PTSD会增加妇女的肥胖风险


  【24drs.com】创伤后压力异常(PTSD)被认为与妇女过重及肥胖的风险增加有关。
  
  「护士健康研究」这项研究的最新结果显示,在研究期间发生PTSD症状的正常体重妇女,变得过重的风险比经历创伤但无PTSD者增加36%。
  
  资深作者、纽约市Mailman公卫学院Karestan Koenen博士指出,PTSD不只是心智健康议题,除了心血管疾病和糖尿病,现在,PTSD的健康风险清单新增肥胖这项。
  
  这篇研究在线登载于11月20日的JAMA Psychiatry期刊。
  
  研究者指出,虽然PTSD被定义为肥胖的可能风险因素,但是不清楚PTSD是否改变了体重增加趋势或者是共病症。
  
  为了探讨这个问题,研究者进行了这篇首次探讨PTSD和肥胖之关系的纵向研究。
  
  他们写道,这篇研究首度检视了曝露于民间情境下发生创伤事件的妇女,其PTSD症状和BMI[身体质量指数]趋势之间的前瞻式关系。
  
  为了研究,研究者分析了「护士健康研究 II」部分样本的资料,该研究共包括1989年时、年纪22-44岁的54,224名研究对象,测量他们的创伤和PTSD症状,追踪这些研究对象到2005年。
  
  使用创伤与PTSD筛检问卷测量PTSD症状、发生时间、创伤情况;根据BMI值,超过25.0与30.0分别视为发生过重和肥胖;根据50,504名回覆者的资料进行最后分析。
  
  PTSD的阈值是在1个月以上持续有4个以上症状,常见的症状包括重复经历创伤事件、感受处于威胁、回避社交行为。
  
  结果显示,1989年BMI正常的妇女中,在1989年发生至少4种PTSD症状,和变得过重或肥胖的风险增加有关(胜算比1.36;95%信心区间[CI] 1.19 - 1.56)。
  
  即使是低于阈值症状的妇女,风险也是较高的,校正忧虑这项也被视为肥胖的风险因素后,风险依旧。
  
  在1989年前开始有PTSD症状的妇女,BMI比没有PTSD的妇女增加更快速。
  
  研究者指出,PTSD对妇女体重之影响可能比一般族群更大。
  
  Koenen博士表示,护士相当适合进行这类研究,因为她们的BMI等健康测量相当准确;但是,她们也比较重视健康,所以可能比我们更不容易变肥胖,所以研究结果可能比原来预期的更保守。
  
  研究者推测,PTSD可能是因为刺激生物和行为机转而影响体重,包括一些不健康的生活型态行为,例如不运动和吃垃圾食物,神经内分泌功能失调。
  
  研究者指出,研究结果认为PTSD妇女应监测或进行心脏代谢不良后果之筛检。此外,他们认为,应将PTSD治疗扩展纳入饮食和运动之测量,以降低肥胖风险。目前,健康行为完全没有在PTSD的治疗范围内。
  
  资料来源:http://www.24drs.com/professional/list/content.asp?x_idno=7032&x_classno=0&x_chkdelpoint=Y
  

PTSD Boosts Obesity Risk in Women

By Caroline Cassels
Medscape Medical News

Post-traumatic stress disorder (PTSD) has been linked to an increased risk for overweight and obesity in women.

The latest results from the Nurses Health Study show that women of normal weight who developed PTSD symptoms during the study period had 36% increased odds of becoming overweight compared with their counterparts who experienced trauma but had no PTSD symptoms.

"PTSD is not just a mental health issue. Along with cardiovascular disease and diabetes, we can now add obesity to the list of known health risks of PTSD," senior author Karestan Koenen, PhD, Mailman School of Public Health in New York City, said in a release.

The study was published online November 20 in JAMA Psychiatry.

First Study of Its Kind

Although it has been identified as a possible risk factor for obesity, it is unclear whether PTSD alters the trajectory of weight gain or whether it is a comorbid condition, the researchers note.

To examine this question, the researchers conducted what they report as the first longitudinal study to examine the relationship between PTSD and obesity.

"This study is the first to examine the prospective relation of PTSD symptoms to BMI [body mass index] trajectories and obesity in women exposed to a wide range of traumatic events occurring in civilian settings," they write.

For the study, the investigators analyzed data from a subsample of the Nurses Health Study II, which included 54,224 participants aged 22 to 44 years in 1989 and in whom trauma and PTSD symptoms were measured. Participants were followed-up until 2005.

Symptoms of PTSD, time of onset, and trauma were measured using the Trauma and PTSD Screening Questionnaire. The development of overweight and obesity was determined using BMI cut points of 25.0 and 30.0, respectively. The final analysis was based on data from 50,504 respondents.

The threshold for PTSD was the persistence of 4 or more symptoms duriong a period of 1 month or longer. Common symptoms included re-experiencing the traumatic event, feeling under threat, and social avoidance.

Risk Likely Underestimated

The results revealed that the onset of at least 4 PTSD symptoms in 1989 was associated with an increased risk of becoming overweight or obese (odds ratio, 1.36; 95% confidence interval [CI], 1.19 - 1.56) among women with normal BMI in 1989.

The higher risk was evident even for women with subthreshold symptom levels, and the risk remained after adjusting for depression, which is also thought to be a major risk factor for obesity.

Women with PTSD symptoms that began prior to 1989 experienced a more rapid increase in BMI than women without PTSD.

The researchers note that the impact of PTSD on women's weight may be even greater in the general population.

"Nurses are great for studies because they report health measures like BMI with a high degree of accuracy. But they are also more health conscious and probably less likely to become obese than most of us, which makes these results more conservative than they would otherwise be," said Dr. Koenen.

The investigators speculate that PTSD may influence weight gain through simultaneous biological and behavioral mechanisms, including unhealthy lifestyle behaviors, such as physical inactivity and consumption of junk food, and dysregulated neuroendocrine function.

According to investigators, the study's results suggest that women with PTSD should be monitored or undergo screening for adverse cardiometabolic outcomes.

In addition, they suggest that PTSD treatment should be expanded to include such measures as diet and exercise to mitigate the risk for obesity. They point out that currently, "health behaviors are completely outside the scope of PTSD treatments."

The authors report no relevant financial relationships.

JAMA Psychiatry. Published online November 20, 2013.

    
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