Depressive Symptoms and Increased Visceral Fat in Middle-Aged Women

Abstract

Objective-Mechanisms underlying the association between depression and increased cardiovascular risk remain poorly understood. Central adiposity is one potential pathway. Prior research has shown an association between depression and central adiposity but few studies have examined whether depressive symptoms are differentially associated with visceral adipose tissue (VAT), which is more metabolically active and confers greater cardiovascular risk than subcutaneous fat (SAT).Methods-We investigated the cross-sectional association between depressive symptoms, assessed by the Center for Epidemiological Studies Depression Scale (CES-D), and VAT and SAT, assessed by computed tomography, in a sample of 409 middle-aged women (44.7% African-Americans, 55.3% whites; mean age=50.4 years) participating in the Chicago site of the Study of Women's Health Across the Nation (SWAN).Results-With adjustments for age, race, total percent fat and sex hormone binding globulin (SHBG), each 1-point higher score on the CES-D was associated with 1.03 cm 2 greater VAT (p<. 001). Women with a CES-D score of 16 or greater, indicative of clinically relevant depressive symptomatology, had 24.5% more VAT than women with lower CES-D scores (p<.001). Further adjustment for Framingham Risk Score and physical activity did not alter the findings, and associations did not vary by race. Associations were strongest in obese and overweight women. Depressive symptoms were unrelated to SAT.Address correspondence and reprint requests to: Susan A. Everson-Rose, Ph.D., University of Minnesota, 717 Delaware St SE, Room 166, Minneapolis, MN 55414,, saer@umn.edu. Dr. Everson-Rose was affiliated with Rush University Medical Center when this work was initiated but completed the work after relocation to the University of Minnesota.Portions of this work were presented at the 64 th annual meeting of the American Psychosomatic Society, Denver, CO, 3/4/06 and are published in abstract form (Psychosom Med 2006;68:A-27 NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptConclusions-Increased visceral fat may be one pathway by which depression contributes to excess risk for cardiovascular disease and diabetes. Further research is needed to examine whether depressive symptoms influence accumulation of VAT over time. KeywordsAbdominal obesity; depressive symptoms; African-American; women's health; cardiovascular disease Consistent evidence has accumulated over the past two decades showing that depression or depressive symptoms are related to increased risk of cardiovascular disease (CVD) morbidity and mortality (1) and diabetes (2,3). The pathways or mechanisms that underlie or mediate the association of depression or depressive symptoms with CVD and diabetes -though widely studied -are incompletely understood. The purpose of this study was to examine the relation of depressive symptoms with central adiposity, one pathway by which depression and depressive symptoms may contribute to CVD and diabetes risk.Central adiposity is more atherogenic...

Assessment of dietary habits and nutritional status of depressive patients, depending on place of residence

“…Waist circumferenceconfirming the accumulation of visceral fatin female patientswith depression(> 90cm) has also been reported by otherauthors [5,25]. In the present study, the averagefat content was lowerin female and male urban residents (30% and29%, respectively) compared to female and male village inhabitants (37% and 30%, respectively), although statistically significant difference was found onlybetween women.…”

“…Other authors reported lower average VAT (94.6 cm 2 ) and a higher proportion of SAT (389.5 cm 2 ) in comparison with those found in the present study [5]. In patients with depression, waist circumference was strongly correlated with both subcutaneous, r = 0.83 and visceral adipose tissue, r = 0.77, p <0,001) [5].…”

“…In the remaining groups, the percentage of excessive body weight was found in 70% of female rural inhabitants and in over 80% in the male groups. Other authors have also demonstrated a significant percentage of depressive patients with BMI exceeding 25kg/m 2 [5,23,24,25].…”

“…In patients with depression, waist circumference was strongly correlated with both subcutaneous, r = 0.83 and visceral adipose tissue, r = 0.77, p <0,001) [5]. It has been demonstrated that visceral adipose tissue is metabolically active, associated with the secretion of pro-inflammatory factors (Interleukin 6, IL-6), tumor necrosis factor ɑ (TNFɑ), adipocytokines, hemostasis and fibrinolysis markers (including plasminogen activator inhibitor-1, PAI-1) and growth factors (vascular endothelial growth factor, VEGF).…”

“…It has been estimated that by 2020, depression will be among the three main health problems worldwide [4]. In many studies, depression has appeared to be an independent predictor of cardiovascular diseases, including coronary heart disease, to facilitate body weight gain and increase the percentage of patients with overweight or obesity, especially abdominal obesity and accumulation of metabolically active visceral adipose tissue (VAT) [2,5,6,7]. Depression has also been shown to occur in approximately 30% of patients with type 1 and type 2 diabetes [8].…”