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Xu Y, Ning W, Zhang Y, Ba Y, Liu H, Liu L, Wang L, Guo C, Xu H, Weng S, Zhou Z, Cai Z, Ma H, Zhang G, Jia Y, Han X. Associations Between Cardiovascular Health (Life's Essential 8) and Mental Disorders. Clin Cardiol 2024; 47:e70019. [PMID: 39314085 PMCID: PMC11420513 DOI: 10.1002/clc.70019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 09/07/2024] [Accepted: 09/10/2024] [Indexed: 09/25/2024] Open
Abstract
BACKGROUND Mental health was closely associated with cardiovascular disease (CVD). We aimed to investigate the association between cardiovascular health (CVH), as defined by Life's Essential 8 (LE8), and the presence of depression and anxiety. HYPOTHESIS We hypothesized that CVH, as defined by LE8, was negatively associated with the prevalence of depression and anxiety. METHODS A cross-sectional study was conducted on participants (≥ 20 years old) from the National Health and Nutrition Examination Survey (NHANES). The LE8 score (ranging from 0 to 100) was composed of the health behavior score and the health factor score, which were further categorized into three levels as follows: low (0-49), moderate (50-79), and high (80-100). Weighted multivariable logistic regressions and restricted cubic splines were utilized to assess the association between LE8 and mental disorders. RESULTS Among the 13 028 participants included in this research, 1206 were determined to have depression symptoms and 2947 were determined to have anxiety symptoms. In the weighted and adjusted model, LE8 was negatively associated with the prevalence of depression (odds ratio [OR], 95% confidence interval [CI]: 0.61, 0.58-0.65) and anxiety (OR, 95% CI: 0.78, 0.75-0.81). Furthermore, a nonlinear dose-response relationship was observed between LE8 and anxiety. CONCLUSIONS CVH defined by the LE8 was independently and negatively associated with the prevalence of depression and anxiety. Interventions targeting LE8 components may improve both CVH and mental health.
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Affiliation(s)
- Yudi Xu
- Department of NeurologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
| | - Wenjing Ning
- School of NursingThe Hong Kong Polytechnic UniversityHung HomHong Kong
| | - Yuyuan Zhang
- Department of Interventional RadiologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Yuhao Ba
- Department of Interventional RadiologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Huimin Liu
- Department of NeurologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
| | - Long Liu
- Department of Hepatobiliary and Pancreatic SurgeryThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
| | - Libo Wang
- Department of Hepatobiliary and Pancreatic SurgeryThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
| | - Chunguang Guo
- Department of Endovascular SurgeryThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
| | - Hui Xu
- Department of Interventional RadiologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Siyuan Weng
- Department of Interventional RadiologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Zhaokai Zhou
- Department of Urology SurgeryThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
| | - Zongao Cai
- Department of Vascular SurgeryThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
| | - Hongxuan Ma
- Department of Kidney TransportationThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
| | - Ge Zhang
- Department of CardiologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
| | - Yanjie Jia
- Department of NeurologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
| | - Xinwei Han
- Department of Interventional RadiologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
- Interventional Institute of Zhengzhou UniversityZhengzhouHenanChina
- Interventional Treatment and Clinical Research Center of Henan ProvinceZhengzhouHenanChina
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Prugger C, Perier MC, Sabia S, Fayosse A, van Sloten T, Jouven X, Pentti J, Kivimäki M, Empana JP. Association between changes in cardiovascular health and the risk of multimorbidity: community-based cohort studies in the UK and Finland. THE LANCET REGIONAL HEALTH. EUROPE 2024; 42:100922. [PMID: 38764806 PMCID: PMC11098950 DOI: 10.1016/j.lanepe.2024.100922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 03/29/2024] [Accepted: 04/16/2024] [Indexed: 05/21/2024]
Abstract
Background Better cardiovascular health is associated with lower risk of various chronic diseases, but its association with multimorbidity is poorly understood. We aimed to examine whether change in cardiovascular health is associated with multimorbidity risk. Methods The primary analysis was conducted in the Whitehall II multiwave prospective cohort study (UK) and the validation analysis in the Finnish Public Sector cohort study (Finland). Change in cardiovascular health was assessed using the American Heart Association Life's Simple 7 (LS7) and Life's Essential 8 (LE8) at baseline and re-assessments, using objective measures in Whitehall II and self-reports and pharmacy claims in the Finnish Public Sector cohort study, respectively. Multimorbidity was defined as the presence of two or more of 12 chronic diseases during follow-up. We estimated hazard ratios (HR) and 95% confidence intervals (CI) using Cox's proportional hazard models with age as time scale, adjusting for sex, education, occupation, marital status, and ethnicity. Findings In the primary analysis among 9715 participants, mean age was 44.8 (standard deviation 6.0) years and 67.6% participants were men at baseline. During the median follow-up of 31.4 (interquartile range 26.8-32.3) years, 2751 participants developed multimorbidity. The hazard of multimorbidity decreased by 8% (HR 0.92, 95% CI 0.88-0.96) per ideal LS7 metric increment over 5 years and by 14% (HR 0.86, 95% CI 0.80-0.93) per ten points increase in LE8 score over 10 years. These findings were replicated in the validation analysis among 75,377 participants in terms of 4-year change in cardiovascular health. Interpretation Improvement in cardiovascular health was associated with lower multimorbidity risk in two community-based cohort studies. Interventions improving cardiovascular health of the community may contribute to multimorbidity prevention. Funding None.
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Affiliation(s)
- Christof Prugger
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Public Health, Seestraße 73, 13347, Berlin, Germany
| | - Marie-Cécile Perier
- Université Paris Cité, Paris, INSERM U970, Paris Cardiovascular Research Centre (PARCC), 56 rue Leblanc, 75015, Paris, France
| | - Séverine Sabia
- Université Paris Cité, INSERM U1153, Epidemiology of Aging and Neurodegenerative Diseases, 10 avenue de Verdun, 75010, Paris, France
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Pl, London, Wc1E 7Hb, United Kingdom
| | - Aurore Fayosse
- Université Paris Cité, INSERM U1153, Epidemiology of Aging and Neurodegenerative Diseases, 10 avenue de Verdun, 75010, Paris, France
| | - Thomas van Sloten
- Department of Vascular Medicine, University Medical Centre Utrecht, Lundlaan 4, 3584 EA, Utrecht, the Netherlands
| | - Xavier Jouven
- Université Paris Cité, Paris, INSERM U970, Paris Cardiovascular Research Centre (PARCC), 56 rue Leblanc, 75015, Paris, France
| | - Jaana Pentti
- Clinicum, Faculty of Medicine, University of Helsinki, Haartmaninkatu 8, 00290, Helsinki, Finland
- Department of Public Health, University of Turku, Kiinamyllynkatu 8-10, 20520, Turku, Finland
- Centre for Population Health Research, Turku University Hospital, University of Turku, Kiinamyllynkatu 8-10, 20520, Turku, Finland
- Finnish Institute of Occupational Health, Topeliuksenkatu 41 b, 00250, Helsinki, Finland
| | - Mika Kivimäki
- UCL Brain Sciences, University College London, 17 Queen Square, WC1N 3AR, London, United Kingdom
- Clinicum, Faculty of Medicine, University of Helsinki, Tukholmankatu 8, 00290, Helsinki, Finland
| | - Jean-Philippe Empana
- Université Paris Cité, Paris, INSERM U970, Paris Cardiovascular Research Centre (PARCC), 56 rue Leblanc, 75015, Paris, France
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Huang X, Zhang J, Liang J, Duan Y, Xie W, Zheng F. Association of Cardiovascular Health With Risk of Incident Depression and Anxiety. Am J Geriatr Psychiatry 2024; 32:539-549. [PMID: 37968161 DOI: 10.1016/j.jagp.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVE To investigate the association between cardiovascular health (CVH), defined by the American Heart Association's Life's Essential 8 (LE8) score, and incident depression and anxiety. DESIGN A prospective cohort study using data from UK Biobank. SETTING Participants were enrolled from March 2006 to October 2010. PARTICIPANTS Participants without cardiovascular diseases and common mental disorders at baseline and having complete data on metrics of LE8 were included. MEASUREMENTS CVH was assessed by LE8 score including eight components. The overall CVH was categorized as low (LE8 score <50), moderate (50≤ LE8 score <80), and high (LE8 score ≥80). RESULTS We included 115,855 participants (mean age: 55.7 years; female: 52.6%). During a median follow-up of 12.4 years, 3,194 (2.8%) and 4,005 (3.5%) participants had incident depression and anxiety, respectively. Compared with participants having low CVH, those having moderate and high CVH had 37% (HR = 0.63, 95% CI: 0.57-0.70) and 52% (HR = 0.48, 95% CI: 0.41-0.55) lower risk of incident depression. Similarly, moderate and high CVH were related to a lower risk of incident anxiety (HR = 0.81, 95% CI: 0.73-0.89 and HR = 0.68, 95% CI: 0.60-0.78). Restricted cubic spline showed that LE8 score was inversely related to incident depression and anxiety in a linear manner, and the risk of incident depression and anxiety decreased by 17% (HR = 0.83, 95% CI: 0.80-0.85) and 10% (HR = 0.90, 95% CI: 0.88-0.92) for 10-point increment in LE8 score, respectively. CONCLUSIONS Higher CVH, evaluated by LE8 score, is strongly associated with a lower risk of incident depression and anxiety, suggesting the significance of optimizing CVH by adopting LE8.
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Affiliation(s)
- Xinghe Huang
- School of Nursing (XH, JZ, JL, FZ), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Junyu Zhang
- School of Nursing (XH, JZ, JL, FZ), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie Liang
- School of Nursing (XH, JZ, JL, FZ), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanping Duan
- Department of Psychological Medicine (YD), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wuxiang Xie
- Peking University Clinical Research Institute (WX), Peking University First Hospital, Beijing, China
| | - Fanfan Zheng
- School of Nursing (XH, JZ, JL, FZ), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Zeng G, Lin Y, Lin J, He Y, Wei J. Association of cardiovascular health using Life's Essential 8 with depression: Findings from NHANES 2007-2018. Gen Hosp Psychiatry 2024; 87:60-67. [PMID: 38306947 DOI: 10.1016/j.genhosppsych.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 02/04/2024]
Abstract
OBJECTIVE Few studies have explored the correlation between cardiovascular health (CVH) and depression. We aimed to investigate the relationship between CVH using Life's Essential 8 (LE8) and depression among US adults. METHODS 16,362 individuals from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2018 were included. The patient Health Questionnaire (PHQ-9) was utilized to recognized depression (PHQ-9 ≥ 10). LE8 was scored by four health behaviors (sleep, tobacco/nicotine exposure, physical activity and diet) and four health factors (body mass index, non-high-density lipoprotein cholesterol, blood glucose and blood pressure) and classified into low, moderate and high CVH groups. Weighted logistic regressions, restricted cubic splines and sensitivity analyses were utilized to investigate the correlation between LE8 and depression. RESULTS 1306 subjects had depression (7.98% of the participants), of which 860 (7.42%), 305 (17.24%) and 141 (3.01%) had low, moderate and high CVH, separately. In the fully adjusted model, LE8 was negatively correlated with depression (OR: 5.50, 95% CI 3.92-7.71, P < 0.001). Furthermore, there were inversely dose-response relationships between LE8 and depression (overall P < 0.001). CONCLUSIONS Adhering to a high CVH, estimated by the LE8 score, was correlated with lower odds of depression.
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Affiliation(s)
- Guixing Zeng
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yujie Lin
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiarong Lin
- Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
| | - Yaxing He
- School of Instrumentation and Optoelectronic Engineering, Beihang University, Beijing, China
| | - Junping Wei
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
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Xu H, Liang X, Wang L, Wei J, Guo B, Zeng C, Feng S, Wang S, Yang X, Pan Y, Wang Z, Xie L, Reinhardt JD, Tang W, Zhao X. Role of metabolic risk factors in the relationship between ambient fine particulate matter and depressive symptoms: Evidence from a longitudinal population study. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 270:115839. [PMID: 38118332 DOI: 10.1016/j.ecoenv.2023.115839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND There is growing evidence indicating a connection between fine particulate matter (PM2.5) and depressive symptoms. Metabolic risk factors are critical determinants of depressive symptoms. However, the mediating role of these factors on the association between PM2.5 and depressive symptoms remains elusive. We aimed to investigate whether and to what extent metabolic risk factors mediated the link between long-term PM2.5 exposure and depressive symptoms. METHODS This study comprised 7794 individuals aged between 30 and 79 years who participated in two waves of the on-site surveys in the China Multi-Ethnic Cohort. Ambient PM2.5 concentrations were assessed utilizing a random forest method based on satellite data. We employed the Patient Health Questionnaire-9 to assess depressive symptoms at wave 2, and the overall as well as three sub-domain symptom scores (emotional, neurovegetative, and neurocognitive symptoms) were calculated. Three metabolic risk factors, including hypertension, diabetes, and dyslipidemia, were considered. Mediation analyses were conducted to assess the indirect effects of PM2.5 on depressive symptoms through metabolic risk factors. RESULTS We found a positive association between chronic exposure to ambient PM2.5 and overall depressive symptoms as well as the three sub-domains. In mediation analyses, metabolic risk factors partially mediated the associations of PM2.5 on depressive symptoms. The natural indirect effects (RR, 95% CI) of PM2.5 on overall, emotional, neurovegetative, and neurocognitive symptoms mediated through metabolic risk factors were 1.004(1.001, 1.007), 1.004 (1.001, 1.008), 1.004 (1.001, 1.007), and 1.003(0.999, 1.007), respectively. Larger indirect effects were found in elderly participants (mediated proportion, 29.3%), females (13.3%), and people who did not consume alcohol (19.6%). CONCLUSIONS Metabolic risk factors may act as mediators in the relationship between chronic PM2.5 exposure and depression. Treatment of metabolic risk factors may be an opportunity to reduce the burden of depression caused by long-term exposure to PM2.5.
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Affiliation(s)
- Huan Xu
- Institute for Disaster Management and Reconstruction, Sichuan University-The Hongkong Polytechnic University, Chengdu, Sichuan, China; West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xian Liang
- Chengdu Center for Disease Control and Prevention, Chengdu, Sichuan, China
| | - Lei Wang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jing Wei
- Department of Atmospheric and Oceanic Science, Earth System Science Interdisciplinary Center, University of Maryland, College Park, MD, USA
| | - Bing Guo
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chunmei Zeng
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shiyu Feng
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Songmei Wang
- School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Xianxian Yang
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
| | - Yongyue Pan
- School of Medicine, Tibet University, Lhasa, Tibet, China
| | - Ziyun Wang
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, Guizhou, China
| | - Linshen Xie
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Jan D Reinhardt
- Institute for Disaster Management and Reconstruction, Sichuan University-The Hongkong Polytechnic University, Chengdu, Sichuan, China; Department of Rehabilitation Medicine, Jiangsu Province Hospital/Nanjing Medical University First Affiliated Hospital, Nanjing, China; Swiss Paraplegic Research, Nottwil, Switzerland; Faculty for Health and Medicine, University of Lucerne, Switzerland.
| | - Wenge Tang
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China.
| | - Xing Zhao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
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De La Roca-Chiapas JM, Grajeda Gutiérrez CF, Íñiguez Venegas VJ, Hernández González MA, Reyes Pérez V. Depression symptoms and suicide risk of internal medicine residents before and after first year of the COVID-19 pandemic. Front Psychol 2023; 14:1074709. [PMID: 37645061 PMCID: PMC10461619 DOI: 10.3389/fpsyg.2023.1074709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 07/19/2023] [Indexed: 08/31/2023] Open
Abstract
Introduction Depression is a mental health disorder characterized by the presence of sadness or loss of the ability to feel pleasure, with a high incidence in patients with COVID 19. The investigations have focused on patient care and little on the care of health personnel, these being the ones with the highest mortality rate, so the objective of the study was to investigate the prevalence of depression symptoms and suicide risk and understand the association of depressive disorder and suicide risk with levels of serum cholesterol and low levels of serum cortisol among internal medicine fellows in a specialist medical hospital in Leon, Guanajuato, Mexico, before and after COVID-19. Methods In this longitudinal study, internal medicine residents were initially monitored for 2months before starting to care for patients with COVID-19. Participants were asked to fill out depression symptoms and suicide risk surveys. We measured the serum cholesterol and cortisol of each participant, and again after 11months of treating COVID-19 patients. Results Depression symptoms and suicide risk were assessed; significant differences were found between the two time periods for depression (p < 0.01), and no difference was found for suicide risk (p = 0.182). We found a significant correlation between serum cholesterol levels and suicide risk (r = 0.366, p < 0.01); we also found differences in serum cortisol levels (p < 0.01) and cholesterol (p < 0.0001) before and after the pandemic. Conclusion Caring for patients with COVID-19 in the hospital contributed to an increase in levels of depression symptoms and suicidal ideation, as well as differences in levels of cortisol and cholesterol in resident physicians of internal medicine; among the possible reasons for this change could be the conditions of personal protection while treating patients, the uncertainty in the first months of not knowing how the virus was transmitted and not having or knowing when vaccinations would be available, as well as the lack of a strategy of adequate mental health support from the institutions dedicated to their academic training.
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Affiliation(s)
| | | | | | | | - Verónica Reyes Pérez
- Department of Psychology, Division of Health Sciences, University of Guanajuato, Leon, Guanajuato, Mexico
- Division of Health Sciences, University of Guanajuato, León, Mexico
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Zhang Y, Lu J, Huang S, Chen Y, Fang Q, Cao Y. Sex differences in the association between serum α-Klotho and depression in middle-aged and elderly individuals: A cross-sectional study from NHANES 2007-2016. J Affect Disord 2023:S0165-0327(23)00713-9. [PMID: 37236270 DOI: 10.1016/j.jad.2023.05.073] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 05/05/2023] [Accepted: 05/21/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Klotho is a well-known anti-aging protein that exerts pleiotropic effects; however, little is known regarding serum α-Klotho in the context of depression. Here, we evaluated the association between serum α-Klotho levels and depression in middle-aged and older individuals. METHODS In this cross-sectional study, data were collected from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2016 with a total of 5272 participants who were ≥40 years of age. Depression was evaluated using the 9-item Patient Health Questionnaire (PHQ-9). The association between serum α-Klotho levels and depression was determined on the basis of multivariable logistic regression models. RESULTS The mean age of the enrolled adults was 58.94 ± 10.54 years, of which 49.5 % were female. When serum α-Klotho was log10-transformed, it was significantly inversely associated with depression in females in the final adjusted model (odds ratio [OR], 0.32; 95 % confidence interval [CI], 0.12-0.85). In the contrast, serum α-Klotho (log10) was significantly positively associated with depression in males in one of the adjusted models (OR, 3.71; 95 % CI, 1.17-11.8), and this disappeared after adjusting other covariates (all P > 0.05). Based on further stratified respective analyses of females and males, the results were stable. LIMITATIONS The cross-sectional study could not yield any conclusions regarding causality. CONCLUSIONS In the present study, serum α-Klotho levels were negatively related to the prevalence of depression in middle-aged and elderly women. This study provides new evidence of sex differences in the association between serum α-Klotho levels and depression.
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Affiliation(s)
- Yi Zhang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China; Department of Neurology, The Affiliated Changzhou NO.2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Jieyi Lu
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Shicun Huang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yuan Chen
- Department of Neurology, The Affiliated Changzhou NO.2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Qi Fang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China.
| | - Yin Cao
- Department of Neurology, The Affiliated Changzhou NO.2 People's Hospital of Nanjing Medical University, Changzhou, China.
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