title: Posttraumatic Stress Disorder as a Catalyst for the Association Between Metabolic Syndrome and Reduced Cortical Thickness.
abstract: Metabolic syndrome (MetS), defined by a constellation of cardiometabolic pathologies, is highly prevalent among veterans, especially veterans with posttraumatic stress disorder (PTSD), and poses a major risk for adverse health outcomes, including neurodegeneration and mortality. Given this, we evaluated 1) the association between MetS and neural integrity, indexed by cortical thickness; 2) the relationship between PTSD and MetS; and 3) whether PTSD was associated with cortical thickness indirectly through MetS.
  
  
  
  The sample consisted of 346 U.S. military veterans (89.3% male; 71.4% white) who deployed to Iraq, Afghanistan, or both. Neuroimaging data were available for 274 participants.
  
  
  
  In whole-brain analyses, MetS was negatively associated with cortical thickness in two left and four right hemisphere regions, as follows: bilateral temporal lobe, including temporal pole, fusiform gyrus, and insula, and extending into occipital cortex (left hemisphere) and orbitofrontal cortex (right hemisphere); bilateral precuneus, posterior cingulate, calcarine, and occipital-parietal cortex; and right rostral anterior cingulate cortex and central sulcus/postcentral gyrus. Path models showed that PTSD predicted MetS (β = .19, p < .001), which was associated with reduced cortical thickness (β = -.29 to -.43, all p < .001).
  
  
  
  Results from this young veteran sample provide evidence that PTSD confers risk for cardiometabolic pathology and neurodegeneration and raise concern that this cohort may be aging prematurely and at risk for substantial medical and cognitive decline. This study highlights the need to identify the molecular mechanisms linking PTSD to MetS and effective interventions to reduce PTSD-related health comorbidities.
authors.affiliation: National Center for PTSD, Boston, Massachusetts; Department of Psychiatry, Boston, Massachusetts. Electronic address: erika.wolf@va.gov.
authors.forename: Erika J
authors.initials: EJ
authors.lastname: Wolf
authors.affiliation: National Center for PTSD, Boston, Massachusetts; Department of Psychiatry, Boston, Massachusetts.
authors.forename: Naomi
authors.initials: N
authors.lastname: Sadeh
authors.affiliation: Behavioral Science Division, Neuroimaging Research for Veterans Center, Boston, Massachusetts; Geriatric Research, Education and Clinical Center, Boston, Massachusetts; Translational Research Center for TBI and Stress Disorders, Boston, Massachusetts; Biomedical Genetics, Boston University School of Medicine, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Leritz
authors.affiliation: Research Service, VA Boston Healthcare System, Boston, Massachusetts; Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Logue
authors.affiliation: Boston VA Research Institute, Inc, Boston, Massachusetts.
authors.forename: Tawni B
authors.initials: TB
authors.lastname: Stoop
authors.affiliation: Geriatric Research, Education and Clinical Center, Boston, Massachusetts; Translational Research Center for TBI and Stress Disorders, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
authors.forename: Regina
authors.initials: R
authors.lastname: McGlinchey
authors.affiliation: Geriatric Research, Education and Clinical Center, Boston, Massachusetts; Translational Research Center for TBI and Stress Disorders, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
authors.forename: William
authors.initials: W
authors.lastname: Milberg
authors.affiliation: National Center for PTSD, Boston, Massachusetts; Department of Psychiatry, Boston, Massachusetts; Biomedical Genetics, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Miller
mesh_terms: D000328:Adult; D002540:Cerebral Cortex / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D007839:Functional Laterality; D006801:Humans; D007091:Image Processing, Computer-Assisted; D054542:Iraq War, 2003-2011; D008279:Magnetic Resonance Imaging; D008297:Male; D008659:Metabolic Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology*; D011569:Psychiatric Status Rating Scales; D013313:Stress Disorders, Post-Traumatic / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology*; D014481:United States; D014728:Veterans
keywords: Accelerated aging; Cortical thickness; Magnetic resonance imaging; Metabolic syndrome; Posttraumatic stress disorder; Structural equation modeling
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