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The characteristics of the participants by followed up status and sex are listed in Table 1. No significant difference was observed between the subjects who were followed up and those who were lost, except that those who were lost to follow-up had fewer years of education and a slightly higher GDS score. Among the followed up subjects, compared with female participants, male participants were more likely to be educated, married, and wealthy, and usually reported a high prevalence of smoking and tea drinking, more social activities, and a lower prevalence of hypertension, sleep disturbance, and living alone.
Characteristics Total Followed up Lost Male Female P-value No. of subjects 1,459 605 854 514 Age (years), mean (SD) 70.94 (4.24) 71.27 (4.31) 70.70 (4.17) 0.01 71.10 Education years* 0 202 (13.85) 42 (6.94) 160 (18.74) < 0.001 99 (19.26) 1–6 478 (32.76) 185 (30.58) 293 (34.31) 166 (32.30) > 6 779 (53.39) 378 (62.48) 401 (46.96) 249 (48.44) Married 1,118 (76.63) 553 (91.40) 565 (66.16) < 0.001 382 (74.32) Living alone 214 (14.67) 47 (7.77) 167 (19.56) < 0.001 85 (16.54) High income 513 (35.16) 240 (39.67) 273 (31.97) 0.002 164 (31.91) Smoking 190 (13.02) 187 (30.91) 3 (0.35) < 0.001 79 (15.37) Tea drinking 219 (15.01) 147 (24.30) 72 (8.43) < 0.001 61 (11.87) Exercise 1,043 (71.49) 434 (71.74) 609 (71.31) 0.86 372 (72.37) Social activities 1,334 (91.43) 567 (93.72) 767 (89.81) 0.009 465 (90.47) Hypertension 611 (41.88) 221 (36.53) 390 (45.67) 0.0005 203 (39.49) Diabetes 258 (17.68) 101 (16.69) 157 (18.38) 0.40 97 (18.87) Sleep disturbance 772 (52.91) 280 (46.28) 492 (57.61) < 0.001 264 (51.36) General obesity Underweight 30 (2.06) 11 (1.82) 19 (2.22) 0.66 19 (3.70) Normal weight 479 (32.83) 196 (32.40) 283 (33.14) 0.49 172 (33.46) Overweight 650 (44.55) 280 (46.28) 370 (43.33) 215 (41.83) Obesity 300 (20.56) 118 (19.50) 182 (21.31) 108 (21.01) Abdominal obesity 791 (54.22) 323 (53.39) 468 (54.80) 0.59 281 (54.67) Baseline scores GDS* 2 (1, 4) 2 (1, 4) 2 (1, 5) 0.22 3 (1, 5) GDA 0 (0, 1) 0 (0, 1) 0 (0, 2) 0.005 0 (0, 2) LS 1 (1, 1) 1 (1, 1) 1 (1, 1) 0.31 1 (1, 1) W 0 (0, 1) 0 (0, 1) 0 (0, 1) 0.15 1 (0, 1) Follow-up scores GDS 3 (2, 5) 3 (2, 5) 3 (2, 5) 0.34 − GDA 1(0, 2) 1 (0, 2) 1 (0, 2) 0.08 − LS 1 (1.1) 1 (1, 1) 1 (1, 1) 0.40 − W 1 (0.1) 1 (0, 1) 1 (0, 1) 0.60 − Note. Data were shown as n (%) for categorical variables and as x (s) for continuous variables. *The difference between the subjects who were followed up and those lost to follow-up was statistically significant (P < 0.05). The GDS, GDA, LS, and W scores were shown as M (IQR). GDS, geriatric depression scale; GDA, general depressive affect; LS, life satisfaction; W, withdrawal. Table 1. Characteristics of study participants by psychological resilience status
Compared with the group of normal weight, those obesity subjects were significantly more likely to have “worsening depressive symptoms,” with OR (95% CI) of 1.42 (1.02–1.98); among those depression-free participants at baseline, the risk of incident depression at follow-up was also significantly increased, with OR (95% CI) of 1.65 (1.10–2.47). However, abdominal obesity was not statistically associated with the worsening of depressive symptoms or the incidence of depression (Table 2).
Obesity status Model 1 Model 2 Model 3 Worsen depressive symptoms (n = 1,429) General obesity Normal weight 1.00 (reference) 1.00 (reference) 1.00 (reference) Overweight 1.00 (0.76, 1.30) 0.98 (0.75, 1.29) 0.97 (0.74, 1.29) Obesity 1.53 (1.13, 2.12)** 1.43 (1.03, 1.97)* 1.42 (1.02, 1.98)* Abdominal obesity No 1.00 (reference) 1.00 (reference) 1.00 (reference) Yes 1.13 (0.86, 1.47) 1.08 (0.83, 1.42) 1.10 (0.83, 1.44) Incident depression (n = 1,085) General obesity Normal weight 1.00 (reference) 1.00 (reference) 1.00 (reference) Overweight 1.09 (0.78, 1.51) 1.06 (0.76, 1.49) 1.05 (0.75, 1.48) Obesity 1.80 (1.23, 2.63)** 1.68 (1.14, 2.47)** 1.65 (1.10, 2.47)** Abdominal obesity No 1.00 (reference) 1.00 (reference) 1.00 (reference) Yes 1.05 (0.76, 1.45) 0.99 (0.71, 1.38) 0.99 (0.71, 1.39) Note. *P < 0.05, **P < 0.01. Model 1: adjusted for baseline GDS score alone; Model 2: additionally adjusted for age, sex, education level, marital status, living alone, and home income; and Model 3: further adjusted for smoking, exercise, tea drinking, social activities, diabetes, hypertension, and sleep disturbance. Table 2. Association of obesity with worsen depressive symptom and incident depression
We further conducted analyses among male and female subjects separately and observed that the association of general obesity with worsening depressive symptoms and incident depression existed in male participants alone, with OR (95% CI) of 2.08 (1.27–3.42) and 2.12 (1.20–3.74), respectively. However, abdominal obesity was not significantly associated with depression in either sex (Table 3).
Obesity status Male Female Model 1 Full model Model 1 Full model Worsening depressive symptoms General obesity Normal weight 1.00 (reference) 1.00 (reference) 1.00 (reference) 1.00 (reference) Overweight 1.38 (0.92, 2.08) 1.42 (0.93, 2.19) 0.78 (0.55, 1.10) 0.73 (0.51, 1.06) Obesity 2.08 (1.27, 3.42)** 2.12 (1.25, 3.58)* 1.24 (0.82, 1.89) 1.05 (0.67, 1.64) Abdominal obesity No 1.00 (reference) 1.00 (reference) 1.00 (reference) 1.00 (reference) Yes 1.10 (0.74, 1.63) 1.08 (0.72, 1.63) 1.14 (0.80, 1.63) 1.11 (0.76, 1.62) Incident depression General obesity Normal weight 1.00 (reference) 1.00 (reference) 1.00 (reference) 1.00 (reference) Overweight 1.05 (0.64, 1.74) 1.07 (0.63, 1.81) 1.11 (0.72, 1.72) 1.04 (0.66, 1.65) Obesity 2.12 (1.20, 3.74)** 2.24 (1.22,4.11)** 1.56 (0.93, 2.61) 1.24 (0.71, 2.15) Abdominal obesity No 1.00 (reference) 1.00 (reference) 1.00 (reference) 1.00 (reference) Yes 1.01 (0.63, 1.62) 1.01 (0.62, 1.67) 1.09 (0.70, 1.70) 1.02 (0.64, 1.63) Note. Data were presented as OR (95% CI). Model 1: adjusted for baseline GDS score alone; Full model: additionally adjusted for age, sex, education level, marital status, living alone, home income, smoking, exercise, tea drinking, social activities, diabetes, hypertension, and sleep disturbances. *P < 0.05, **P < 0.01. Table 3. Association of obesity with worsening depressive symptoms and incident depression among male and female participants
Analysis revealed that general obesity was associated with high level of CRP (Linear trend, P < 0.001), with OR (95% CI) of 2.58 (1.75–3.81) in all the followed up subjects, and among the participants free of depression at baseline, the results were consistent, with OR (95% CI) of 3.15 (1.97–5.04) (Figure 1).
The results revealed that the baseline CRP levels were not significantly associated with the GDS score at follow-up (P > 0.05) or with the score difference between baseline and follow-up (P > 0.05). However, it was significantly positively related with LS score (P < 0.05), specific dimension of depression, with β (95% CI) of was 0.015 (0.001, 0.03) and 0.018 (0.002, 0.03) among all participants and subjects free of depression at baseline, respectively, for score at follow-up; and for score difference between baseline and follow-up, the β was 0.04. No significant associations were observed between the CRP levels and GDA or W (Table 4).
GDS and
dimensionsScore at follow-up Difference between baseline and follow-up All followed up Free of depression at baseline All followed up Free of depression at baseline GDS 0.003 (−0.02,0.03) 0.001 (−0.03, 0.03) −0.012 (−0.16, 0.13) −0.010 (−0.16, 0.14) GDA −0.002 (−0.03, 0.03) −0.005 (−0.04, 0.03) 0.039 (−0.003, 0.08) 0.034 (−0.009, 0.08) LS 0.015 (0.001, 0.03)* 0.018 (0.002, 0.03)* 0.038 (0.006, 0.07)* 0.039 (0.005, 0.07)* W −0.016 (−0.04, 0.01) −0.022 (-0.05, 0.01) −0.028 (−0.07, 0.02) −0.036 (−0.08, 0.01) Note. GDS, geriatric depression scale; GDA, general depressive affect; LS, life satisfaction; W, withdrawal. Data were shown as β (95% CI). In the linear regression models, CRP level were transformed to log (X) and included as independent variable; and GDS, GDA, LS, and W scores were transformed into log (1+Y) values and included as dependent variable, when scores at follow-up were investigated. *P < 0.05. Table 4. Associations of baseline CRP levels with scores of GDS and its dimensions
Obesity is positively Associated with Depression in Older Adults: Role of Systemic Inflammation
doi: 10.3967/bes2023.059
- Received Date: 2023-04-17
- Accepted Date: 2023-05-16
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Key words:
- Depression /
- Obesity /
- Older adults /
- Body mass index /
- Inflammatory reaction
Abstract:
The authors declare no conflict of interest.
Citation: | GUO Ye Xin, WANG An Qi, GAO Xin, NA Jun, ZHE Wei, ZENG Yi, ZHANG Jing Rui, JIANG Yuan Jing, YAN Fei, YUNUS Mukaram, WANG Hui, YIN Zhao Xue. Obesity is positively Associated with Depression in Older Adults: Role of Systemic Inflammation[J]. Biomedical and Environmental Sciences, 2023, 36(6): 481-489. doi: 10.3967/bes2023.059 |