Metabolic alterations in malnourished, depressed aged subjects

Arch. Gerontol. 0167.4943/98/$19,00 METABOLIC

Geriatr. suppl. 6 (1998) 525-530 0 1998 Elsevier Science Ireland ALTERATIONS

F.

VETTA,

E.

DE

S.

IN

RONZONI,

GENNARO,

1st Medical Clinic, Via del Policlinico

MALNOURISHED,

M.R.

P.F.A.

“La 155,

Ltd. All right

DEPRESSED

LUPATELLI,

LATO,

Sapienza” I-00161

P.

reserved

L.

CICCONETTI

University Roma, Italy

of

525 AGED

SUBJECTS

PALLESCHI,

M.

and

MARIGLIANO

Rome,

V.

MIGLIORI,

Policlinico

Umberto

I.

SUMMARY Several studies have focused their attention on metabolic alterations, chiefly cholesterol plasma levels, related to depression, showing contrasting data. The aim of this study was at evaluating the correlation between anthropometric, metabolic parameters and depression in malnourished aged patients. We included 73 elderly subjects [mean age 79.15 + 15.3: 40 females and 33 males) ageand sexmatched; 48 patients of this poor were malnourished. All subjects underwent a complete anthropometric and biochemical nutritional assessment as well as a psychometric examination, usinq the mini mental state examination [MMSE). the qeriatric depression scale (GDS-) and self-sufficiency tests in form of the activity of daily livinq (ADL) as well as the instrumental for of it (IADL). Student’s t test and. linea; regression analysis were carried out for statistical analysis. Malnourished subjects showed higher values in CDS scores than controls (p = O-03), without statistically significant differences in the MMSE scores and cholesterol levels of the two groups, while in depressed group we found lower sideremia (p < 0.0001). higher triglycerides (p c 0.05), and insulinemia (p < 0.001) and impaired self sufficiency (p = 0.001). Linear regression analysis showed a strict correlation between CDS and triglycerides (r = 0.387, p = 0.03), centripetal adipose tissue distribution parameters [r = 0.678, p < 0.0001). triceps skinfold [t= 0.473, p = 0.008) and sideremia (r = -0.538, p = 0.001). Our data suggest that depression is closely related to malnutrition and to ensuing metabolic alterations, too. The direct correlation between CDS scores and metabolic disorders in these patients can be explained by previous reports supporting the hypothesis that cytokines could have a primary role both in malnutrition and in affective disorders. Keywords orders

: depression depression

in

in

aging,

nutritional

state

and

depression,

metabolic

dis-

INTRODUCTION Epidemiological the

elderly

pulation

studies

have (Kok

shown

et al.,

to

the

role

maintenance and factors

of

metabolic and

derly,

and,

ing

a dangerous

all

these

life

nutritional the

as

vitious

well

There status

other

As factors

depression, alterations.

on

Late

disorders. of

the

depression

1995).

bio-socio-psychological out

concerning

that

hand, circle

are in

is

prevalence widely

affective in

affective

disorders

a matter

of

in

promoting

as

of

many

fact,

many the

relationship

data an

Vetta

al.,

studies

have

po-

role

as pointed

development

and

the

depression of in

hyporexia, 1996).

in

elderly

interpreted

impairment induce

et

be

a key

affective may

disorders the

between

suggesting

itself 1996;

should

both

other

preventing depression

(Morley,

of represented

dietary the

el-

promotSeveral

data

526 have

suggested

vels

(Brown

et

showed

a

showed

contradictory

The

intriguing

links

al. , 1994:

Olusi

reduction

aim

of

metabolic

of

this

both

to

PATIENTS

and

33 males, matched.

A

in

rin men,

the

likely disease,

fold

MAMC

was

daily

living

(MMSE)

SD. ables.

to the

arm

and

al.,

using

was the

an

cm

pharmacological variables

or

urinary

medications

with

(hemochrome

test

etc.). biochemical

tape

following

cholesterolemia,

mass

index

measure

and

equation:

circumference

tri-

= BMI,

TSF

and

a Harpenden

= AC

(MacBurney

1963),

1969).

the

MAMC

state

et al.,

Brody, and

5 0.05

carried

out

statistical

IBM-compatible

regression

A p value

wo-

skin

the

geriatric

et

were the mini

-

al.,

(n

1990).

assessed

by

instrumental mental

depression

x TSF),

the

ac-

activity

state

of

examination

scale

(CDS)

and

linear

(Yesa-

scores.

analysis

on

18.6

variables.

(Katz

and 1975)

for

c

conditions,

disease,

(body

psycho-affective

scale

(Lawton et

1983)

analysis

Linear

the

transfer-

metabolic

transferrin,

a fiberglass

with

(ADL)

(IADL)

(Folstein

ganization

using

cri-

mm

and

or

and

using

parameters

protocol.

, serum

men

by from

inclusion

< 13.2

inflammatory

serum

anthropometric

for

sex-

affected

the

gldl and

nutritional

by

albumin,

men

and

and

obtained

the

conditions

blockers,

estimated

were was

1994),

cm

endocrinological

anthropometric

the

< 20.2

chronic

beta

was serum

living

Statistical sion

diseases,

sufficiency

et al.,

ex-

females

age-

approved

< 3.5 for

40

males)

al.,

albumin

the

modulators,

corresponded

of daily

a cohort

years,

consent

pathologic

or

106

21

et

< 10 mm

were:

to

and

(MAMC)

acute

calculated

self

tivity

patients,

Committee

serum

(TSF)

directly

operator

measured

were:

affect

formula,

A single

AC

them 1997).

controls.

written

(Haymsfield

diabetes,

status

and

The

of

al.,

anthropometric,

subjects,

65

Ethics

reports

loosing

caliper

where

aged

females

Institutional

criteria

immune

leukocyte

MAMC).

between

than

Informed

group

nutritional

glyceridemia)

correlation

et

lestudies

most

Santanello

self-sufficient

(27

skinfold

to

corticosteroids, with

plasmatic some

subjects,

1995;

ranging

circumference

protein

The

depressed al.,

malnourished

years,

subjects

local

Exclusion

enteral

cholesterol

Notwithstanding

depression

73 elderly

15.3

previous

arm-muscle

(neoplastic

vage

48

triceps

treatments

or

+

malnourished mg/dl,

women.

in and

malnutrition.

to

the

mid

for

of

and

< 230

the

study

79.2

group

According teria

evaluate

depression

the

age

protein-calorie

subjects,

in et

alterations

for

mean

chronic

levels

(Engstrom to

and

1996).

METHODS

We selected

all

was

metabolic

AND

Fido,

cholesterol

study

depression

and

results

parameters

posed

between

analysis was

by

package 486 was

considered

EPIINFO

computer. used

Student’s

to

t test 5 for

Data compare

as statistically

the

World

are

expressed

CDS

scores

significant.

regresHealth

as to

other

Or-

means vari-

+

527 RESULTS The min gldl;

subjects

malnourished

3.07

+ 0.3

g/dl;

lymphocytes

ugldl;

MAMC

cantly

1914 19.7

lower The

+-

cm;

those

MMSE

of

scores

did

malnourished

26.24

showed

higher

in

10.0

+ 5.37

values

The

data

3.71

mm.

Fe All

< 8.0001)

significant vs

malnourished

regarding are

Serum (Hb)

content)

these

50.17

values

albu-

9.2

+ 2.2 + 10.51

were

signifi-

. differences

in

controls

27.1

+ 2.18).

patients

than

in

the

two

while

controls

groups

CDS

(13.9

scores

+ 5.8

vs

the

metabolic

presented

in

Table

alterations

related

to

the

affective

state

I.

I

COMPARISON AND

OF

THE

CONTROLS

METABOLIC

(meann

Cholesterol (mg/dl) Triglycerides (mgldl) Basal insulin (~U/ml) Sideremia (pgldl)

The

data

elderly

ficantly

show

(Table

impaired, Linear and

subjects

The

the

self to

measured

+ 7 + -7

12.0 48.0 3.1 18.4

cholesterol

while

regression the

Control

subjects

identical

as compared

scores Table

I).

IN

Depressed

124.1 118.5 11.4 44.8

patients,

ALTERATIONS

DEPRESSED

SUBJECTS

+ SD)

Parameters

sed

show

+

values:

hemoglobin

(total

+ 2.1 (p

mean

mgldl;

p = 0.03).

modifications, Table

9.4

controls

not

following

+ 43.4 sideremia

TSF

the

(MMSE:

the

181.4 259/mm3;

+ 3.8

than

displayed

transferrin

other

metabolic

in

scores

controls

analysis

levels

+ 8.9 7 42.0 7 2.8 -7 35.1 the

3 parameters

sufficiency

the

129.7 95.5 6.1 92.8

(data

revealed

the

0.001 and

from

non-depres-

each

depressed

other

group

were

(Table

correlation

between

II).

II

CORRELATIONS Dependent Triglycerids Waist/hip I nsulinemia TSF Sideremia

BETWEEN variable

ratio

CDS

SCORES

AND

signialso

shown).

a signififcant

parameters

NS 0.05 0.001

depressed differ

of not

P<

METABOLIC

r 0.387 0.678 0.649 -0.473 - 0.538

PARAMETERS p < (or 0.03 0.001 0.001 0.008 0.001

=)

CDS

528 Finally, of age,

our

with

Table

data

show

an

a progressive

age-related

reduction

increase

in old-old

in

CDS

patients

values

(Table

until

85 years

III).

III

AGE-RELATED Age

CHANGES

IN CDS

SCORES

groups

A B C

65-74 years 75-84 years 85 years or

10.15 15.21 7.50

more

CDS

score

A/B B/C A/C

0.005 0.001 0.01

+ 5.69 T 5.60 z 4.80

p =

DISCUSSION Aging

is

As

a matter

are

common

physical

associated

of

fact,

findings

activity

(Morley,

in and

1996).

The drive

Recent

studies

suggest

higher

plasmatic

feeling

(Vetta

pathological causes All regard

to

modifications suing

or

more

and

and

well

values as

iron

with

to

of

oxide

decrease

occur

due

a

in aging

decreased

cholecystokinin.

deficiency,

hyporexia

data, CDS

in

as

and

adipose

well

early

while

the

and

as

satiation

al.

to

lead

most

common

results

suggest

to

1995). with

our

that

depression,

data,

cholesterol probably

percentage

of

dietary

allowances

previous

en-

depressed

reports,

sub(RDA)

1996)

glucocorticoid

showed

sideremia,

Recently, distribution

(1993,

the

Silver,

Therefore

1995) to

can

of

1994).

with

tissue

related

alterations.

contradictory

triglycerides,

distribution.

et

of

subjects. al.,

Somers,

agreement

are and

recommended

and

scores

Maes

effects

A substantial

than

adipose

insulinemia

metabolism

et

conditions

(Morley

associated

intake.

tissue

medical

drug

depressed

(Engstrom

in

and

explanation

epiphenomenon,

less

centripetal

of

is effect

promote

adverse

the

(Christensen our

depression,

higher

the that

aging

nitric

modifications

levels

food

consume

between

that

and

to

an in

nutrients

centripetal

showed

can

metabolic

reports be

Furthermore correlation

of satiating

subjects

modifications

counterbalance

composition

psychological

plasma

a reduction

indeed,

jects, one

cytokines

and

previous could

to

of

contribute

cholesterol to

older

Depression

loss

factors

according

in

modifications.

biochemical

1995).

hyporexia.

these

to

body

increased

metabolic

several

order in

an

of environmental,

of weight

and

hyporexia

to

that

levels

variety

in

modifications

and

al.,

physiological loss

elderly,

physiological

feeding

et

multifacetted weight

the

the

opioid

A

with hyporexia,

Raikkonen is

strictly

noted,

in activity

a strict

hyperinsulinemia et related depressed and

al.

(1994) to

stress

subjects,

alterations,

as

529

All

these

recent

reports

(Maes kine

depression-related

et

showing

al. , 1996).

serum

In and

levels and

may

disease

mass

involving are

an

with

discharge

the

both

(Vetta

in

distribution

al.,

1995).

support

the

be

homeostatic to clarify

balance the

as of

cyto-

by

that

hy-

increased fat

mass

depression

a neuro-immune-endo-

human

meaning

subjects

activity,

acids

hypothesis

by

Higher

and

fatty

considered

explained

1995).

a centripetal non-esterified

be

depressed

et al., corticosteroid

et

should

necessary

can

enhanced

of Vetta

knowledge

alterations

studies

alterations ones

promote

1993;

present

metabolic

further

fat

following

modifications

cytokines malnourished

Hotamisligil,

conclusion,

related

crinological theless,

in

a reduced

triglyceride (Spigelman

serum and

concentrations

perinsulinemia,

metabolic

organism. of

this

Never-

correlation.

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