The effectiveness of emotional wellness programs on mental health outcomes for adults with multiple sclerosis: a systematic review and meta-analysis.

BACKGROUND: People with multiple sclerosis (MS) have a greater prevalence of depression and anxiety than the general population. Emotional wellness programs (any psychological or psychosocial interventions that focus on awareness, acceptance, managing, or challenging thoughts and feelings) could be important for people with MS. However, there have been no reviews on the effectiveness of emotional wellness programs for people with MS. The objective of this review was to determine the effectiveness of emotional wellness programs on mental health outcomes for adults with MS. INCLUSION CRITERIA: Randomised controlled trials (RCTs) and quasi-experimental trials evaluating emotional wellness programs for adults with any form of MS were included. Mental health outcomes included were depression, anxiety, quality of life, and stress. The comparator groups were waitlist controls, usual care, or another intervention. METHODS: This review was registered with PROSPERO (registration number CRD42019131082) and conducted in accordance with PRISMA guidelines. CINAHL, Cochrane, MEDLINE, PsycInfo, Web of Science, ProQuest Dissertations and Theses, Cochrane register of Controlled Trials, and Google Scholar were searched for English- language publications. Titles and abstracts were initially screened, followed by a screen of full text articles. Studies were critically appraised for methodological quality using the JBI standardised critical appraisal checklists. Data were extracted on intervention details, study outcome measures, behaviour change techniques, and results. Random effects meta-analyses were performed for outcomes assessed in at least five studies, with results reported as the standardised mean difference (SMD). RESULTS: This review comprised 25 RCTs and four quasi-experimental studies (n participants=2323); 21 were included in meta-analyses. Meta-analyses produced statistically significant results favouring the interventions (SMD (95% CI) for depression -0.55 (-0.87, -0.24); anxiety -0.42 (-0.70, -0.14); quality of life 0.28 (0.14, 0.43); and stress -1.00 (-1.58, -0.43)). The most commonly used behaviour change techniques were behaviour practice/rehearsal, social comparison, and social support. CONCLUSIONS: This review provides evidence to support the effectiveness of emotional wellness programs for improving mental health outcomes in adults with MS. However, these findings should be interpreted with caution given the high degree of heterogeneity between the studies, and potential for biases in analysis due to missing data and/or incomplete reporting.

Physical activity during pregnancy is associated with a lower prevalence of gestational diabetes mellitus in Vietnam.

AIMS: To assess the association between physical activity (PA) during pregnancy and the prevalence of gestational diabetes mellitus (GDM) accounting for sitting time. METHODS: The study used data from a cohort study of 2030 pregnant women in Vietnam. Women were recruited from six hospitals in Ha Noi, Hai Phong, and Ho Chi Minh City. Baseline measurements including PA and GDM were taken at 24-28 weeks of gestation. PA was assessed during the past 3 months before the interview using the interviewer-administered Pregnancy Physical Activity Questionnaire. GDM was diagnosed at 24-28 weeks of gestation using the 2013 World Health Organization criteria. RESULTS: 1987 out of 2030 pregnant women were included in the final analysis, of which 432 had GDM (21.7%). Women undertaking the highest level (upper tertile) of PA during pregnancy appeared to have a lower risk of GDM [odds ratio (OR) 0.70, 95% confidence interval (CI) 0.53-0.94, Ptrend 0.017] when compared to those at the lowest tertile of PA. Similarly, women with increased levels of moderate-intensive activity and household/caregiving activity during pregnancy were associated with reduced risks of GDM (OR 0.66, 95% CI 0.50-0.86, Ptrend 0.002 and OR 0.72, 95% CI 0.55-0.95, Ptrend 0.020, respectively). These apparent inverse associations were not attenuated by their sitting time. There were no significant associations between sitting time, light-intensity activity, vigorous-intensity activity, occupation, sports/exercise, commuting, or meeting exercise guidelines and GDM risk. CONCLUSIONS: High levels of PA, particularly moderate-intensity and household/caregiving activities during pregnancy were associated with a lower prevalence of GDM independent of sitting time.

Soyfood and isoflavone intake and risk of type 2 diabetes in Vietnamese adults.

BACKGROUND/OBJECTIVES: Animal studies have demonstrated that soy isoflavones exert antidiabetic effects. However, evidence regarding the association between soyfood intake, a unique source of isoflavones, and type 2 diabetes remains inconclusive. This study assessed the relationship between habitual intakes of soyfoods and major isoflavones and risk of type 2 diabetes in Vietnamese adults. SUBJECTS/METHODS: A hospital-based case-control study was conducted in Vietnam during 2013-2015. A total of 599 newly diagnosed diabetic cases (age 40-65 years) and 599 hospital-based controls, frequency matched by age and sex, were recruited in Hanoi, capital city of Vietnam. Information on frequency and quantity of soyfood and isoflavone intake, together with demographics, habitual diet and lifestyle characteristics, was obtained from direct interviews using a validated and reliable questionnaire. Unconditional logistic regression analyses were performed to examine the association between soy variables and type 2 diabetes risk. RESULTS: Higher intake of total soyfoods was significantly associated with a lower risk of type 2 diabetes; the adjusted odds ratio (OR) for the highest versus the lowest intake was 0.31 (95% confidence interval (CI): 0.21-0.46; P<0.001). An inverse dose-response relationship of similar magnitude was also observed for total isoflavone intake (OR: 0.35; 95% CI: 0.24 to 0.49; P<0.001). In addition, inverse associations of specific soyfoods (soy milk, tofu and mung bean sprout) and major isoflavones (daidzein, genistein and glycitein) with the type 2 diabetes risk were evident. CONCLUSIONS: Soyfood and isoflavone intake was associated with a lower type 2 diabetes risk in Vietnamese adults.

Association of adulthood weight gain with circulating adipokine and insulin resistance in the Japanese population.

BACKGROUND/OBJECTIVES: Although adipokines and insulin resistance are known to be correlated with body fatness, it is unclear whether they are independently related to weight gain experience. We examined the associations of serum adipokines and marker of insulin resistance with past weight gain during adulthood by taking the degree of attained body mass index (BMI) level into consideration. SUBJECTS/METHODS: Subjects were 399 Japanese municipal employees, aged ⩾ 30 years, who participated in a health survey. Serum adipokines were measured using a Luminex suspension bead-based multiplexed array. Weight change during adulthood was calculated as the difference between measured current weight and recalled weight at the age of 20 years. Multiple regression was performed to calculate mean adipokine levels and homeostasis model assessment of insulin resistance (HOMA-IR) according to weight gain (< 5 kg, 5-9.9 kg, or ⩾ 10 kg) with adjustment for current BMI. RESULTS: Weight gain from the age of 20 years was significantly and positively associated with leptin levels even after adjustment for current BMI (P for trend < 0.001), whereas it was significantly and inversely associated with adiponectin levels in a BMI-adjusted model among subjects aged ⩾ 40 years (P for trend=0.03). Weight gain was associated with HOMA-IR in a BMI-unadjusted model (P for trend < 0.001), but this association was largely attenuated after adjustment for BMI. Resistin, plasminogen activator inhibitor-1 and visfatin were not associated with past weight gain. CONCLUSIONS: Results suggest that a large weight gain during adulthood is associated with higher leptin and lower adiponectin levels independently of the degree of attained BMI level.

Serum pyridoxal concentrations and depressive symptoms among Japanese adults: results from a prospective study.

BACKGROUND/OBJECTIVES: Vitamin B6 is suggested to have a protective role against depression. However, the association between vitamin B6 intake and depression remains inconclusive, and few studies have examined the relationship between circulating vitamin B6 concentrations and depressive symptoms. Here, we investigated the cross-sectional and prospective associations between serum pyridoxal concentrations and depressive symptoms among Japanese workers. SUBJECTS/METHODS: Participants were 422 municipal employees (aged 21-67 years) who participated in a baseline survey in 2006 for cross-sectional analysis, and 210 subjects without depressive symptoms at baseline (2006) who completed both baseline and follow-up (2009) surveys for prospective analysis. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. Logistic regression analysis was used to estimate the odds ratio of depressive symptoms (CES-D scale of ≥ 19) according to tertile of serum pyridoxal with adjustment for potential confounding variables. RESULTS: In the cross-sectional analysis, serum pyridoxal concentrations were significantly associated with a decreased prevalence of depressive symptoms (P for trend=0.03); the multivariable-adjusted odds ratio of depressive symptoms for the highest tertile of pyridoxal was 0.54 (95% confidence interval 0.30-0.96) compared with the lowest tertile. In longitudinal analyses, higher serum pyridoxal concentrations at baseline were associated with a trend toward reduced depressive symptoms after 3 years; the multivariable-adjusted odds ratio of depressive symptoms for the highest versus the lowest tertile of pyridoxal concentration was 0.55 (95% confidence interval 0.13-2.32). CONCLUSIONS: A higher vitamin B6 status may be associated with a decreased risk of depressive symptoms in Japanese.

Serum 25-hydroxyvitamin D and markers of insulin resistance in a Japanese working population.

BACKGROUND/OBJECTIVES: The association between vitamin D status and insulin resistance (IR) has been less studied among Asians, and it remains elusive whether calcium could modify such an association. We examined the association of serum 25-hydroxyvitamin D (25(OH)D) concentrations with IR markers and the potential effect modification by calcium intake among a Japanese population. SUBJECTS/METHODS: The authors analyzed data (n=494) from a cross-sectional survey conducted in 2009 among a Japanese working population aged 20-68 years. Fasting serum 25(OH)D and insulin, as well as fasting plasma glucose were determined, and homeostatic model assessment of IR (HOMA-IR) was calculated. Calcium intake was assessed using a validated diet history questionnaire. Multiple linear regression was done with adjustment of potential confounding variables. RESULTS: Fasting insulin and HOMA-IR were significantly inversely associated with 25(OH)D concentration across quartiles of 25(OH)D after fully adjusting for covariates (P(trend)=0.04 and 0.02, respectively). Across clinically relevant categories of 25(OH)D, compared with participants in the vitamin D sufficiency group, those in the vitamin D insufficiency group had a 5% higher HOMA-IR score, and those in the hypovitaminosis D group had an 18% higher HOMA-IR score (P(trend)=0.01). In an analysis by calcium intake, the HOMA-IR score was highest among participants with both a low calcium intake and lowest 25(OH)D concentrations, with significant inverse trend being observed in the group with lower calcium intake (P(trend)=0.02). CONCLUSIONS: Our findings suggest that low vitamin D status is associated with IR among Japanese adults.