Increased depression and metabolic risk in postmenopausal breast cancer survivors

Abstract

Objective: Breast cancer survivors (BCS) are at high risk for the development of obesity, type 2 diabetes mellitus, and metabolic syndrome. There is increasing interest in the association between depression and metabolic dysfunction, which is relevant in this population as depression is often present in the chronic phase of cancer recovery. Thus, the aim of this study was to evaluate metabolic risk in BCS with and without depression compared to non-cancer controls.Methods: African American (46 %) and Caucasian (54 %) postmenopausal BCS (N = 28; age: 60 ± 2 years; mean ± SEM) were matched for race, age (±2 years), and BMI (±2 kg/m 2 ) to non-cancer controls (N = 28). Center for Epidemiologic Studies Depression Scale (CES-D) >16 or antidepressant medication usage was used to classify depression. Metabolic status was defined by 2-hr glucose during an OGTT and classification of metabolic syndrome.Results: Compared to non-cancer controls, BCS had similar 2-hr glucose, but higher fasting glucose and total cholesterol, and were 2.5 times more likely to have metabolic syndrome (21 vs. 52 %)(P's < 0.05). Conversely, HDL-C was 16 % higher in BCS (P < 0.05). Forty three % of BCS were on antidepressants compared to 14 % in non-cancer controls, despite similar mean CES-D scores (6 ± 1). Depressed BCS (46 %) had a higher BMI, waist circumference, fasting glucose, and more metabolic syndrome components than non-depressed BCS (P's < 0.05). Conclusions:BCS have a heightened prevalence of depression that may be associated with an increased prevalence of metabolic syndrome. These results support the need to monitor weight gain, depression, and the progression of metabolic abnormalities after cancer diagnosis and treatment. Further studies into the mechanistic link between depression and metabolic disease are necessary to identify strategies that can offset their impact on obesity and associated cardiovascular risk following a breast cancer diagnosis.

Changes in eating habits and food preferences in breast cancer patients undergoing adjuvant chemotherapy

“…A recent meta-analysis showed, in fact, that chemotherapy leads to a body weight increase of 2.7 kg on average (95% Confidence Interval [CI] 2.0–7.5 kg), with a significant degree of variation due to high heterogeneity between studies 13 . The pathophysiology of weight gain during chemotherapy has not been fully elucidated and is believed to have a multifactorial etiology: among these potential contributors there are premenopausal status at breast cancer diagnosis 14 , fatigue and reduced physical activity 17 – 19 along with the consequent reduction in lean body mass and resting energy expenditure 17 , 18 , increased food intake due to treatment-related appetite 19 , common use of steroids 20 and anti-depressant drugs 21 during chemotherapy.…”

Ease of walking associates with greater free-living physical activity and reduced depressive symptomology in breast cancer survivors: pilot randomized trial

“…Adjusting to life can be especially difficult following breast cancer diagnosis, and as such, depression is one of the most frequently cited psychological disturbances [5]. Though multiple factors contribute to depression, the propensity for weight gain among BCS may be a significant component [6]. Likewise, late-age diagnosis of breast cancer increases the risk for functional impairment and physical inactivity [7].…”

Acid-Producing Diet and Depressive Symptoms among Breast Cancer Survivors: A Longitudinal Study

“…For instance, increased glutamate released from cancer cells can lead to excitotoxicity [8], tissue destruction due to surgery or chemotherapy can lead to inflammation [9,10], and stress caused by cancer diagnosis and treatment can disrupt the hypothalamic-pituitary-adrenal (HPA) axis [11]. Observational studies have shown that metabolic syndrome [12], social support [13,14], severe life difficulties [9], and poor diet quality [15] were also associated with depression in cancer survivors.…”