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Suicide: A Weighty Matter?

Suicide: A Weighty Matter? We applaud the article by Mukamal and colleagues1 linking higher BMI to lower suicide risk. However, note that we previously reported the inverse connection of BMI to suicide.2 Indeed, we showed that this was part of a broader set of relationships. Moreover, we had predicted this association. We theorized that markers of insulin resistance—including high BMI—might be linked to reduced risk of suicide. Why? Free fatty acid levels are elevated in insulin resistance. Free fatty acids compete with and displace tryptophan from binding to serum albumin, thus increasing the fraction of tryptophan that is free, and that can cross the blood-brain barrier where it is the substrate for the rate-limiting reaction in serotonin formation. Thus, we theorized that more insulin resistance may portend higher central serotonin levels and fewer suicides. Greater insulin sensitivity, analogously, may predict greater suicide risk. We tested this merging physiological data from Helsinki Heart Study screenees with Finnish hospitalization and mortality data. We compared the least insulin resistant quartile to the rest for each of 3 available markers (BMI, high-density lipoprotein cholesterol, and systolic blood pressure). Having any one of these markers was linked to elevated suicide risk (that is, increased risk if more insulin sensitive); and having 2 or 3 of these markers was linked to still greater suicide risk.2 Thus, the study by Mukamal and colleagues1 corroborates our finding, extending it to a different sample. Correspondence: Dr Golomb, UCSD Department of Medicine, 9500 Gilman Dr, Mail Code 0995, La Jolla, CA 92093-0995 (bgolomb@ucsd.edu). References 1. Mukamal KJKawachi IMiller MRimm EB Body mass index and risk of suicide among men. Arch Intern Med 2007;167 (5) 468- 475PubMedGoogle ScholarCrossref 2. Golomb BATenkanen LAlikoski T et al. Insulin sensitivity markers: predictors of accidents and suicides in Helsinki Heart Study screenees. J Clin Epidemiol 2002;55 (8) 767- 773PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Suicide: A Weighty Matter?

Abstract

We applaud the article by Mukamal and colleagues1 linking higher BMI to lower suicide risk. However, note that we previously reported the inverse connection of BMI to suicide.2 Indeed, we showed that this was part of a broader set of relationships. Moreover, we had predicted this association. We theorized that markers of insulin resistance—including high BMI—might be linked to reduced risk of suicide. Why? Free fatty acid levels are elevated in insulin resistance. Free fatty acids...
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Publisher
American Medical Association
Copyright
Copyright © 2007 American Medical Association. All Rights Reserved.
ISSN
0003-9926
DOI
10.1001/archinte.167.17.1908-a
pmid
17893319
Publisher site
See Article on Publisher Site

Abstract

We applaud the article by Mukamal and colleagues1 linking higher BMI to lower suicide risk. However, note that we previously reported the inverse connection of BMI to suicide.2 Indeed, we showed that this was part of a broader set of relationships. Moreover, we had predicted this association. We theorized that markers of insulin resistance—including high BMI—might be linked to reduced risk of suicide. Why? Free fatty acid levels are elevated in insulin resistance. Free fatty acids compete with and displace tryptophan from binding to serum albumin, thus increasing the fraction of tryptophan that is free, and that can cross the blood-brain barrier where it is the substrate for the rate-limiting reaction in serotonin formation. Thus, we theorized that more insulin resistance may portend higher central serotonin levels and fewer suicides. Greater insulin sensitivity, analogously, may predict greater suicide risk. We tested this merging physiological data from Helsinki Heart Study screenees with Finnish hospitalization and mortality data. We compared the least insulin resistant quartile to the rest for each of 3 available markers (BMI, high-density lipoprotein cholesterol, and systolic blood pressure). Having any one of these markers was linked to elevated suicide risk (that is, increased risk if more insulin sensitive); and having 2 or 3 of these markers was linked to still greater suicide risk.2 Thus, the study by Mukamal and colleagues1 corroborates our finding, extending it to a different sample. Correspondence: Dr Golomb, UCSD Department of Medicine, 9500 Gilman Dr, Mail Code 0995, La Jolla, CA 92093-0995 (bgolomb@ucsd.edu). References 1. Mukamal KJKawachi IMiller MRimm EB Body mass index and risk of suicide among men. Arch Intern Med 2007;167 (5) 468- 475PubMedGoogle ScholarCrossref 2. Golomb BATenkanen LAlikoski T et al. Insulin sensitivity markers: predictors of accidents and suicides in Helsinki Heart Study screenees. J Clin Epidemiol 2002;55 (8) 767- 773PubMedGoogle ScholarCrossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Sep 24, 2007

References