Higher anthocyanin intake is associated with lower depressive symptoms in adults with and without major depressive disorder.

Background: Major depressive disorder (MDD) is a significant cause of disability globally and an emerging body of evidence suggests that dietary components, including flavonoids, may impact depression-related biochemical pathways. Further research that characterizes dietary intake of flavonoids in diverse population groups, including people with MDD and explores the relationship between flavonoid intake and depression is needed. This study aimed to determine dietary flavonoid and subclass intake and assess the association with depressive symptomatology in a sample of adults with and without MDD. Methodology: Participants with and without MDD (determined using DSM 5) completed the Depression, Anxiety, and Stress Scale-21 (DASS-21). Diet history interviews were analyzed using PhenolExplorer to quantify flavonoid subclasses (flavan-3-ols, flavonols, anthocyanins, flavones, flavanones, isoflavones), and total flavonoid intake. Independent t-tests and linear regression, adjusting for age, sex, and BMI were performed. Results: Participants (n = 93; 75% female) had a mean age of 26.0 ± 8.2 years. Participants with MDD had significantly higher DASS-depression scores (n = 44; DASS-depression 27.3 ± 9.8) compared to participants without MDD (n = 49; DASS-depression 3.1 ± 4.4; p < .001). Intakes of total flavonoids and subclasses were similar between groups, except for anthocyanins where participants with MDD reported lower intakes of anthocyanins compared to participants without MDD (median intake: 0.08 mg/day and 11.6 mg/day, respectively; p = .02). In the total sample, higher anthocyanin intake was associated with lower DASS-depression score (B = -4.1; SE = 1.8; 95% CI [-7.7, -0.4]; p = .029). Conclusion: Intake of total flavonoids and most subclasses were similar between people with and without MDD. However, a dietary deficit of anthocyanins (found in purple/red fruits and vegetables) was evident in participants with MDD, and higher anthocyanin intake was associated with lower depressive symptomatology in the total sample. Further research in larger samples is warranted to explore if the documented association is independent of MDD status.

Pro-inflammatory cytokines IL-1α, IL-6 and TNF-α in major depressive disorder: Sex-specific associations with psychological symptoms.

The pro-inflammatory cytokines IL-1α, IL-6 and TNF-α are associated with major depressive disorder, psychological distress, cardiovascular health and obesity. However, there is limited research that has examined multiple associations between these variables, particularly among individuals with major depressive disorder who are treatment free, in comparison with a control cohort, and including analyses of sex differences. In this study, data were analysed from 60 individuals with major depressive disorder and 60 controls, including plasma IL-1α, IL-6 and TNF-α, adiposity measures (body mass index, waist circumference), cardiovascular health indices (blood pressure, heart rate) and psychological symptoms (depressive severity, anxiety, hostility, stress). The cytokines were compared by group and sex and correlated with measures of adiposity, cardiovascular health indices and psychological health. Plasma IL-1α and IL-6 were higher in major depressive disorder group versus control, but with a sex interaction for IL-6, with this group difference only among females. TNF-α did not differ between groups. IL-1α and IL-6 correlated with depressive severity, anxiety, hostility and stress, whereas TNF-α correlated only with anxiety and hostility. Psychopathology was associated with IL-1α in males only and with IL-6 and TNF-α in females only. None of the cytokines correlated with body mass index, waist circumference, blood pressure or heart rate. The result of group by sex interaction for IL-6 and sex-specific associations between pro-inflammatory cytokines and psychometrics could be aetiologically important in depression interventions and treatments for females versus males, warranting further investigation.

Plasma prolactin is higher in major depressive disorder and females, and associated with anxiety, hostility, somatization, psychotic symptoms and heart rate.

Background: Major Depressive Disorder (MDD) is linked to poor physical health including an increased risk of developing cardiometabolic disease (CMD), yet the underlying physiology of this relationship is not clear. One pathophysiological mechanism that may underlie this relationship is neuroendocrine dysregulation, including that of the hormone prolactin. Prolactin has a role in the regulation of stress, and it is linked to anxiety, hostility, and weight gain, which are all implicated in MDD and increased CMD risk. However, little research has examined plasma prolactin in association with psychological symptoms of MDD or biometric indices of CMD risk. Method: Plasma samples of 120 participants (n â€‹= â€‹60 meeting DSM-5 criteria for MDD and n â€‹= â€‹60 control; age and sex matched) were analysed to assess prolactin concentration. Biometric data (BMI, waist circumference, blood pressure and heart rate) were collected, and participants completed the Brief Symptom Inventory (BSI) and Depression Anxiety Stress Scale (DASS). Results: Plasma prolactin was higher in participants with MDD versus controls (8.79 â€‹± â€‹5.16 â€‹ng/mL and 7.03 â€‹± â€‹4.78 â€‹ng/mL, respectively; F â€‹= â€‹4.528, p â€‹= â€‹0.035) and among females versus males (9.14 â€‹± â€‹5.57 â€‹ng/mL and 6.31 â€‹± â€‹3.70 â€‹ng/mL, respectively; F â€‹= â€‹9.157, p â€‹= â€‹0.003). Prolactin was correlated with several psychological symptoms including anxiety, hostility and somatization, and with heart rate, but not with any other biometric measures. Conclusions: The results of this study indicate that neuroendocrine dysregulation in MDD may extend to the hormone prolactin, with prolactin being specifically associated with a subset of related psychometric and cardiovascular measures.

Morphology and anatomical relations of iliac and femoral bony landmarks, gluteal muscles and the sciatic nerve: Sex differences and clinical implication

The objective of this study was to determine sex differences in the anatomical relations between clinically relevant and palpable bony landmarks (anterior superior iliac spine, or ASIS), posterior superior iliac spine (PSIS), iliac tubercle and greater trochanter, and with the gluteal muscles and sciatic nerve. After dissection, distances along the iliac crest, angles and distances between bony landmarks, muscle thicknesses of gluteus maximus and gluteus medius, the fibre angles of gluteus maximus, and anatomical relations between the sciatic nerve and bony landmarks, were measured. In 23 cadavers (11 males; 12 females), iliac crest total length, distances between the greater trochanter, ASIS and iliac tubercle, and between the sciatic nerve and iliac crest, but only the angle at the PSIS between the iliac tubercle and greater trochanter, were significantly larger in males. Distances and angles reflecting horizontal measures, iliac crest proportions, and gluteus maximus fibres angles were not different between sexes. Gluteus maximus muscle fibre angles differed significantly along the sagittal plane and from medial to lateral. In conclusion, while males have a larger ilium and taller pelvis, there was no sex difference in pelvic width. Therefore, the female pelvis is shorter and relatively wider with respect to pelvic height, but is not absolutely wider than the male pelvis. This puts females at a greater risk of sciatic nerve injury with a dorsogluteal site injection. The angles of the gluteus maximus muscle fibres varied along their length and were not consistently 45o as commonly described

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Effects of thickness of muscle and subcutaneous fat on efficacy of gluteal intramuscular injection sites.

Intramuscular injections given at the dorsogluteal and ventrogluteal sites are intended for the gluteus maximus and gluteus medius muscles, respectively. However, little research has confirmed the reliability of these sites for the presence and thickness of the target and other muscles, and subcutaneous fat. This study characterised and compared these at the V-method and G-method ventrogluteal sites and dorsogluteal site (n=60). Gluteus maximus, medius and minimus were identified at each site, plus tensor fascia latae at ventrogluteal sites. Gluteus maximus and subcutaneous fat were significantly thicker and gluteus minimus significantly thinner at the dorsogluteal site than both ventrogluteal sites. Gluteus medius was the thickest muscle at each injection site, and thicker at the G-method than the V-method ventrogluteal site. Therefore, the dorsogluteal site reliably targets gluteus maximus, and the G-method ventrogluteal site was more reliable than the V-method ventrogluteal site to target gluteus medius in terms of presence and thickness.

Comparison of the G and V methods for ventrogluteal site identification: Muscle and subcutaneous fat thicknesses and considerations for successful intramuscular injection.

The ventrogluteal site is increasingly recommended for long-acting antipsychotic intramuscular injections; however, it remains infrequently utilized due to nurses' lack of confidence in site identification. The more recent G (geometric) method of ventrogluteal site identification is less subjective and likely more reliable than the V method for successful intramuscular injection outcomes. Knowledge of muscle and subcutaneous fat thicknesses, and the influence of sex and anthropometry on theoretical injection outcome, is necessary to support evidence-based use of the ventrogluteal site. In the presents study, we compared the V and G methods for injection site subcutaneous fat, muscle, and total tissue thicknesses, and theoretical injection outcome (bone injury, intramuscular or subcutaneous), and determined anthropometric predictors of injection outcome. Subcutaneous fat and muscle thicknesses were measured via ultrasound, bilaterally at V and G method sites (28 males, 32 females). Muscle and total tissue were significantly thicker, and successful intramuscular injection significantly more likely, using the G versus V method (75% versus 57%). Females had significantly thicker subcutaneous fat than males at both sites. Even using the G method, 92% of males but only 59% of females, would have a successful intramuscular injection, with remaining females at risk of bone injury (16%) or subcutaneous injection (25%). The G method site is more reliable for successful intramuscular injection, with less risk of bone injury than the V method site. Appropriate needle-length selection is essential for females with a body mass index (BMI) <23 kg m-2 and weight <60 kg (to avoid bone injury), and BMI >30 kg m-2 and hip >90 cm (to avoid subcutaneous injection).

Influence of gender, BMI and body shape on theoretical injection outcome at the ventrogluteal and dorsogluteal sites.

AIMS AND OBJECTIVES: This study aimed to determine the influences of gender, BMI and observed body shape on subcutaneous fat and muscle thicknesses, and theoretical injection outcome, at the ventrogluteal and dorsogluteal intramuscular injection sites. BACKGROUND: Debate continues as to whether the dorsogluteal or ventrogluteal injection site is more reliable for a successful intramuscular injection outcome. Subcutaneous fat and muscle thicknesses at the injection site are direct determinants of intramuscular injection outcome. BMI and observed body shape influence gluteal subcutaneous fat and muscle thicknesses, and therefore injection outcome, with potentially distinct effects at the ventrogluteal and dorsogluteal sites. DESIGN: This was a cross-sectional study. METHODS: Demographic data were collected, and subcutaneous fat and muscle thicknesses were quantified bilaterally at the dorsogluteal and ventrogluteal injection sites using ultrasound, for 145 participants (57% female). RESULTS: Subcutaneous fat and muscle were significantly thicker at the dorsogluteal than the ventrogluteal site, and 75% and 86% of participants would receive a successful intramuscular injection at these sites, respectively. There were significant effects of gender, BMI and observed body shape on subcutaneous fat thickness and theoretical injection outcome at both sites. Females, obese individuals and endomorph individuals had thicker subcutaneous fat and were more likely to have a subcutaneous injection outcome. CONCLUSIONS: Gender, BMI and observed body shape could be used to guide site and needle length selection when administering gluteal intramuscular injections to increase the likelihood of a successful intramuscular injection outcome. RELEVANCE TO CLINICAL PRACTICE: Both gluteal injection sites should be avoided in obese individuals and endomorph individuals. An intramuscular injection will be successful: using a 32-mm needle at the ventrogluteal site for all males and normal-weight females and using a 38-mm needle for all females at the ventrogluteal site, and for all males and at least 98% of females at the dorsogluteal site.

Ventrogluteal versus dorsogluteal site selection: A cross-sectional study of muscle and subcutaneous fat thicknesses and an algorithm incorporating demographic and anthropometric data to predict injection outcome.

BACKGROUND: The dorsogluteal and ventrogluteal intramuscular injection sites both have their use in clinical practice; however, it has not been established in whom one or the other should be preferentially targeted or avoided. There is a need for an evidence-based approach towards site selection for a successful intramuscular injection outcome and to avoid unwanted injection outcomes of inadvertent subcutaneous injection or bone contact. Injection outcome is dependent on injection site subcutaneous fat thickness and muscle thickness; these are likely influenced by gender and anthropometry. OBJECTIVES: To determine whether subcutaneous fat, muscle, and total tissue thicknesses differ between the dorsogluteal and ventrogluteal sites, and whether theoretical injection outcome (intramuscular, subcutaneous, or bone contact) can be predicted by demographic and anthropometric data and described by an algorithm. DESIGN: Cross-sectional study design. SETTINGS: University in Australia. PARTICIPANTS: 145 volunteers (57% female) of at least 18 years of age recruited through the university community. METHODS: Anthropometric data was collected and subcutaneous fat and muscle thicknesses were quantified by ultrasonography. Anthropometric differences between theoretical injection outcome groups (bone contact versus intramuscular versus subcutaneous at the ventrogluteal and dorsogluteal sites) was determined for each gender (ANOVA). Multiple regression analysis was conducted to determine the influence of demographic and anthropometric data on theoretical intramuscular injection outcome. An algorithm to guide site selection was developed for each gender, based on the anthropometric measures that best discriminated between injection outcomes. RESULTS: Subcutaneous fat, muscle and total tissue were significantly thicker at the dorsogluteal site than the ventrogluteal site, and subcutaneous fat was significantly thicker in females than males at both sites (all p<0.001); there was no gender difference for muscle or total tissue thickness at either site. Female gender, and waist and hip circumference were significant predictors of subcutaneous fat thickness at both sites; male gender was a significant predictor of dorsogluteal site muscle thickness (all p<0.05). In the algorithm developed for site selection based on theoretical injection outcome, the best discriminators were: weight, BMI and waist circumference for females, and weight and distance between the iliac tubercle and anterior superior iliac spine for males. CONCLUSIONS: The algorithm describes when each of the ventrogluteal and dorsogluteal sites is appropriate or should be avoided, based on easily obtained anthropometric data. This has direct relevance in clinical practice in evidence-based site selection for gluteal intramuscular injections for optimal medication and health outcomes.