Obesity and Sarcopenic Obesity Characterized by Low-grade Inflammation Are Associated with Increased Risk for Major Depression in Women

Overview

Journal Front Nutr

Specialty Nutritional Sciences

Date 2023 Oct 16

PMID 37841401

Authors

Julie A Pasco

Michael Berk

Brenda Penninx

Natalie K Hyde

Kara L Holloway-Kew

Emma C West

Mark A Kotowicz

Kara B Anderson

Adrienne ONeil

Pamela G Rufus-Membere

Lana J Williams

Affiliations

Soon will be listed here.

Abstract

Background: We aimed to determine women's risk of major depressive disorder (MDD) in relation to obesity phenotypes characterized by levels of circulating high-sensitivity C-reactive protein (hsCRP).

Methods: This population-based retrospective cohort study comprised 808 women (ages 20-84 y) recruited 1994-1997 and followed for a median 16.1 y (IQR 11.9-16.8). At baseline, body fat and lean tissue mass were measured by whole body dual-energy x-ray absorptiometry (DXA). Obesity was identified as high fat mass index (>12.9 kg/m), body fat percentage (≥35%) and body mass index (≥30 kg/m); sarcopenic obesity referred to a high ratio fat mass/fat-free mass (≥0.80). Systemic inflammation was operationalized as serum hsCRP concentration in the upper tertile (>2.99 mg/L). Obesity phenotypes were: non-obese + lowCRP, non-obese + highCRP, obese + lowCRP, and obese + highCRP. During follow-up, the Structured Clinical Interview for DSM-IV-TR (SCID-I/NP) was used to identify lifetime history of MDD and age of onset. Poisson regression models were used to estimate the MDD rate for each obesity phenotype during follow-up. Demographic, health and lifestyle factors were tested as potential confounders.

Results: During 11,869 p-y of follow-up, 161 (19.9%) women experienced an MDD episode. For obesity phenotypes based on fat mass index, models adjusted for baseline age and prior MDD, and non-obese + lowCRP as reference, RR for non-obese + highCRP was 1.21 (95% CI 0.80, 1.82), obese + lowCRP 1.46 (0.86, 2.47) and obese + highCRP 1.56 (1.03, 2.37). Patterns were similar for obesity by body fat percentage, body mass index and sarcopenic obesity.

Conclusion: Consistently across different obesity definitions, this longitudinal study reports that women with both obesity and systemic inflammation are at increased risk of subsequent MDD. Future research should examine whether tackling this metabolically unhealthy obesity type - through, for example, lifestyle or medication approaches - can reduce depression risk.

References

Gimeno R, Klaman L . Adipose tissue as an active endocrine organ: recent advances. Curr Opin Pharmacol. 2005; 5(2):122-8. DOI: 10.1016/j.coph.2005.01.006. View

Kohler C, Evangelou E, Stubbs B, Solmi M, Veronese N, Belbasis L . Mapping risk factors for depression across the lifespan: An umbrella review of evidence from meta-analyses and Mendelian randomization studies. J Psychiatr Res. 2018; 103:189-207. DOI: 10.1016/j.jpsychires.2018.05.020. View

Stefan N, Haring H, Hu F, Schulze M . Metabolically healthy obesity: epidemiology, mechanisms, and clinical implications. Lancet Diabetes Endocrinol. 2014; 1(2):152-62. DOI: 10.1016/S2213-8587(13)70062-7. View

Pasco J, Sui S, West E, Anderson K, Rufus-Membere P, Tembo M . Fatty Liver Index and Skeletal Muscle Density. Calcif Tissue Int. 2022; 110(6):649-657. PMC: 9108103. DOI: 10.1007/s00223-021-00939-9. View

Kelly T, Wilson K, Heymsfield S . Dual energy X-Ray absorptiometry body composition reference values from NHANES. PLoS One. 2009; 4(9):e7038. PMC: 2737140. DOI: 10.1371/journal.pone.0007038. View

Pilati I, Slee A, Frost R . Sarcopenic Obesity and Depression: A Systematic Review. J Frailty Aging. 2022; 11(1):51-58. DOI: 10.14283/jfa.2021.39. View

Davis J, Mohebbi M, Collier F, Loughman A, Staudacher H, Shivappa N . The role of diet quality and dietary patterns in predicting muscle mass and function in men over a 15-year period. Osteoporos Int. 2021; 32(11):2193-2203. PMC: 8155648. DOI: 10.1007/s00198-021-06012-3. View

Chae W, Nubel J, Baumert J, Gold S, Otte C . Association of depression and obesity with C-reactive protein in Germany: A large nationally representative study. Brain Behav Immun. 2022; 103:223-231. DOI: 10.1016/j.bbi.2022.04.024. View

Prado C, Wells J, Smith S, Stephan B, Siervo M . Sarcopenic obesity: A Critical appraisal of the current evidence. Clin Nutr. 2012; 31(5):583-601. DOI: 10.1016/j.clnu.2012.06.010. View

10.

Luppino F, de Wit L, Bouvy P, Stijnen T, Cuijpers P, Penninx B . Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry. 2010; 67(3):220-9. DOI: 10.1001/archgenpsychiatry.2010.2. View

11.

Penninx B, Lange S . Metabolic syndrome in psychiatric patients: overview, mechanisms, and implications. Dialogues Clin Neurosci. 2018; 20(1):63-73. PMC: 6016046. View

12.

Merchant R, Seetharaman S, Au L, Wong M, Wong B, Tan L . Relationship of Fat Mass Index and Fat Free Mass Index With Body Mass Index and Association With Function, Cognition and Sarcopenia in Pre-Frail Older Adults. Front Endocrinol (Lausanne). 2022; 12:765415. PMC: 8741276. DOI: 10.3389/fendo.2021.765415. View

13.

Seo Y, Lee S, Ahn J, Min S, Kim M, Kim J . Association of Metabolically Healthy Obesity and Future Depression: Using National Health Insurance System Data in Korea from 2009-2017. Int J Environ Res Public Health. 2020; 18(1). PMC: 7795335. DOI: 10.3390/ijerph18010063. View

14.

Heber D, Ingles S, Ashley J, Maxwell M, Lyons R, Elashoff R . Clinical detection of sarcopenic obesity by bioelectrical impedance analysis. Am J Clin Nutr. 1996; 64(3 Suppl):472S-477S. DOI: 10.1093/ajcn/64.3.472S. View

15.

Daly M . The relationship of C-reactive protein to obesity-related depressive symptoms: a longitudinal study. Obesity (Silver Spring). 2013; 21(2):248-50. DOI: 10.1002/oby.20051. View

16.

Hamer M, Batty G, Kivimaki M . Risk of future depression in people who are obese but metabolically healthy: the English longitudinal study of ageing. Mol Psychiatry. 2012; 17(9):940-5. PMC: 3428506. DOI: 10.1038/mp.2012.30. View

17.

De Lorenzo A, Deurenberg P, Pietrantuono M, Di Daniele N, Cervelli V, Andreoli A . How fat is obese?. Acta Diabetol. 2003; 40 Suppl 1:S254-7. DOI: 10.1007/s00592-003-0079-x. View

18.

Tomazic A, Zvanut B, Grbac L, Jurdana M . Identification of sarcopenic obesity in adults undergoing orthopaedic surgery: Relationship between "a body shape index" (ABSI) and fat-free mass. A cross -sectional study. PLoS One. 2022; 17(6):e0269956. PMC: 9216617. DOI: 10.1371/journal.pone.0269956. View

19.

Pasco J, Nicholson G, Williams L, Jacka F, Henry M, Kotowicz M . Association of high-sensitivity C-reactive protein with de novo major depression. Br J Psychiatry. 2010; 197(5):372-7. DOI: 10.1192/bjp.bp.109.076430. View

20.

Pasco J, Kotowicz M, Henry M, Nicholson G, Spilsbury H, Box J . High-sensitivity C-reactive protein and fracture risk in elderly women. JAMA. 2006; 296(11):1353-5. DOI: 10.1001/jama.296.11.1353. View