Naudé Dewald, Smith Wayne, Jansen van Vuren Esmé
Hypertension in Africa Research Team (HART), North-West University, Private Bag X6001, Potchefstroom 2520, South Africa.
Hypertension in Africa Research Team (HART), North-West University, Private Bag X6001, Potchefstroom 2520, South Africa; South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.
Psychoneuroendocrinology. 2025 Sep;179:107521. doi: 10.1016/j.psyneuen.2025.107521. Epub 2025 Jun 13.
Depression is associated with increased adiposity, and insulin resistance (IR) and leptin have been proposed as potential mediators of this relationship. However, the exact nature of this relationship is poorly understood in young adults. Therefore, we investigated the relationship of total depressive symptom severity and specific depressive symptom clusters with adiposity and metabolic markers in young South African adults.
We stratified 997 adults (aged 20-30 years) according to increasing body mass index (BMI) and waist-to-height-ratio (WHtR) categories. The Patient Health Questionnaire (PHQ-9) was used to assess total depressive symptom severity, somatic- and cognitive-affective depressive symptom cluster scores. Leptin, insulin, and glucose were measured using fasting blood samples. The homeostatic model assessment for IR (HOMA-IR) was calculated.
After adjustment for confounders, leptin, insulin, glucose, and HOMA-IR were higher across increasing BMI and WHtR categories (all p < 0.001). The PHQ-9 total score was positively associated with BMI in BMI-stratified overweight and obese adults (all p ≤ 0.025). Reciprocal associations between the PHQ-9 total score and WHtR were absent in all WHtR groups. The PHQ-9 total score was positively associated with leptin in WHtR-stratified normal weight adults (p = 0.005) and with HOMA-IR in WHtR-stratified underweight and BMI-stratified normal weight adults (all p ≤ 0.029). Independent of adiposity status, the PHQ-9 total score was positively associated with insulin (all p = 0.026). Associations with the PHQ-9 total score were mainly driven by the somatic-affective symptom cluster. Somatic-affective symptoms were also inversely associated with fasting glucose in BMI-stratified underweight adults (p = 0.008).
In young apparently healthy adults, general adiposity is linked to greater total depressive symptom severity and somatic-affective depressive symptoms. Insulin might play a role in pathophysiological processes associated with depressive symptoms, irrespective of adiposity status, while fasting glucose and HOMA-IR may play a role in underweight individuals.
抑郁症与肥胖增加有关，胰岛素抵抗（IR）和瘦素被认为是这种关系的潜在介导因素。然而，在年轻成年人中，这种关系的确切性质尚不清楚。因此，我们调查了南非年轻成年人中抑郁症状总严重程度和特定抑郁症状群与肥胖及代谢指标之间的关系。
我们根据体重指数（BMI）和腰高比（WHtR）的增加类别，对997名成年人（年龄20 - 30岁）进行分层。使用患者健康问卷（PHQ - 9）评估抑郁症状总严重程度、躯体和认知情感抑郁症状群得分。通过空腹血样测量瘦素、胰岛素和葡萄糖。计算胰岛素抵抗的稳态模型评估（HOMA - IR）。
在对混杂因素进行调整后，随着BMI和WHtR类别的增加，瘦素、胰岛素、葡萄糖和HOMA - IR均升高（所有p < 0.001）。在按BMI分层的超重和肥胖成年人中，PHQ - 9总分与BMI呈正相关（所有p≤0.025）。在所有WHtR组中，PHQ - 9总分与WHtR之间不存在相互关联。在按WHtR分层的正常体重成年人中，PHQ - 9总分与瘦素呈正相关（p = 0.005），在按WHtR分层的体重过轻和按BMI分层的正常体重成年人中，与HOMA - IR呈正相关（所有p≤0.029）。独立于肥胖状态，PHQ - 9总分与胰岛素呈正相关（所有p = 0.026）。与PHQ - 9总分的关联主要由躯体情感症状群驱动。在按BMI分层的体重过轻成年人中，躯体情感症状也与空腹血糖呈负相关（p = 0.008）。
在年轻的貌似健康的成年人中，总体肥胖与更高的抑郁症状总严重程度和躯体情感抑郁症状有关。胰岛素可能在与抑郁症状相关的病理生理过程中起作用，而与肥胖状态无关，而空腹血糖和HOMA - IR可能在体重过轻的个体中起作用。
