Longitudinal Associations between
Abdominal Obesity and Depression
Results from the Health, Aging, and Body Composition Study
Nicole Vogelzangs1, Brenda Penninx1, Aartjan Beekman1,
Gretchen Brenes2, Anne Newman3, Tamara Harris4,
Suzanne Satterfield5, Kristine Yaffe6, Stephen Kritchevsky2
1Psychiatry
and EMGO institute, VU University Medical Center, Amsterdam, The Netherlands
2Wake
Forest University, NC, 3University of Pittsburgh, PA, 4NIA, Bethesda, MD,
5University of Tennessee, TN, 6University of California, CA
Background
o
Studies show a link between obesity and depression
(e.g. Roberts et al, Am J Epidemiol, 2000; Lincinio, Rev Bras Psiquiatr, 2003)
o
Abdominal obesity is associated with poorer health
outcome than overall obesity (e.g. Goodpaster et al, Diabetes Care,
2003; Nicklas et al, Am J Epidemiol, 2004)
o
This may be due to specific properties of visceral fat
(e.g. Bjorntorp, GH & IGF Res, 1998; Park et al, Diab Res Clin Prac, 2005)
o
These mechanisms also play a role in depression
(e.g. Bjorntorp, Obesity Rev, 2001; Kahl et al, Psychosom Med, 2005)
=> depression might be specifically associated with
abdominal obesity, independent of overall obesity
Background
Cross-sectional studies show an association between
abdominal obesity and depression (e.g. Thakore et al, Biol Psychiatry,
1997; Weber-Hamann et al, Psychosom Med, 2002; Lee et al, Obesity Res, 2005)
life-style behaviors,
self-image, co-morbid diseases,
inflammation
Abdominal
obesity
?
life-style behaviors,
sex steroid hormones,
cortisol
Depression
Research questions
1. Is abdominal obesity associated with depressed mood,
independent of overall obesity?
2. What is the direction of such a link:
a. Does abdominal obesity predict the incidence of
depressed mood in non-depressed persons at
baseline?
b. Does depressed mood at baseline predict an increase
in abdominal visceral fat over time?
Health ABC Study
o Population-based prospective cohort study with 5 years
of annual follow-up
o 3075 well-functioning black and white older men and
women, aged 70-79 years
Depressed mood
o Center for Epidemiological Studies-Depression Scale
(CES-D-20 and CES-D-10)
o Depressed mood at baseline: CES-D-20 ≥ 16
o Incident depressed mood: CES-D-10 ≥ 10 on any of the
annual follow-up assessments in persons without
baseline depressed mood
o Mean follow-up: 4.4 ± 1.0 years
Obesity
Baseline and 5-year follow-up
o Overall obesity:
o Body Mass Index: weight / height2 (kg/m2)
o % body fat (dual X-ray absorptiometry scan)
o Abdominal obesity:
o Waist circumference (cm)
o Sagittal diameter (cm)
o Abdominal visceral fat (CT scan at L4-L5 level; cm2)
Statistical analyses
1. Cox regression: N=2528
baseline
abdominal obesity
incident
depressed mood
2. Linear regression: N=1733
baseline
depressed mood
5-year change in
abdominal obesity
Covariates:
age, sex, race, site, education, smoking, alcohol use, physical activity,
cardiovascular disease, diabetes
Additional adjustment: overall obesity (BMI)
Sample characteristics (mean (SD) or %)
Men N=1275
Women N=1379
73.7 (2.8)
73.5 (2.9)
Black
35.5
44.7
Baseline depressed mood
2.3
2.9
Incident depressed mood a
18.1
24.8
BMI (kg/m2)
27.1 (3.9)
27.7 (5.4)
% body fat
29.4 (4.9)
40.7 (5.7)
101.1 (10.6)
98.2 (13.4)
22.6 (3.1)
21.9 (3.4)
156.0 (71.6)
131.9 (60.3)
Change in BMI (kg/m2)
-0.5 (1.6)
0.0 (2.0)
Change in % body fat
0.9 (2.5)
-0.1 (2.8)
Change in waist circumference (cm)
0.7 (6.1)
-1.7 (11.6)
Change in sagittal diameter (cm)
0.4 (2.1)
0.8 (2.0)
Change in abd. visceral fat (cm2)
-1.0 (46.2)
-11.6 (33.9)
Age (years)
Waist circumference (cm)
Sagittal diameter (cm)
Abdominal visceral fat (cm2)
a
among non-depressed at baseline
Risk of incident depressed mood (21.6%)
N=2528
HRa
BMI
1.03 0.94-1.12 .54
% body fat
1.06 0.94-1.21 .35
Waist circumference
1.05 0.97-1.15 .23 1.10 0.95-1.28 .21
Sagittal diameter
1.08 0.99-1.17 .11 1.19 1.01-1.40 .04
95%CI
P
HRb
95%CI
P
Abdominal visceral fat 1.10 1.01-1.20 .04 1.14 1.01-1.27 .03
a
Adjusted for sociodemographics, life-style behaviors and diseases
b
Additionally adjusted for BMI
HR
Riska of incident depressed mood
by abdominal visceral fat
2.5
2
1.5
1.48
1.17
1.26
1.12
1
0.5
0
Q1
Q2
Q3
Q4
Q5
Quintiles of abdominal visceral fat
a
Adjusted for sociodemographics, life-style behaviors, diseases, and BMI
Depressed mood and 5-year change in obesity
N=1733
CES-D Score
βa
P
CES-D≥16
βa
P
BMI
.049
.04
.054
.03
% body fat
.029
.24
.023
.34
Waist circumference
.029
.14
.043
.03
Sagittal diameter
.043
.06
.062
.006
Abdominal visceral fat b
.046
.05
.082
<.001
Men
.073
.04
.147
<.001
Women
.027
.38
.035
.24
a
Adjusted for sociodemographics, life-style behaviors, diseases, and BMI (for abdominal
obesity measures)
b
A sex interaction was observed for CES-D≥16: p=.02
Adjusteda mean 5-year change in abdominal visceral fat
cm2
Men
p=.001
30
Women
p=.14
27.7
25
20
15
10
5
0
-5
-2.0
-4.3
-10
-15
-12.0
No depressed mood
Depressed mood
a
Adjusted for sociodemographics, life-style behaviors, diseases, and BMI
Conclusions
o In an older population, abdominal visceral obesity is
independently and more strongly associated with depressed
mood than overall obesity
o The association between abdominal obesity and depressed
mood is bidirectional:
o Abdominal obesity predicts the onset of depressed mood
o In older men only, depressed mood predicts an increase
in abdominal visceral fat over time