Browsing by Author "Vrany, Elizabeth"

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    Depressive Symptoms are Associated with Poor Adherence to Some Lifestyle but not Medication Recommendations to Prevent Cardiovascular Disease: National Health and Nutrition Examination Survey (NHANES) 2005-2010
    (Office of the Vice Chancellor for Research, 2013-04-05) Berntson, Jessica; Stewart, Kendra Ray; Vrany, Elizabeth; Khambaty, Tasneem; Stewart, Jesse C
    Depression has been linked to poor medical adherence; however, most studies have involved persons with preexisting conditions, such as cardiovascular disease (CVD). Our aim was to examine relationships between depressive symptoms and adherence to medication and lifestyle recommendations intended to prevent CVD in a community sample. We selected adults ≥18 years (53%-56% female, 47%-52% non-white) with a history of hypertension and/or hypercholesterolemia, but free of CVD, who participated in 2005-2010 waves of NHANES – a survey of a large probability sample representative of the U.S. population. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depressive symptoms (converted to z-scores). The NHANES Blood Pressure and Cholesterol questionnaire was used to assess self-reported adherence to five medication and lifestyle recommendations: take antihypertensive medication (N=3313), take lipid-lowering medication (N=2266), control/lose weight (N=2177), eat fewer high fat/cholesterol foods (N=2924), and increase physical activity (N=2540). Logistic regression models (adjusting for age, sex, race-ethnicity, education, body mass, diabetes, smoking status, daily alcohol intake and NHANES sample design) revealed that a 1-SD increase in PHQ-9 total score was associated with a 14% lower likelihood of adherence to the control/lose weight recommendation (OR=0.86, 95% CI: 0.75-0.98, p=.02) and a 25% lower likelihood of adherence to the increase physical activity recommendation (OR=0.75, 95% CI: 0.65-0.86, p<.001). PHQ-9 total score was not associated with the likelihood of adherence to antihypertensive medication (OR, 0.93, 95% CI: 0.82-1.05, p=0.21), lipid-lowering medication (OR=0.99, 95% CI: 0.86-1.14, p=0.90), or eat fewer high fat/cholesterol foods recommendations (OR=0.94, 95% CI: 0.82-1.08, p=0.40). Adherence rates for depressed verses nondepressed adults to the control/lose weight recommendation were 75% and 85% and the increase physical activity recommendation were 63% and 79%, respectively. Our findings suggest that poor adherence to weight and activity recommendations, but not medication and diet recommendations, may partially explain the excess CVD risk of depressed persons.
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    Food attentional biases and adiposity: are energy intake and external eating mediators of this relationship?
    (2015-08) Vrany, Elizabeth; Stewart, Jesse C.; Cyders, Melissa Anne; Mosher, Catherine Esther
    Obesity is a substantial threat to the health of over a third of adults in the United States. Some evidence suggests that food attentional bias, or the tendency to automatically direct attention toward food-related stimuli in the environment, may contribute to the development of obesity in susceptible individuals. This study hypothesized that (1) food attentional bias would be positively associated with adiposity, (2) food attentional bias would be positively associated with energy intake and external eating, and (3) energy intake and external eating would partially mediate the association between food attentional bias and adiposity. Data were collected from a sample of 120 undergraduate students. Three measures of food attentional bias were obtained: reaction time bias obtained from a visual dot-probe task and direction bias and duration bias obtained from eye tracking. Adiposity indices of body mass index (kg/m2) and body fat percent were measured using standard medical devices. Data were obtained for two mediators: 1) energy intake was assessed by web-based automated 24-hour dietary recall and 2) external eating was assessed using the External Eating Subscale of the Dutch Eating Behavior Questionnaire. Separate linear regression models examining the association between each measure of food attentional bias with each measure of adiposity (adjusted for age, sex, race/ethnicity, and subjective hunger) indicated no associations. Similarly, linear regression analyses revealed no associations between measures of food attentional bias and energy intake or external eating. Models testing for statistical mediation demonstrated that energy intake and external eating were not significant mediators. However, mediation analyses demonstrated a significant overall effect and direct effect between direction bias and BMI in a reduced sample used to test for energy intake as a mediator, suggesting the presence of an association which may not have been detected in the larger sample due to methodological issues, measurement error, or type I error. Despite the overall null results, these findings, in conjunction with previous studies on food attentional biases and adiposity, highlight the need for future investigations examining prospective associations between food attentional bias and adiposity.
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    Somatic Symptoms, but Not Nonsomatic Symptoms, of Depression are Associated with Insulin Resistance: National Health and Nutrition Examination Survey (NHANES) 2005-2010
    (Office of the Vice Chancellor for Research, 2013-04-05) Vrany, Elizabeth; Berntson, Jessica; Khambaty, Tasneem; Stewart, Jesse C
    While there is a well-established link between depression and type 2 diabetes, depressive symptoms have received little attention in this literature. To begin to address this gap, we examined relationships among the somatic and nonsomatic symptoms of depression and insulin resistance, which is involved in the development of type 2 diabetes. Participants were 4,834 adults (mean age = 44.3 years, 50% female, 19% African American, 20% Mexican American) who participated in the 2005-2010 waves of NHANES – a survey of a large representative sample of the U.S. population. Participants with the following conditions were excluded: diabetes, cardiovascular disease, liver disease, kidney disease, or pregnancy. Depressive symptoms were measured using the Patient Health Questionnaire (PHQ-9), and somatic and nonsomatic subscales were derived based on confirmatory factor analysis. Our index of insulin resistance was the homeostatic model assessment (HOMA) score, which we computed from fasting plasma glucose and insulin levels. Separate regression analyses (adjusted for age, sex, race-ethnicity, education, BMI, and NHANES sample design) demonstrated positive relationships between PHQ-9 total (B=0.04, SEB=0.01, p<0.0001), somatic (B=0.07, SEB=0.02, p=0.0004), and nonsomatic (B=0.06, SEB=0.02, p=0.0004) scores and HOMA score. When the subscales were entered simultaneously into a regression model, the somatic score (B=0.05, SEB=0.02, p=0.03), but not the nonsomatic score (B=0.03, SEB=0.02, p=0.06), remained associated with HOMA score. A significant interaction was found for race-ethnicity, and further analyses demonstrate that the somatic symptoms of depression are only significantly associated with HOMA among Caucasians (B=0.07, SEB=0.02, p=0.02). Our cross-sectional findings suggest that the relationship between depression and insulin resistance may be driven by the somatic symptoms of depression and that this relationship may only be present only occur in Caucasians. The findings suggest that Caucasian adults with the somatic symptoms of depression may be at an elevated risk of type 2 diabetes.