Results: Hypoglycemia in general, and reactive hypoglycemia were highly frequent (79% and 28% of the sample, respectively). Hypoglycemia events (< 70 mg/dL) were equally experienced among groups, whilst severe hypoglycemia (< 54 mg/dL) was more frequent in BED at the late stage of OGTT (5 h; 2 = 1.120, p = .011). The FA and BED groups exhibited significantly higher number of reactive hypoglycemia (2 = 13.898, p = .003), in different times by diagnosis (FA: 210'-240'; BED: at the 270'). FA severity was the only predictor of early and reactive hypoglycemia.
Impairment in blood glucose control may be attended in binge eating disorder (BED) and food addiction (FA), two distinct eating disorders which are characterized by the recurrent consumption of highly palatable food rich in high-glucose index carbohydrates. Conversely, rapid changes in blood glucose, such as hypoglycemia, may intensify craving for high-calorie products, thus reinforcing pathological eating behaviours. This study investigated the presence of hypoglycemia events in people suffering from BED, FA, both, or no eating disorder, and explored whether the severity of eating behaviours correlated with a higher probability of having hypoglycemia. Results showed that people with BED and FA experienced more episodes of symptomatic hypoglycemia than those with obesity but no eating disorder. The severity of binge eating was associated with more severe hypoglycemia events, indicated by lower plasma glucose values. Lastly, people with severe FA were more prone to experiencing early post-meal hypoglycemia accompanied by symptoms. These results inform professionals dealing with eating disorders about the need to refer patients for metabolic evaluation. On the other hand, clinicians dealing with obesity should screen for and address BED and FA in patients seeking care for weight loss.
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Cardiac implantable electrical devices (CIEDs), including pacemakers, defibrillators, and biventricular pacing devices, are used to monitor atrial tachyarrhythmias. Recent studies1,2,3,4 have focused on detecting atrial high-rate episodes (AHRE), also called subclinical atrial fibrillation (SCAF), even in asymptomatic patients. The increased risk of major adverse cardiovascular events (MACE), particularly myocardial infarction (MI), has been studied in patients with atrial fibrillation (AF)5, but only rarely in those with AHRE. However, a recent study has demonstrated that longer duration of AHRE independently predicted MACE, including MI, cardiac revascularization, ventricular tachycardia/fibrillation, cardiovascular hospitalization, acute heart failure, and cardiovascular death6.
Development of the study cohort. Initially, 644 patients were recruited for the study; however, 174 were excluded due to a previous diagnosis of AF. Therefore, the final study cohort consisted of 470 patients, of which 123 experienced MACCE (AF atrial fibrillation, AHRE atrial high-rate episodes, MACCE major adverse cardio/cerebrovascular events; N number).
Binge eating disorder (BED) is characterized by recurrent episodes of eating large amount of food in a short amount of time with the subjective feeling of losing control, at least three of the associated features (i.e., high speed, embarrassment while eating, eating when not physically hungry, eating until uncomfortably full, and guilt, or disgust associated with the episodes), and without any compensatory behaviour taking place to counterweigh the food intake [1]. Research that has examined BED from a psychopathological perspective has highlighted that episodes of binge eating are consequential to a state of negative affect, and that the emotional state tends to improve shortly after the binge episode [2, 3].
Seasonal variation of manic and depressive symptoms is a controversial topic in bipolar disorder research. Several studies report seasonal patterns of hospital admissions for depression and mania and variation in symptoms that appear to follow a seasonal pattern, whereas others fail to report such patterns. Differences in research methodologies, data analysis strategies, and temporal resolution of data may partly explain the variation in findings between studies. The current study adds a novel perspective to the literature by investigating specific meteorological factors such as atmospheric pressure, hours of sunshine, relative humidity, and daily maximum and minimum temperatures as more proximal predictors of self-reported daily mood change in people diagnosed with bipolar disorder. The results showed that daily maximum temperature was the only meteorological variable to predict clinically-relevant mood change, with increases in temperature associated with greater odds of a transition into manic mood states. The mediating effects of sleep and activity were also investigated and suggest at least partial influence on the prospective relationship between maximum temperature and mood. Limitations include the small sample size and the fact that the number and valence of social interactions and exposure to natural light were not investigated as potentially important mediators of relationships between meteorological factors and mood. The current data make an important contribution to the literature, serving to clarify the specific meteorological factors that influence mood change in bipolar disorder. From a clinical perspective, greater understanding of seasonal patterns of symptoms in bipolar disorder will help mood episode prophylaxis in vulnerable individuals.
Five further studies investigating prospective relationships between mood and weather in people with BD have failed to find the seasonal patterns reported above. Bauer et al. [9] reported finding no seasonal variation in daily mood self-reports amongst 360 BD outpatients. Friedman et al. [11] found no relationship between clinically-defined depressive episodes and calendar month amongst patients with BD-I enrolled in the Systematic Treatment Enhancement Program for BD (STEP-BD). Christensen et al. [12] investigated seasonal variation via meteorological factors (e.g., temperature, relative humidity, barometric pressure, hours of sunshine), and whether such factors predicted the onset of manic and depressive episodes amongst 56 patients with an ICD-10 diagnosis of Bipolar Affective Disorder over a period of 3 years. Again, no meaningful relationships were found. Finally, Murray et al. [13] reported finding no relationship between season and clinician-rated symptoms of mania or depression amongst 429 patients with BD. Null findings were also reported in a large population-based study of seasonal variation in depressive symptoms [14].
The outcomes of the current study provide a novel perspective on the questions surrounding seasonal mood patterns in BD. In particular, we were interested in the specific meteorological factors (if any) that affect mood in this population, and possible mediators of these relationships. The data supported a small effect of temperature on mood in this sample, with higher maximum temperature being associated with worsening of mood towards mania. This effect of temperature was likely mediated by sleep. The lack of consensus in the BD literature on weather-mood relationships is largely due to variations in how mood disorder states are measured and conceptualised in BD (episodes, hospitalisation, self-reports) and the most appropriate time lag to monitor these relationships (synchronous, previous day, weekly, monthly). The current study investigated the relationship between meteorological factors and mood at a more proximal level than previous investigations by using daily and more specific meteorological data as well as daily reports of mood, and thus makes an important contribution to our understanding of seasonal mood patterns in BD. A more nuanced understanding of meteorological influences on mood in BD will assist clinical- and self-management of manic and depressive episodes that recur with the seasons. 589ccfa754
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