Disrupted Insulin sensitivity and adiposity in kids tied to psychosis in later life: JAMA
Cardiometabolic disorders often occur concomitantly with depression and schizophrenia, leading to a reduced quality of life, increased health care costs, and a shortened life expectancy. Traditionally, this comorbidity has been attributed to chronic lifestyle factors or the adverse effects of psychotropic medications. In a recent study, researchers have found that disrupted insulin sensitivity could be a shared risk factor for comorbid cardiometabolic disorders and psychosis. They also reported that puberty-onset major increase in BMI could be a risk factor or risk indicator for adult depression. The study findings were published in the JAMA Psychiatry on January 13, 2021.
Existing studies have predominantly included prevalent depression or psychosis cases which cannot appropriately test the direction of the association between cardiometabolic and psychiatric phenotypes. The most longitudinal studies have included one-off measures of cardiometabolic indices, overlooking dynamic temporal changes in these markers. It is unclear whether longitudinal trends in cardiometabolic traits from childhood are associated with risks for adult psychosis and depression. Therefore, researchers of the University of Cambridge School of Clinical Medicine, UK conducted a study 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.
Researchers conducted a cohort study analyzing the data from within the Avon Longitudinal Study of Parents and Children (ALSPAC). They used body mass index and FI level data for growth mixture modelling to delineate developmental trajectories. They also used it to assess the associations with psychosis and depression. They evaluated data of fasting insulin levels measured at 9, 15, 18, and 24 years, and BMI at 1, 2, 3, 4, 7, 9, 10, 11, 12, 15, 18, and 24 years. A total of 10,463 participants had data available for BMI. Using the data from the aforementioned patient groups, researchers created 3 distinct trajectories for fasting insulin levels and 5 distinct trajectories for BMI. They used data related to sex, race/ethnicity, paternal social class, childhood emotional and behavioural problems, and cumulative scores of sleep problems, average calorie intake, physical activity, smoking, and alcohol and substance use in childhood and adolescence as confounders in adjusted analyses. The major outcomes assessed were psychosis risk and depression risk at 24 years.
Upon analysis, researchers found individuals with persistently high fasting insulin levels were associated with a psychosis at-risk mental state (aOR, 5.01; 95% CI, 1.76-13.19) and psychotic disorders (aOR, 3.22), but not depression (aOR, 1.98). They also found a puberty-onset major increase in BMI was associated with depression (aOR, 4.46) but not psychosis (aOR, 1.98).
The authors concluded, " 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".
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