Research paperThe relationship between visceral adiposity and depressive symptoms in the general Korean population
Introduction
In Korea, depressive symptoms or depression are prevalent psychiatric diseases. For depression, an annual point prevalence rate and a lifetime prevalence rate are 2.5% and 5.6% (Cho et al., 2010). Subsequently, the increasing prevalence of depression will raise the problem of disease burden over time (Cho et al., 2010, Lépine and Briley, 2011). Many investigators consider depression or depressive symptoms as an output of another disease (Kim et al., 2015, Morrison et al., 2015, Phillips, 2011). The need for a more comprehensive analysis of depression has led investigators to record the evidences of associations between depression and more well-defined disease classifications, such as the general medical condition (Vaccarino et al., 2008, Windle and Windle, 2013).
In particular, metabolic syndrome is the representative medical condition associated with depression (Grundy, 2004). A previous meta-analysis showed that depression and metabolic syndrome, which includes a cluster of cardiovascular disease risk factors such as abdominal obesity, high triglyceride (TG) levels, low high-density lipoprotein cholesterol (HDL) levels, high blood pressure, and high glucose levels, are mutually associated (Pan et al., 2012). In contrast, other studies have been unable to show the association between the two conditions (Herva et al., 2006, Hildrum et al., 2009). Furthermore, a few investigators speculate that the sex of an individual may contribute to this association, and should therefore be investigated (Gil et al., 2006, Kinder et al., 2004, Laudisio et al., 2009, Marcellini et al., 2009, Nishina et al., 2011, Pulkki-Råback et al., 2009, Toker et al., 2008). Our team has analyzed the association between subjective depressive symptoms and metabolic syndrome, and in our previous study, we have shown that subjective depressive symptoms are associated with metabolic syndrome in women (Rhee et al., 2014). Some studies showed that the intersection of ethnicity, sex, and age might influence the association between Body Mass Index (BMI) and depressive symptoms (Assari, 2014a, Carter and Assari, 2016, Assari, 2014b, Assari, 2016, Assari et al., 2017). Another study has also found that lipid profiles are associated with both obesity and insulin resistance (Grundy, 2004).
Due to such results, many investigators have become interested in studying obesity among the factors associated with metabolic syndrome (Merikangas et al., 2012). Waist circumference has been previously investigated in a study, in which authors could not prove the association between waist circumference and mental disorders from an epidemiologic perspective (Hach et al., 2006). A Korean study showed that women with general obesity were less likely to have depressive symptoms and women with abdominal obesity by waist circumference were less likely to have depressive symptoms in middle age (Yim et al., 2017). Another commonly used surrogate measure of adiposity is a direct measure of visceral and subcutaneous adipose tissue by computed tomography (CT). Intra-abdominal fat deposition was found to have increased in patients with major depressive illness, as measured by CT; however, the study was conducted in a small number of participants (Thakore et al., 1997). A subsequent study found that insulin resistance, as well as visceral fat was related to depressive symptoms; however, the participants only consisted of middle-aged men (Yamamoto et al., 2016). Depressive symptoms were found to be associated with visceral adiposity only in women in a community-based sample study, although participants were confined to the middle-aged group in this study (Murabito et al., 2013). Another study failed to show the association between depressive symptoms and increased levels of visceral fat in a sample of 409 middle-aged women (Everson-Rose et al., 2009).
Our study examines the association between clinically significant depressive symptoms and intra-abdominal fat in a large sample of the general Korean population. Participants include people that participated in a health screening program. We hypothesize that depressive symptoms and intra-abdominal fat are mutually associated and a sex-dependent differentiation exists in this association. To test the hypotheses, we investigated the cross-sectional association between intra-abdominal fat measured with abdominal CT and subjective depressive symptoms measured using the Beck Depressive Inventory (BDI), BMI, and other factors, such as diabetes and hypertension.
Section snippets
Study sample
Individuals who underwent routine health examinations at the Seoul National University Hospital Healthcare System, Gangnam Center, from October 2004 to July 2012 were included in our study. These examinations are performed to screen for and enable early diagnoses of certain diseases and are available to all individuals who pay fees. The center has various options of routine health examinations that each individual can choose from. There were 11,434 cases of individuals who underwent at least
Demographic characteristics
We divided the participants into the clinically depressive and the non-depressive group (i.e., the control group) using the cutoff value of BDI score, above or equal to 16 points. In this case, 333 of 7238 participants exhibited BDI values higher than 16 points, and were thus classified to the clinically depressed group. Other demographic, anthropometric, and adipose tissue characteristics of the subjects are presented in Table 1. There was no significant difference between the clinically
Discussion
We analyzed 4945 male and 2293 female participants. Of these, 172 male and 161 female participants were confined to the clinically depressed group. Because sex showed significant interactions with intra-abdominal fat (p < 0.001) we performed multiple logistic regression in each sex. After controlling for confounding factors, clinically significant depressive symptoms were found to be associated with visceral adiposity area in women. For each 1 cm2 of visceral adipose tissue area in women, the
Conclusion
In conclusion, our large-sample study showed that clinically significant depressive symptoms were associated with intra-abdominal fat and the ratio of visceral and total adipose area only in women after controlling for confounding factors including BMI. However, there was no association between intra-abdominal fat and the ratio of visceral and total adipose area in men. DM and BMI was associated with the risk of having clinically significant depressive symptoms in men. Considering sex, the
Contributors
All authors have read the manuscript carefully and approved this to be submitted in your journal. This large sample size study was designed and organized by Yong Min Ahn, Dae Hyun Yoon, Sung Joon Cho, Hyun Jeong Lee, Sang Jin Rhee and Eun Young Kim. Yong Min Ahn and Dae Hyun Yoon are correspondents who are responsible for the design and the concept of the research and take full responsibilities. Sung Joon Cho is the first author and takes responsibility for the data analysis and the
Conflict of interest
The authors declare that there is no conflict of interest.
Role of the funding
This work was supported by grant A121987 from the Korea Healthcare Technology R & D Project, Ministry of Health and Welfare, Republic of Korea.
Acknowledgements
The following institutions are joining: Seoul National University Hospital, Seoul National University, Seoul National University Hospital Medical Research Collaborating Center, National Cancer Control Institute, Seoul National University Health Care Center.
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