Exercice physique Vs pharmacothérapie dans le traitement de la dépression majeure

Exercise and Pharmacotherapy in the Treatment of Major Depressive Disorder

 

Abstract

Objective

To assess whether patients receiving aerobic exercise training performed either at home or in a supervised group setting achieve reductions in depression comparable to standard antidepressant medication (sertraline) and greater reductions in depression compared to placebo controls.

Methods

Between October 2000 and November 2005, we performed a prospective, randomized controlled trial (SMILE study) with allocation concealment and blinded outcome assessment in a tertiary care teaching hospital. A total of 202 adults (153 women; 49 men) diagnosed with major depression were assigned randomly to one of four conditions: supervised exercise in a group setting; home-based exercise; antidepressant medication (sertraline, 50–200 mg daily); or placebo pill for 16 weeks. Patients underwent the structured clinical interview for depression and completed the Hamilton Depression Rating Scale (HAM-D).

Results

After 4 months of treatment, 41% of the participants achieved remission, defined as no longer meeting the criteria for major depressive disorder (MDD) and a HAM-D score of <8. Patients receiving active treatments tended to have higher remission rates than the placebo controls: supervised exercise = 45%; home-based exercise = 40%; medication = 47%; placebo = 31% (p = .057). All treatment groups had lower HAM-D scores after treatment; scores for the active treatment groups were not significantly different from the placebo group (p = .23).

Conclusions

The efficacy of exercise in patients seems generally comparable with patients receiving antidepressant medication and both tend to be better than the placebo in patients with MDD. Placebo response rates were high, suggesting that a considerable portion of the therapeutic response is determined by patient expectations, ongoing symptom monitoring, attention, and other nonspecific factors.

 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2702700/

 

En résumé: L'exercice physique est équivalent à la pharmacothérapie dans le traitement de la dépression majeure. 

 

Deux fruits par jour.

Abstract

Background: Few observational studies have examined the effect of dietary fiber intake and fruit and vegetable consumption on total mortality and have reported inconsistent results. All of the studies have been conducted in the general population and typically used only a single assessment of diet.

Objective: We investigated the association of fiber intake and whole-grain, fruit, and vegetable consumption with all-cause mortality in a Mediterranean cohort of elderly adults at high cardiovascular disease (CVD) risk by using repeated measurements of dietary information and taking into account the effect of a dietary intervention.

Design: We followed up 7216 men (55–75 y old) and women (60–75 y old) at high CVD risk in the Prevención con Dieta Mediterránea (PREDIMED) trial for a mean of 5.9 y. Data were analyzed as an observational cohort. Participants were initially free of CVD. A 137-item validated food-frequency questionnaire administered by dietitians was repeated annually to assess dietary exposures (fiber, fruit, vegetable, and whole-grain intakes). Deaths were identified through the continuing medical care of participants and the National Death Index. An independent, blinded Event Adjudication Committee adjudicated causes of death. Cox regression models were used to estimate HRs of death during follow-up according to baseline dietary exposures and their yearly updated changes.

Results: In up to 8.7 y of follow-up, 425 participants died. Baseline fiber intake and fruit consumption were significantly associated with lower risk of death [HRs for the fifth compared with the first quintile: 0.63 (95% CI: 0.46, 0.86; P = 0.015) and 0.59 (95% CI: 0.42, 0.82; P = 0.004), respectively]. When the updated dietary information was considered, participants with fruit consumption >210 g/d had 41% lower risk of all-cause mortality (HR: 0.59; 95% CI: 0.44, 0.78). Associations were strongest for CVD mortality than other causes of death.

En résumé:

La consommation de plus de 210g/j de fruits (équivalent de 2 fruits) réduirait la mortalité totale de 40%. 

La consommation de plus de 21g de fibres / J réduirait la mortalité totale de 25%.

Les noix, pas seulement délicieuses...

http://www.biomedcentral.com/1741-7015/11/164

 

Frequency of nut consumption and mortality risk in the PREDIMED nutrition intervention trial

 

Abstract

Background

Prospective studies in non-Mediterranean populations have consistently related increasing nut consumption to lower coronary heart disease mortality. A small protective effect on all-cause and cancer mortality has also been suggested. To examine the association between frequency of nut consumption and mortality in individuals at high cardiovascular risk from Spain, a Mediterranean country with a relatively high average nut intake per person.

Methods

We evaluated 7,216 men and women aged 55 to 80 years randomized to 1 of 3 interventions (Mediterranean diets supplemented with nuts or olive oil and control diet) in the PREDIMED (‘PREvención con DIeta MEDiterránea’) study. Nut consumption was assessed at baseline and mortality was ascertained by medical records and linkage to the National Death Index. Multivariable-adjusted Cox regression and multivariable analyses with generalized estimating equation models were used to assess the association between yearly repeated measurements of nut consumption and mortality.

Results

During a median follow-up of 4.8 years, 323 total deaths, 81 cardiovascular deaths and 130 cancer deaths occurred. Nut consumption was associated with a significantly reduced risk of all-cause mortality (P for trend <0.05, all). Compared to non-consumers, subjects consuming nuts >3 servings/week (32% of the cohort) had a 39% lower mortality risk (hazard ratio (HR) 0.61; 95% CI 0.45 to 0.83). A similar protective effect against cardiovascular and cancer mortality was observed. Participants allocated to the Mediterranean diet with nuts group who consumed nuts >3 servings/week at baseline had the lowest total mortality risk (HR 0.37; 95% CI 0.22 to 0.66).

Conclusions

Increased frequency of nut consumption was associated with a significantly reduced risk of mortality in a Mediterranean population at high cardiovascular risk.

 

 

 

http://ije.oxfordjournals.org/content/41/2/377.long

Who are the participants in the PREDIMED study?

Participants are men (55–80 years old) or women (60–80 years old) who were free of CVD at baseline. Inclusion criteria were to have either type 2 diabetes or ≥3 major cardiovascular risk factors, out of the following: current smoking (>1 cig/day during the last month); hypertension (systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg or antihypertensive medication); LDL cholesterol ≥160 mg/dl or lipid-lowering therapy; HDL cholesterol ≤40 mg/dl in men or ≤50 mg/dl in women; body mass index ≥25 kg/m²; and family history of premature CHD.

Exclusion criteria were the previous history of CVD (i.e. a previous medical diagnosis of CHD, stroke or peripheral arterial disease), any severe chronic illness, immunodeficiency or human immunodeficiency virus (HIV) positive status, illegal drug or alcohol misuse, history of allergy to olive oil or nuts and low predicted likelihood of changing dietary habits according to the Prochaska and DiClemente stages of change model.²¹ Figure 1 provides further details on the selection procedure. 

En résumé :

La consommation de 30g de fruits à coque (noix,amandes, noisettes) par jour, plus de 3 fois par semaine, réduit la mortalité globale de 50% en prévention primaire chez les patients à haut risque cardiovasculaire.

Lait, fracture du col et mortalité, qu'en pensez-vous?

 

Milk intake and risk of mortality and fractures in women and men: cohort studies

Abstract

Objective To examine whether high milk consumption is associated with mortality and fractures in women and men.

Design Cohort studies.

Setting Three counties in central Sweden.

Participants Two large Swedish cohorts, one with 61 433 women (39-74 years at baseline 1987-90) and one with 45 339 men (45-79 years at baseline 1997), were administered food frequency questionnaires. The women responded to a second food frequency questionnaire in 1997.

Main outcome measure Multivariable survival models were applied to determine the association between milk consumption and time to mortality or fracture.

Results During a mean follow-up of 20.1 years, 15 541 women died and 17 252 had a fracture, of whom 4259 had a hip fracture. In the male cohort with a mean follow-up of 11.2 years, 10 112 men died and 5066 had a fracture, with 1166 hip fracture cases. In women the adjusted mortality hazard ratio for three or more glasses of milk a day compared with less than one glass a day was 1.93 (95% confidence interval 1.80 to 2.06). For every glass of milk, the adjusted hazard ratio of all cause mortality was 1.15 (1.13 to 1.17) in women and 1.03 (1.01 to 1.04) in men. For every glass of milk in women no reduction was observed in fracture risk with higher milk consumption for any fracture (1.02, 1.00 to 1.04) or for hip fracture (1.09, 1.05 to 1.13). The corresponding adjusted hazard ratios in men were 1.01 (0.99 to 1.03) and 1.03 (0.99 to 1.07). In subsamples of two additional cohorts, one in males and one in females, a positive association was seen between milk intake and both urine 8-iso-PGF2α (a biomarker of oxidative stress) and serum interleukin 6 (a main inflammatory biomarker).

Conclusions High milk intake was associated with higher mortality in one cohort of women and in another cohort of men, and with higher fracture incidence in women. Given the observational study designs with the inherent possibility of residual confounding and reverse causation phenomena, a cautious interpretation of the results is recommended.

En résumé, d'après cette cohorte, pour chaque verre de lait par jour consommé, la mortalité globale augmente de 15% chez la femme et de 3% chez l'homme.
Qu'en est il du risque de fracture du col... Aucune différence!!! Probable cause, le D-galactose, surtout présent dans les produits laitiers non-fermentés.

30% de mortalité en moins pour les modérement sédentaires par rapport aux sédentaires!!

Physical activity and all-cause mortality across levels of overall and abdominal adiposity in European men and women: the European Prospective Investigation into Cancer and Nutrition Study (EPIC) 

Abstract

Background: The higher risk of death resulting from excess adiposity may be attenuated by physical activity (PA). However, the theoretical number of deaths reduced by eliminating physical inactivity compared with overall and abdominal obesity remains unclear.

Objective: We examined whether overall and abdominal adiposity modified the association between PA and all-cause mortality and estimated the population attributable fraction (PAF) and the years of life gained for these exposures.

Design: This was a cohort study in 334,161 European men and women. The mean follow-up time was 12.4 y, corresponding to 4,154,915 person-years. Height, weight, and waist circumference (WC) were measured in the clinic. PA was assessed with a validated self-report instrument. The combined associations between PA, BMI, and WC with mortality were examined with Cox proportional hazards models, stratified by center and age group, and adjusted for sex, education, smoking, and alcohol intake. Center-specific PAF associated with inactivity, body mass index (BMI; in kg/m²) (>30), and WC (≥102 cm for men, ≥88 cm for women) were calculated and combined in random-effects meta-analysis. Life-tables analyses were used to estimate gains in life expectancy for the exposures.

Results: Significant interactions (PA × BMI and PA × WC) were observed, so HRs were estimated within BMI and WC strata. The hazards of all-cause mortality were reduced by 16–30% in moderately inactive individuals compared with those categorized as inactive in different strata of BMI and WC. Avoiding all inactivity would theoretically reduce all-cause mortality by 7.35% (95% CI: 5.88%, 8.83%). Corresponding estimates for avoiding obesity (BMI >30) were 3.66% (95% CI: 2.30%, 5.01%). The estimates for avoiding high WC were similar to those for physical inactivity.

Conclusion: The greatest reductions in mortality risk were observed between the 2 lowest activity groups across levels of general and abdominal adiposity, which suggests that efforts to encourage even small increases in activity in inactive individuals may be beneficial to public health.

http://ajcn.nutrition.org/content/101/3/613.full

Questionnaire:  (je ne sais pas si c'est le même mais ça y ressemble si on se fie aux questions posées dans l'article)

http://www.patient.co.uk/doctor/general-practice-physical-activity-questionnaire-gppaq

http://onlinelibrary.wiley.com/doi/10.1002/9781118702758.app8/pdf

 Quel est votre niveau d'activité?

Une raison de plus d'aimer le chocolat noir

Cocoa flavanol consumption improves cognitive function, blood pressure control, and metabolic profile in elderly subjects: the Cocoa, Cognition, and Aging (CoCoA) Study—a randomized controlled trial

Background: Recent evidence has indicated that flavanol consumption may have many health benefits in humans, including improved cognitive activities.

Objective: The aim was to evaluate the effect of flavanol consumption on cognitive performance in cognitively intact elderly subjects. 

Design: This was a double-blind, controlled, parallel-arm study conducted in 90 elderly individuals without clinical evidence of cognitive dysfunction who were randomly assigned to consume daily for 8 wk a drink containing 993 mg [high flavanol (HF)], 520 mg [intermediate flavanol (IF)], or 48 mg [low flavanol (LF)] cocoa flavanols (CFs). Cognitive function was assessed at baseline and after 8 wk by using the Mini-Mental State Examination (MMSE), the Trail Making Test (TMT) A and B, and the Verbal Fluency Test (VFT). 

Results: The changes in MMSE score in response to the 3 different treatments were not different. In contrast, there was a positive impact of the intervention on specific aspects of cognitive function. Mean changes (±SEs) in the time required to complete the TMT A and B after consumption of the HF (−8.6 ± 0.4 and −16.5 ± 0.8 s, respectively) and IF (−6.7 ± 0.5 and −14.2 ± 0.5 s, respectively) drinks significantly (P < 0.0001) differed from that after consumption of the LF drinks (−0.8 ± 1.6 and −1.1 ± 0.7 s, respectively). Similarly, VFT scores significantly improved among all treatment groups, but the magnitude of improvement in the VFT score was significantly (P < 0.0001) greater in the HF group (7.7 ± 1.1 words/60 s) than in the IF (3.6 ± 1.2 words/60 s) and LF (1.3 ± 0.5 words/60 s) groups. Significantly different improvements in insulin resistance (P < 0.0001), blood pressure (P < 0.0001), and lipid peroxidation (P = 0.001) were also observed for the HF and IF groups in comparison with the LF group. Changes in insulin resistance explained ∼17% of changes in composite z score (partial r² = 0.1703, P < 0.0001).

Conclusions: This dietary intervention study provides evidence that regular CF consumption can reduce some measures of age-related cognitive dysfunction, possibly through an improvement in insulin sensitivity. These data suggest that the habitual intake of flavanols can support healthy cognitive function with age. This trial was registered at www.controlled-trials.com as ISRCTN68970511.

En résumé: Le flavanol de cacao: Diminue la résistance à l'insuline, et améliore la pression artérielle et la fonction cognitive chez les patients agés .

Article complet: http://ajcn.nutrition.org/content/101/3/538.full

http://fr.wikipedia.org/wiki/Flavan-3-ol#Plantes_riches_en_flavanols

Composition en flavanols de fruits et légumes, crus (Résultats en mg/kg de matière fraîche)
	(–)-épicatéchine	(+)-catéchine	Total
Fève (Vicia faba), graine crue	225,1	128,3	353,4
Mûre (Rubus sp.)	180,8	6,6	187,4
Raisin noir	86,4	89,4	175,8
Cerise	95,3	21,7	117,0
Abricot	60,6	49,5	110,1
Framboise	82,6	9,7	92,3
Pomme avec sa peau	81,4	9,5	90,9
Prune	28,4	33,5	61,9
Fraises	0	44,7	44,7

Consommation de sel et mortalité global chez des patients à haut risque cardio-vasculaire

Is complying with the recommendations of sodium intake beneficial for health in individuals at high cardiovascular risk? Findings from the PREDIMED study

 

 

Abstract

Background: Excess sodium intake is associated with high blood pressure, a major risk factor for cardiovascular disease (CVD). It is unknown whether decreasing sodium intake to <2300 mg/d has an effect on CVD or all-cause mortality.

Objective: The objective was to assess whether reductions in sodium intake to <2300 mg/d were associated with either an increased or a decreased risk of fatal and nonfatal CVD and all-cause mortality.

Design: This observational prospective study of the PREvención con DIeta MEDiterránea (PREDIMED) trial included 3982 participants at high CVD risk. Sodium intake was evaluated with a validated food-frequency questionnaire and categorized as low (<1500 mg/d), intermediate (≥1500 to ≤2300 mg/d), high (>2300 to ≤3400 mg/d), or very high (>3400 mg/d). Subsequently, 1-y and 3-y changes in sodium intake were calculated. Multivariate relative risks were assessed by using Cox proportional hazards ratios. Marginal structural models with inverse probability weighting were used to test the effect of changes in sodium intake and the Mediterranean diet (MedDiet).

Results: We documented 125 CVD events and 131 deaths after a 4.8-y median follow-up. Sodium intake <2300 mg/d was associated with a lower risk of all-cause mortality: 48% (HR: 0.52; 95% CI: 0.30, 0.91; P = 0.02) and 49% (HR: 0.51; 95% CI: 0.26, 0.98; P = 0.04) after 1 and 3 y, respectively. Increasing sodium intake after 1 y was associated with a 72% (HR: 1.72; 95% CI: 1.01, 2.91; P = 0.04) higher risk of CVD events. The incidence rate of CVD was reduced for those who reduced their sodium intake and were randomly assigned to MedDiet interventions [4.1/10,000 (95% CI: 3.1, 8.0) compared with 4.4/10,000 (95% CI: 2.7, 12.4) person-years; P = 0.002].

Conclusions: Decreasing sodium intake to <2300 mg/d was associated with a reduced risk of all-cause mortality, whereas increasing the intake to >2300 mg/d was associated with a higher risk of CVD. Our observational data suggest that sodium intake <2300 mg/d was associated with an enhanced beneficial effect of the MedDiet on CVD. These results should be interpreted with caution, and other confirmatory studies are necessary. This study was registered at controlled-trials.com as 35739639.