Prevalence and factors associated with depression in the elderly: a cross-sectional study / Prevalência e fatores associados à depressão em idosos: um estudo transversal

ABSTRACT: Introduction: Depression is a psychiatric disease that causes losses in the biopsychosocial aspect of the affected individuals. The prevalence in the elderly population is significant, and identify the factors related to this outcome allows preventive measures and treatment can be early applied. Objective: Assessing the association between depression and sociodemographic and health risk factors in the elderly. Methods: This is a cross-sectional study involving 388 elderly of both genders, aged 65 years and older, urban residents of the city of Cuiabá, state of Mato Grosso (MT), Brazil. A socio-demographic questionnaire, as well as a self-report of chronic diseases and lifestyle, a self-report questionnaire of functional capacity, occurrence of falls, Geriatric Depression Scale, mental state assessment, and anthropometry tests were used. The chi-square test, oddsratio (OR), and multiple logistic regression with 95% confidence interval and p<5% were used in the statistical analysis. Results: There was a predominance of women (64%) who were mulatto/caboclo/brown skin (43%) and married (45%). Depression was significantly associated with: the lowest level of education, <8 years (OR=2.15; p=0.012), partial or total dependence of instrumental activities of daily living (OR=1.85; p=0.003), having five or more diseases (OR=2.93, p=0.002), falls in the last twelve months (OR=1.90; p=0.021), and sleep (OR=2.39; p<0.001) and visual difficulties (OR=2.28; p<0.001). Conclusion: Depression in this group of elderly was associated with modifiable and preventable factors in the health of these people. Thus, the early diagnosis of risk factors associated with depression, the inclusion of social, physical and cognitive activities must be considered for their prevention. (AU)

RESUMO: Introdução: Depressão é uma doença psiquiátrica e provoca prejuízos no aspecto biopsicossocial dos indivíduos acometidos. Sua prevalência na população idosa é expressiva, a identificação dos fatores relacionados a este desfecho permitem que medidas preventivas e de tratamento sejam aplicadas precocemente. Objetivo: Avaliar a associação entre depressão, os fatores sociodemográficos e os riscos para a saúde em idosos. Métodos: Estudo transversal com 388 idosos de ambos os sexos com idade igual ou superior a 65 anos, residentes do município de Cuiabá, estado de Mato Grosso (MT), Brasil. Foram usados questionários sociodemográficos, instrumentos de autorrelato de doenças crônicas, de estilo de vida, ocorrência de quedas e de capacidade funcional, escala de depressão geriátrica, avaliação do estado mental e testes de antropometria. Na análise estatística utilizou-se teste do qui-quadrado, odds ratio (OR) e regressão logística múltipla com intervalo de confiança de 95% e p<5%. Resultados: Encontrou-se predominância de mulheres (64%), sendo mulata/cabocla/parda (43%) e casadas (45%). A depressão foi significativamente associada com: o tercil mais baixo de educação <8 anos (OR=2,15; p=0,012); com dependência parcial ou total de atividades instrumentais da vida diária (OR=1,85; p=0,003); ter cinco ou mais doenças crônicas (OR=2,93; p=0,002), ocorrência de quedas nos últimos doze meses (OR=1,90; p=0,021); dificuldades de sono (OR=2,39; p<0,001) e visual (OR=2,28; p<0,001). Conclusão: A depressão estava associada a fatores modificáveis e que podem ser prevenidos. Desta forma, o diagnóstico precoce destes fatores de risco, a inclusão de atividades socias, físicas e cognitivas devem ser consideradas para sua prevenção. (AU)

Nutritional recovery with a soybean diet impaired the glucagon response but did not alter liver gluconeogenesis in the adult offspring of rats deprived of protein during pregnancy and lactation.

Nutritional recovery of early malnutrition with a soybean diet reduces liver glycogen stores in the fed state and produces liver insulin resistance. We investigated whether nutritional recovery on a soybean flour diet alters hepatic gluconeogenesis in the adult offspring of rats deprived of protein during pregnancy and lactation. Male rats from mothers that were fed either 17% (C) or 6% (L) protein during pregnancy and lactation were maintained on a 17% casein (CC, n = 16 and LC, n = 17), 17% soybean flour (CS, n = 10 and LS, n = 10), or 6% casein (LL, n = 10) diet after weaning. The soybean diet reduced basal serum glucose (soybean diet, 5.6 ± 0.6 mmol/L vs. casein diet, 6.2 ± 0.6 mmol/L; p < 0.05) but increased alanine aminotransferase mRNA/GAPDH (soybean diet, 0.062 ± 0.038 vs. casein diet, 0.024 ± 0.011; p < 0.01), phosphoenolpyruvate carboxykinase mRNA/GAPDH (soybean diet, 1.53 ± 0.52 vs. casein diet, 0.95 ± 0.43; p < 0.05), and glycerokinase protein content (soybean diet, 0.86 ± 0.08 vs. casein diet, 0.75 ± 0.11; p < 0.05). The serum glucose concentration (recovered groups, 5.6 ± 0.5 mmol/L vs. control groups, 6.2 ± 0.7 mmol/L; p < 0.05) and phosphoenolpyruvate carboxykinase activity (recovered groups, 2.8 ± 0.6 µU/mg vs. control groups, 3.6 ± 0.6 µU/mg; p < 0.05) were decreased in rats subjected to protein restriction in early life. The glucose area under the curve during the pyruvate tolerance test did not differ among groups, whereas glucose area under the curve after glucagon infusion was reduced by early malnutrition (recovered groups, 4210 ± 572 mg/dL·40 min vs. control groups, 4493 ± 688 mg/dL·40 min; p < 0.001) and by the soybean diet (soybean diet, 3995 ± 500 mg/dL·40 min vs. casein diet, 4686 ± 576 mg/dL·40 min; p < 0.05). Thus, the soybean diet impaired the response to glucagon but did not alter gluconeogenesis.

THE EFFECT OF CAFFEINE SUPPLEMENTATION ON TRAINED INDIVIDUALS SUBJECTED TO MAXIMAL TREADMILL TEST.

BACKGROUND: Intense physical training increases oxidative stress and inflammation, resulting into muscle and cellular damage. The aim of this study was to analyze the effect of caffeine supplementation on trained young individuals subjected to two treadmill maximal tests. MATERIALS AND METHODS: It was a double-blind and crossover study comprising 24 active individuals within the age group 18-30 years. The comparisons were conducted: the effect of exercise (week 1 x 2) and caffeine intake (GC x GP) on thiobarbituric acid (TBARS), interleukin 6 (IL-6), interleukin 10 (IL-10) and superoxide dismutase (SOD) variables during pre-exercise time (30 min. after caffeine or placebo intake) and post-exercise (5 min after treadmill test). RESULTS: The comparison between weeks 1 and 2 showed increase in the first week, in the following items: TBARS, IL-6 and IL-10 in the GC and GP groups. The comparison within the same week showed that GC individuals presented lower post-exercise TBARS values in the first and second weeks; IL- 6 presented higher post-exercise values in the GC group in both weeks. The paired analysis comparing pre- and post-exercise, with and without caffeine showed that IL-6 presented higher post-exercise values in the GC group. CONCLUSION: Caffeine used by athletes can decrease oxidative stress. The increased IL-6 suggest that this ergogenic supplement may stimulate muscle hypertrophy, since IL-6 has myokine effect. However, the caffeine effect on IL-6 level and muscle hypertrophy increase should be better investigated in future studies.

A low-protein diet during pregnancy prevents modifications in intercellular communication proteins in rat islets.

BACKGROUND: Gap junctions between ß-cells participate in the precise regulation of insulin secretion. Adherens junctions and their associated proteins are required for the formation, function and structural maintenance of gap junctions. Increases in the number of the gap junctions between ß-cells and enhanced glucose-stimulated insulin secretion are observed during pregnancy. In contrast, protein restriction produces structural and functional alterations that result in poor insulin secretion in response to glucose. We investigated whether protein restriction during pregnancy affects the expression of mRNA and proteins involved in gap and adherens junctions in pancreatic islets. An isoenergetic low-protein diet (6% protein) was fed to non-pregnant or pregnant rats from day 1-15 of pregnancy, and rats fed an isocaloric normal-protein diet (17% protein) were used as controls. RESULTS: The low-protein diet reduced the levels of connexin 36 and ß-catenin protein in pancreatic islets. In rats fed the control diet, pregnancy increased the levels of phospho-[Ser(279/282)]-connexin 43, and it decreased the levels of connexin 36, ß-catenin and beta-actin mRNA as well as the levels of connexin 36 and ß-catenin protein in islets. The low-protein diet during pregnancy did not alter these mRNA and protein levels, but avoided the increase of levels of phospho-[Ser(279/282)]-connexin 43 in islets. Insulin secretion in response to 8.3 mmol/L glucose was higher in pregnant rats than in non-pregnant rats, independently of the nutritional status. CONCLUSION: Short-term protein restriction during pregnancy prevented the Cx43 phosphorylation, but this event did not interfer in the insulin secretion.

A low-protein diet during pregnancy prevents modifications in intercellular communication proteins in rat islets

.

Treinamento aeróbio em intensidade leve à moderada altera positivamente o perfil metabólico e substratos teciduais em ratos alimentados com dieta hiperlipídica / Light to moderate intensity aerobic training positively change the metabolic profile and tissue substrates in rats fed with high fat diet

O presente estudo verificou os efeitos do treinamento aeróbio em intensidade leve à moderada sobre o perfil metabólico e substratos teciduais de ratos alimentados com dieta hiperlipídica. Dezenove ratos Wistar machos foram alimentados com dieta chocolate durante 2 meses após o desmame e separados em 2 grupos: Exercício Chocolate (EC) (n=9) e Sedentário Chocolate (SC) (n=10). O treinamento consistiu de natação (8 semanas, 5 dias/semana, 1h/dia, sobrecarga equivalente a 2% do peso corporal). Ao final do experimento, os ratos foram eutanasiados para a determinação das concentrações séricas de glicose, AGL, triglicerídeos, colesterol total, HDL e LDL; nos tecidos muscular e hepático foram mensurados os conteúdos de glicogênio e triglicerídeos. O treinamento reduziu os triglicerídeos séricos e hepáticos bem como o ganho de peso corporal; ainda, aumentou o conteúdo de triglicerídeos musculares. Concluímos que o treinamento aeróbio em intensidade leve à moderada alterou positivamente o perfil metabólico e os substratos teciduais dos ratos alimentados com dieta hiperlipídica.

The present study verified the effects of aerobic training of moderate intensity on metabolic profile and tissue substrates of rats fed high fat diet. Nineteen male Wistar rats were fed chocolate diet during 2 months after weaning and separated into two groups: Exercise Chocolate (EC) (n=9) and Sedentary Chocolate (SC) (n=10). Exercise training consisted of swimming (8 weeks, 5days/week, 1hour/day, overload equivalent to 2% of body weight). At the end of the experiment, the animals were euthanized in order to determine the serum glucose, FFA, triglycerides, total cholesterol, HDL, and LDL; triglycerides and glycogen contents were measured in muscle and hepatic tissues. Training decreased triglycerides in serum and liver as well as the body weight gain; in addition, increased muscle triglycerides content. We concluded that light to moderate intensity aerobic training change positively the metabolic profile and tissue substrates in rats fed high-fat diet.

A low-protein diet during pregnancy alters glucose metabolism and insulin secretion.

In pancreatic islets, glucose metabolism is a key process for insulin secretion, and pregnancy requires an increase in insulin secretion to compensate for the typical insulin resistance at the end of this period. Because a low-protein diet decreases insulin secretion, this type of diet could impair glucose homeostasis, leading to gestational diabetes. In pancreatic islets, we investigated GLUT2, glucokinase and hexokinase expression patterns as well as glucose uptake, utilization and oxidation rates. Adult control non-pregnant (CNP) and control pregnant (CP) rats were fed a normal protein diet (17%), whereas low-protein non-pregnant (LPNP) and low-protein pregnant (LPP) rats were fed a low-protein diet (6%) from days 1 to 15 of pregnancy. The insulin secretion in 2.8 mmol l(-1) of glucose was higher in islets from LPP rats than that in islets from CP, CNP and LPNP rats. Maximal insulin release was obtained at 8.3 and 16.7 mmol l(-1) of glucose in LPP and CP groups, respectively. The glucose dose-response curve from LPNP group was shifted to the right in relation to the CNP group. In the CP group, the concentration-response curve to glucose was shifted to the left compared with the CNP group. The LPP groups exhibited an "inverted U-shape" dose-response curve. The alterations in the GLUT2, glucokinase and hexokinase expression patterns neither impaired glucose metabolism nor correlated with glucose islet sensitivity, suggesting that ß-cell sensitivity to glucose requires secondary events other than the observed metabolic/molecular events.

Extra-pancreatic insulin production in RAt lachrymal gland after streptozotocin-induced islet beta-cells destruction.

Previous work has revealed that insulin is secreted in the tear film; its mRNA is expressed in the lachrymal gland (LG) and its receptor in tissues of the ocular surface. To test the hypothesis of insulin production in the LG, we compared normal and diabetic rats for: (1) the presence of insulin and C-peptide, (2) glucose- and carbachol-induced insulin secretion ex-vivo, and (3) biochemical and histological characteristics of diabetic LG that would support this possibility. Four weeks after streptozotocin injection, blood and tears were collected from streptozotocin-diabetic male Wistar rats. Insulin levels in the tear film rose after glucose stimulation in diabetic rats, but remained unchanged in the blood. Ex vivo static secretion assays demonstrated that higher glucose and 200 microM carbachol significantly increased mean insulin levels from LG samples of both groups. Insulin and C-peptide were expressed in LG of diabetic rats as determined by RIA. Comparable synaptophysin immune staining and peroxidase activity in the LG of both groups suggest that the structure and function of these tissues were maintained. These findings provide evidence of insulin production by LG. Higher expression of reactive oxygen species scavengers may prevent oxidative damage to LG compared to pancreatic beta-cells.

Palmitic acid increase levels of pancreatic duodenal homeobox-1 and p38/stress-activated protein kinase in islets from rats maintained on a low protein diet.

A severe reduction in insulin release in response to glucose is consistently noticed in protein-deprived rats and is attributed partly to the chronic exposure to elevated levels of NEFA. Since the pancreatic and duodenal transcription factor homeobox 1 (PDX-1) is important for the maintenance of beta-cell physiology, and since PDX-1 expression is altered in the islets of rats fed a low protein (LP) diet and that rats show high NEFA levels, we assessed PDX-1 and insulin mRNA expression, as well as PDX-1 and p38/stress activated protein kinase 2 (SAPK2) protein expression, in islets from young rats fed low (6%) or normal (17%; control) protein diets and maintained for 48 h in culture medium containing 5.6 mmol/l glucose, with or without 0.6 mmol/l palmitic acid. We also measured glucose-induced insulin secretion and glucose metabolism. Insulin secretion by isolated islets in response to 16.7 mmol/l glucose was reduced in LP compared with control rats. In the presence of NEFA, there was an increase in insulin secretion in both groups. At 2.8 mmol/l glucose, the metabolism of this sugar was reduced in LP islets, regardless of the presence of this fatty acid. However, when challenged with 16.7 mmol/l glucose, LP and control islets showed a severe reduction in glucose oxidation in the presence of NEFA. The PDX-1 and insulin mRNA were significantly higher when NEFA was added to the culture medium in both groups of islets. The effect of palmitic acid on PDX-1 and p38/SAPK2 protein levels was similar in LP and control islets, but the increase was much more evident in LP islets. These results demonstrate the complex interrelationship between nutrients in the control of insulin release and support the view that fatty acids play an important role in glucose homeostasis by affecting molecular mechanisms and stimulus/secretion coupling pathways.

Characterization of the insulinotropic action of a phospholipase A2 isolated from Crotalus durissus collilineatus rattlesnake venom on rat pancreatic islets.

The ability of PLA2 and crotapotin, isolated from Crotalus durissus collilineatus rattlesnake venom, to stimulate insulin secretion from isolated rat islets was examined. PLA2 and crotapotin stimulated insulin secretion at 2.8 mmol/L glucose, whereas at a high glucose concentrations (16.7 mmol/L) only PLA2 stimulated secretion. Nifedipine (10 micromol/L) did not alter the ability of PLA2 to increase insulin secretion stimulated by a depolarizing concentration of K+ (30 mmol/L). PLA2 did not affect 14CO2 production but significantly increased the efflux of arachidonic acid from isolated islets. These results indicate that PLA2-stimulated secretion is not dependent on an additional influx of Ca2+ through L-type Ca(2+)-channels but rather is associated with arachidonic acid formation in pancreatic islets.

Decreased insulin secretion in islets from rats fed a low protein diet is associated with a reduced PKAalpha expression.

A low protein diet has been shown to affect the amount and activity of several enzymes and to decrease insulin secretion by islets isolated from rats fed such a diet. To understand the mechanisms involved in this phenomenon, we investigated the effects of forskolin, a stimulator of adenylyl cyclase, on insulin secretion by pancreatic islets from rats fed a normal (17%; NP) or low (6%; LP) protein diet for 8 wk. Isolated islets were incubated for 1 h in Krebs-bicarbonate solution containing 8.3 mmol glucose/L, with or without 10 micromol forskolin/L. The forskolin-induced insulin secretion was higher in islets from NP rats than in those from LP rats (P<0.05). Western blotting revealed that the amount of the alpha catalytic subunit of protein kinase A (PKAalpha) was 35% lower in islets from LP rats than in islets from NP rats (P<0.05). Moreover, PKAalpha mRNA expression was reduced by 30% in islets from LP rats (P<0.05). Our results indicated a possible relationship between a low protein diet and a reduction in PKAalpha expression. These alterations in PKAalpha may be responsible in part for the decreased insulin secretion by islets from rats fed a low protein diet.