasing their cerebral energy need, whereas obese men were low reactive in this respect. Third, normal weight subjects preferred carbohydrates after stress to supply their brain, while obese men preferred fat and protein instead. We conclude that the brain of obese people organizes its need, supply, and demand in a low reactive manner.
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Affiliation(s)
- Britta Kubera
- Medical Clinic 1, University of LübeckLübeck, Germany
| | | | - Sophia Zug
- Medical Clinic 1, University of LübeckLübeck, Germany
| | | | - Ines Wilhelm
- Department of Neuroendocrinology, University of LübeckLübeck, Germany
| | | | - Sonja Entringer
- Department of Psychiatry and Human Behavior, University of California, IrvineCA, USA
| | - Dirk Langemann
- Institute of Technical Computational Mathematics, University of BraunschweigBraunschweig, Germany
| | - Achim Peters
- Medical Clinic 1, University of LübeckLübeck, Germany
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