Waist circumference, abdominal obesity, and depression among overweight and obese U.S. adults: national health and nutrition examination survey 2005-2006

BMC Psychiatry

Lina S Balluz¹  Satvinder Dhingra¹  James Tsai²  Chaoyang Li¹  Earl S Ford²  Guixiang Zhao² 

[1]Division of Behavioral Surveillance, Public Health Surveillance Program Office, Office of Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA

[2]Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA 30341, USA

关键词: waist circumference;    PHQ-9 diagnostic algorithm;    depressive symptoms;    abdominal obesity;   

Others  :  1124506
DOI  :  10.1186/1471-244X-11-130

 received in 2010-10-20, accepted in 2011-08-11,  发布年份 2011

【 摘 要 】

Background

Obesity is associated with an increased risk of mental illness; however, evidence linking body mass index (BMI)-a measure of overall obesity, to mental illness is inconsistent. The objective of this study was to examine the association of depressive symptoms with waist circumference or abdominal obesity among overweight and obese U.S. adults.

Methods

A cross-sectional, nationally representative sample from the 2005-2006 National Health and Nutrition Examination Survey was used. We analyzed the data from 2,439 U.S. adults (1,325 men and 1,114 nonpregnant women) aged ≥ 20 years who were either overweight or obese with BMI of ≥ 25.0 kg/m². Abdominal obesity was defined as waist circumference of > 102 cm for men and > 88 cm for women. Depressive symptoms (defined as having major depressive symptoms or moderate-to-severe depressive symptoms) were assessed by the Patient Health Questionnaire-9 diagnostic algorithm. The prevalence and the odds ratios (ORs) with 95% confidence intervals (CIs) for having major depressive symptoms and moderate-to-severe depressive symptoms were estimated using logistic regression analysis.

Results

After multivariate adjustment for demographics and lifestyle factors, waist circumference was significantly associated with both major depressive symptoms (OR: 1.03, 95% CI: 1.01-1.05) and moderate-to-severe depressive symptoms (OR: 1.02, 95% CI: 1.01-1.04), and adults with abdominal obesity were significantly more likely to have major depressive symptoms (OR: 2.18, 95% CI: 1.35-3.59) or have moderate-to-severe depressive symptoms (OR: 2.56, 95% CI: 1.34-4.90) than those without. These relationships persisted after further adjusting for coexistence of multiple chronic conditions and persisted in participants who were overweight (BMI: 25.0-< 30.0 kg/m²) when stratified analyses were conducted by BMI status.

Conclusion

Among overweight and obese U.S. adults, waist circumference or abdominal obesity was significantly associated with increased likelihoods of having major depressive symptoms or moderate-to-severe depressive symptoms. Thus, mental health status should be monitored and evaluated in adults with abdominal obesity, particularly in those who are overweight.

【 授权许可】

   
2011 Zhao et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Kumanyika SK, Obarzanek E, Stettler N, Bell R, Field AE, Fortmann SP, Franklin BA, Gillman MW, Lewis CE, Poston WC, Stevens J, Hong Y: Population-based prevention of obesity: the need for comprehensive promotion of healthful eating, physical activity, and energy balance: a scientific statement from American Heart Association Council on Epidemiology and Prevention, Interdisciplinary Committee for Prevention. Circulation 2008, 118:428-464.
• [2]Flegal KM, Carroll MD, Ogden CL, Curtin LR: Prevalence and trends in obesity among US adults, 1999-2008. JAMA 2010, 303:235-41.
• [3]Visscher TL, Seidell JC: The public health impact of obesity. Annu Rev Public Health 2001, 22:355-375.
• [4]Friedman N, Fanning EL: Overweight and obesity: an overview of prevalence, clinical impact, and economic impact. Dis Manag 2004, 7(Suppl 1):S1-S6.
• [5]Guh DP, Zhang W, Bansback N, Amarsi Z, Birmingham CL, Anis AH: The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health 2009, 9:88-107. BioMed Central Full Text
• [6]Zhang C, Rexrode KM, van Dam RM, Li TY, Hu FB: Abdominal obesity and the risk of all-cause, cardiovascular, and cancer mortality: sixteen years of follow-up in US women. Circulation 2008, 117:1658-1667.
• [7]Ball K, Burton NW, Brown WJ: A prospective study of overweight, physical activity, and depressive symptoms in young women. Obesity (Silver Spring) 2009, 17:66-71.
• [8]Bjerkeset O, Romundstad P, Evans J, Gunnell D: Association of adult body mass index and height with anxiety, depression, and suicide in the general population: the HUNT study. Am J Epidemiol 2008, 167:193-202.
• [9]de Wit LM, van SA, van HM, Penninx BW, Cuijpers P: Depression and body mass index, a u-shaped association. BMC Public Health 2009, 9:14-19. BioMed Central Full Text
• [10]Johnston E, Johnson S, McLeod P, Johnston M: The relation of body mass index to depressive symptoms. Can J Public Health 2004, 95:179-183.
• [11]Lim W, Thomas KS, Bardwell WA, Dimsdale JE: Which measures of obesity are related to depressive symptoms and in whom? Psychosomatics 2008, 49:23-28.
• [12]Mather AA, Cox BJ, Enns MW, Sareen J: Associations of obesity with psychiatric disorders and suicidal behaviors in a nationally representative sample. J Psychosom Res 2009, 66:277-285.
• [13]Petry NM, Barry D, Pietrzak RH, Wagner JA: Overweight and obesity are associated with psychiatric disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychosom Med 2008, 70:288-297.
• [14]Simon GE, Von KM, Saunders K, Miglioretti DL, Crane PK, van BG, Kessler RC: Association between obesity and psychiatric disorders in the US adult population. Arch Gen Psychiatry 2006, 63:824-830.
• [15]Zhao G, Ford ES, Dhingra S, Li C, Strine TW, Mokdad AH: Depression and anxiety among US adults: associations with body mass index. Int J Obes (Lond) 2009, 33:257-266.
• [16]Birnbaum HG, Kessler RC, Kelley D, Ben-Hamadi R, Joish VN, Greenberg PE: Employer burden of mild, moderate, and severe major depressive disorder: mental health services utilization and costs, and work performance. Depress Anxiety 2010, 27:78-89.
• [17]Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B: Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet 2007, 370:851-858.
• [18]Hach I, Ruhl UE, Klose M, Klotsche J, Kirch W, Jacobi F: Obesity and the risk for mental disorders in a representative German adult sample. Eur J Public Health 2007, 17:297-305.
• [19]Pagoto SL, Ma Y, Bodenlos JS, Olendzki B, Rosal MC, Tellez T, Merriam P, Ockene IS: Association of depressive symptoms and lifestyle behaviors among Latinos at risk of type 2 diabetes. J Am Diet Assoc 2009, 109:1246-1250.
• [20]Rivenes AC, Harvey SB, Mykletun A: The relationship between abdominal fat, obesity, and common mental disorders: results from the HUNT study. J Psychosom Res 2009, 66:269-275.
• [21]Turley M, Tobias M, Paul S: Non-fatal disease burden associated with excess body mass index and waist circumference in New Zealand adults. Aust N Z J Public Health 2006, 30:231-237.
• [22]Herva A, Laitinen J, Miettunen J, Veijola J, Karvonen JT, Laksy K, Joukamaa M: Obesity and depression: results from the longitudinal Northern Finland 1966 Birth Cohort Study. Int J Obes (Lond) 2006, 30:520-527.
• [23]Ho RC, Niti M, Kua EH, Ng TP: Body mass index, waist circumference, waist-hip ratio and depressive symptoms in Chinese elderly: a population-based study. Int J Geriatr Psychiatry 2008, 23:401-408.
• [24]Fox CS, Massaro JM, Hoffmann U, Pou KM, Maurovich-Horvat P, Liu CY, Vasan RS, Murabito JM, Meigs JB, Cupples LA, D'Agostino RB Sr, O'Donnell CJ: Abdominal visceral and subcutaneous adipose tissue compartments: association with metabolic risk factors in the Framingham Heart Study. Circulation 2007, 116:39-48.
• [25]Pou KM, Massaro JM, Hoffmann U, Lieb K, Vasan RS, O'Donnell CJ, Fox CS: Patterns of abdominal fat distribution: the Framingham Heart Study. Diabetes Care 2009, 32:481-485.
• [26]Ahlberg AC, Ljung T, Rosmond R, McEwen B, Holm G, Akesson HO, Björntorp P: Depression and anxiety symptoms in relation to anthropometry and metabolism in men. Psychiatry Res 2002, 112:101-110.
• [27]Everson-Rose SA, Lewis TT, Karavolos K, Dugan SA, Wesley D, Powell LH: Depressive symptoms and increased visceral fat in middle-aged women. Psychosom Med 2009, 71:410-416.
• [28]Katz JR, Taylor NF, Goodrick S, Perry L, Yudkin JS, Coppack SW: Central obesity, depression and the hypothalamo-pituitary-adrenal axis in men and postmenopausal women. Int J Obes Relat Metab Disord 2000, 24:246-251.
• [29]Moreira RO, Marca KF, Appolinario JC, Coutinho WF: Increased waist circumference is associated with an increased prevalence of mood disorders and depressive symptoms in obese women. Eat Weight Disord 2007, 12:35-40.
• [30]Centers for Disease Control and Prevention: National Center for Health Statistics: National Health and Nutrition Examination Survey. [http://www.cdc.gov/nchs/nhanes/nhanes_questionnaires.htm] webcite (accessed 25th Sept. 2010)
• [31]Centers for Disease Control and Prevention: The Third National Center for Health Statistics: National Health and Nutrition Examination Survey (NHANES III 1988-94) reference manuals and reports [CD-ROM]. National Center for Health Statistics, Bethesda, MD; 1996.
• [32]Chumlea NC, Kuczmarski RJ: Using a bony landmark to measure waist circumference. J Am Diet Assoc 1995, 95:12.
• [33]Pratt LA, Brody DJ: Depression in the United States household population, 2005-2006. NCHS Data Brief 2008, 1-8.
• [34]Kroenke K, Spitzer RL: The PHQ-9: A New Depression Diagnostic and Severity Measure. Psychiatric Annals 2002, 32:1-7.
• [35]Kroenke K, Spitzer RL, Williams JB: The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001, 16:606-13.
• [36]Martin A, Rief W, Klaiberg A, Braehler E: Validity of the Brief Patient Health Questionnaire Mood Scale (PHQ-9) in the general population. Gen Hosp Psychiatry 2006, 28:71-77.
• [37]Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ: Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003, 42:1206-1252.
• [38]Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J: A new equation to estimate glomerular filtration rate. Ann Intern Med 2009, 150:604-612.
• [39]Akbaraly TN, Kivimaki M, Brunner EJ, Chandola T, Marmot MG, Singh-Manoux A, Ferrie JE: Association between metabolic syndrome and depressive symptoms in middle-aged adults: results from the Whitehall II study. Diabetes Care 2009, 32:499-504.
• [40]Dunbar JA, Reddy P, vis-Lameloise N, Philpot B, Laatikainen T, Kilkkinen A, Bunker SJ, Best JD, Vartiainen E, Kai Lo S, Janus ED: Depression: an important comorbidity with metabolic syndrome in a general population. Diabetes Care 2008, 31:2368-2373.
• [41]Herva A, Rasanen P, Miettunen J, Timonen M, Laksy K, Veijola J, Laitinen J, Ruokonen A, Joukamaa M: Co-occurrence of metabolic syndrome with depression and anxiety in young adults: the Northern Finland 1966 Birth Cohort Study. Psychosom Med 2006, 68:213-216.
• [42]Koponen H, Jokelainen J, Keinanen-Kiukaanniemi S, Kumpusalo E, Vanhala M: Metabolic syndrome predisposes to depressive symptoms: a population-based 7-year follow-up study. J Clin Psychiatry 2008, 69:178-182.
• [43]Takeuchi T, Nakao M, Nomura K, Yano E: Association of metabolic syndrome with depression and anxiety in Japanese men. Diabetes Metab 2009, 35:32-36.
• [44]Lee ES, Kim YH, Beck SH, Lee S, Oh SW: Depressive mood and abdominal fat distribution in overweight premenopausal women. Obes Res 2005, 13:320-325.
• [45]Ma J, Xiao L: Obesity and Depression in US Women: Results From the 2005-2006 National Health and Nutritional Examination Survey. Obesity 2010, 18:347-353.
• [46]Flegal KM, Shepherd JA, Looker AC, Graubard BI, Borrud LG, Ogden CL, Harris TB, Everhart JE, Schenker N: Comparisons of percentage body fat, body mass index, waist circumference, and waist-stature ratio in adults. Am J Clin Nutr 2009, 89:500-508.
• [47]Ford ES, Mokdad AH, Giles WH: Trends in waist circumference among U.S. adults. Obes Res 2003, 11:1223-1231.
• [48]Blaine B: Does depression cause obesity? A meta-analysis of longitudinal studies of depression and weight control. J Health Psychol 2008, 13:1190-1197.
• [49]Ludescher B, Najib A, Baar S, Machann J, Schick F, Buchkremer G, Claussen CD, Eschweiler GW: Increase of visceral fat and adrenal gland volume in women with depression: preliminary results of a morphometric MRI study. Int J Psychiatry Med 2008, 38:229-240.
• [50]Vogelzangs N, Kritchevsky SB, Beekman AT, Newman AB, Satterfield S, Simonsick EM, Yaffe K, Harris TB, Penninx BW: Depressive symptoms and change in abdominal obesity in older persons. Arch Gen Psychiatry 2008, 65:1386-1393.
• [51]Bjorntorp P: Do stress reactions cause abdominal obesity and comorbidities? Obes Rev 2001, 2:73-86.
• [52]Rosmond R, Dallman MF, Bjorntorp P: Stress-related cortisol secretion in men: relationships with abdominal obesity and endocrine, metabolic and hemodynamic abnormalities. J Clin Endocrinol Metab 1998, 83:1853-1859.
• [53]Laimer M, Kramer-Reinstadler K, Rauchenzauner M, Lechner-Schoner T, Strauss R, Engl J, Deisenhammer EA, Hinterhuber H, Patsch JR, Ebenbichler CF: Effect of mirtazapine treatment on body composition and metabolism. J Clin Psychiatry 2006, 67:421-424.
• [54]Beydoun MA, Wang Y: Gender-ethnic disparity in BMI and waist circumference distribution shifts in US adults. Obesity 2009, 17:169-176.
• [55]Li C, Ford ES, McGuire LC, Mokdad AH: Increasing trends in waist circumference and abdominal obesity among US adults. Obesity 2007, 15:216-224.
• [56]Wang Y, Beydoun MA, Liang L, Caballero B, Kumanyika SK: Will all Americans become overweight or obese? estimating the progression and cost of the US obesity epidemic. Obesity 2008, 16:2323-2330.