{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T10:32:47Z","timestamp":1791196367782,"version":"4.1.0"},"reference-count":73,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2013,12,12]],"date-time":"2013-12-12T00:00:00Z","timestamp":1386806400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bipolar Disorders"],"published-print":{"date-parts":[[2014,6]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Individuals with bipolar disorder (<jats:styled-content style=\"fixed-case\">BD<\/jats:styled-content>) are disproportionately affected by symptoms of being overweight and metabolic syndrome when compared to the general population. The pertinence of this observation is underscored by observations that excess weight is associated with a more complex illness presentation, course, and outcome in <jats:styled-content style=\"fixed-case\">BD<\/jats:styled-content>. We present the first preliminary report of our <jats:styled-content style=\"fixed-case\">BIPFAT<\/jats:styled-content> study, which explored shared hypothesized pathophysiological pathways between being overweight and having <jats:styled-content style=\"fixed-case\">BD<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We investigated the tryptophan\u2013kynurenine metabolism pathway as a proxy of dysregulated inflammatory homeostasis in euthymic, overweight individuals with <jats:styled-content style=\"fixed-case\">BD<\/jats:styled-content> (n\u00a0=\u00a078) compared to healthy controls (n\u00a0=\u00a0156).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Both blood kynurenine concentrations and the kynurenine to tryptophan ratio [(Kyn:Trp); an estimate of tryptophan breakdown] were significantly higher in the total sample of euthymic patients with <jats:styled-content style=\"fixed-case\">BD,<\/jats:styled-content> with greater increases noted in both parameters in the subsample of overweight patients with <jats:styled-content style=\"fixed-case\">BD<\/jats:styled-content>. When compared to controls, peripheral neopterin concentrations were significantly lower. Within the <jats:styled-content style=\"fixed-case\">BD<\/jats:styled-content> group, there were also significant between\u2010group differences in neopterin concentrations, with higher levels in those who were overweight and in subjects with <jats:styled-content style=\"fixed-case\">BD<\/jats:styled-content> in the later stages of illness compared to earlier stages.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Increased tryptophan breakdown, as well as neopterin levels in <jats:styled-content style=\"fixed-case\">BD,<\/jats:styled-content> may be an indirect mediator of immune\u2010mediated inflammation. In <jats:styled-content style=\"fixed-case\">BD<\/jats:styled-content>, this may account for the high prevalence of medical comorbidities and increased mortality. The observation of increased kynurenine levels and Kyn:Trp, and altered circulating neopterin levels provides indirect evidence of increased activity of tryptophan\u2010degrading indoleamine 2,3\u2010dioxygenase in euthymic individuals with <jats:styled-content style=\"fixed-case\">BD,<\/jats:styled-content> underscoring the role of inflammatory mediators as a causative and\/or consequent factor. More robust abnormalities in the overweight subsample underscore the additional <jats:italic>inflammatory burden<\/jats:italic> of medical comorbidity and suggest a shared pathophysiology as well as a mechanism mediating <jats:styled-content style=\"fixed-case\">BD<\/jats:styled-content> and cardiovascular disease.<\/jats:p><\/jats:sec>","DOI":"10.1111\/bdi.12166","type":"journal-article","created":{"date-parts":[[2013,12,12]],"date-time":"2013-12-12T06:31:06Z","timestamp":1386829866000},"page":"432-440","source":"Crossref","is-referenced-by-count":76,"title":["Tryptophan breakdown is increased in euthymic overweight individuals with bipolar disorder: a preliminary report"],"prefix":"10.1111","volume":"16","author":[{"given":"Eva Z","family":"Reininghaus","sequence":"first","affiliation":[{"name":"Department of Psychiatry Medical University of Graz Graz Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger 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