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Common mental disorder and obesity: insight from four repeat measures over 19 years: prospective Whitehall II cohort study.

ABSTRACT: OBJECTIVES:To examine potential reciprocal associations between common mental disorders and obesity, and to assess whether dose-response relations exist. DESIGN:Prospective cohort study with four measures of common mental disorders and obesity over 19 years (Whitehall II study). SETTING:Civil service departments in London. PARTICIPANTS:4363 adults (28% female, mean age 44 years at baseline). MAIN OUTCOME:Common mental disorder defined as general health questionnaire "caseness;" overweight and obesity based on Word Health Organization definitions. RESULTS:In models adjusted for age, sex, and body mass index at baseline, odds ratios for obesity at the fourth screening were 1.33 (95% confidence interval 1.00 to 1.77), 1.64 (1.13 to 2.36), and 2.01 (1.21 to 3.34) for participants with common mental disorder at one, two, or three preceding screenings compared with people free from common mental disorder (P for trend<0.001). The corresponding mean differences in body mass index at the most recent screening were 0.20, 0.31, and 0.50 (P for trend<0.001). These associations remained after adjustment for baseline characteristics related to mental health and exclusion of participants who were obese at baseline. In addition, obesity predicted future risk of common mental disorder, again with evidence of a dose-response relation (P for trend=0.02, multivariable model). However, this association was lost when people with common mental disorder at baseline were excluded (P for trend=0.33). CONCLUSIONS:These findings suggest that in British adults the direction of association between common mental disorders and obesity is from common mental disorder to increased future risk of obesity. This association is cumulative such that people with chronic or repeat episodes of common mental disorder are particularly at risk of weight gain.

SUBMITTER: Kivimaki M

PROVIDER: S-EPMC2758338 | biostudies-literature | 2009 Oct

REPOSITORIES: biostudies-literature

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Common mental disorder and obesity: insight from four repeat measures over 19 years: prospective Whitehall II cohort study.

Kivimäki Mika M Lawlor Debbie A DA Singh-Manoux Archana A Batty G David GD Ferrie Jane E JE Shipley Martin J MJ Nabi Hermann H Sabia Séverine S Marmot Michael G MG Jokela Markus M

BMJ (Clinical research ed.) 20091006

<h4>Objectives</h4>To examine potential reciprocal associations between common mental disorders and obesity, and to assess whether dose-response relations exist.<h4>Design</h4>Prospective cohort study with four measures of common mental disorders and obesity over 19 years (Whitehall II study).<h4>Setting</h4>Civil service departments in London.<h4>Participants</h4>4363 adults (28% female, mean age 44 years at baseline).<h4>Main outcome</h4>Common mental disorder defined as general health questio ...[more]

PMID: 19808765

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Project description:Background Increased vagal modulation is a mechanism that may partially explain the protective effect of healthy lifestyles. However, it is unclear how healthy lifestyles relate to vagal regulation longitudinally. We prospectively examined associations between a comprehensive measure of 4 important lifestyle factors and vagal modulation, indexed by heart rate variability (HRV) over 10 years. Methods and Results The fifth (1997-1999), seventh (2002-2004), and ninth (2007-2009) phases of the UK Whitehall II cohort were analyzed. Analytical samples ranged from 2059 to 3333 (mean age: 55.7 years). A healthy lifestyle score was derived by giving participants 1 point for each healthy factor: physically active, not smoking, moderate alcohol consumption, and healthy body mass index. Two vagally mediated HRV measures were used: high-frequency HRV and root mean square of successive differences of normal-to-normal R-R intervals. Cross-sectionally, a positively graded association was observed between the healthy lifestyle score and HRV at baseline (Poverall?0.001). Differences in HRV according to the healthy lifestyle score remained relatively stable over time. Compared with participants who hardly ever adhered to healthy lifestyles, those with consistent healthy lifestyles displayed higher high-frequency HRV (?=0.23; 95% CI, 0.10-0.35; P=0.001) and higher root mean square of successive differences of normal-to-normal R-R intervals (?=0.15; 95% CI, 0.07-0.22; P?0.001) at follow-up after covariate adjustment. These differences in high-frequency HRV and root mean square of successive differences of normal-to-normal R-R intervals are equivalent to ?6 to 20 years differences in chronological age. Compared with participants who reduced their healthy lifestyle scores, those with stable scores displayed higher subsequent high-frequency HRV (?=0.24; 95% CI, 0.01-0.48; P=0.046) and higher root mean square of successive differences of normal-to-normal R-R intervals (?=0.15; 95% CI, 0.01-0.29; P=0.042). Conclusions Maintaining healthy lifestyles is positively associated with cardiac vagal functioning, and these beneficial adaptations may be lost if not sustained.

Project description:To assess longer-term patterns of glaucoma medication adherence and identify whether patterns established during the first year of medication use persist during 3 subsequent years of follow-up.Retrospective, longitudinal cohort analysis.Beneficiaries aged ?40 years who were enrolled in a United States (US)-managed care plan for ?7 years between 2001 and 2012 and newly diagnosed and treated for open-angle glaucoma.For each enrollee, we quantified medication adherence using the medication possession ratio. Group-based trajectory modeling (GBTM) was applied to identify patterns of adherence for 1 and 4 years of follow-up. The percent of beneficiaries who remained in the same trajectory group in the 1- and 4-year models was tabulated to evaluate group stability. Factors impacting adherence at 1 and 4 years were identified using regression analyses.Patterns of glaucoma medication adherence.Of the 1234 eligible beneficiaries, GBTM identified 5 distinct glaucoma medication adherence patterns in both the 1-year and 4-year follow-up periods. These groups were as follows: (1) never adherent after their index prescription fill (7.5% and 15.6% of persons in the 1- and 4-year models, respectively); (2) persistently very poor adherence (14.9% and 23.4% of persons in the 1- and 4-year models, respectively); (3) declining adherence (9.5% and 9.1% of persons in the 1- and 4-year models, respectively); (4) persistently moderate adherence (48.1% and 37.0% of persons in the 1- and 4-year models, respectively); and (5) persistently good adherence (20.0% and 15.0% of persons in the 1- and 4-year models, respectively). More than 90% of beneficiaries in the 4 groups with the worst and best adherence patterns (groups 1, 2, 3, 5) maintained their patterns from their first year throughout their 4 years of follow-up. Those with persistently moderate adherence (group 4), the largest group, were most likely to change groups from 1 to 4 years of follow-up. Persons with the best adherence over 4 years were more likely to be white, to be older, to earn >$60 000/year, and to have more eye care visits (P < 0.05 for all comparisons). Those with a higher initial copayment cost had lower adherence rates (? = -0.06/dollar, P = 0.03).For most patients who were newly prescribed glaucoma medications, adherence patterns observed in the first year of treatment reflect adherence patterns over the subsequent 3 years. Investing resources in both identifying and helping patients with suboptimal adherence patterns over the first year may have a large impact on longer-term adherence.

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Common mental disorder and obesity: insight from four repeat measures over 19 years: prospective Whitehall II cohort study.

Publications

Common mental disorder and obesity: insight from four repeat measures over 19 years: prospective Whitehall II cohort study.

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