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Major depressive disorder (MDD) and obesity have a complex bidirectional relationship. However, most studies do not assess increased appetite or weight as a depressive symptom due to limitations in rating scales. Here we aimed to analyze frequently employed depressive-symptom scales and discuss the relevance of weight and appetite assessment items. To elaborate this perspective, we searched for validated questionnaires and scales evaluating depressive symptoms in English. We analyzed appetite and weight items from 20 depressive-symptoms rating scales. Only 8 of 20 rating scales assessed for increased weight or appetite. The scales reported in the literature as the most employed in antidepressants efficacy trials do not assess increased appetite or weight. The current use of rating scales limits our understanding of the relationship between MDD, antidepressants, and obesity. It is necessary to improve our weight and appetite measurements in MDD to clarify the respective impact of depressive symptoms and antidepressants on weight change. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to study how acid accumulation (lower plasma bicarbonate and higher anion gap [AG] and corrected anion gap [CAG]) correlates with metabolic parameters, food intake, and 24‐h energy expenditure (EE). Methods: Acid accumulation was measured in 286 healthy adults with estimated glomerular filtration rate > 60 mL/min/1.73 m2. Measurements included body composition by dual‐energy x‐ray absorptiometry scan, ad libitum energy intake by a vending machine paradigm over 3 days, and 24‐h EE in a whole‐room indirect calorimeter. Results: Lower bicarbonate, higher AG, and higher CAG were correlated with higher waist and thigh circumferences, body fat (percentage), fat mass, triglycerides, and lower high‐density lipoprotein cholesterol. Acid accumulation markers were correlated with higher total energy (CAG partial r = 0.17; p = 0.02), fat (CAG partial r = 0.17; p = 0.02), protein intake (CAG partial r = 0.20; p = 0.006), and 24‐h EE (CAG partial r = 0.24; p = 0.0007). A mediation analysis of CAG and total energy intake found that 24‐h EE was a partial mediator (40%), but the association remained significant (β = 0.15; p < 0.0001). Conclusions: In healthy individuals, acid accumulation was associated with an unfavorable metabolic phenotype; higher 24‐h EE; and increased total energy, fat, and protein intake. Acid accumulation markers, as putative markers of higher dietary acid load (e.g., from protein), may affect energy balance physiology promoting weight gain. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the clinical trial in the July 28, 2016 issue titled "Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results" concerning the risk of important cardiovascular outcomes among patients with type 2 diabetes.