A baseline questionnaire about medical history and health practices was completed and then repeated every 2 years through 2006. Self-reported symptoms of depression, use of antidepressant medication, and physician-diagnosed depression were used as measures of depression. Depressed mood was assessed using the 5-item Mental Health Index, with a score of 52 or less indicating severe depression.
Those who reported a diagnosis of type 2 diabetes mellitus had the diagnosis confirmed by means of a supplementary questionnaire validated by medical record review.
During the 10-year follow-up, 2844 women were diagnosed as having type 2 diabetes and 7415 developed depression.
The relative risk of developing type 2 diabetes among women who were depressed was 1.17 (95% confidence interval [CI], 1.05 – 1.30). Study participants using antidepressants had a relative risk of 1.25 (95% CI, 1.10 – 1.41).
After controlling for all covariates, the investigators found women with diabetes had a relative risk of 1.29 (95% CI, 1.18 – 1.40) of developing clinical depression.
In addition, the relative risk for depression in diabetic subjects taking no diabetic medication, oral hypoglycemic agents, and insulin was 1.25 (95% CI, 1.09 – 1.42), 1.24 (95% CI, 1.09 – 1.41), and 1.53 (95% CI, 1.26 – 1.85), respectively.
The results also showed that compared with their nondiabetic counterparts, women with diabetes were more likely to have a higher body mass index and less likely to be physically active, a finding that suggests these 2 risk factors could be “major mediating factors.”
Nevertheless, they note the association remained significant after controlling for body mass index and lifestyle factors, which suggests “depression has effects on incident diabetes independent of adiposity and inactivity.”
The finding that women taking antidepressant medications were at higher risk of developing type 2 diabetes compared with those with severe depressive symptoms or physician-diagnosed depression has at least 2 possible explanations — antidepressant medications may be a marker of more severe, chronic, or recurrent depression or the medications themselves may increase diabetes risk.
“Although antidepressant medication use might be a marker of severe depression, its specific association with elevated risk of diabetes warrants further scrutiny,” they write.
In addition, the study authors note that these findings reinforce the hypothesis that diabetes may be related to stress: “Depression may result from the biochemical changes directly caused by diabetes or its treatment, or from the stresses and strains associated with living with diabetes and its often debilitating consequences.”
“This large, well-established cohort study provides evidence that the association between depression and diabetes is bidirectional and this association is partially explained by, but independent of, other known risk factors such as adiposity and lifestyle variables. Future studies are needed to confirm our findings in different populations and to investigate the potential mechanisms underlying this association,” the investigators conclude.
The study was funded by the National Institutes of Health and the National Alliance for Research on Schizophrenia and Depression. The study authors have disclosed no relevant financial relationships.
Arch Intern Med. 2010;170:1884-1891.
People who take aspirin regularly for a year or more may be at an increased risk of developing Crohn's disease, according to a new study by the University of East Anglia (UEA). Led by Dr Andrew Hart of UEA's School of Medicine, the research was presented for the first time at the Digestive Disease Week conference in New Orleans.
Crohn's disease is a serious condition affecting 60,000 people in the UK and 500,000 people in the US. It is characterized by inflammation and swelling of any part of the digestive system. This can lead to debilitating symptoms and requires patients to take life-long medication. Some patients need surgery and some sufferers have an increased risk of bowel cancer.
Though there are likely to be many causes of the disease, previous work on tissue samples has shown that aspirin can have a harmful effect on the bowel. To investigate this potential link further, the UEA team followed 200,000 volunteers aged 30-74 in the UK, Sweden, Denmark, Germany and Italy. The volunteers had been recruited for the EPIC study (European Prospective Investigation into Cancer and Nutrition) between 1993 and 1997.
The volunteers were all initially well, but by 2004 a small number had developed Crohn's disease. When looking for differences in aspirin use between those who did and did not develop the disease, the researchers discovered that those taking aspirin regularly for a year or more were around five times more likely to develop Crohn's disease.
The study also showed that aspirin use had no effect on the risk of developing ulcerative colitis — a condition similar to Crohn's disease.
“This is early work but our findings do suggest that the regular use of aspirin could be one of many factors which influences the development of this distressing disease in some patients,” said Dr Hart.
“Aspirin does have many beneficial effects, however, including helping to prevent heart attacks and strokes. I would urge aspirin users to continue taking this medication since the risk of aspirin users possibly developing Crohn's disease remains very low — only one in every 2000 users, and the link is not yet finally proved.”
Further work must now be done in other populations to establish whether there is a definite link and to check that aspirin use is not just a marker of another risk factor which is the real cause of Crohn's disease. The UEA team will also continue its wider research into other potential factors in the development of Crohn's disease, including diet.
There are many situations where referral may be indicated including:
a new diagnosis requiring specific dietary modification (eg. diabetes, food allergy, abnormal blood lipids)
poor understanding of dietary management (eg. a patient who has had diabetes for years but has poor blood glucose control)
significant unintentional weight change (either weight loss or gain)
evidence of recent poor food intake, poor appetite or difficulty preparing or eating food (eg. poor dentition or social isolation)
deterioration of symptoms or change in care needs (especially for cancer or HIV patients or the elderly)
any nutritional deficiencies (eg. anaemia or iodine deficiency)
changes in medication prescribed that may affect dietary intake
alternative methods of feeding (eg. enteral)
texture modified food (dysphagic patients)
periodic review for chronic conditions.
When referring, it is useful to include relevant medical history, recent biochemical and metabolic test results, and details of any medications currently prescribed.