Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, AJ Ernststraat 887, 1081 HL Amsterdam, Netherlands.
J Clin Psychiatry. 2010 Apr;71(4):391-9. doi: 10.4088/JCP.08m04743blu. Epub 2009 Dec 15.
Although several cross-sectional studies have linked obesity and depression, less is known about their longitudinal association and about the relative influence of obesity subtypes. We prospectively examined whether obesity (specifically, abdominal) increased the risk of onset of depression in a population-based sample of older persons.
Participants were 2,547 nondepressed, well-functioning white and black persons, aged 70-79 years, enrolled in the Health, Aging, and Body Composition Study, an ongoing prospective community-based cohort study. Baseline measurements were conducted between April 1997 and June 1998. Overall obesity was assessed by body mass index (BMI) and percent body fat (measured by dual energy x-ray absorptiometry), whereas abdominal obesity measures included waist circumference, sagittal diameter, and visceral fat (measured by computer tomography). Onset of significant depressive symptoms was defined as a Center for Epidemiologic Studies Depression 10-item score > or = 10 at any annual follow-up over 5 years and/or new antidepressant medication use. Persistent depression was defined as depression at 2 consecutive follow-up visits.
Over 5 years, significant depressive symptoms emerged in 23.7% of initially nondepressed persons. In men, both overall (BMI: hazard ratio [HR] per SD increase = 1.20; 95% CI, 1.03-1.40) and abdominal obesity (visceral fat: HR per SD increase = 1.19; 95% CI, 1.07-1.33) predicted onset of depressive symptoms after adjustment for sociodemographics. When BMI and visceral fat were adjusted for each other, only visceral fat was significantly associated with depression onset (HR = 1.18; 95% CI, 1.04-1.34). Stronger associations were found for persistent depressive symptoms. No associations were found in women.
This study shows that obesity, in particular visceral fat, increases the risk of onset of significant depressive symptoms in men. These results suggest that specific mechanisms might relate visceral fat to the onset of depression.
虽然有几项横断面研究表明肥胖与抑郁有关，但对于它们之间的纵向关联以及肥胖亚型的相对影响知之甚少。我们前瞻性地研究了肥胖（特别是腹部肥胖）是否会增加老年人人群中抑郁发病的风险。
参与者为 2547 名无抑郁、功能良好的白人和黑人，年龄在 70-79 岁之间，参加了健康、衰老和身体成分研究（一项正在进行的基于社区的前瞻性队列研究）。基线测量于 1997 年 4 月至 1998 年 6 月进行。总体肥胖通过体重指数（BMI）和体脂百分比（通过双能 X 射线吸收法测量）来评估，而腹部肥胖的测量指标包括腰围、矢状直径和内脏脂肪（通过计算机断层扫描测量）。显著抑郁症状的发作定义为在 5 年的任何年度随访中，流行病学研究中心抑郁 10 项量表评分≥10 分，或开始使用抗抑郁药物。持续性抑郁定义为在 2 次连续随访时出现抑郁。
在 5 年内，最初无抑郁的人群中有 23.7%出现了显著的抑郁症状。在男性中，总体肥胖（BMI：每标准差增加的风险比[HR]为 1.20；95%可信区间[CI]为 1.03-1.40）和腹部肥胖（内脏脂肪：每标准差增加的 HR 为 1.19；95%CI 为 1.07-1.33）在调整社会人口统计学因素后均预测了抑郁症状的发作。当 BMI 和内脏脂肪相互调整时，只有内脏脂肪与抑郁发作显著相关（HR = 1.18；95%CI 为 1.04-1.34）。对于持续性抑郁症状，相关性更强。在女性中未发现相关性。
这项研究表明，肥胖，特别是内脏脂肪，会增加男性发生显著抑郁症状的风险。这些结果表明，特定的机制可能与内脏脂肪有关。
