Relationship between Depression and Constipation: Results from a Large Cross-sectional Study in Adults / 대한소화기학회지

Background/Aims@#Accumulating evidence based on a few studies suggests a relationship between depression and functional constipation. This study examined whether depression is associated with a higher risk of functional constipation and whether it is gender specific. @*Methods@#This cross-sectional study was carried out on 3,362 adults aged 18-55 years. In this study, functional gastrointestinal symptoms were determined using an Iranian reliable and valid version of the modified Rome III questionnaire. The Iranian validated version of the hospital anxiety and depression scale was used to evaluate the psychological health. Scores of eight or more on the depression subscale in the questionnaire were considered the presence of depression. Simple and multiple binary logistic regression were used for data analysis. @*Results@#The mean±SD age of participants was 36.29±7.87 years, and 58.5% were female. The prevalence of depression and constipation in the study sample was 28.6% and 23.9%, respectively. In the full adjusted model, in the total sample, depressed people showed a significantly higher risk of constipation; adjusted OR (AOR), 1.69 (95% CI, 1.37-2.09). Although a significant association was observed between depression and constipation in both genders, the association was stronger in men than women (AOR, 2.28; 95% CI, 1.50, 3.63 vs. AOR, 1.55; 95% CI, 1.21, 1.99). @*Conclusions@#These study findings showed that depressed people are at a significantly higher risk of being affected by constipation. The current study findings justify the importance of mental health evaluations in all patients with functional gastrointestinal disorders, particularly among constipated individuals.

Somatic Complaints Are Significantly Associated with Chronic Uninvestigated Dyspepsia and Its Symptoms: A Large Cross-sectional Population Based Study

BACKGROUND/AIMS: Somatization may influence persistence and severity of symptoms in gastrointestinal diseases. Some studies suggest that somatization is associated with chronic uninvestigated dyspepsia (CUD); however, the association is unclear. We aimed to determine the association between the profiles of somatic complaints with CUD and its symptoms. METHODS: In a cross-sectional study conducted on 4763 Iranian adults, somatic complaints were assessed using a comprehensive 31-items questionnaire. Patients with CUD were identified by the Rome III diagnostic criteria. Profiles of somatic complaints were derived from factor analysis. Logistic regression analysis was used to assess the relationship between extracted profiles with CUD and its symptoms. RESULTS: CUD, bothersome postprandial fullness, early satiation, and epigastric pain or burning was identified in 723 (15.2%), 384 (8.1%), 302 (6.3%), and 371 (7.8%) of the study population. The frequency of all 31 somatic complaints was significantly higher in patients with CUD compared with controls (P < 0.001), and the most frequent was severe fatigue (45.1%). The profiles of somatic complaints were extracted in 4 domains, including “psychological”, “gastrointestinal”, “neuro-skeletal”, and “pharyngeal-respiratory”. The psychological (OR, 1.49; 95% CI, 1.44–1.54), gastrointestinal (OR, 2.22; 95% CI, 2.09–2.37), neuro-skeletal (OR, 1.52; 95% CI, 1.44–1.59), and pharyngeal-respiratory (OR, 2.09; 95% CI, 1.94–2.25) profiles were significantly associated with greater odds of CUD. CONCLUSIONS: CUD and its symptoms are strongly associated with higher levels of somatic complaints and their related extracted profiles. This perhaps explains that why it can be difficult to treat, however further prospective investigations are required to confirm these associations.

Protein-energy malnutrition in goitrous schoolchildren of Isfahan, Iran

Some studies have shown the possible role of protein-energy malnutrition [PEM] in persistence of endemic goiter in iodine replenished areas. The present study was conducted to assess the association between PEM and goiter in schoolchildren of Isfahan, Iran. In a cross-sectional study using multistage cluster random-sampling, 2331 schoolchildren with age ranged from 6-13 years old with a female to male ratio of 1.60 were enrolled. Thyroid size was examined by two endocrinologists for goiter detection. Children were considered goitrous if they had palpable or visible goiters according to World Health Organization [WHO]/United Nations children's Fund/International Council for the Control of Iodine Deficiency criteria. Weight and standing height were measured using the standard tools and anthropometric indices were calculated using the WHO AnthroPlus software developed by the World Health Organization. Height-for-age Z-scores [HAZ], weight-for-age Z-scores [WAZ] and body mass index [BMI] for age were calculated for each child. Children with a HAZ, WAZ or BMI-for-age of Z-score < -2.0 were classified as stunted, underweight or thin, respectively. Blood samples were drowned to measure serum thyroid hormones. Overall, 32.9% of subjects were classified as goitrous. Weight, height, BMI, WAZ and BMI-for-age Z-score were significantly lower in children with goiter than in children who did not have goiter [P < 0.05]. The prevalence of goiter in thin children was higher than that in non-thin ones [48.4 vs. 31.6%, odds ratio [OR]: 2.02, 95% confidence interval [CI]: 1.52-2.69, P < 0.001]. Although 33.4% of non-stunted children were goitrous, 31% of stunted ones had goiter [P = 0.5]. According to the logistic regression model taking sex and age as covariates, the only significant parameter affecting palpable goiter detection was thinness [OR = 2.13, 95% CI: 1.22-3.69, P < 0.001]. In the present study, we found a high prevalence of goiter in children who were malnourished. It seems that PEM may play a role in the still high prevalence of goiter in this region

dish-based semi-quantitative food frequency questionnaire for assessment of dietary intakes in epidemiologic studies in Iran: design and development

Earlier forms of food frequency questionnaire [FFQ] used in Iran have extensive lists of foods, traditional categories and food-based design, mostly with the interviewer-administered approach. The aim of the current paper is to describe the development of a dish-based, machine-readable, semi-quantitative food frequency questionnaire [DFQ]. Within the framework of the Study on the Epidemiology of Psychological, Alimentary Health and Nutrition project, we created a novel FFQ using Harvard FFQ as a model. The following steps were taken to develop the questionnaire: Construction of a list of commonly consumed Iranian foods, definition of portion sizes, design of response options for consumption frequency of each food item and finally a pilot test of the preliminary DFQ. From a comprehensive list of foods and mixed dishes, we included those that were nutrient-rich, consumed reasonably often or contributed to between-person variations. We focused on mixed dishes, rather than their ingredients, along with foods. To shorten the list, the related food items or mixed dishes were categorized together in one food group. These exclusions resulted in a list of 106 foods or dishes in the questionnaire. The portion sizes used in the FFQ were obtained from our earlier studies that used dietary recalls and food records. The frequency response options for the food list varied from 6-9 choices from "never or less than once a month" to "12 or more times per day". The DFQ could be a reasonable dietary assessment tool for future epidemiological studies in the country. Validation studies are required to assess the validity and reliability of this newly developed questionnaire

Comparing the effects of group and home-based physical activity on mental health in the elderly

The present study focuses on comparing the effects of home based [HB] and group based [GB] physical activity on mental health in a sample of older adults in Shahr-e-kord. In this quasi-experimental study, a twice weekly physical activity program for 2 months was provided either individually at home or in a group format for 181 people who were divided into two groups [HB and GB]. The outcome, mental health, was measured with the 28 item General Health Questionnaire [GHQ 28]. Mental health status improved after participation in the physical activity program. The decrease in GHQ 28 total score in GB group, 3 months after intervention, was 3.61 +/- 2.28 [P < 0.001]. In HB group, this reduction was 1.20 +/- 2.32 during the same period [P < 0.001]. The difference of these "before-after differences" between the two groups in the GHQ 28 and all its subscales was statistically significant [P < 0.001]. Also, the effects of GB physical activity on mental health compared with HB physical activity, adjusted for related baseline variables, were significant. These findings reveal the probable effects of GB rather than HB physical activity on mental health among the elderly.

Thyroid disorders in children and adolescents with type 1 diabetes mettitus in Isfahan, Iran

Studies in different populations have shown great variation in the prevalence of thyroid diseases in patients with type 1 diabetes mellitus [TIDM]. Our aim was to study the prevalence of thyroid disorders such as autoimmunity of thyroid [AIT], thyroid dysfunction, and goiter in children and adolescents with TIDM, compared with age- and sex-matched healthy controls in Isfahan. One hundred patients with TIDM who were referred to Isfahan Endocrine and Metabolism Research Center and 184 healthy schoolchildren matched for age and sex were included. They were examined for goiter by two endocrinologists. Thyroid function test and serum thyroid antibodies [anti-TPO Ab and anti-Tg AbJ were measured. The prevalence of subclinical hypothyroidism was high in both groups [18%]. TIDM patients had lower frequency of goiter [21% vs. 38%, P=0.001], and higher prevalence of positive AIT [22% vs. 8%, P=0.001], anti-TPO Ab positivity [19.3% vs. 5.3%, P=0.000], and anti-Tg Ab [11.1% vs. 6.4%, P=0.1] in comparison with the control group. Being positive for AIT in diabetic patients meant an odds ratio of 5 [Cl 95%: 1.5-15.6] for thyroid dysfunction. There was no association between age, sex, duration of diabetes and HbAic with serum anti-TPO Ab and anti-Tg Ab concentrations in this group. Our results demonstrated the high prevalence of AIT and thyroid dysfunction in patients with TIDM. We suggest regular thyroid function and antibody testing in these patients