Longitudinal Trends in Childhood Insulin Levels and Body Mass Index and Associations With Risks of Psychosis and Depression in Young Adults.
Longitudinal Trends in Childhood Insulin Levels and Body Mass Index and Associations With Risks of Psychosis and Depression in Young Adults.
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DOI：
10.1001/jamapsychiatry.2020.4180
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发表时间：
2021-04-01
期刊：
影响因子：
25.8
通讯作者：
Khandaker GM
中科院分区：
文献类型：
--
作者：
Perry BI;Stochl J;Upthegrove R;Zammit S;Wareham N;Langenberg C;Winpenny E;Dunger D;Jones PB;Khandaker GM
童年期胰岛素水平和体重指数的纵向趋势是否与成年抑郁症和精神病相关？这项队列研究对 10-463 名个体从 1 岁到 24 岁的重复测量数据进行了研究，确定了空腹胰岛素水平和体重指数的变化轨迹。 9 岁时持续较高的空腹胰岛素水平与 24 岁时的精神病有关，青春期开始的体重指数增加与 24 岁时的抑郁症有关。这项研究的结果表明，从童年开始的胰岛素敏感性和肥胖的变化可能与精神病和抑郁症具有特定的疾病相关性，并且代表了预防和治疗精神病和抑郁症患者心脏代谢疾病的目标。心脏代谢疾病通常与精神病和抑郁症同时发生，导致高死亡率，并且在精神疾病发作时即可检测到。然而，尚不清楚童年时期心脏代谢特征的纵向趋势是否与成人精神病和抑郁症的风险相关。旨在检查儿童早期空腹胰岛素（FI）水平和体重指数（BMI）的特定发育轨迹是否与年轻人的精神病和抑郁症纵向相关。雅芳父母和儿童纵向研究的一项队列研究是一项前瞻性研究，其中包括 14-975 名具有人口代表性的英国队列，使用 1 至 24 岁参与者的数据进行。体重指数和 FI 水平数据用于生长混合模型，以描绘发育轨迹，并评估与精神病和抑郁症的关联。该研究于2019年7月15日至2020年3月24日期间进行。在9、15、18和24岁时测量空腹胰岛素水平，在1、2、3、4、7、9、10、11、12、15、18和24岁时测量BMI。有关性别、种族/族裔、父亲社会阶层、童年情绪和行为问题、睡眠问题累积分数、平均卡路里摄入量、体力活动、吸烟、酒精和儿童和青春期物质使用的数据被检查为潜在的混杂因素。精神病风险（明确的精神病经历、精神病、高危精神状态和阴性症状评分）抑郁风险（使用计算机化临床访谈表（修订版）进行测量）在 24 岁时进行评估。根据 5790 名参与者（3132 [54.1%] 女性）的 FI 水平可用数据和 10~463 名参与者（5336 [51.0%] 女性）的 BMI 数据，注意到 3 种不同的 FI 水平轨迹和 5 种不同的 BMI 轨迹，所有这些轨迹均在儿童中期进行区分。持续高 FI 水平轨迹与精神病高危精神状态（调整比值比 [aOR]，5.01；95% CI，1.76-13.19）和精神障碍（aOR，3.22；95% CI，1.29-8.02）相关，但与抑郁症无关（aOR，1.38；95% CI，0.75-2.54）。青春期BMI的大幅增加与抑郁症相关（aOR，4.46；95% CI，2.38-9.87），但与精神病无关（aOR，1.98；95% CI，0.56-7.79）。精神病和抑郁症的心脏代谢合并症可能具有独特的、疾病特异性的早期起源。胰岛素敏感性受损可能是合并心脏代谢疾病和精神病的共同危险因素。青春期体重指数的大幅增加可能是成人抑郁症的危险因素或风险指标。这些标志物可能代表预防和治疗精神病和抑郁症患者心脏代谢紊乱的目标。这项队列研究考察了从儿童期到 24 岁的空腹胰岛素水平和体重指数的变化，以及该队列在 24 岁时患精神疾病的风险。
Are longitudinal trends in insulin levels and body mass index from childhood associated with adult depression and psychosis? This cohort study of repeated-measure data from age 1 to 24 years in up to 10 463 individuals identified trajectories of fasting insulin levels and body mass index. Persistently high fasting insulin levels from age 9 years were associated with psychosis at 24 years, and puberty-onset body mass index increase was associated with depression at 24 years. This study’s findings suggest that changes in insulin sensitivity and adiposity starting from childhood may have disorder-specific associations with psychosis and depression and represent targets for prevention and treatment of cardiometabolic disorders in people with psychosis and depression. Cardiometabolic disorders often occur concomitantly with psychosis and depression, contribute to high mortality rates, and are detectable from the onset of the psychiatric disorders. However, it is unclear whether longitudinal trends in cardiometabolic traits from childhood are associated with risks for adult psychosis and depression. To examine whether specific developmental trajectories of fasting insulin (FI) levels and body mass index (BMI) from early childhood were longitudinally associated with psychosis and depression in young adults. A cohort study from the Avon Longitudinal Study of Parents and Children, a prospective study including a population-representative British cohort of 14 975 individuals, was conducted using data from participants aged 1 to 24 years. Body mass index and FI level data were used for growth mixture modeling to delineate developmental trajectories, and associations with psychosis and depression were assessed. The study was conducted between July 15, 2019, and March 24, 2020. Fasting insulin levels were measured at 9, 15, 18, and 24 years, and BMI was measured at 1, 2, 3, 4, 7, 9, 10, 11, 12, 15, 18, and 24 years. Data on sex, race/ethnicity, paternal social class, childhood emotional and behavioral problems, and cumulative scores of sleep problems, average calorie intake, physical activity, smoking, and alcohol and substance use in childhood and adolescence were examined as potential confounders. Psychosis risk (definite psychotic experiences, psychotic disorder, at-risk mental state status, and negative symptom score) depression risk (measured using the computerized Clinical Interview Schedule–Revised) were assessed at 24 years. From data available on 5790 participants (3132 [54.1%] female) for FI levels and data available on 10 463 participants (5336 [51.0%] female) for BMI, 3 distinct trajectories for FI levels and 5 distinct trajectories for BMI were noted, all of which were differentiated by mid-childhood. The persistently high FI level trajectory was associated with a psychosis at-risk mental state (adjusted odds ratio [aOR], 5.01; 95% CI, 1.76-13.19) and psychotic disorder (aOR, 3.22; 95% CI, 1.29-8.02) but not depression (aOR, 1.38; 95% CI, 0.75-2.54). A puberty-onset major increase in BMI was associated with depression (aOR, 4.46; 95% CI, 2.38-9.87) but not psychosis (aOR, 1.98; 95% CI, 0.56-7.79). The cardiometabolic comorbidity of psychosis and depression may have distinct, disorder-specific early-life origins. Disrupted insulin sensitivity could be a shared risk factor for comorbid cardiometabolic disorders and psychosis. A puberty-onset major increase in BMI could be a risk factor or risk indicator for adult depression. These markers may represent targets for prevention and treatment of cardiometabolic disorders in individuals with psychosis and depression. This cohort study examines changes in fasting insulin levels and body mass index from childhood to age 24 years and the risk for psychiatric disorders in that cohort at age 24 years.
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