Conflicting relationship between dietary intake and metabolic health in PTSD: A systematic review

Abstract

Posttraumatic stress disorder (PTSD) is a disabling psychological condition associated with significant physical comorbidities. There has been growing evidence to support the relationship between PTSD and cardiometabolic disease. Disordered eating behaviors often seen in people with PTSD symptoms may explain increased cardiometabolic risk. This systematic review aimed to assess the quality of evidence surrounding dietary intake of individuals with symptoms or a diagnosis of PTSD and their associated risk with cardiometabolic health outcomes. Online databases Scopus, ProQuest (Health), Embase, Medline, PsycINFO, and CINAHL with Full Text were searched for peer-reviewed English articles prior to December 2017 that examined dietary intake and cardiometabolic health outcomes in adults with PTSD symptoms or diagnosis. The quality of each study was graded based on the design and methodology using adapted quality assessment tools. Seven studies with five unique participant samples were included in the review. Study methods, design, populations, and outcomes were inconsistent across studies. Dietary intake was considerably varied and limited associations were demonstrated between dietary intake and cardiometabolic risk factors in the PTSD cohorts. Due to the variability of measures and study outcomes, there was insufficient evidence to determine the relationship between dietary intake and PTSD-related cardiometabolic health outcomes. Future studies are needed to examine these associations in individuals with PTSD: specifically higher quality descriptive studies are necessary to confirm a link between diet and cardiometabolic disease in PTSD.

Physical inactivity, cigarette smoking, and psychiatric comorbidity among veterans with posttraumatic stress disorder.

“…Poor diet quality is a leading cause of cardiovascular and metabolic disease and disability (Lim et al, 2012). Outside the eating disorder research (e.g., binging as a form of emotional avoidance), the impact of PTSD on diet is a topic that has not been given the scientific or clinical attention it deserves (Theal et al, 2018). This gap in the scientific literature needs to be addressed in future studies.…”

PTSD is associated with poor health behavior and greater Body Mass Index through depression, increasing cardiovascular disease and diabetes risk among U.S. veterans

“…Although a recent literature review (Hall et al, 2015) and meta-analysis (van den Berk-Clark et al, 2018) noted that in general PTSD appears to be associated with poorer activity and diet in several studies, evidence is mixed and few studies looking at these associations have examined the role of depression, used rigorous objective measurement procedures, or applied longitudinal designs (Hall et al, 2015). Findings regarding associations with eating behaviors are especially limited and inconsistent (Theal et al, 2018), though some studies have found positive associations between PTSD and dietary intake (van den Berk-Clark et al, 2018). In addition to a need for more rigorous research on the association between PTSD and dietary behaviors, it is important to distinguish between dietary behavior types and whether some differentially affect the association of PTSD with CVD risk factors.…”

Neurophysiology and Psychopathology Underlying PTSD and Recent Insights into the PTSD Therapies—A Comprehensive Review

“…Patients with PTSD often have elevated BMI, glucose, insulin, and creatinine, which may be associated with cardiometabolic dysfunction [30] (Figure 1). For example, macrophages accumulate inside adipose tissue during obesity/insulin resistance generating cytokines and adipokines that may lead to inflammation [72]. Hyperinsulinemia sensitizes adipose tissue to lipid synthesis, which is associated with increased activity of glucocorticoids [66].…”