体重指数 (BMI) 与重度抑郁症患者治疗结果的关联。
The association of body mass index (BMI) with treatment outcomes in patients with major depressive disorder.
机构信息
The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
Department of Child and Adolescent Psychiatry and Psychotherapy, Centre for Integrative Psychiatry, School of Medicine, Kiel, Germany; Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Child and Adolescent Psychosomatic Medicine and Psychotherapy, Altona Children's Hospital, Hamburg, Germany.
出版信息
J Affect Disord. 2021 Feb 15;281:799-804. doi: 10.1016/j.jad.2020.11.059. Epub 2020 Nov 12.
BACKGROUND
In patients with major depressive disorder (MDD), poor antidepressant treatment response might be associated with an excessive body mass index (BMI). However, the impact of underweight on treatment response is unclear. Moreover, it has not been studied whether a continuous or categorical BMI measure should be used to predict of treatment response.
METHODS
Post-hoc analysis of data collected in a clinical trial including adults with MDD (n=202) reporting outcomes of antidepressant medication, i.e. paroxetine, mirtazapine or paroxetine+mirtazapine. Measures included baseline BMI (underweight=BMI <18.5, normal weight:=BMI:18.5-23.9, overweight=BMI≥24) and symptom severity (17-item-Hamilton Depression scale; HAMD-17) assessed at weeks 0, 2, 3, 4, 6 and 8. Univariate analyses were used to explore the effect of baseline BMI on HAMD-17 reduction, response (defined as ≥50% HAMD-17 reduction) and remission (defined as HAMD-17 ≤7) at endpoint. Pearson correlation were used to explore the relationship between body weight, BMI as continuous measure and HAMD-17 reduction. Logistic regression was used to determine the predictors for remission. Multiple linear regression was used to establish the correlation of BMI with change of HAMD-17.
RESULTS
111 (55.0%) patients were normal weight, 20 (9.9%) were underweight, 71 (35.1%) were overweight. Underweight patients showed the best improvement to antidepressant treatment. Non-remitters had greater body weight and BMI than remitters (P<0.05). The reduction of HAMD-17 was correlated with baseline body weight (r=-0.16, P=0.032) and BMI (r=-0.19, P=0.012). Logistic regression found patients with BMI<24 to be 2 times (OR=1.958, 95%CI: 1.015, 3.774) remitters (P=0.045) than overweight patients. The multiple linear regression showed that the change of HAMD-17 total score decreased with increasing BMI (β=-0.32, P = 0.016).
CONCLUSION
We confirmed that BMI can predict treatment outcomes in MDD. For the first time we found that underweight patients benefit most from antidepressant treatment. The findings may be useful to physicians in their decision regarding the choice of antidepressants according to BMI.
背景
在患有重度抑郁症（MDD）的患者中，抗抑郁治疗反应不佳可能与体重指数（BMI）过高有关。然而，体重过轻对治疗反应的影响尚不清楚。此外，尚未研究应该使用连续的还是分类的 BMI 测量来预测治疗反应。
方法
对一项临床试验中收集的数据进行了事后分析，该试验纳入了 202 名患有 MDD 的成年人，报告了抗抑郁药物（即帕罗西汀、米氮平或帕罗西汀+米氮平）的治疗结果。测量指标包括基线 BMI（体重过轻=BMI<18.5、正常体重=BMI：18.5-23.9、超重=BMI≥24）和症状严重程度（17 项汉密尔顿抑郁量表；HAMD-17），分别在第 0、2、3、4、6 和 8 周进行评估。采用单变量分析来探讨基线 BMI 对 HAMD-17 降低、反应（定义为 HAMD-17 降低≥50%）和缓解（定义为 HAMD-17≤7）的影响。采用 Pearson 相关分析来探讨体重与 BMI 连续测量值与 HAMD-17 降低之间的关系。采用 logistic 回归确定缓解的预测因素。采用多元线性回归确定 BMI 与 HAMD-17 变化的相关性。
结果
111 名（55.0%）患者为正常体重，20 名（9.9%）为体重过轻，71 名（35.1%）为超重。体重过轻的患者对抗抑郁治疗的改善效果最佳。未缓解者的体重和 BMI 均大于缓解者（P<0.05）。HAMD-17 的降低与基线体重（r=-0.16，P=0.032）和 BMI（r=-0.19，P=0.012）呈负相关。logistic 回归发现 BMI<24 的患者缓解的可能性是超重患者的 2 倍（OR=1.958，95%CI：1.015，3.774，P=0.045）。多元线性回归显示 HAMD-17 总分的变化随 BMI 的增加而降低（β=-0.32，P=0.016）。
结论
我们证实 BMI 可以预测 MDD 的治疗结果。我们首次发现体重过轻的患者从抗抑郁治疗中获益最大。这些发现可能对医生根据 BMI 选择抗抑郁药物的决策有用。
Zotero 插件