Adults With Clinically Meaningful Depressive Symptoms Are More Vulnerable to the Effects of a Pro-inflammatory Diet on Frailty Onset

Abstract Objectives The dietary inflammatory index (DII®) reflects the inflammatory potential from dietary intakes. A pro-inflammatory diet (higher DII score) has been linked with frailty and increased risk of depression. It is unclear if depressive symptoms exacerbate the association between a pro-inflammatory diet and frailty. We determined if the association between DII score and frailty differed by depressive symptoms in adults from the Framingham Heart Study (FHS). Methods This prospective study included non-frail individuals (n = 1712) with baseline (1998–2001) diet assessment from food frequency questionnaire (FFQ), depressive symptoms from Center for Epidemiologic Studies Depression (CES-D) scale and follow-up frailty measurement (2011–2014). Energy-adjusted DII (E-DIITM) scores were calculated from foods and nutrients reported on the FFQ. Frailty was defined as fulfilling ≥3 Fried frailty criteria: unintentional weight loss, exhaustion, low physical activity, slow gait speed, and low grip strength. We stratified by baseline CES-D scores <16 or ≥ 16, which denotes the absence or presence of clinically meaningful depressive symptoms, respectively. Logistic regression estimated odds ratios (OR) and 95% confidence intervals (95%CI) for frailty development, adjusting for baseline age, sex, energy intake, current smoking, treatment for diabetes and/or cardiovascular disease, and non-skin cancers. Results Of the 1712 non-frail individuals at baseline (mean age: 58 ± 8 years, range: 33–81; 45% male), 227 individuals became frail over 16 years. Mean E-DII for all participants was −1.95 ± 2.20 (range: −6.71–5.44). Mean E-DII in frail individuals was −1.73 ± 2.13, while in non-frail individuals it was −1.98 ± 2.21. In those with CES-D < 16, one-unit increase in E-DII (more pro-inflammatory diet) was associated with 16% higher odds (95%CI:1.08–1.26) of frailty. In the cohort who had CES-D ≥16(∼6%), one-unit increase in E-DII was associated with 51% higher odds of frailty (95%CI:1.12–2.03). Conclusions In this cohort of older adults, those with depressive symptoms had higher odds of frailty with a more inflammatory diet compared to those without. Thus, especially among those with depressive symptoms, addressing the pro-inflammatory diet components may be a useful strategy for reducing or preventing frailty in older adults. Funding Sources NIA(T32-AG023480)

Download Full-text

Individual and Synergistic Relationships of Low Muscle Mass and Low Muscle Function with Depressive Symptoms in Korean Older Adults

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph181910129 ◽

2021 ◽

Vol 18 (19) ◽

pp. 10129

Author(s):

Youngyun Jin ◽

Seamon Kang ◽

Hyunsik Kang

Keyword(s):

Older Adults ◽

Depressive Symptoms ◽

Muscle Mass ◽

Muscle Function ◽

Depression Scale ◽

Epidemiologic Studies ◽

Community Dwelling ◽

Mean Power ◽

Increased Risk ◽

Appendicular Skeletal Muscle

This study examined the relationship of low appendicular skeletal muscle mass and low muscle function with depressive symptoms in Korean older adults. Community-dwelling Korean older adults aged 65 years and older (n = 521) participated in this study. Appendicular muscle mass (ASM) and muscle function (MF) scores were assessed using dual-energy X-ray absorptiometry (DXA) scanning and sit-to-stand mean power based on a 30 s chair stand test, respectively. Depressive symptoms were evaluated using the Korean form of the Center for Epidemiologic Studies Depression Scale. Logistic regression was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of depressive symptoms according to ASM- and MF-based subgroups; normal ASM/normal MF, low ASM/normal MF, normal ASM/low MF, and low ASM/low MF. The prevalence of depressive symptoms was 21.3% in all patients: 20.7% in women and 21.5% in men. Compared to the normal ASM/normal MF participants (OR = 1), the risk of depressive symptoms rose incrementally in subjects with low ASM/normal MF (OR = 2.963, p = 0.019), normal AMS/low MF (OR = 3.843, p = 0.002), and low ASM/low MF (OR = 7.907, p < 0.001), respectively. The current findings suggest that the coexistence of low ASM and low MF is significantly and independently associated with an increased risk for depressive symptoms, with dynapenia having a stronger relationship.

Download Full-text

Hearing Impairment and Risk of Depression in Older Adults in Health ABC

Innovation in Aging ◽

10.1093/geroni/igaa057.1509 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 466-466

Author(s):

Danielle Powell ◽

Joshua Betz ◽

Kristine Yaffe ◽

Stephen Kritchevsky ◽

Elsa Strotmeyer ◽

...

Keyword(s):

Older Adults ◽

Depressive Symptoms ◽

Hearing Impairment ◽

Depressive Symptomatology ◽

Depression Scale ◽

Normal Hearing ◽

Epidemiologic Studies ◽

Cross Sectional ◽

Rates Of Change ◽

Increased Risk

Abstract Whether hearing impairment (HI) is associated with depressive symptoms remains disputed for older adults, in part due to varying definition employed, use of subjective hearing measures, or cross-sectional analysis. We studied 1936 men and women (mean age 74.1 years, 41.7% black race) enrolled in the prospective Health, Aging and Body Composition study Hearing thresholds at 500-4000 Hz were averaged to create a pure tone average (PTA) and HI was defined using clinical cutpoints in the better-hearing ear. Depression was measured using the Center for Epidemiologic Studies Depression Scale (CES-D) or the CES-D 10, a revised 10 question scale depending on visit. Linear mixed effects models with random intercepts and slopes were used to estimate difference in rates of change in depressive symptomatology by hearing status over nine years. Cox proportional hazard models were used to examine the association between HI and incident depression defined as change in CES-D score >=10 points. In models adjusted for demographic and clinical covariates, participants with HI demonstrated a higher baseline prevalence of depressive symptoms compared to those with normal hearing (20.7% vs. 8.4%).Rates of change did not differ by HI status. Participants with moderate or greater HI had an increased risk of 9-year incident depression (HR=1.28, 95% CI: 1.00-1.62) compared to participants with normal hearing. HI is associated with increased risk of incident depression and a greater overall prevalence of depression compared to normal hearing, underscoring the importance of further research on whether rehabilitative therapies can mitigate this association.

Download Full-text

Abstract MP60: Depressive Symptoms and Risk of Incident Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis

Circulation ◽

10.1161/circ.137.suppl_1.mp60 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Parveen K Garg ◽

Wesley T O'Neal ◽

Ana V Diez Roux ◽

Alvaro Alonso ◽

Elsayed Soliman ◽

...

Keyword(s):

Atrial Fibrillation ◽

Depressive Symptoms ◽

Proportional Hazards ◽

Depression Scale ◽

Epidemiologic Studies ◽

Cox Proportional Hazards ◽

Fee For Service ◽

Score Distribution ◽

Ethnic Study ◽

Increased Risk

Background: Depression has been suggested as a potential risk factor for atrial fibrillation (AF) through effects on the autonomic nervous system and hypothalamus-pituitary-adrenal axis. Current literature examining the prospective relationship between depression and AF is inconsistent and limited to studies performed in predominantly white populations. We determined the relationship of both depressive symptoms and anti-depressant use with incident AF in a multi-ethnic cohort. Methods: The Multi-Ethnic Study of Atherosclerosis is a prospective study of 6,814 individuals without clinical cardiovascular disease. Depressive symptoms were assessed at baseline by the 20-item Center for Epidemiologic Studies Depression Scale (CES-D) and use of anti-depressant medications. Five CES-D groups were created based on the score distribution in approximate quartiles, and the top quartile split in 2 such that the top group represented persons with a score ≥16, a value commonly used to identify clinically relevant symptoms. Incident AF was identified from study ECGs verified for AF, ICD-9 hospital discharge diagnoses consistent with AF, and, for participants enrolled in fee-for-service Medicare, inpatient and outpatient AF claims data. Results: 6,644 participants (mean age=62; 53% women; 38% white; 28% black; 22% Hispanic; 12% Chinese-American) were included and followed for a median of 13 years. In separate adjusted Cox proportional hazards analyses, a CES-D≥16 (referent=CES-D<2) and anti-depressant use were each associated with higher incidence of AF (Table). Associations did not differ by race or gender (interaction p-values of 0.18 and 0.17 respectively). Similar results were obtained using time-updated measures of depression. Conclusions: Depressive symptoms are associated with an increased risk of incident AF. Further study into whether improving depressive symptoms reduces AF incidence is important.

Download Full-text

Perceived and content-related emotional demands at work and risk of long-term sickness absence in the Danish workforce: a cohort study of 26 410 Danish employees

Occupational and Environmental Medicine ◽

10.1136/oemed-2019-106015 ◽

2019 ◽

Vol 76 (12) ◽

pp. 895-900 ◽

Cited By ~ 3

Author(s):

Elisabeth Framke ◽

Jeppe Karl Sørensen ◽

Mads Nordentoft ◽

Nina Føns Johnsen ◽

Anne Helene Garde ◽

...

Keyword(s):

Depressive Symptoms ◽

Sickness Absence ◽

Cox Regression ◽

Environment And Health ◽

Frequency Of Contact ◽

Increased Risk ◽

Unit Increase ◽

Estimated Risk ◽

Emotional Demands

ObjectivesThis study aimed to examine whether high emotional demands at work predict long-term sickness absence (LTSA) in the Danish workforce and whether associations differ by perceived and content-related emotional demands.MethodsWe included 26 410 individuals from the Work Environment and Health in Denmark Study, a nationwide sample of the Danish workforce. Emotional demands at work were measured with two items: one assessing perceived emotional demands (asking how often respondents were emotionally affected by work) and one assessing content-related emotional demands (frequency of contact with individuals in difficult situations). LTSA was register based and defined as spells of ≥6 weeks. Respondents with LTSA during 2 years before baseline were excluded. Follow-up was 52 weeks. Using Cox regression, we estimated risk of LTSA per one-unit increase in emotional demands rated on a five-point scale.ResultsDuring 22 466 person-years, we identified 1002 LTSA cases. Both perceived (HR 1.20, 95% CI 1.12 to 1.28) and content-related emotional demands (HR 1.07, 95% CI 1.01 to 1.13) predicted risk of LTSA after adjustment for confounders. Further adjustment for baseline depressive symptoms substantially attenuated associations for perceived (HR 1.08, 95% CI 1.01 to 1.16) but not content-related emotional demands (HR 1.05, 95% CI 1.00 to 1.11). Individuals working in occupations with above-average values of both exposures had an increased risk of LTSA (HR 1.32, 95% CI 1.14 to 1.52) compared with individuals in all other job groups.ConclusionsPerceived and content-related emotional demands at work predicted LTSA, also after adjustment for baseline depressive symptoms, supporting the interpretation that high emotional demands may be hazardous to employee’s health.

Download Full-text

Identifying the Factors Related to Depressive Symptoms Amongst Community-Dwelling Older Adults with Mild Cognitive Impairment

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16183449 ◽

2019 ◽

Vol 16 (18) ◽

pp. 3449 ◽

Cited By ~ 1

Author(s):

Dan Song ◽

Doris S.F. Yu ◽

Polly W.C. Li ◽

Qiuhua Sun

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Depressive Symptoms ◽

Mild Cognitive Impairment ◽

Geriatric Depression Scale ◽

Depression Scale ◽

Community Dwelling ◽

Cross Sectional ◽

Increased Risk ◽

Community Dwelling Older Adults

High-level depressive symptoms have been reported in individuals with mild cognitive impairment (MCI), resulting in increased risk of progression to dementia. However, studies investigating the correlates of depressive symptoms among this population are scarce. This study aimed to investigate the significant socio-demographic, lifestyle-related and disease-related correlates of depressive symptoms among this cohort. Cross-sectional data were obtained from a sample of 154 Chinese community-dwelling older adults with MCI. MCI subjects were screened by the Montreal Cognitive Assessment. Depressive symptoms were measured by the Geriatric Depression Scale. Possible correlates of depressive symptoms in individuals with MCI were explored by multiple linear regressions. The prevalence of depressive symptoms among Chinese older adults with MCI was 31.8%. In multiple regression analysis, poor perceived positive social interaction, small social network, low level of physical activity, poor functional status, subjective memory complaint, and poor health perception were correlated with depressive symptoms. The findings highlight that depressive symptoms are sufficient to warrant evaluation and management in older adults with MCI. Addressing social isolation, assisting this vulnerable group in functional and physical activities, and cultivating a positive perception towards cognitive and physical health are highly prioritized treatment targets among individuals with MCI.

Download Full-text

Depressive symptoms prospectively predict cardiovascular disease among older adults: Findings from the Maine-Syracuse Longitudinal Study

Journal of Health Psychology ◽

10.1177/1359105318782375 ◽

2018 ◽

Vol 25 (12) ◽

pp. 2006-2016

Author(s):

Emily AP Haigh ◽

Olivia E Bogucki ◽

Peter J Dearborn ◽

Michael A Robbins ◽

Merrill F Elias

Keyword(s):

Cardiovascular Disease ◽

Older Adults ◽

Depressive Symptoms ◽

Meta Analysis ◽

Disease Status ◽

Depression Status ◽

Increased Risk ◽

Long Term Follow Up ◽

Prospective Association

A recent meta-analysis identified a prospective association between depression and cardiovascular disease; however, there was no association for studies with long-term follow-up periods. The literature has primarily focused on baseline depression status or symptoms, which may not capture the chronic nature of depression. This study examined the prospective relationship between depressive symptoms and cardiovascular disease up to 15 years later in 274 cardiovascular disease–free older adults. Depressive and anxiety symptoms, mean arterial pressure, and cardiovascular disease status were assessed. Baseline and chronic depressive symptoms predicted increased risk of cardiovascular disease, underscoring the importance of assessing and treating depression in older adults.

Download Full-text

Depressive Symptoms and Diurnal Salivary Cortisol Patterns Among Female Caregivers of Stroke Survivors

Biological Research For Nursing ◽

10.1177/1099800412439458 ◽

2012 ◽

Vol 14 (4) ◽

pp. 396-404 ◽

Cited By ~ 15

Author(s):

Karen L. Saban ◽

Herbert L. Mathews ◽

Fred B. Bryant ◽

Timothy E. O’Brien ◽

Linda Witek Janusek

Keyword(s):

Depressive Symptoms ◽

Chronic Stress ◽

Caregiver Burden ◽

Perceived Stress ◽

Salivary Cortisol ◽

Allostatic Load ◽

Depression Scale ◽

Epidemiologic Studies ◽

Stroke Survivors ◽

Increased Risk

Informal caregivers of stroke survivors experience elevated chronic stress and are at risk of developing depressive symptoms. The cumulative effects of chronic stress can increase allostatic load and dysregulate biological processes, thus increasing risk of stress-related disease. Stress-induced alterations in the pattern of cortisol secretion vary with respect to stressor onset, intensity, and chronicity. Little is known about the psychoendocrine response to stress in female caregivers of stroke survivors. The purpose of this study was to examine perceived stress, caregiver burden, and the association between caregiver depressive symptoms and diurnal cortisol in 45 females caring for a significant other who experienced a stroke within the past year. Women completed the Center for Epidemiologic Studies Depression Scale (CES-D) and collected saliva for cortisol upon awakening, 30 min postawakening, noon, and bedtime for 2 consecutive days. Results revealed that women had high levels of perceived stress and caregiver burden. In women with CES-D scores ≥ 16, salivary cortisol levels were significantly lower across the day relative to women with CES-D scores < 16. This difference persisted after adjusting for age, number of caregiving hours per week, perceived social support, and quality of sleep. Younger age was associated with more depressive symptoms as well as lower levels of cortisol at awakening and 30 min postawakening. Results demonstrate that the burden of caregiving increases risk of depressive symptoms and hypocortisolism across the day. Hypocortisolism may contribute to increased risk of depressive symptoms as a result of the loss of glucocorticoid attenuation of stress-induced inflammation.

Download Full-text

Telephone-based Behavioral Activation with Mental Imagery for depression: a pilot randomized clinical trial in isolated older adults during the Covid-19 pandemic

10.31234/osf.io/uxa6y ◽

2021 ◽

Author(s):

Johnny Pellas ◽

Fritz Renner ◽

Julie Lin Ji ◽

Mattias Damberg

Keyword(s):

Older Adults ◽

Clinical Trial ◽

Depressive Symptoms ◽

Randomized Clinical Trial ◽

Mental Imagery ◽

Treatment Condition ◽

Behavioral Activation ◽

Mental Health Problems ◽

Older Individuals ◽

Increased Risk

ObjectivesTo shield vulnerable persons, particularly the eldery, during the Covid-19 pandemic governments around the world have adviced to use social distancing and self-isolation. Social isolation might put older adults at an increased risk for mental health problems such as depression. There is a need for brief, easy-accessible psychological treatments for depressive symptoms that can be delivered remotely. The aim of this study was to investigate the feasibility, acceptability and preliminary efficacy of telephone-delivered Behavioral Activation with Mental Imagery for the treatment of depressive symptoms in individuals 65 years and older living in isolation during the covid-19-pandemic.MethodsIn this open-label pilot randomized clinical trial, N = 41 individuals aged 65 years or older with clinically significant symptoms of depression were randomly assigned to either a Behavioral Activation with Mental Imagery treatment condition, or an Attention-Assessment control condition delivered over the telephone over a four week period.ResultsDepressive symptoms decreased more in the treatment condition compared to the control condition. At post treatment 2 out of 16 participants in the treatment condition met diagnostic criteria for depression compared to 9 out of 13 in the control condition. Most participants in the treatment condition were satisfied with the treatment and few adverse effects were observed.ConclusionsThis pilot study suggests that behavioral activation with mental imagery delivered over the telephone is feasible, acceptable and potentially efficacious for the treatment of depressive symptoms in older individuals living in isolation. Replication in larger samples is needed.

Download Full-text

Increasing mixed-berry flavonoid intake may reduce depressive symptoms in older adults: Framingham Heart Study

Innovation in Aging ◽

10.1093/geroni/igab046.3127 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 864-864

Author(s):

Courtney Millar ◽

Alyssa Dufour ◽

Marian Hannan ◽

Shivani Sahni

Keyword(s):

Older Adults ◽

Depressive Symptoms ◽

Framingham Heart Study ◽

Randomized Clinical Trials ◽

Epidemiological Studies ◽

Prospective Longitudinal Study ◽

Heart Study ◽

Flavonoid Intake ◽

Prospective Longitudinal ◽

Dietary Flavonoids

Abstract Depression affects more than 250 million people worldwide. Although epidemiological studies have linked higher dietary flavonoids with depression prevention in older women, it is unknown if increasing dietary flavonoids could effectively reduce depression. Mixed berries (blueberry, blackberry, and raspberry) are a rich source of flavonoids, particularly anthocyanin, flavanol, and flavan-3-ol subclasses. Our aim was to determine the association of mixed-berry flavonoid intake with change in depressive symptoms over ~8 years in older adults from the Framingham Heart Study. This community-based prospective longitudinal study included 1,278 adults with assessments on diet (food frequency questionnaire) and depressive symptoms (Center for Epidemiologic Studies Depression, CES-D) at baseline (1998-2001) and follow-up (2005-2008). Absolute change in mixed-berry flavonoid intake (defined as sum of anthocyanin, flavanol, and flavon-3-ols, mg/day) and change in CES-D scores were calculated. Linear regression estimated beta and standard error (SE) for change in CES-D scores per 250 mg/day increase in mixed-berry flavonoids (obtained from ~3/4 cup of mixed berries), adjusting for baseline age, sex, energy-intake, current smoking, body mass index, physical activity, cardiovascular disease, and non-melanoma cancer. Mean age was 59±9 years (range: 33-81), 57% female and mean change in mixed-berry flavonoid intake was 15.0±72.8 mg/day over ~8 years. In adjusted models, each 250 mg/day increase in mixed-berry flavonoid intake was associated with a 1-point reduction in depressive symptoms (beta: -1.06, SE: 0.61, p=0.08) over ~8 years, although this was not statistically significant. These data highlight the need for randomized clinical trials of flavonoid-rich berries to target depressive symptoms in older adults.

Download Full-text

Family Proximity as a Moderator of Spousal Associations of Depression among Mexican Older Adults

Innovation in Aging ◽

10.1093/geroni/igab046.2781 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 755-756

Author(s):

Katie Newkirk ◽

Maria Aranda ◽

Catalina Mourgues-Codern ◽

Ana Quiñones ◽

Rafael Samper-Ternent ◽

...

Keyword(s):

Older Adults ◽

Depressive Symptoms ◽

Protective Factor ◽

Depression Scale ◽

Epidemiologic Studies ◽

Rate Of Change ◽

Public Health Issue ◽

Moderation Effect ◽

Rate Of Increase ◽

Mitigating Factors

Abstract Depression among older adults is a public health issue, and a large literature highlights the importance of close relationships as both a risk and protective factor for depression. Research in U.S. samples suggests that one spouse’s depressive symptoms can increase their partner’s depressive symptoms, especially for women (Kouros & Cummings, 2010; Tower & Kasl, 1996). Little is known about interpersonal associations in depression, mitigating factors, and the role of gender among older couples in Mexico. This study examined (1) the effects of an individual’s depressive symptoms on their spouse’s symptoms and 2) whether living close to family buffered depression associations using data from the Mexican Health and Aging Study (n=4,071 dyads, age 50+ at initial interview). Depressive symptoms were measured in 2001, 2003, 2012, 2015, and 2018 using a modified 8-item version of the Center for Epidemiologic Studies-Depression Scale. Multilevel modeling was used to fit a dual-intercept growth model (centered at 2012) of husbands’ and wives’ depressive symptoms over time, controlling for age and education. Results showed a partner effect for husbands and wives, such that having a spouse with greater depressive symptoms in 2001 was associated with greater subsequent depressive symptoms, but not with rate of change in symptoms, in 2012. There was also a moderation effect such that the deleterious effect of husbands’ depressive symptoms on wives’ symptoms, as well as rate of increase in symptoms, was higher when family lived nearby, suggesting family may potentially exacerbate depression associations among spouses rather than a buffering them as hypothesized.

Download Full-text