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Depression, stress and diet can all alter inflammation. This double-blind, randomized crossover study addressed the impact of daily stressors and a history of major depressive disorder (MDD) on inflammatory responses to high-fat meals. During two separate 9.5?h admissions, 58 healthy women (38 breast cancer survivors and 20 demographically similar controls), mean age 53.1 years, received either a high saturated fat meal or a high oleic sunflower oil meal. The Daily Inventory of Stressful Events assessed prior day stressors and the Structured Clinical Interview for DSM-IV evaluated MDD. As expected, for a woman with no prior day stressors, C-reactive protein (CRP), serum amyloid A (SAA), intercellular adhesion molecule-1 (sICAM-1) and vascular cell adhesion molecule-1 (sVCAM-1) were higher following the saturated fat meal than the high oleic sunflower oil meal after controlling for pre-meal measures, age, trunk fat and physical activity. But if a woman had prior day stressors, these meal-related differences disappeared-because the stressors heightened CRP, SAA, sICAM-1 and sVCAM-1 responses to the sunflower oil meal, making it look more like the responses to the saturated fat meal. In addition, women with an MDD history had higher post-meal blood pressure responses than those without a similar history. These data show how recent stressors and an MDD history can reverberate through metabolic alterations, promoting inflammatory and atherogenic responses.Molecular Psychiatry advance online publication, 20 September 2016; doi:10.1038/mp.2016.149.
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Depression, Daily Stressors, and Inflammatory Responses to
High-Fat Meals: When Stress Overrides Healthier Food Choices
Janice K. Kiecolt-Glaser, PhD1,2, Christopher P. Fagundes, PhD3,4, Rebecca Andridge,
PhD5, Juan Peng, MS6, William B. Malarkey, MD1,7, Diane Habash, PhD8, and Martha A.
Belury, PhD1,9
1Institute for Behavioral Medicine Research, The Ohio State University College of Medicine,
Columbus, OH, USA
2Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine,
Columbus, OH, USA
3Department of Psychology, Rice University, Houston, TX, USA
4Department of Symptoms Research, MD Anderson Cancer Center, Houston, TX, USA
5Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH,
USA
6Center for Biostatistics, The Ohio State University, Columbus, OH, USA
7Department of Medicine, The Ohio State University Medical Center, Columbus, OH, USA
8Health and Rehabilitation Sciences, The Ohio State University Medical Center, Columbus, OH,
USA
9Department of Human Sciences, College of Education and Human Ecology, The Ohio State
University, Columbus, OH, USA
Abstract
Depression, stress, and diet can all alter inflammation. This double-blind, randomized crossover
study addressed the impact of daily stressors and a history of major depressive disorder (MDD) on
inflammatory responses to high-fat meals. During two separate 9.5 hour admissions, 58 healthy
women (38 breast cancer survivors and 20 demographically-similar controls), mean age 53.1
years, received either a high saturated fat meal or a high oleic sunflower oil meal. The Daily
Inventory of Stressful Events assessed prior day stressors and the Structured Clinical Interview for
DSM-IV evaluated MDD. As expected, for a woman with no prior day stressors, C-reactive
protein (CRP), serum amyloid A (SAA), intercellular adhesion molecule-1 (sICAM-1), and
vascular cell adhesion molecule-1 (sVCAM-1) were higher following the saturated fat meal than
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Correspondence: Janice K. Kiecolt-Glaser, PhD Institute for Behavioral Medicine Research, The Ohio State University College of
Medicine, 460 Medical Center Drive, Columbus, OH 43210 (Janice.Kiecolt-Glaser@osumc.edu), 614-293-3499.
Conflicts of Interest
NIH has funded work by Drs. Kiecolt-Glaser, Malarkey, Fagundes, and Belury. Dr. Andridge and Ms. Peng declare no conflict of
interest.
HHS Public Access
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Mol Psychiatry
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the high oleic sunflower oil meal after controlling for pre-meal measures, age, trunk fat, and
physical activity. But if a woman had prior day stressors, these meal-related differences
disappeared – because the stressors heightened CRP, SAA, sICAM-1, and sVCAM-1 responses to
the sunflower oil meal, making it look more like the responses to the saturated fat meal. In
addition, women with an MDD history had higher post-meal blood pressure responses than those
without a similar history. These data show how recent stressors and an MDD history can
reverberate through metabolic alterations, promoting inflammatory and atherogenic responses.
Introduction
Adherence to a Mediterranean-type diet can reduce the risk for depression, cardiovascular
disease, type 2 diabetes, and total mortality (1–4). Reduced inflammation may be the
cornerstone for the Mediterranean diet’s benefits (5–8).
The central fat source in the Mediterranean diet, olive oil, appears to be a key anti-
inflammatory dietary component (8, 9). Indeed, a meta-analysis concluded that olive oil
interventions lowered CRP and interleukin 6 (IL)-6 compared to control conditions (9). The
major dietary fatty acids in the North American diet are palmitic acid, a saturated fatty acid
found in meat and dairy products, and the monounsaturated oleic acid, the main fatty acid in
olive oil, and many vegetable oils (10).
Saturated fatty acids trigger proinflammatory signaling pathways (11). For example,
palmitic acid activated toll-like receptor 4 (TLR4), leading to nuclear transcription factor κB
(NF-κB) signaling and increased gene expression of IL-6, IL-8, vascular cell adhesion
molecule-1 (VCAM-1), and intercellular adhesion molecule-1 (ICAM-1) in contrast, the
monounsaturated palmioleate did not have inflammatory sequelae (11). A meal made with
butter, a rich source of saturated fatty acids, activated NF-κB in peripheral blood
mononuclear cells and also increased sICAM-1 concentrations, but a meal with olive oil, a
rich source of oleic acid, did not (12). Palmitate-stimulated monocytes also fuel ICAM-1
expression in endothelial cells via an IL-1 signaling pathway (13).
High saturated fat meals raise adhesion molecule concentrations while monounsaturated fat
meals lower concentrations (14). For example, high palmitate milkshakes boosted sICAM-1
levels while olive oil milkshakes decreased sICAM-1 (14). Similarly, a high-palmitic fatty
acid oil breakfast heightened post-meal sICAM-1 and sVCAM-1, but a refined olive oil
breakfast lowered their concentrations (15). Postprandial sICAM-1 levels were amplified by
a 12-week high saturated fat diet and reduced by a monounsaturated fat diet (16).
These meal-related differences are important because adhesion molecules play a central role
in the development of atherosclerosis and diabetes (17–23). Plasma sICAM-1 reflects a
more generalized inflammatory process, while sVCAM-1 appears to be a better indicator of
plaque burden (19). In healthy people sICAM-1 serves as a more reliable prognostic
indicator of cardiovascular disease than sVCAM-1, but sVCAM-1 better predicts
cardiovascular events among patients with atherosclerotic disease than sICAM-1 (17–19).
Furthermore, adhesion molecules and inflammation are associated with an increased risk of
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hypertension (24, 25), and monounsaturated fat interventions have reduced blood pressure
(26, 27).
Elevated sICAM-1 levels also predict type II diabetes (20–23). For example, data from the
Nurses’ Health Study showed that sICAM-1 independently predicted incident diabetes (21).
In a large population-based prospective, sICAM-1 levels were higher among those
participants who developed diabetes than in those who did not (20).
In addition to these dietary fat influences, depression and stressors can also boost NF-κB
signaling, thus augmenting inflammation and increasing adhesion molecule concentrations
(1, 28–30). For example, sICAM-1 levels were higher among all 18 physicians following an
academic oral presentation compared to their own values two hours earlier, as well as their
data from parallel assessments obtained on a control day (31). Comparisons of 22 patients
who developed posttraumatic stress disorder (PTSD) following a myocardial infarction (MI)
and 22 who did not develop post-MI PTSD showed that those with PTSD had higher
concentrations of sICAM-1 and sVCAM-1 at rest, as well as following a trauma-specific
interview than their PTSD-free counterparts (32). Among patients who had experienced a
recent acute coronary syndrome, sICAM-1 levels were higher among those with major
depression than those who did not meet criteria (33). Young adults with major depression
had higher levels of sICAM-1 than nondepressed controls (34), and heightened sICAM-1
concentrations have also been found in healthy adults with elevated depressive symptoms
(35–38).
People with a history of depression experience more major and minor stressors than those
without a similar history, and past depression can also boost emotional reactivity to stressors
(39, 40). Thus a mood disorder history could act synergistically with stress through multiple
pathways.
Indeed, other data from this same sample of healthy breast cancer survivors and controls
demonstrated that women with a history of depression who had also experienced more prior
day stressors had a higher peak postprandial triglyceride response than other participants
(41). Similarly, in our subsequent study with married couples that included the same high-fat
meals, men and women who had a mood disorder history and who also displayed more
hostile behaviors during the laboratory marital conflict discussions had lower post-meal
resting energy expenditure, higher insulin, and higher peak triglyceride responses than other
participants (42).
Accordingly, this secondary analysis assessed the impact of prior day stressors and past
depression on metabolic responses to two different high-fat meals (41). We expected that our
high saturated fat meal would increase inflammatory markers and adhesion molecules, but
not our high oleic sunflower oil meal (14–16). We also hypothesized that both prior day
stressors and an MDD history would be associated with higher post-meal concentrations of
inflammatory markers and adhesion molecules.
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METHODS AND MATERIALS
Design and Overview
This double-blind, randomized crossover study assessed metabolic responses following
high-fat meals. Women received one high saturated fat meal and one high oleic sunflower oil
meal during two separate 9.5 hour Clinical Research Center (CRC) visits spaced 1–4 weeks
apart. The Ohio State institutional review board approved this study, and each participant
provided informed consent.
After fasting for 12 hours, a catheter was inserted in the arm on admission. Women had 20
minutes to eat the meal. Blood samples were obtained before and 2, 4, and 7 hours after the
meal. Body composition was assessed by dual x-ray absorptiometry (DXA) (43).
Participants
The parent study was designed to assess whether a high-fat diet in combination with a
depression history increased fatigue in post-treatment cancer survivors and benign controls,
and thus the 58 healthy women included 38 breast cancer survivors and 20 benign controls
(women who had an initial abnormal mammogram) were recruited from a large
observational study (41). Exclusions included a history of any other prior cancer, chronic
obstructive pulmonary disease, symptomatic ischemic heart disease, alcohol/drug abuse, and
immune-related conditions such as diabetes, autoimmune disease, and major inflammatory
diseases. Medication exclusions included blood lipid medications, angiotensin type I
receptor blockers, and medications with major immunological or endocrinological
consequences, e.g., steroids. We invited 91 women from the large observational study who
met these criteria to participate; of those, 3 had exclusionary health problems not previously
identified, 18 declined to participate, and 14 did not respond to our recruitment letter.
Demographic and laboratory data did not differ between groups with the exception of higher
sICAM-1 in survivors compared to controls (Table 1). Survivors averaged 27.03 months
(SD=17.45) since diagnosis and 19.87 months (SD=6.47) since treatment completion. Only
one participant failed to return for her second visit.
Standardized Pre-Study Meals
Participants were instructed to avoid alcohol use the day before study visits, and any
strenuous physical activity two days previously (44). They were also asked not to take
aspirin, vitamins, antioxidants, or other dietary supplements for the 7 days before each
admission.
On the day before each of the two study visits participants received three standardized meals
from the CRC’s metabolic kitchen to reduce the variability associated with recent intake.
Equations from the Dietary Reference Intakes calculated the total kcal requirements for each
participant based on age, height, weight, and physical activity (45). Macronutrient targets (as
percent of total energy) for these meals were 54.9 ± 2.68% carbohydrate, 27.6 ±2.13% fat,
and 17.6 ± 0.95% protein. The fat content was 9.10 ± 1.20 % saturated fats, 9.43 ± 1.55%
monounsaturated fats, and 7.26 ± 1.25% polyunsaturated fats. Participants ate their last meal
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no later than 7:30 pm the night before admission; the dinner was light and low in fat (44).
Compliance was good: women consumed 91.83 ± 8.41% of these meals.
Research Meals
Both research meals included eggs, turkey sausage, biscuits, and gravy for a total of 930
kcals, with 60 grams fat, 59 grams carbohydrate, and 36 grams protein (percent of total kcals
= 60, 25, 15, respectively). However, the saturated:unsaturated fatty acid ratio varied
between the meals; the high saturated fat meal contained 16.84 g palmitic and 13.5 g oleic
(ratio=1.93), compared to 8.64 g palmitic and 31.21 g oleic for the high oleic sunflower oil
meal (ratio=0.67).
Assays
Serum CRP, serum amyloid A (SAA), sICAM-1 and sVCAM-1 were measured in duplicate
with the Vascular Injury Panel 2 Multispot Kit on an MSD Imager 2400 (both Meso Scale
Discovery, Rockville, MD), following kit instructions. Both samples for each subject were
analyzed within the same plate, and all plates were from the same kit/lot. The intra-assay
coefficient of variation (CV) and inter-assay CV for each analyte were: CRP 6.28% and
7.36%, SAA 4.90% and 3.09%, sICAM-1 4.19% and 6.92%, and sVCAM-1 2.14% and
5.16%.
Blood Pressure
Blood pressure was assessed using the Critikon Dinamap 1846 SX (GE, Tampa, FL) every 2
minutes for 20 minutes at baseline, and then every 2 minutes for 10 minutes immediately
following the meal. Subsequently, 2 readings were taken 2 minutes apart every hour for the
remainder of the visit.
Interview Data
The mood disorder modules of the Structured Clinical Interview for DSM-IV (SCID)
provided data on lifetime prevalence of major depressive disorder (MDD) (46). SCID data
showed that 29% (n=17) had met MDD criteria. The average time since diagnosis was 8.32
years (SD=10.94).
The Daily Inventory of Stressful Events (DISE) assessed the number of daily stressors
within the last 24 hours (47). The transcribed interview responses were rated in a consensus
meeting using the DISE’s extensive electronic “dictionary” which specifies codable events
(47). In our sample 31 women reported at least one recent stressor at one visit, 21 at both
visits, and 6 women reported no stressors.
Questionnaires
Following CRC admission participants completed several questionnaires. The Center for
Epidemiological Studies Depression Scale (CES-D) assessed depressive symptomatology in
the last week (48). The Community Healthy Activities Model Program for Seniors
questionnaire (CHAMPS) assessed the weekly frequency and duration of various physical
activities (49, 50). These measures have well-established reliability and validity (48–50).
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Statistical methods
The primary analyses used linear mixed models, since these models allow explicit modeling
of the within-subject correlations due to repeated study visits and repeated measurements
during each visit.
Demographics and other pre-meal characteristics were compared across groups (cancer,
control) using two-sample t-tests and chi-square tests for data collected at only one visit
(e.g., age) and linear mixed models with a random subject effect for data collected at both
visits (e.g., body mass index). Four primary outcome measures (CRP, SAA, sICAM-1, and
sVCAM-1) were right-skewed and were natural-log transformed to better approximate
normality of residuals. Linear mixed effects models were used to model post-meal outcome
values, with the premeal (fasting) outcome measurement included as a covariate. All models
included the three-way interaction of group (cancer, control) by meal type by time point and
all lower-order terms to properly account for the design of the parent study. However, there
were no significant effects of group (p > 0.2 for all tests) and thus reported results are
averaged over group.
Of primary interest was the impact of prior day stressors and MDD history on post-meal
responses. Initial models contained interactions of these predictors with time post-meal
(categorical) and with meal type; nonsignificant interactions were removed for final models.
All models further controlled on additional covariates to guard against confounding,
including age, trunk fat, physical activity (caloric expenditure per week), and study visit
(first vs. second). Additional models also controlled for menopausal status, but results were
unchanged, thus final models did not include this factor. To capture the within-subject
correlations within and across visits, all models included a pair of correlated subject-specific
random meal effects, which allowed the magnitude of within-subject correlation for the two
meal types to differ. The Kenward-Roger adjustment to the degrees of freedom was used to
control type I error (51). All analyses were conducted in SAS version 9.3 (Cary, North
Carolina).
Results
There were no associations between fasting levels of CRP, SAA, sICAM-1, or sVCAM-1
and either prior day stressors (p > 0.2 for all tests) or MDD history (p > 0.15 for all tests),
after controlling for visit, age, trunk fat, and physical activity. Trunk fat was significantly
positively associated with fasting levels of CRP (p<0.0001), SAA (p = 0.004), and
sVCAM-1 (p = 0.05), and marginally associated with fasting sICAM-1 (p = 0.09). Each 1 kg
increase in trunk fat was associated with a 12.7% increase in the geometric mean of CRP, a
5.0% increase in the geometric mean of SAA, a 1.0% increase in the geometric mean of
sICAM-1, and a 1.2% increase in the geometric mean of sVCAM-1. Physical activity was
marginally negatively associated with fasting SAA (p = 0.09), with a 100 kcal increase in
caloric expenditure associated with a 1.3% decrease in the geometric mean of SAA. Both
fasting sICAM-1 and fasting CRP were elevated at the first study visit compared to the
second, with a 9.5% higher geometric mean (p<0.0001) for sICAM-1 and a 21% higher
geometric mean for CRP (p = 0.06). Age and cancer status were not significantly associated
with fasting levels of any outcome (p > 0.1 for all tests).
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When modeling the postprandial responses, controlling for pre-meal levels, there were
significant two-way interactions of prior day stressors by meal type in the models for CRP
(p = 0.04), sICAM-1 (p = 0.02), and sVCAM-1 (p = 0.05), and a borderline interaction for
SAA (p = 0.09). Thus the effect of stressors on post-meal inflammation depended on the
meal type, and differences between the meals depended on a woman’s number of prior day
stressors. A larger number of stressors was associated with higher levels of postprandial
CRP, SAA, sICAM-1, and sVCAM-1 after the high oleic sunflower oil meal but not after the
high saturated fat meal (Figure 1, Table 2). After the high oleic sunflower oil meal, each
additional prior day stressor was associated with a 2.9% increase in the geometric mean of
CRP, a 2.3% increase in the geometric mean of SAA, a 1.7% increase in the geometric mean
of sICAM-1, and a 2.1% increase in the geometric mean of sVCAM-1. In contrast, after the
high saturated fat meal there was no significant effect of stressors (Table 2). As shown in
Figure 1, for a woman with no prior day stressors, post-meal inflammation was higher
following the high saturated fat meal than the high oleic sunflower oil meal. But having prior
day stressors shifted the response to the high oleic sunflower oil meal such that it looked like
the response to the high saturated fat meal. There were no significant effects of MDD history
on these outcomes (p > 0.07 for all tests).
There were no associations between pre-meal levels of SBP or DBP, and prior day stressors
(p > 0.15 for all tests) or MDD history (p > 0.15 for all tests), after controlling for visit, age,
trunk fat, and physical activity. Subjects with MDD history had marginally higher SBP (p =
0.06) and DBP (p = 0.10).
There were no significant effects of prior day stressors or meal type on the blood pressure
outcomes (p > 0.25 for all tests). There was a significant main effect of MDD history on
postprandial DBP (p = 0.05), even after controlling for pre-meal levels. In the post-meal
period, DBP was higher for subjects with a history of MDD compared to those without
(Figure 2). There was also a significant interaction between MDD history and time on
postprandial SBP (p = 0.02) despite controlling for pre-meal levels. Subjects with a history
of MDD had elevated SBP at most time points, particularly at around 3 hours and 6–7 hours
post-meal (Figure 2).
Discussion
This study is the first to demonstrate that stressors can heighten inflammatory responses to
high oleic sunflower oil meals. Importantly, the stress- and depression-related metabolic
responses to the two meals revealed adverse effects that were not evident when fasting. As
expected, CRP, sICAM-1, and sVCAM-1 were higher following the saturated fat meal than
the high oleic sunflower oil meal. However, a higher number of prior day stressors was
associated with higher postprandial CRP, SAA, sICAM-1, and sVCAM-1 after the high oleic
sunflower oil meal, but not after the high saturated fat meal. Putting it another way, for a
woman with no prior day stressors, outcomes were higher after the saturated fat meal than
after the sunflower oil meal. But if a woman had prior day stressors, the differences
disappeared – because the stressors heightened responses to the sunflower oil meal, making
it look more like the responses to the saturated fat meal.
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The endothelial activation that was reflected by the heightened post-meal sICAM-1 and
sVCAM-1 concentrations may also mirror a more chronic inflammatory responsiveness
associated with atherosclerosis of brain arteries, a process that could itself promote
depression (33, 52). Among adults with moderate to severe traumatic brain injury, higher
levels of sICAM-1, sVCAM-1, and soluble Fas in cerebrospinal fluid had a 3.92-fold
increase in the odds for developing posttraumatic depression at 6 months (53); indeed,
having any one of these markers above the 75th percentile had a predictive value of 85.7%
for posttraumatic depression at six months (53). Similarly, among patients treated with
interferon-α for melanoma, sICAM-1 levels were correlated with the development of
depressive symptoms during treatment (54). Postmortem studies of depressed older adults
revealed elevated ICAM-1 expression in the dorsolateral prefrontal cortex compared to
nondepressed controls (55, 56). ICAM-1 is thought to play a key role in blood-brain barrier
(BBB) permeability, and enhanced levels of depressive symptoms may reflect greater BBB
porousness (54). The fact that a Mediterranean diet offers some protection against the
development of both depressive symptoms and depressive disorders (4, 57, 58) may be
related to its anti-inflammatory actions (8, 9).
Women with an MDD history had higher post-meal blood pressure responses than those
without a similar history, with no differences evident in the fasted state; MDD history was
not related to the inflammatory responses. A meta-analysis of prospective cohort studies
concluded that depression increases the risk of hypertension, an important risk factor for
cardiovascular disease (59). Other research from this sample has demonstrated that women
with an MDD history who had also experienced more prior day stressors had a higher peak
postprandial triglyceride response than other participants (41). Larger post-meal triglyceride
responses are reliably associated with enhanced cardiovascular risk and the progression of
atherosclerosis (60–62). Depression has well-established effects on cardiovascular morbidity
and mortality, and these two different meal-related changes highlight previously
unrecognized depression-sensitive mechanistic pathways (63, 64).
Strengths of our study included control of both the composition and energy content of each
woman’s diet on the day prior to admission as well as during admission. The only difference
between the two challenge meals was the fat source. Both meals included 930 kcal and 60 g
fat, values that are quite comparable to common fast food choices. For example, a Burger
King Double Whopper with cheese has 990 kcal and 64 g fat, while a Big Mac cheeseburger
and medium French fries contain 930 kcals and 58 g fat.
It is unclear why, with the addition of a stressor to the high saturated fat meal, there were no
further increase in levels of CRP, sICAM-1 and sVCAM-1, while stress-related changes
were observed in response to the high oleic sunflower oil meal. Speculatively, inflammatory
markers may have already reached their ceiling level in response to the high saturated fat
condition, a reasonable possibility because our participants did not have overt signs of
cardiac disease or other diseases associated with chronically elevated inflammation.
Our two meals, regardless of their fat source, were high in energy and fat, and they included
refined flour and little fiber. We do not know whether a relatively healthier meal (e.g.,
energy balanced, lower in total fat, higher in polyunsaturated oils and containing more
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protein and fiber with fewer simple carbohydrates) would attenuate the adverse postprandial
inflammatory and metabolic changes, one limitation. Nonetheless, our study meals reflected
typical everyday dietary choices because they were designed to mimic common fast food
meals.
The inclusion of healthy breast cancer survivors could have affected our results, another
limitation. However, we found no reliable post-meal differences between cancer survivors
and controls in these analyses, or in other metabolic data from this study (41). We selected
our healthy survivors using the same inclusion/exclusion criteria as our controls; had we
used a larger and more representative sample of cancer survivors we might have seen group
differences related to cancer treatment. Additionally, depressive symptoms did not differ
between cancer survivors and controls, and the relatively low levels of depressive symptoms
limited our ability to see depression-related effects.
These data are important because heightened inflammation characterizes a number of
disorders and systemic diseases including cardiovascular disease, diabetes, metabolic
syndrome, rheumatoid arthritis, asthma, multiple sclerosis, chronic pain, and psoriasis; each
of these also features an elevated risk for depression (65, 66). Our data show how recent
stressors and a depression history can reverberate through these metabolic alterations to fuel
inflammation, which can, in turn, promote depression.
Acknowledgments
The study was supported in part by NIH grants CA154054, CA172296, UL1TRR025755, and CA016058. The
sponsor had no role in the design and conduct of the study; collection, management, analysis, and interpretation of
the data; and preparation, review, or approval of the manuscript. We are grateful to Michael Di Gregorio, M.A., for
his role as a key organizer and experimenter, and to Bryon Laskowski for laboratory analyses.
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Figure 1.
Mean post-meal sICAM-1, sVCAM-1, SAA, and CRP as a function of the number of prior
day stressors and meal type. Results are estimates from linear mixed effects models
controlling for pre-meal values, cancer status, visit, age, trunk fat, physical activity, and
depression history. Bars are +/− 1 standard error.
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Figure 2.
Post-meal trajectories of mean SBP and DBP as a function of major depression history.
Results are estimates from linear mixed effects models controlling for pre-meal values,
cancer status, visit, age, trunk fat, physical activity, and prior day stressors. Bars are +/− 1
standard error.
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Author Manuscript Author Manuscript Author Manuscript Author Manuscript
Kiecolt-Glaser et al. Page 16
Table 1
Subject Characteristics
Control Subjects (n=20) Breast Cancer Survivors (n=38) P-value
Age, years 55.0 (10.2) 52.1 (7.3) 0.23
Body Mass Index, kg/m2 26.7 (4.1) 28.8 (5.3) 0.13
Waist, cm 91.2 (10.3) 96.6 (12.8) 0.11
Trunk fat, g (DXA) 13994.2 (5218.7) 16983.8 (5758.6) 0.06
Lean body mass, g (DXA) 40559.1 (3839.9) 42541.1 (5239.7) 0.14
Caloric expenditure per week, moderate intensity exercise 1331 (1285) 1066 (1196) 0.44
Systolic blood pressure, mmHg 124.0 (18.5) 124.9 (20.1) 0.89
Diastolic blood pressure, mmHg 72.6 (7.9) 75.5 (8.6) 0.21
Pulse pressure, mmHg 51.4 (15.0) 49.5 (14.7) 0.60
Fasting sICAM-1 290.7 (86.9) 326.7 (78.4) 0.04
Fasting sVCAM-1 423.5 (137.0) 416.4 (114.2) 0.95
Fasting CRP 2.9 (5.3) 2.6 (2.9) 0.72
Fasting SAA 6892.4 (10338.1) 6018.3 (5208.3) 0.74
Post-menopausal 13 (65%) 32 (84%) 0.10
CES-D score 8.23 (5.70) 11.01 (7.54) 0.15
Number of prior day stressors 1.2 (1.1) 1.1 (1.2) 0.56
History of major depression 3 (15%) 14 (37%) 0.08
Data shown are mean (SD) or N (%). Body Mass Index, blood pressure, CES-D, and number of stressors were measured at both study visits; data
shown are aggregated across the two measurements per subject.
CES-D, Center for Epidemiological Studies Depression Scale; DXA, dual x-ray absorptiometry
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Table 2
Estimated changes in post-meal sICAM-1, sVCAM-1, CRP, and SAA for each additional prior day stressor, for each meal type. Estimates from linear
mixed models controlling for cancer status, visit, age, trunk fat, physical activity, and depression history.
High oleic sunflower oil High saturated fat oil
Estimate 95% CI P-value Estimate 95% CI P-value
sICAM-1 1.7% (0.2%,3.1%) 0.02 −0.7% (−2.1%,0.8%) 0.34
sVCAM-1 2.1% (0.6%,3.6%) 0.007 0.1% (−1.5%,1.6%) 0.93
CRP 2.9% (0.6%,5.3%) 0.02 −0.5% (−2.9%,2.0%) 0.68
SAA 2.3% (0.1%,4.5%) 0.04 −0.5% (−3.0%,2.0%) 0.69
Mol Psychiatry
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... Currently, it has been found that inflammation is closely related to neurological diseases [31][32][33] . Notably, exercise can reduce inflammation and counteract the symptoms of nervous system diseases and these effects are closely related to exercise intensity [31] . ...
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Cardiovascular diseases are the world's leading cause of death. Prevention by nutrition is an easy and effective approach especially by advising foods with nutraceutic properties like high phenolic olive oil (HPOO). The aim of this review was to systematically access and meta-analyse the effects of HPOO on risk factors of the cardiovascular system and thusly to evaluate its use as a nutraceutical in prevention. Medline/PubMed, EMBase, the Cochrane Library, CAMbase and CAM-QUEST were searched through July 2013. Randomized controlled trials (RCTs) comparing high vs. low (resp. non) phenolic olive oils in either healthy participants or patients with cardiovascular diseases were included. For study appraisal the Cochrane Collaboration's risk of bias tool was used. Main outcomes were blood pressure, serum lipoproteins and oxidation markers. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated and analysed by the generic inverse variance methods using a random effects model. Eight cross over RCTs comparing ingestion (21-90 d) of high vs. low (resp. non) phenolic olive oils with a total of 355 subjects were included. There were medium effects for lowering systolic blood pressure (n = 69; SMD -0.52; CI -0.77/-0.27; p < 0.01) and small effects for lowering oxLDL (n = 300; SMD -0.25; CI [-0.50/0.00]; p = 0.05). No effects were found for diastolic blood pressure (n = 69; SMD -0.20; CI -1.01/0.62; p = 0.64); malondialdehyde (n = 71; SMD -0.02; CI [-0.20/0.15]; p = 0.79), total cholesterol (n = 400; SMD -0.05; CI [-0.16/0.05]; p = 0.33); HDL (n = 400; SMD -0.03; CI [-0.14/0.08]; p = 0.62); LDL (n = 400; SMD -0.03; CI [-0.15/0.09]; p = 0.61); and triglycerides (n = 360; SMD 0.02; CI [-0.22/0.25]; p = 0.90). The small number of studies/participants limits this review. HPOO provides small beneficial effects on systolic blood pressure and serum oxidative status (oxLDL). HPOO should be considered as a nutraceutical in cardiovascular prevention. Copyright © 2015 Elsevier GmbH. All rights reserved.
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Increased intake of saturated fatty acids (SFAs), such as palmitate (Pal), is linked to a higher risk of type 2 diabetes and cardiovascular disease. Although recent studies have investigated the direct effects of SFAs on inflammatory responses in vascular endothelial cells, it remains unknown whether SFAs also induce these responses mediated by circulating cells. In this study, especially focused on adhesion molecules and monocytes, we investigated the indirect effects of Pal on expression and release of ICAM-1 and E-selectin in vascular endothelial cells. Phorbol 12-myristate 13-acetate (PMA)-treated THP-1 (pTHP-1) cells and human monocytes were stimulated with various free fatty acids (FFAs). SFAs, but not unsaturated fatty acids (UFAs), increased interleukin (IL)-1β secretion and decreased IL-1 receptor antagonist (IL-1Ra) secretion, resulting in an increase in the IL-1β/IL-1Ra secretion ratio. UFAs dose-dependently inhibited the increase in IL-1β secretion and decrease in IL-1Ra secretion induced by Pal. Moreover, in human aortic and vein endothelial cells, expression and release of ICAM-1 and E-selectin were induced by treatment with conditioned medium collected from Pal-stimulated pTHP-1 cells and human monocytes, but not by Pal itself. The up-regulated expression and release of adhesion molecules by the conditioned medium were mostly abolished by recombinant human IL-1Ra supplementation. These results suggest that the Pal-induced increase in the ratio of IL-1β/IL-1Ra secretion in monocytes up-regulates endothelial adhesion molecules, which could enhance leukocyte adhesion to endothelium. This study provides further evidence that IL-1β neutralization through receptor antagonism may be useful for preventing the onset and development of cardiovascular disease. J. Cell. Physiol. © 2014 Wiley Periodicals, Inc.
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Background Depression and stress promote obesity. This study addressed the impact of daily stressors and a history of major depressive disorder (MDD) on obesity-related metabolic responses to high-fat meals. Methods This double-blind, randomized, crossover study included serial assessments of resting energy expenditure (REE), fat and carbohydrate oxidation, triglycerides, cortisol, insulin, and glucose before and after two high-fat meals. During two separate 9.5-hour admissions, 58 healthy women (38 breast cancer survivors and 20 demographically similar control subjects), mean age 53.1 years, received either a high saturated fat meal or a high oleic sunflower oil meal. Prior day stressors were assessed by the Daily Inventory of Stressful Events. Results Greater numbers of stressors were associated with lower postmeal REE (p = .008), lower fat oxidation (p = .04), and higher insulin (p = .01), with nonsignificant effects for cortisol and glucose. Women with prior MDD had higher cortisol (p = .008) and higher fat oxidation (p = .004), without significant effects for REE, insulin, and glucose. Women with a depression history who also had more stressors had a higher peak triglyceride response than other participants (p = .01). The only difference between meals was higher postprandial glucose following sunflower oil compared with saturated fat (p = .03). Conclusions The cumulative 6-hour difference between one prior day stressor and no stressors translates into 435 kJ, a difference that could add almost 11 pounds per year. These findings illustrate how stress and depression alter metabolic responses to high-fat meals in ways that promote obesity.