Subtypes of major depressive disorders and objectively measured physical activity and sedentary behaviors in the community.

BACKGROUND: Lack of physical activity (PA) and high sedentary behavior (SB) may enhance mental health problems, including depression, and are associated with increased mortality. Aside from a large body of research on major depressive disorder (MDD) assessed as an entity and either PA or SB, few studies have examined associations among subtypes of MDD and both PA and SB simultaneously derived from wrist-worn accelerometers. Accordingly, our aim was to explore the associations among MDD subtypes (atypical, melancholic, combined atypical-melancholic and unspecified) and four actigraphy-derived behaviors combining the levels of PA and SB. METHODS: The sample stemmed from CoLaus|PsyCoLaus, a population-based cohort study, consisting of 2375 participants (55.1% women; mean age: 62.4 years) who wore an accelorometer for 14 days after a physical exam and subsequently completed a semi-structured psychiatric interview. Activity behaviors were defined according to the combination of the levels of moderate-to-vigorous intensity PA and SB. Associations of remitted MDD subtypes, current MDD and physical inactivity behaviors were assessed using multinomial logistic regression, adjusted for socio-demographic characteristics, a history of anxiety, alcohol and drug use disorders and cardiovascular risk factors. RESULTS: In the fully adjusted model, participants with the remitted combined atypical-melancholic subtype had a higher risk of being more physically inactive. CONCLUSIONS: Our findings suggest that low PA and high SB are not restricted to the duration of depressive episodes in people with atypical and melancholic episodes. The lack of PA and high SB in this group of depressive patients exposes them to an additional long-term cardiovascular risk and measures to increase PA may be particularly fruitful in this MDD subgroup.

Determinants of serum uric acid levels in an adult general population: results from the Moli-sani Study.

OBJECTIVES: High levels of serum uric acid (UA) are associated with cerebro-cardiovascular disease risk factors. This study aimed at evaluating the main determinants of serum UA levels in relation to biochemical, lifestyle, and clinical variables. METHODS: The study population included 15,594 participants (48% men, age ≥ 35 years) to the Moli-sani Study, for whom data on serum UA levels were available. Association of UA with dependent variables was investigated by multivariable linear regression analysis separately for men and women. RESULTS: Average serum UA levels were higher in men than in women (6.1 ± 1.3 vs 4.6 ± 1.2 mg/dL, respectively). Cystatin C, creatinine, albumin, triglycerides, body mass index (BMI), and diuretic therapy were the major determinants of the heterogeneity of UA levels. In women, the final model, resulting from the stepwise analysis, explained 41.6% of the UA variability. In particular, cystatin C explained 22.5% of UA variance, followed by BMI (7.2%), albumin (4.0%), and creatinine (1.9%). The final model in men fitted the data less than in women (total R2 = 29.1%), and creatinine was found to be the main determinant of UA levels (10.1%), followed by triglycerides (7.6%), BMI (3.7%), and albumin (2.0%). CONCLUSIONS: In a general adult population, the major determinants of serum UA levels are cystatin C, creatinine, BMI, triglycerides, albumin, and the use of diuretics. Knowledge of its main determinants will be useful to better evaluate the relationship between UA levels and detrimental health outcomes and to clarify if an increase in uricemia is a marker or an independent risk factor. Key Points • Increased serum uric acid (UA) levels are reportedly associated with cardiovascular disease risk factors. • The major determinants of heterogeneity of UA levels are cystatin C, creatinine, BMI, triglycerides, albumin, and the use of diuretics, in a general adult population. • Studying the main determinants associated with high levels of serum uric acid would help better understanding if uric acid is a marker or an independent cardiovascular risk factor.

Facing the Unseen - Metabolic Syndrome in Psoriatic Arthritis.

Psoriatic arthritis (PsA) is a heterogeneous multifaceted inflammatory artropathy, associated or not with psoriasis, part of the spondyloarthropaties group. Beyond articular and skin manifestations, patients with psoriatic disease are prone to associated comorbidities, including cardiovascular disease (CVD), obesity and metabolic syndrome, diabetes, or fatty liver disease; in order to improve the prognosis and the quality of life for these patients, it is mandatory to prevent, identify and properly manage any of the comorbidities. We aimed to assess the presence of traditional CV risk factors and MetS in a group of PsA patients, compared to controls and their possible inter-relation. We performed an observational study on 41 consecutive patients diagnosed with PsA based on CASPAR established criteria. Our subjects met the criteria of MetS in a percentage of 43.90% of the cases and AHT, frequently reported in higher percentages for PsA or psoriasis patients, compared to general population was also revealed in significant percentages by our data. Regarding dyslipidemia, it is confirmed and validated by several studies that patients diagnosed with PsA or psoriasis associate an altered lipid metabolism and our study noticed data accordingly. As PsA is a condition characterized by chronic inflammation, a non-traditional CV risk factor, each patient should benefit from a periodic close evaluation in order to approach a compete and early therapeutic intervention and reduce further CV morbidity and mortality rates.

A preliminary report on physical activity patterns among children aged 8-14 years to predict risk of cardiovascular diseases in Malwa region of Punjab.

OBJECTIVE: To determine the pattern of physical activity specific to age and gender among young Indian school going girls and boys aged 8-14 years. DESIGN: Cross-sectional study. SETTING: Private and government sponsored schools in Patiala and Mansa District of Punjab, India. PARTICIPANTS: Two hundred thirty four school going girls and boys aged 8-14 years. METHODOLOGY: A structured questionnaire recorded the various forms of daily physical activity, sedentary activity as well as physical activity level of all the participants. The energy expenditure was also calculated using the standard metabolic equivalent index. RESULTS: There is a significant difference between mean weights of participants belonging to different physical activity levels (p<.04). In comparison to boys, the girl participants have significant lower values of physical activity duration as well as total metabolic equivalent expenditure (p<.05). The total duration of moderate/vigorous physical activity declined in both girls and boys as the age increased. CONCLUSION: Physical activity among children in Northern regions of India is on decline as their age increases especially among girls. It is important to determine physical activity duration in early age groups and motivate children for daily physical activity.

[Control of cardiovascular risk factors in coronary patients one year after cardiac rehabilitation]. / Contrôle des facteurs de risque chez les patients coronariens un an après une réadaptation cardiaque.

OBJECTIVE: To assess risk factors monitoring in coronary patients one year after cardiac rehabilitation. METHOD: From 2015 to 2015, cardiac morbidity, total mortality and risk factors data were collected from a 4-week ambulatory cardiac rehabilitation program with a control one year later and were compared with the results of Euroaspire and Reach studies. RESULTS: Out of 1091 (87%) coronary patients, 746 (68%) were re-examined 12months later (aged 60years (ranging from 20 to 85years), 15% women, 44% hypertensive, 36% smokers, 17% diabetics, 74% with dyslipidemia). At the end of the program, management of CV risk factors was improved (BP ≤ 140/90mmHg and BMI > 30: 80 and 20% vs 65 and 25% at the beginning of the program; LDL < 0.7g/L: 42% and smoking: 4% vs 18% when hospitalized for their cardiac event). Unfortunately, this benefit decreased significantly at one year (BP ≤ 140/90mmHg: 63%, LDL < 0.7g/L: 27%; smoking: 6%) but it remains better than in Euroaspire IV study: 57, 20 et 16% respectively). While 54% had insufficient physical activity before cardiac rehabilitation, they were only 23% at 1-year vs 60% in Euroaspire study. We reported a total mortality of 0.6% vs 2.9% in Reach study and 12% cardiac hospitalization (53% for a new coronary event). CONCLUSION: Participation of coronary patients in a cardiac rehabilitation program significantly improves management of CV risk factors, morbidity and mortality. However, the control obtained at the end of the program decreases at one year.

Clinical correlates of serum pigment epithelium-derived factor in type 2 diabetes patients.

AIM: To determine if serum pigment epithelium-derived factor (PEDF) levels in Type 2 diabetes are related to vascular risk factors and renal function. METHODS: PEDF was quantified by ELISA in a cross-sectional study of 857 male Veterans Affairs Diabetes Trial (VADT) subjects, and associations with cardiovascular risk factors and renal function were determined. In a subset (n=246) in whom serum was obtained early in the VADT (2.0±0.3 years post-randomization), PEDF was related to longitudinal changes in renal function over 3.1 years. RESULTS: Cross-sectional study: In multivariate regression models, PEDF was positively associated with serum triglycerides, waist-to-hip ratio, serum creatinine, use of ACE inhibitors or angiotensin receptor blockers, and use of lipid-lowering agents; it was negatively associated with HDL-C (all p<0.05). Longitudinal study: PEDF was not associated with changes in renal function over 3.1 years (p>0.09). CONCLUSIONS: Serum PEDF in Type 2 diabetic men was cross-sectionally associated with dyslipidemia, body habitus, use of common drugs for blood pressure and dyslipidemia, and indices of renal function; however, PEDF was not associated with renal decline over 3.1years.

Calidad de vida relacionada con la salud en usuarios de un programa comunitario de actividad f¡sica / Quality of life related to users of a communitary health program of phycal activity

Introducción:en Colombia existen pocos es- tudios que den cuenta de la percepción de la calidad de vida relacionada con la salud (CVRS) en usuarios de los programas de actividad física (AF). Objetivo: determinar la percepción de CVRS de los usuarios de un programa de AF en un municipio colombiano. Metodología:estudio transversal descriptivo. Participaron 1076 suje- tos, con promedio edad 56,6 años DE 12,8; el 88,3% mujeres. Se evaluaron variables socio- demográficas, factores de riesgo cardiovascular, niveles de AF y la percepción de la CVRS. Se realizó el análisis univariado, bivariado (U de Mann-whitney y Kruskal Wallis) y multivariado exploratorio (regresión lineal). Significancia estadística p<0,05. Resultados: Se incluyeron 1076 participantes, promedio edad 56,6 anos DE 12,8; el 88,3% mujeres. Los puntajes de CVRS variaron entre 65 y 70,2 con valores m s bajos en la dimension “ambiental” y mas alta en la “fisica”. Las variables que se asociaron a deterioro de la percepcion de CVRS fueron: dimension “fisica” (ser hombre, mayor edad, educacion baja, viudo, desempleado, fumar, ser hipertenso y tener diabetes mellitus); dimension psicologica (mayor edad, educacion baja, desempleado, fumador; dimension “social” (educacion baja); dimension “ambiental” (vivir en  area rural, educacion baja, desempleado y obesidad por % de grasa). Conclusion: La percepcion de CVRS se deteriora con variables sociodemograficas como el ser hombre, tener mayor edad, poseer un bajo nivel educativo, estar desempleado y padecer enfermedades como el tabaquismo, la hipertension arterial y la diabetes mellitus, con mayor afectacion en las dimensiones fisica y psicologica.

Introduction: There are in Colombia a few studies that give an account of Health- Related Quality of Life (HRQOL) in the programs of physical activity (PA) users. Objective: To determine the HRQOL perception among users of a PA program within a Colombian town. Methodology: transversal, descriptive study. Socio-demographic variables were evaluated, cardio-vascular risk factors, levels of PA and HRQOL perception. Univariate analysis were done, bivariate (U of Mann – whitney and Kruskal Wallis) and exploratory multivariate (lineal regression). Statistical significance p ˂0,05. Results: 1076 participants were included, average 56,6 years of age SD 12,8; 88.3% were women. The HRQOL scores varied between 65 and 70,2 with lower values among the environment dimension and the highest on the physical. The associated variables to the decline of the HRQOL perception were: physical dimension (to a man, adult, low educational background, widower, unemployed, smoker, hypertensive, and to have diabetes mellitus); psychological dimension (adult, low educational background, unemployed, smoker); social dimension (low educational background); environmental dimension (to live in a rural area, low educational background, unemployed and obesity percentage of fat). Conclusion: The HRQOL perception decayed with socio-demographic variables like to a man, being an adult, to have a low educational background, being an unemployed and to suffer from illnesses like smoking, high blood pressure and diabetes mellitus, affecting the physical and psychological dimensions.

Pediatric obesity: looking into treatment.

Prevalence of pediatric obesity continues to rise worldwide. Increasing the number of health care practitioners as well as pediatricians with expertise in obesity treatment is necessary. Because many obese patients suffer obesity-associated cardiovascular, metabolic and other health complications that could increase the severity of obesity, it is fundamental not only to identify the child prone to obesity as early as possible, but to recognize, treat and monitor obesity-related diseases during adolescence. This short review outlines the treatment of pediatric obesity that may have applications in the primary care setting. It examines current information on eating behavior, sedentary behavior, and details studies of multidisciplinary, behavior-based, obesity treatment programs. We also report the less common and more aggressive forms of treatment, such as medication and bariatric surgery. We emphasize that health care providers have the potential to improve outcomes by performing early identification, helping families create the best possible home environment, and by providing structured guidance to obese children and their families.