Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK.
National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, and King's College London, London, UK.
Psychol Med. 2024 Feb;54(3):601-610. doi: 10.1017/S0033291723002283. Epub 2023 Aug 31.
Research implicates inflammation in the vicious cycle between depression and obesity, yet few longitudinal studies exist. The rapid weight loss induced by bariatric surgery is known to improve depressive symptoms dramatically, but preoperative depression diagnosis may also increase the risk for poor weight loss. Therefore, we investigated longitudinal associations between depression and inflammatory markers and their effect on weight loss and clinical outcomes in bariatric patients.
This longitudinal observational study of 85 patients with obesity undergoing bariatric surgery included 41 cases with depression and 44 controls. Before and 6 months after surgery, we assessed depression by clinical interview and measured serum high-sensitivity C-reactive protein (hsCRP) and inflammatory cytokines, including interleukin (IL)-6 and IL-10.
Before surgery, depression diagnosis was associated with significantly higher serum hsCRP, IL-6, and IL-6/10 ratio levels after controlling for confounders. Six months after surgery, patients with pre-existing depression still had significantly higher inflammation despite demonstrating similar weight loss to controls. Hierarchical regression showed higher baseline hsCRP levels predicted poorer weight loss ( = -0.28, = 0.01) but had no effect on depression severity at follow-up ( = -0.02, = 0.9). Instead, more severe baseline depressive symptoms and childhood emotional abuse predicted greater depression severity after surgery ( = 0.81, < 0.001; and = 0.31, = 0.001, respectively).
Depression was significantly associated with higher inflammation beyond the effect of obesity and other confounders. Higher inflammation at baseline predicted poorer weight loss 6 months after surgery, regardless of depression diagnosis. Increased inflammation, rather than depression, may drive poor weight loss outcomes among bariatric patients.
研究表明，炎症在抑郁和肥胖之间的恶性循环中起作用，但纵向研究较少。减重手术引起的快速体重减轻已知可显著改善抑郁症状，但术前抑郁诊断也可能增加体重减轻不良的风险。因此，我们研究了肥胖症患者中抑郁和炎症标志物之间的纵向关联及其对体重减轻和临床结果的影响。
这项对 85 名接受减重手术的肥胖症患者的纵向观察性研究包括 41 例抑郁症患者和 44 例对照组。手术前和手术后 6 个月，我们通过临床访谈评估抑郁情况，并测量血清高敏 C 反应蛋白（hsCRP）和炎症细胞因子，包括白细胞介素（IL）-6 和 IL-10。
在控制混杂因素后，术前诊断为抑郁症与 hsCRP、IL-6 和 IL-6/10 比值显著升高相关。手术后 6 个月，尽管对照组患者的体重减轻与对照组相似，但仍存在明显的抑郁和炎症。分层回归显示，较高的基线 hsCRP 水平预测体重减轻较差（ = -0.28， = 0.01），但对随访时的抑郁严重程度没有影响（ = -0.02， = 0.9）。相反，基线时更严重的抑郁症状和儿童期情感虐待预测术后抑郁严重程度更大（ = 0.81， < 0.001；和 = 0.31， = 0.001，分别）。
除肥胖和其他混杂因素的影响外，抑郁与更高的炎症显著相关。基线时较高的炎症水平预测手术后 6 个月体重减轻较差，无论是否存在抑郁诊断。在减重患者中，增加的炎症而不是抑郁可能导致体重减轻不良的结果。
