The combined effect of socioeconomic status and metabolic syndrome on depression: the Korean National Health and Nutrition Examination Survey (KNHANES)

The heterogeneity of metabolic syndrome presentation and challenges this causes in its pharmacological management: a narrative review focusing on principal risk modifiers

INTRODUCTION

Metabolic syndrome (MetS), i.e. the cluster of cardiometabolic risk factors comprising visceral obesity, impaired glucose metabolism, arterial hypertension and atherogenic dyslipidemia, is prevalent globally and exacts a heavy toll on health care expenditures.

AREAS COVERED

The pathophenotypes of individual traits of the MetS in adults are discussed first, with strong emphasis on nonalcoholic fatty liver disease (NAFLD) and sex differences. Next, I discuss recent studies on phenotypic and outcome heterogeneity of the MetS, highlighting the role of NAFLD, sex, reproductive status, and depressive disorders. In the second half of the article, the therapeutic implications of the variable MetS types and features are analyzed, focusing on the most recent developments, and guidelines.

EXPERT OPINION

I have identified physiological, pathological, social and medical sources of phenotypical heterogeneity in the MetS and its constitutive traits. Improved understanding of these variables may be utilized in the setting of future precision medicine approaches in the field of metabolic disorders and target organ damage.

A prospective registry analysis of psychosocial and metabolic health between women with and without metabolic syndrome after a complicated pregnancy

PURPOSE

Pregnancy complications affect over one quarter of Australian pregnancies, and this group of mothers is vulnerable and more likely to experience adverse cardiometabolic health outcomes in the postpartum period. Metabolic syndrome is common in this population and may be associated with postpartum mental health issues. However, this relationship remains poorly understood. To compare the differences in psychosocial parameters and mental health outcomes between women with metabolic syndrome and women without metabolic syndrome 6 months after a complicated pregnancy.

METHODS

This study is prospective registry analysis of women attending a postpartum healthy lifestyle clinic 6 months following a complicated pregnancy. Mental health measures included 9-item Patient Health Questionnaire (PHQ-9), 7-item Generalised Anxiety Disorder questionnaire (GAD-7), self-reported diagnosed history of depression, anxiety and/or other psychiatric condition, and current psychotropic medication use.

RESULTS

Women with metabolic syndrome reported significantly more subjective mental health concerns, were more likely to have a history of depression and other psychiatric diagnoses and were more likely prescribed psychotropic medications. However, there were no significant differences in PHQ-9 and GAD-7 scores.

CONCLUSION

Amongst new mothers who experienced complications of pregnancy, those with metabolic syndrome represent a particularly vulnerable group with regards to psychosocial disadvantage and mental health outcomes. These vulnerabilities may not be apparent when using common standardised cross-sectional mental health screening tools such as PHQ-9 and GAD-7.

Association of Muscle Strength with Non-Alcoholic Fatty Liver Disease in Korean Adults

Sarcopenia is known to be associated with non-alcoholic fatty liver disease (NAFLD). However, few studies have revealed the association between muscle strength and prevalence of NAFLD. We investigated the association by using relative handgrip strength in a nationwide cross-sectional survey. The participants were recruited from the Korean National Health and Nutrition Examination Surveys (KNHANES). A total of 27,531 subjects from the KNHANES were selected in our study. We used normalized handgrip strength, which is called relative handgrip strength. The index was defined as handgrip strength divided by BMI. These subjects were divided into quartile groups according to relative handgrip strength. NAFLD was defined as hepatic steatosis index >36. Multinomial logistic regression was analysed to investigate the association between relative handgrip strength with prevalence of NAFLD. The mean age of study population was 45.8 ± 0.3 in men, and 48.3 ± 0.2 in women. The proportion of males was 37.5%. In multiple linear regression, relative handgrip strength was inversely associated with HSI index (Standardized β = −0.70; standard error (SE), 0.08; p < 0.001 in men, Standardized β = −0.94; standard error (SE), 0.07; p < 0.001 in women). According to the logistic regression model, the prevalence of NAFLD decreased with quartile 4 groups in relative handgrip strength, compared with quartile 1 groups (OR 0.42 [0.32–0.55] in men; OR 0.30 [0.22–0.40] in women). Relative handgrip strength, used as a biomarker of sarcopenia, is independently inversely associated with NAFLD.

Biological, Psychological, and Social Determinants of Depression: A Review of Recent Literature

Depression is one of the leading causes of disability, and, if left unmanaged, it can increase the risk for suicide. The evidence base on the determinants of depression is fragmented, which makes the interpretation of the results across studies difficult. The objective of this study is to conduct a thorough synthesis of the literature assessing the biological, psychological, and social determinants of depression in order to piece together the puzzle of the key factors that are related to this condition. Titles and abstracts published between 2017 and 2020 were identified in PubMed, as well as Medline, Scopus, and PsycInfo. Key words relating to biological, social, and psychological determinants as well as depression were applied to the databases, and the screening and data charting of the documents took place. We included 470 documents in this literature review. The findings showed that there are a plethora of risk and protective factors (relating to biological, psychological, and social determinants) that are related to depression; these determinants are interlinked and influence depression outcomes through a web of causation. In this paper, we describe and present the vast, fragmented, and complex literature related to this topic. This review may be used to guide practice, public health efforts, policy, and research related to mental health and, specifically, depression.

Association between self-reported medical diagnosis of depression and metabolic syndrome in a population-based study: A propensity score-matched analysis

The aim was to compare the metabolic syndrome in adults with and without depression in Korea using the 2013-2015 Korea National Health and Nutrition Examination Survey. A cross-sectional study was conducted involving secondary data analysis. National survey data on the self-reported medical diagnosis of depression and metabolic syndrome were collected between 2013 and 2015 and released for research purposes in 2017. We conducted a propensity score-matched study that included adults (n = 494) with and without depression at a 1:1 ratio, to reduce the impact of potential confounding factors between groups. Depression was not significantly associated with changes in metabolic syndrome. However, participants with depression had significantly higher triglycerides than those without depression (p = .008), highlighting the importance of periodically checking triglycerides in depressed patients. Nurses need to check the subcomponents of metabolic syndrome in depressed patients periodically, especially regarding the management of triglycerides.

The role of multiparity and maternal age at first pregnancy in the association between early menarche and metabolic syndrome among middle-aged and older women

OBJECTIVE

To analyze whether maternal age at first pregnancy and parity are mediators of the association between early menarche and metabolic syndrome in a sample of middle-aged and older women.

METHODS

Cross-sectional study of 428 women (40 to 80 y), who had experienced a pregnancy in their lifetime, was performed between 2014 and 2016. Age at first pregnancy, parity, and early menarche were self-reported. Metabolic syndrome was assessed using the criteria described by the National Cholesterol Education Program's Adult Treatment Panel III. The association between metabolic syndrome and early menarche was assessed by logistic regression analysis. The mediating role of age at first pregnancy and multiparity in the relationship between early menarche and metabolic syndrome was assessed through mediation analysis, adjusted for covariates.

RESULTS

According to adjusted logistic regression models, early menarche was associated with higher odds of prevalent metabolic syndrome (OR: 2.26; 95% CI: 1.15-4.46). Mediation analysis showed a significant direct effect of early menarche on metabolic syndrome (β: 0.808; 95% CI: 0.107-1.508). Of the two mediators tested, age at first pregnancy was significant (β: 0.065; 95% CI: 0.004-0.221), ie, participants with and without early menarche differ, on average, by 0.879 SDs in the log odds of MetS (total effect), of which 0.065 SDs (8%), on average, would be attributable to the effect of early menarche on age at first pregnancy (indirect effect), which, in turn, affects MetS.

CONCLUSIONS

Age at first pregnancy may partially contribute to the association between early menarche and metabolic syndrome among middle-aged and older women who had experienced a pregnancy over their lifetime.

Discovery of Depression-Associated Factors From a Nationwide Population-Based Survey: Epidemiological Study Using Machine Learning and Network Analysis

BACKGROUND

In epidemiological studies, finding the best subset of factors is challenging when the number of explanatory variables is large.

OBJECTIVE

Our study had two aims. First, we aimed to identify essential depression-associated factors using the extreme gradient boosting (XGBoost) machine learning algorithm from big survey data (the Korea National Health and Nutrition Examination Survey, 2012-2016). Second, we aimed to achieve a comprehensive understanding of multifactorial features in depression using network analysis.

METHODS

An XGBoost model was trained and tested to classify "current depression" and "no lifetime depression" for a data set of 120 variables for 12,596 cases. The optimal XGBoost hyperparameters were set by an automated machine learning tool (TPOT), and a high-performance sparse model was obtained by feature selection using the feature importance value of XGBoost. We performed statistical tests on the model and nonmodel factors using survey-weighted multiple logistic regression and drew a correlation network among factors. We also adopted statistical tests for the confounder or interaction effect of selected risk factors when it was suspected on the network.

RESULTS

The XGBoost-derived depression model consisted of 18 factors with an area under the weighted receiver operating characteristic curve of 0.86. Two nonmodel factors could be found using the model factors, and the factors were classified into direct (P<.05) and indirect (P≥.05), according to the statistical significance of the association with depression. Perceived stress and asthma were the most remarkable risk factors, and urine specific gravity was a novel protective factor. The depression-factor network showed clusters of socioeconomic status and quality of life factors and suggested that educational level and sex might be predisposing factors. Indirect factors (eg, diabetes, hypercholesterolemia, and smoking) were involved in confounding or interaction effects of direct factors. Triglyceride level was a confounder of hypercholesterolemia and diabetes, smoking had a significant risk in females, and weight gain was associated with depression involving diabetes.

CONCLUSIONS

XGBoost and network analysis were useful to discover depression-related factors and their relationships and can be applied to epidemiological studies using big survey data.

Psychiatric morbidities of female obesity before and after dieting: an Egyptian sample

Background

The rate of occurrence of psychiatric morbidities like anxiety, depression, perceived stress, and the overall quality of life are very high among female patients with obesity; therefore, our study investigates such variables before and after weight loss in female patients on diet restriction; this can help obesity-multidisciplinary teams target these psychiatric correlates to reach a more satisfactory outcome.

Results

Anxiety, depression, and perceived stress scores decreased significantly in parallel to the weight loss reported (p < 0.0001). Except for social functioning, all other domains of quality of life improved significantly after weight loss. Those with higher education level showed significantly lower stress, anxiety, and depression scores before weight loss compared to married and highly educated ones respectively. After weight loss, highly educated participants showed lower perceived stress and depression scores than those with middle education.

Conclusions

Anxiety, depression, and perceived stress factors are significantly decreased after weight reduction with an improved quality of life as well compared to their scores prior.