Association between visceral adipose tissue and major depressive disorder across the lifespan: A scoping review

Type 2 diabetes mellitus modifies and mediates the association between the visceral adiposity index and depression: A cross-sectional study using NHANES 2005-2018 data

BACKGROUND

The objective of this investigation was to explore the correlation between the visceral adiposity index (VAI) and depression, and to analyze how type 2 diabetes mellitus (T2DM) may influence this relationship.

METHODS

This study included data of 12,378 participants sourced from the National Health and Nutrition Examination Survey (NHANES) 2005-2018. Utilizing multivariate logistic regression and restricted cubic spline (RCS) regression, we examined the correlation between VAI and depression. Additionally, we investigated the interactive and mediating effects of T2DM on the association between VAI and depression.

RESULTS

Controlling for all potential confounders, the Ln logarithmic transformation of VAI showed a significant positive correlation with depression [odds ratio (OR) = 1.16, 95 % confidence interval (CI): 1.01-1.35, P = 0.041]. T2DM exhibited a notable interaction effect on the relationship connecting lnVAI and depression (P for interaction = 0.013). Specifically, the T2DM group exhibited a notable positive correlation between lnVAI and depression (OR = 1.46, 95 % CI: 1.17-1.82, P < 0.001), whereas such correlation didn't reach statistical significance within the non-T2DM group. The RCS model revealed a J-shaped nonlinear link between lnVAI and depression, with an inflection point value of 0.052. Mediation analysis indicated that diabetes accounted for 8.0 % of the correlation between lnVAI and depression. Furthermore, sensitivity analysis confirmed the consistency of these findings.

CONCLUSIONS

A J-shaped nonlinear dose-response relationship was observed between lnVAI and depression among American adults, with a threshold of 0.052. T2DM not only served as a mediator between the two variables but also modified their association.

Understanding immune system dysfunction and its context in mood disorders: psychoneuroimmunoendocrinology and clinical interventions

Mood disorders include a set of psychiatric manifestations of increasing prevalence in our society, being mainly represented by major depressive disorder (MDD) and bipolar disorder (BD). The etiopathogenesis of mood disorders is extremely complex, with a wide spectrum of biological, psychological, and sociocultural factors being responsible for their appearance and development. In this sense, immune system dysfunction represents a key mechanism in the onset and pathophysiology of mood disorders, worsening mainly the central nervous system (neuroinflammation) and the periphery of the body (systemic inflammation). However, these alterations cannot be understood separately, but as part of a complex picture in which different factors and systems interact with each other. Psychoneuroimmunoendocrinology (PNIE) is the area responsible for studying the relationship between these elements and the impact of mind-body integration, placing the immune system as part of a whole. Thus, the dysfunction of the immune system is capable of influencing and activating different mechanisms that promote disruption of the psyche, damage to the nervous system, alterations to the endocrine and metabolic systems, and disruption of the microbiota and intestinal ecosystem, as well as of other organs and, in turn, all these mechanisms are responsible for inducing and enhancing the immune dysfunction. Similarly, the clinical approach to these patients is usually multidisciplinary, and the therapeutic arsenal includes different pharmacological (for example, antidepressants, antipsychotics, and lithium) and non-pharmacological (i.e., psychotherapy, lifestyle, and electroconvulsive therapy) treatments. These interventions also modulate the immune system and other elements of the PNIE in these patients, which may be interesting to understand the therapeutic success or failure of these approaches. In this sense, this review aims to delve into the relationship between immune dysfunction and mood disorders and their integration in the complex context of PNIE. Likewise, an attempt will be made to explore the effects on the immune system of different strategies available in the clinical approach to these patients, in order to identify the mechanisms described and their possible uses as biomarkers.

Is BMI a Useful Indicator of Prenatal Health Among Black American Women?

OBJECTIVE

BMI is commonly used to measure risk to prenatal health but may not be sensitive to adiposity-associated health problems for Black women. The aim of the present study was to test associations between indices of prenatal health and BMI in Black women.

METHODS

Data were from 652 women enrolled in two studies. Height and weight were used to calculate BMI. Depression and perceived stress were measured via maternal report, systemic inflammation via C-reactive protein (CRP), and nutrition by the ratio of omega-3 docosahexaenoic acid to omega-6 arachidonic acid fatty acids.

RESULTS

Neither perceived stress, depression, nor fatty acids were associated with prenatal BMI. CRP levels were positively associated with BMI (beta = 6.56, t = 13.30, p < .001). The prevalence of high-risk levels of CRP (> 3 mg/L) was below 10% for all weight classes except for BMI ≥ 40.

CONCLUSIONS

Results suggest that BMI may not be a sensitive index of adiposity related risk to prenatal health for Black women.

Examining Real-World Evidence of Depression-Related Symptom Reduction Through a Comprehensive Holistic Lifestyle Intervention

Depression is a global health concern, with various treatments available. In this study, participants (n = 430) were self-selected or medically referred to a residential lifestyle program at the Black Hills Health & Education Center (BHHEC), with a mean stay of 19 days. Individualized treatment plans included structured physical activity sessions, counseling sessions, and the provision of a vegan diet. Beck Depression Inventory-II, self-reported total exercise minutes, resistance exercise minutes, and sleep, along with the number of holistic treatments and counseling sessions, were evaluated. Paired samples t-tests indicated a significant decrease in depression scores over time (MT1 = 20.14, MT2 = 6.17, P < .001). Results from the multiple linear regression that evaluated total exercise minutes, resistance exercise, number of treatments and counseling sessions, and average reported hours of nightly sleep on depression scores at time 2 indicated that average reported hours of nightly sleep were the only significant predictor of depression scores at time 2 (P < .05). While depression scores significantly improved from baseline to post-assessment for all participants, it is possible that an unmeasured variable, or the synergistic intervention effect of the wellness program, accounted for changes in depressive symptoms over time. Future studies should incorporate sleep quality and assessing time spent in nature to explore these relationships further.

Association between Weight-Adjusted Waist Index and depressive symptoms: A nationally representative cross-sectional study from NHANES 2005 to 2018

BACKGROUND

Depressive symptoms are strongly associated with the development of various diseases and are one of the leading causes of disability in the world. However, the relationship between weight-adjusted waist index (WWI) and depressive symptoms has not been studied. This study aimed to assess the relationship between depressive symptoms and WWI.

METHODS

This study took NHANES data from 2005 to 2018 with 32,374 participants. Depressive symptoms were measured by a questionnaire (PHQ-9).WWI was determined by dividing the square root of waist circumference (cm) by weight (kg). Multivariate logistic regression models, smoothed curve fitting, and weighted generalized additive model (GAM) regression were used to examine the relationship between depressive symptoms and WWI, BMI, and waist circumference. Subgroup analyses and interaction tests were also performed.

RESULTS

In fully adjusted models, the OR (95 % CI) for WWI and depressive symptoms with WWI, BMI, and waist circumference were 1.18 (1.05, 1.34), BMI 1.01 (1.00, 1.02, 1.01 (1.00, 1.01), respectively. Participants in the highest quartile (Q4) had a 49 % higher depressive symptoms compared to those in the lowest quartile (Q1) (OR = 1.49, 95 % CI:1.14-1.96). Subgroup analyses and interaction tests showed a stable relationship between depressive symptoms and WWI.

LIMITATIONS

It is difficult to determine a causal relationship between the two; questionnaire collection may be somewhat biased; CONCLUSIONS: WWI was positively associated with depressive symptoms. This association was stronger than BMI and waist circumference. However, this relationship was stable. This study emphasizes the potential utility of WWI in preventing depressive symptoms and improving prognosis in the population.

The role of cognitive function in the relationship between surrogate markers of visceral fat and depressive symptoms in general middle-aged and elderly population: A nationwide population-based study

BACKGROUND

The relationship between obesity and depressive symptoms is well documented, but not visceral fat, especially among Chinese adults are scarce. We aimed to investigate the association between visceral fat and depressive symptoms and the mediation of cognitive function.

METHODS

A total of 19,919 and 5555 participants from the China Health and Retirement Longitudinal Study were enrolled in the cross-sectional and follow-up analyses. Depressive symptoms were measured by the Center of Epidemiological studies depression scale (CES-D). Visceral fat measured by the waist circumference triglyceride (WT) index [calculated as waist circumference (cm)* triglyceride (mmol/L)]. The relationship between the WT index and depressive symptoms was analyzed by binary logistics and Poisson regression. The mediated role of cognitive ability was examined by intermediary analysis.

RESULTS

In the cross-sectional study, higher visceral fat was associated with a lower risk of depressive symptoms. But in the follow-up study, individuals in quintile 2 to quintile 4 of the WT index have a reduced risk of depressive symptoms after four years. Compared with the lower index, quintile 2 of the WT index protected from difficulty concentrating (RR [95%CI]: 0.90 [0.82,0.98], p = 0.023), feeling scared (RR [95%CI]: 0.86 [0.73,0.98], p = 0.030) and feeling that life could not go on (RR [95%CI]: 0.85 [0.74,0.98], p = 0.023). Moreover, cognitive ability explained 11.52 % of the association between visceral fat and depressive symptoms.

CONCLUSIONS

Our findings show that moderate visceral fat was associated with a lower risk of depressive symptoms in middle-aged and older Chinese, partly mediated by cognitive function.

Living alone is associated with a higher prevalence of psychiatric morbidity in a population-based cross-sectional study

Background

Living alone has been linked to poor mental health, however large-scale epidemiological studies on the association between living alone and psychiatric morbidity including depression and anxiety are lacking. The aim of this study was to investigate this issue in a large Taiwanese cohort.

Methods

In this cross-sectional study, we enrolled 121,601 volunteers from 29 community recruitment stations in Taiwan and divided them into two groups based on whether or not they lived alone. Psychiatric morbidity was defined as a Generalized Anxiety Disorder 2-item score ≥ 3, Patient Health Questionnaire 2-item score ≥ 3, or self-reported depression. Logistic regression was used to explore the associations between living alone and psychiatric morbidity.

Results

The participants who lived alone had a higher prevalence of psychiatric morbidity [odds ratio (OR) = 1.608, 95% confidence interval (CI) = 1.473 to 1.755] after adjusting for potential confounders. In a subgroup analysis, married subjects who lived alone and divorce/separation (OR = 2.013, 95% CI = 1.763 to 2.299) or widowing (OR = 1.750, 95% CI = 1.373 to 2.229) were more likely to have psychiatric morbidity than those who were married and not living alone.

Conclusions

Our findings suggest that living alone is a risk factor for psychiatric morbidity, especially for married subjects who live alone in concordance with divorce, separation, or the death of a spouse.

Association between level of depression and coronary heart disease, stroke risk and all-cause and cardiovascular mortality: Data from the 2005-2018 National Health and Nutrition Examination Survey

Research on the association between level of depression and coronary heart disease (CHD), stroke risk, and all-cause and cardiovascular mortality is lacking in large-scale or population-based studies incorporating cardiovascular disease (CVD) endpoints. We aim to assess the relationship between the level of a person's depression and their risk of CHD, stroke, and all-cause and cardiovascular mortality. Utilizing data from the United States National Health and Nutrition Examination Survey (NHANES), multicycle cross-sectional design and mortality linkage studies were conducted. The study sample included 30918 participants aged 20-85 years old during the 2005-2018 period. Depression was assessed using the nine-item Patient Health Questionnaire (PHQ-9), with scores of 5, 10, 15, and 20 being the cut-off points for mild, moderate, moderately severe, and severe depression, respectively. A series of weighted logistic regression analyses and Cox proportional hazards models were utilized to examine the relationship between the level of depression with the risk of CHD, stroke, all-cause, and cardiovascular mortality. Trend analyses were conducted by entering the level of depression as a continuous variable and rerunning the corresponding regression models. Weighted logistic regression models consistently indicated a statistically significant association between the level of depression and increased risk of CHD and stroke, and those linear trend tests were statistically significant (P for trend < 0.001). Furthermore, weighted Cox regression analyses consistently indicated that participants who had a more severe degree of depression were at a higher risk of all-cause death, and trend analyses suggested similar results (P for trend < 0.001). Another weighted Cox regression analysis also consistently indicated that except for severe depression, the hazard of cardiovascular death was increased with each additional level increase of depression. Our study confirmed that the level of depression was strongly associated with CHD, stroke, and all-cause and cardiovascular mortality, even after accounting for other factors that could impact risk, including variables of age, gender, ethnicity, income, education, body mass index (BMI), marital, and smoking status.

Association between depressive symptoms and pericardial fat in healthy older men and women

Depressive symptoms are associated with increased risk for cardiovascular disease (CVD), and inflammation may contribute to this relationship. Pericardial fat, a highly metabolically active fat depot, is implicated in the pathogenesis of CVD, but its association with depressive symptoms is unclear. This study examined the cross-sectional and longitudinal association between depressive symptoms and pericardial fat over a three-year period. Participants were 543 healthy men and women (mean age = 62.9 years) without history or objective signs of coronary heart disease from the Whitehall II cohort. In men, depressive symptoms were positively associated with pericardial fat at baseline after adjustment for sociodemographics, waist to hip ratio and conventional cardiovascular risk factors. Inflammation, indexed by plasma interleukin 6 concentration, accounted for 17% of this association. Longitudinally, depressive symptoms did not predict pericardial fat three years later in men once baseline levels of pericardial fat were accounted for. No significant associations between depressive symptoms and pericardial fat were found in women. Overall, our findings suggest that greater pericardial fat might be a mechanism by which depressive symptoms are associated with increased risk for CVD in men, and inflammation may also lie on this pathway.

Adipose Tissue Compartments, Inflammation, and Cardiovascular Risk in the Context of Depression

The neurobiological and behavioral underpinnings linking mental disorders, in particular, major depressive disorder (MDD), with cardiovascular disorders are a matter of debate. Recent research focuses on visceral (intra-abdominal and epicardial) adipose tissue and inflammation and their impact on the development of cardiometabolic disorders. Intra-abdominal adipose tissue is defined as an endocrine active fat compartment surrounding inner organs and is associated with type 2 diabetes mellitus, a risk factor for the later development of cardiovascular disorders. Epicardial (pericardial) adipose tissue is a fat compartment surrounding the heart with close proximity to the arteries supporting the heart. Visceral adipose tissue (VAT) is an important source of inflammatory mediators that, in concert with other risk factors, plays a leading role in cardiovascular diseases. In conjunction with the behavioral (physical inactivity, sedentary lifestyle), psychological (adherence problems), and hormonal (dysfunction of the hypothalamus-pituitary-adrenal axis with subsequent hypercortisolism) alterations frequently accompanying MDD, an enhanced risk for cardiovascular disorders results.