Zinc Supplementation and an Improved Quality of Life in Patients with Autoimmune Hepatitis.

Objecive Patients with autoimmune hepatitis (AIH) reportedly have an impaired quality of life (QOL), mainly due to depression, even during remission. In addition, hypozincaemia has been demonstrated in patients with chronic liver disease, including AIH, and is known to be related to depression. Corticosteroids are known to cause mental instability. We therefore investigated the longitudinal association between zinc supplementation and changes in the mental status among AIH patients treated with corticosteroids. Materials This study enrolled 26 patients with serological remission of AIH routinely treated at our facility after excluding 15 patients who either discontinued polaprezinc (150 mg/day) within 24 months or interrupted treatment. Two questionnaires, the Chronic Liver Disease Questionnaire (CLDQ) and SF-36, were adopted to evaluate the QOL before and after zinc supplementation. Results Serum zinc levels were significantly elevated after zinc supplementation (p<0.0001). The CLDQ worry subscale significantly improved after zinc supplementation (p=0.017), but none of the SF-36 subscales was affected. Multivariate analyses demonstrated that daily prednisolone dosing was inversely related to both the CLDQ worry domain score (p=0.036) and the SF-36 mental health component (p=0.031). There was a significant negative correlation between the changes in the daily steroid dose and the CLDQ worry domain scores before and after zinc supplementation (p=0.006). No serious adverse events occurred during the observation period. Conclusion Zinc supplementation safely and efficiently improved mental impairment, possibly caused by continuous treatment with corticosteroids, in patients with AIH.

Preventive effect of morning light exposure on relapse into depressive episode in bipolar disorder.

OBJECTIVE: Light therapy has been suggested to have a curative effect on bipolar depression; however, preventive effects of light exposure on depressive episodes remain unclear. This study evaluated whether daytime light exposure in real-life situations was associated with a preventive effect on relapse into depressive episodes in patients with bipolar disorder. METHODS: This prospective, naturalistic, observational study was conducted in Japan between August 2017 and June 2020. Outpatients with bipolar disorder were objectively evaluated for daytime light exposure over 7 consecutive days using an actigraph that could measure ambient light at baseline assessment and then assessed at 12-month follow-up for relapse into mood episodes. RESULTS: Of 202 participants, 198 (98%) completed follow-up at 12 months and 78 (38%) experienced relapse into depressive episodes during follow-up. In a Cox proportional hazards model adjusting for potential confounders, a longer time above 1000 lux at daytime was significantly associated with decrease in relapse into depressive episodes (per log min; hazard ratio, 0.66; 95% confidence interval, 0.50-0.91). In addition, a higher average illuminance and longer time above 1000 lux in the morning exhibited a significant decrease in relapse into depressive episodes (per log lux and per log min; hazard ratio, 0.65 and 0.61; 95% confidence interval, 0.49-0.86 and 0.47-0.78, respectively). The association between daytime light exposure and relapse into manic/hypomanic/mixed episodes was not significantly different. CONCLUSION: A significant association was observed between increased daytime light exposure, mainly in the morning, and decreased relapse into depressive episodes.

Daytime light exposure in daily life and depressive symptoms in bipolar disorder: A cross-sectional analysis in the APPLE cohort.

OBJECTIVES: Controlled artificial daylight exposure, such as light therapy, is effective in bipolar depression, but the association between uncontrolled daytime light and depressive symptoms in bipolar disorder (BD) is unclear. This study investigated the association between daytime light exposure under real-life situations and depressive symptom in patients with BD. METHODS: This cross-sectional study enrolled 181 outpatients with BD. The average daytime light intensity and the total duration of light intensity of ≥1000 lux were recorded over 7 consecutive days using an actigraph that measured ambient light. Depressive symptoms were assessed using Montgomery-Åsberg Depression Rating Scale, and scores of ≥8 points were treated as depressed state. RESULTS: Ninety-seven (53.6%) subjects were depressed state. At higher average daytime light intensity tertiles, the proportion of depressed state was significantly lower (P for trend, 0.003). In multivariable analysis adjusted for age, employment status, age at onset of BD, Young Mania Rating Scale score, bedtime, and physical activity, the highest tertile group in average daytime light intensity suggested a significantly lower odds ratio (OR) for depressed state than the lowest tertile group (OR, 0.33; 95% confidence interval [CI], 0.14-0.75; P = 0.009). Similarly, the longest tertile group in light intensity ≥1000 lux duration was significantly associated with lower OR for depressed state than lowest tertile group (OR, 0.42; 95% CI, 0.18-0.93; P = 0.033). CONCLUSIONS: The findings suggest that greater daytime light exposure in daily life is associated with decreased depressive symptoms in BD.

Farming habit, light exposure, physical activity, and depressive symptoms. A cross-sectional study of the HEIJO-KYO cohort.

BACKGROUND: Bright light therapy and exercise interventions are effective methods for treating seasonal and non-seasonal affective disorders. Synchronization of internal circadian rhythms with the external environment by light therapy and physical activity may partly explain its efficacy. In the present study, we objectively measured daytime light exposure and physical activity in real life situations with elderly participants, and investigated the association between farming habits and the prevalence of depressive symptoms. METHODS: This cross-sectional was conducted among 1005 participants (mean age: 71.5) of a community-based cohort study. Depressive symptoms were assessed by the Geriatric Depression Scale (GDS score ≥ 6) and administration of antidepressant. RESULTS: Farming habit with long duration (> 7.0 h/week) showed significantly lower odds ratios (OR) for depressive symptoms (adjusted OR 0.63, 95% confidential interval,0.41 to 0.96) compared with participants without farming habit independent of confounders such as age, gender, body mass index smoking, drinking, daytime ambulatory systolic blood pressure, diabetes, living alone, education, income, and daylength. Even in farming with short duration (≤ 7.0 h/week), we found significant association with lower OR for depressive symptoms (adjusted OR 0.64, 95%CI, 0.42 to 0.97). Light exposure and daytime physical activity measured by wrist actigraphy were significantly higher among participants with longer farming habits (p for trend < 0.01). Physical activity mediated 12.0% of association between farming habit and depressive symptoms. LIMITATIONS: A cross-sectional association may be found because the participants with depressive symptoms tended to avoid farming. A longitudinal study is warranted to determine the direction of causality. CONCLUSIONS: Participants with farming habit showed significantly lower OR for depressive symptoms than those without farming habit, and it was partly mediated by physical activity.

The prognostic nutritional index predicts long-term outcomes of gastric cancer patients independent of tumor stage.

PURPOSE: The aim of this study was to investigate the impact of the prognostic nutritional index (PNI) on the long-term outcomes in gastric cancer patients. METHODS: This study reviewed the medical records of 548 patients with gastric cancer who underwent gastrectomy. The PNI was calculated as 10 × serum albumin (g/dl) + 0.005 × total lymphocyte count (per mm(3)). The receiver operating characteristic (ROC) curve analysis was performed to determine the cutoff value of the PNI. The multivariate analysis was performed to identify the prognostic factors. RESULTS: The mean PNI was significantly lower in patients with T3-T4 tumors (P < 0.001) and lymph node metastasis (P < 0.001) than in those without such factors. Patients who had a postoperative complication had a lower mean PNI than those without (P = 0.023). When the ROC curve analysis was performed, the optimal cutoff value of the PNI for predicting the 5-year survival was 48. In the multivariate analysis, a low PNI was an independent predictor for poor overall survival (P < 0.001). In the subgroup analysis, the overall and relapse-free survival rates were significantly lower in the PNI-low group than in the PNI-high group among patients with stage I and stage III disease. CONCLUSIONS: The PNI is a simple and useful marker for predicting the long-term outcomes of gastric cancer patients independent of the tumor stage. Based on our results, we suggest that the PNI should be included in the routine assessment of gastric cancer patients.