Chronic Multisymptom Illness Common in Gulf War Veterans Persistent Stress Linked to Metabolic Syndrome

Veterans who were deploy?ed in the first Persian Gulf War appear to have nearly twice the prevalence of chronic multisymptom illness (CMI)?a cluster of symptoms similar to a set of conditions often called Gulf War syndrome?than veterans de?ploy?ed elsewhere. New evidence suggests that 10 years after the first Gulf War, CMI represents a significant health problem in the United States. These findings were published in the American Journal of Epi?dem?iology (2006;163: 66-75). Chronic Multisymptom Illness... Continued from page 1

The diagnosis of CMI consists of having symptoms for >6 months in at least 2 of the following 3 categories:

? Excessive fatigue

? Mood disorder or difficulty thinking

? Muscle or joint pain.

Lead investigator Melvin Blanchard, MD, of Washington University School of Medicine, St Louis, and associate chief of medicine at the St. Louis VA Medical Center, and colleagues found that among the first Gulf War veterans, CMI incidence was 28.9% compared with just 15.8% in other veterans. Previous studies have suggested that CMI might be declining over time among the deployed veterans. A 1995 study conducted by the Centers for Disease Control and Prevention first evaluated Gulf War veterans' illnesses, identifiying CMI among 44.7% of deployed veterans compared with 15% of nondeployed veterans.

The new study is part of an ongoing analysis of data collected in the National Health Survey of Gulf War Era Veterans and Their Families. The data come from physical evaluations conducted between 1999 and 2001 of >2000 veterans and their families.

The veterans were divided into 2 groups: those who served in the Persian Gulf War, referred to as deployed ?veterans, and those who served elsewhere during the war, referred to as nondeployed veterans.

"CMI should be higher on the radar screen for primary care physicians. It is higher in the veteran population. My suspicion is that CMI is present in the general population as well, but it is not well studied," Dr Blanchard said.

Key points

This condition doubles the risk

of the metabolic syndrome.

Treatment modalities include stress management, exercise,

and depression therapy.

Having CMI doubles the risk of developing the metabolic syndrome, which places the person at increased risk for coronary artery disease, diabetes, and liver cirrhosis. A total of 25% of Persian Gulf deployed veterans with CMI were found to have the metabolic syndrome compared with 13% of deployed veterans without CMI. A similar prevalence pattern was seen in nondeployed veterans with and without CMI. Those with CMI report much poorer quality of life and poorer mental and physical functioning than unaffected veterans.

"CMI is associated with important medical conditions. Physicians need to pay attention to any constellation of findings that may manifest in these patients that are characteristic of CMI. These patients need be treated aggressively. They need stress management, exercise, weight loss if they are overweight, treatment for depression, and treatment for anxiety or any other comorbid psychiatric disorders," Dr Blanchard told IMWR.

Although the researchers are not sure how CMI develops, they suspect that it could be connected to the malfunction of certain body systems, such as the central nervous system, in response to stress. According to Dr Blanchard, stress may help trigger the disorder in the deployed veterans. Those veterans who develop CMI without being in combat or nonveterans with CMI might be responding to other types of life stress, such as divorce, or a death in the family.

"Stress has been shown to alter hormones in the body that regulate food consumption and body fat distribution. We speculate that chronic stress may play a role in the metabolic syndrome. The source of the stress may be war related or even ordinary life. It is interesting that we found the same pattern in the nondeployed veterans. Further study is needed to determine the mechanism for this observation," said Dr Blanchard.

"We did not find any association of CMI with kidney disease, liver disease, thyroid problems, neuropathy, lung disease, or blood abnormalities," he added.