肥胖和抑郁 META分析課件

Overweight,Obesity,andDepression

ASystematicReviewandMeta-analysisofLongitudinalStudiesArchGenPsychiatry.2010;67(3):220-229AuthorsAffiliations:DepartmentsofPsychiatry(DrsLuppino,Penninx,andZitman)MedicalStatisticsandBioinformatics(DrStijnen)LeidenUniversityMedicalCenterContext

Associationbetweenobesityandde-pressionhasrepeatedlybeenestablished.Fortreatmentandpreventionpurposes,itisimportanttoacquiremoreinsightintotheirlongitudinalinteraction.

DataSources:StudieswerefoundusingPubMed,PsycINFO,andEMBASEdatabasesandselectedonseveralcriteria.

StudySelection:Studiesexaminingthelongi-tudinalbidirectionalrelationbetweendepressionandoverweight(bodymassindex25-29.99)orobesity(bodymassindex≥30)wereselected.

DataExtraction:Unadjustedandadjustedoddsratios(ORs)wereextractedorprovidedbytheauthors.DataSynthesis:Obesityatbaselineincreasedtheriskofonsetofdepressionatfollow-up(unadjustedOR,1.55).Overweightincreasedtheriskofonsetofdepressionatfollow-up(unadjustedOR,1.27).Thisassociationwasstatisticallysignificantamongadults(aged20-59yearsand≥60years)butnotamongyoungerpersons(aged＜20years).

Baselinedepression(symptomsanddisorder)wasnotpredictiveofoverweightovertime.However,depressionincreasedtheoddsfordevelopingobesity(OR,1.58).

Conclusions:Thismeta-analysisconfirmsareciprocallinkbetweendepressionandobesity.Obesitywasfoundtoincreasetheriskofdepression,mostpronouncedamongAmericansandforclini-callydiagnoseddepression.Inaddition,depressionwasfoundtobepredictiveofdevelopingobesity.RetrievefulltextExcludeNotsureIncludeExcludeIncludeExclude閱讀標題和摘要排除可能符合納入標準者對照納入標準排除不肯定合格者納入排除補充信息納入收集臨床試驗閱讀全文Studyeliminated1.Studiespresentingsolelycross-sectionalanalyses.2.Articlesdiscussingsubjectsotherthanthedirectrelationshipbetweenunipolardepressionandobesity.3.Articlesexaminingahighlyspecificpopulation.4.Articleswithafollow-upperiodoflessthan1year.5.StudynotexpressingweightasBMI,ornotspecifyingthewaydepressionwasassessedwereexcluded.

EffectsizesForinclusioninthemeta-analysis,effectsizeshadtobeexpressedasORs.Ifthiswasnotthecase,thepublishedeffectsizesweretransformedintoORs.Iftransformationwasnotpossible,thecorrespondingauthorofthatparticulararticlewascontactedandaskedtoprovidetheORsoftheassociationofinterest.Foreachanalysis,only1effectsizeperincludedarticlewasused.StatisticalAnalyses

Datamanagement,transformationofeffectsizes,andcalculationofthepooledmeaneffectsizeswereperformedusingComprehensiveMeta-analysis(CMA)version2.0.Availabledataweredividedinto2directions:BMIcategoriesaspredictorsofdepressionatfollow-upordepressionatbaselineasapredictorofBMIcategoriesatfollow-up.

Allpresentedresultsarebasedonthe15includedstudies.Toexaminethepossibilityofpublicationbias,wefirstinspectedthefunnelplot,whichplotsameasureofstudysize(thestandarderrororprecision)asafunctionofeffectsize.Visualinspectionofafunnelplotprovidesanindicationofpublicationbiaswhenlargerandsmallerstudiesarenonsymme-tricallydistributedacrossthecombinedeffectsize.

ThepresenceofpublicationbiaswasfurthertestedusingtheEggermethod,whichquantifiesthebiascapturedbythefunnelplotbyregressingthestandardnormaldeviationonprecisiondefinedastheinverseofthestandarderror.Ifpublicationbiaswasobserved,theDuvalandTweedietrimandfillprocedurewasusedtocalculateanestimateoftheeffectsizeafterconsideringpublicationbias(adjustedeffectsize).Possibleoutlierswerevisuallyidentifiedandtestedfortheireffectonthesignificanceoftheeffectsize.

Sinceconsiderableheterogeneitywasexpected,allanalyseswereperformedwitharandom-effectsmodel.Toassessheterogeneitybetweenstudies,Q-statisticswerecalculated.AstatisticallysignificantQindicatesahetero-geneousdistributionofORsbetweenstudies,meaningthatsystematicdifferences,possiblyinfluencingtheresults,arepresent.Depressionexposure→ObesityoroverweightoutcomeComment

Theresultsofourlongitudinalmeta-analysisfoundalargerpooledeffectsize(ORsbetween1.20and1.58)thanthepooledORof1.18reportedinthecrosssecti-onalmeta-analysisofdeWitetal.

Reason:Possiblytimeplaysaroleintheassociationbetweendepressionandobesity.Theunfavorableeffectofdepressionondevelopmentofobesityandtheeffectofobesityondevelopmentofdepressionmaybereinforcedbytime.Limitation★1.Thesearchwasrestrictedtoacompu-terizedsearchforEnglishlanguageliterature.Nonetheless,wearenotawareofmissingnon–English-writtenliterature,asourliteraturesearchorhandsearchforreferencesdidnotyieldanyempiricallongitudinalstudiesinotherlanguages.

★2.Unpublishedliteraturewasnotincluded,possiblyresultinginaslightincreasedriskofpublicationbiasfortheincludedstudiesonbaselinedepression.Limitation★3.Althoughthetotalnumberofincludedsubjectsissubstantial,thenumberofincludedarticlesisrelativelysmall.Threearticlescouldnotbeincludedbecausetheydidnotincludetheappropriateavailableeffectsize:AndersonetalandForman-Hoffmanetalexpressedweightoutcomesintermsofweightchange,andFrankoetalpresentedobesityoutcomesasafunctionofincreaseordecreaseofdepre