Practice nurse Reena Patel looks here at two studies. One on obesity and its relation to metabolic health, while another assesses the use of antidepressants for back and OA pain.
Metabolic health and BMI
Inequalities in healthcare have a direct impact on health outcomes. This has been highlighted by the Covid-19 pandemic, where there is a clear link between Covid-19 and deprivation. The highest prevalence of obesity is in the most deprived areas.
Kunzova et al conducted a cross-sectional analysis and meta-analysis study to review what determines metabolic health by looking at obesity traits, socioeconomic elements and behavioural factors. It was the first of its kind and focused on two urban populations in Europe.
The cohort size was 6,000 participants from Switzerland and 2,000 from the Czech Republic. The main determinants of poor metabolic health were divided by a number of variables including body mass index (BMI). Good metabolic health was considered to be where the participant’s blood pressure, lipids and glucose were also in range rather than just their BMI; this differentiated between metabolically healthy and unhealthy obesity. The report noted not all people in a certain BMI range have a similar risk. Some people with metabolically healthy obesity were not at an increased risk of all-cause mortality or cardiovascular events.
In both of the cohorts, those with a high body fat mass and abdominal obesity deemed metabolically unhealthy were older, male and with a low educational attainment. Poor metabolic health in non-obese individuals was associated with low educational level and current smoking. Increasing age and being male were the main determinants of poor metabolic health, irrespective of obesity status.
The study outlines the need for public health strategies against obesity and related comorbidities to improve social conditions and promote healthy lifestyles before there is an increase in metabolic disorders. It also indicates that nurses and public health programmes need to focus on a patient’s metabolic health rather than their BMI or weight alone, especially in areas of economic deprivation and a low educational level.
Kunzova S et al. Determinants of metabolic health across body mass index categories in Central Europe: a comparison between Swiss and Czech populations. Frontiers in Public Health 2020:8:108 doi: 10.3309/fpubh.2020.00108
Antidepressants and back pain
Back pain and osteoarthritis are leading causes of disability worldwide. In 2016, they accounted for the highest expenditure of all health conditions.
Antidepressants are increasingly used for the treatment of back pain, hip and knee OA with most clinical guidelines advocating their use. However, evidence for this prescribing is uncertain.
Ferreira et al looked at the efficacy and safety of antidepressants for the treatment of back pain and OA, using a systematic review and a meta-analysis. Data were extracted from 33 trials with 5,318 participants. The primary outcomes were pain intensity and disability, using a scale score from 0-100, with safety being the secondary outcome. In two of the trials reviewed, 45% of participants had a pre-existing diagnosis of depression; this made no difference to the pain score.
The review found that the effect of serotonin noradrenaline reuptake inhibitors (SNRIs) on pain and disability scores is small and not clinically important for back pain: though there was evidence of reduced pain and disability for up to three months. For OA, SNRIs reduced pain and disability up to three months but the review indicated that a clinically important effect on pain cannot be excluded.
The findings highlighted the possibility that both SNRIs and tricyclic antidepressants (TCAs) may be used for the management of sciatica although their effectiveness was small.
In 67% of the studies, nausea was a common side-effect with all antidepressants, but no serious adverse effects were identified. When recommending medication, patients must be fully informed of this. A common risk factor of long-term analgesia and antidepressants is dependency, impacting on patients’ physical and psychological wellbeing. When carrying out medication reviews a risk-benefit analysis should be done using current national guidelines.
Ferreira G et al. Efficacy and safety of antidepressants for the treatment of back pain and osteoarthritis: systematic review and metanalysis. BMJ 2021;372:m4825 doi:10.1136/bmj.m4825