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。
  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。
  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)。

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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