Depressive Symptoms and Metabolic Syndrome: Is Inflammation the Underlying Link?

doi:10.1016/j.biopsych.2008.05.019

Biological Psychiatry

Volume 64, Issue 10, 15 November 2008, Pages 896-900

https://doi.org/10.1016/j.biopsych.2008.05.019 Get rights and content

Background

Behavioral alterations, including depression, are frequent in individuals with the metabolic syndrome (MetS). Recent findings suggest that chronic activation of innate immunity might be involved. The objective of this study was to examine the relationship between MetS and depressive symptoms and to elucidate the involvement of inflammation in this relationship.

Methods

Participants were 323 male twins, with and without MetS and free of symptomatic cardiovascular disease, drawn from the Vietnam Era Twin Registry. Depressive symptoms were measured with the Beck Depression Inventory (BDI). Inflammatory status was assessed using C-reactive protein (CRP) and interleukin-6 (IL-6); twins with both CRP and IL-6 levels above the median were classified as having an elevated inflammatory status. Factor analysis was performed on individual BDI items to extract specific symptom dimensions (neurovegetative, mood, affective-cognitive).

Results

Subjects with MetS had more depressive symptoms than those without. Depressive symptoms with neurovegetative features were more common and more robustly associated with MetS. Both the BDI total score and each symptom subscore were associated with inflammatory biomarkers. After adjusting for age, education, and smoking status, the MetS was significantly associated with the BDI total score and the neurovegetative score. After further adjusting for inflammation, the coefficient for MetS decreased somewhat but remained statistically significant for the BDI neurovegetative subscore. When controlling for the MetS, inflammation remained significantly associated with the BDI mood subscore.

Conclusions

The MetS is associated with higher depressive symptomatology characterized primarily by neurovegetative features. Inflammation is one determinant of depressive symptoms in individuals with MetS.

Section snippets

Sample and Setting

Participants were drawn from the Twins Heart Study (THS), an investigation of psychological, behavioral, and biological risk factors for subclinical cardiovascular disease in twins. Twins were members of the Vietnam-Era-Twin (VET) Registry (27), a registry composed of 7369 middle-aged male-male twin pairs, each of whom served in the US military during the Vietnam War (27).

The THS participants included 360 twins from the VET Registry, born between 1946 and 1956 and free of symptomatic

Characteristics of Participants

The mean age of study participants was 54.3 years (SD = 2.8, range = 47–60). Seventy-three participants (22.6%) had a lifetime history of depression, and the mean BDI score was 4.8 (SD = 6.5). Forty-five percent (n = 147) of participants met criteria for MetS on the basis of the ATP-III criteria. Physical activity was lower in participants with MetS compared with those without. There was no significant difference between the two subgroups in terms of age, years of education, and current

Discussion

We found a strong association between depressive symptoms and the MetS. This finding is in accordance with previous data documenting an elevated prevalence of behavioral alterations, including depression, in patients with metabolic disturbances (16, 17, 18). The association between MetS and mood has not been found in all studies (32), probably due to methodological differences across studies.

On the basis of dimensional analyses, the present study revealed that depressive symptomatology in MetS

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Research ReportDepressive Symptoms and Metabolic Syndrome: Is Inflammation the Underlying Link?

Background

Methods

Results

Conclusions

Section snippets

Sample and Setting

Characteristics of Participants

Discussion

J Am Coll Cardiol

Lancet

Biol Psychiatry

Neuropsychopharmacology

Biol Psychiatry

Am J Cardiol

Prevalence of the metabolic syndrome among US adults: Findings from the third National Health and Nutrition Examination Survey

JAMA

The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men

JAMA

Review article: The metabolic syndrome—a chronic cardiovascular inflammatory condition

Aliment Pharmacol Ther

Metabolic syndrome: Epidemiology and consequences

J Clin Psychiatry

C-reactive protein in healthy subjects: Associations with obesity, insulin resistance, and endothelial dysfunction: A potential role for cytokines originating from adipose tissue?

Arterioscler Thromb Vasc Biol

Chronic subclinical inflammation as part of the insulin resistance syndrome: The Insulin Resistance Atherosclerosis Study (IRAS)

Circulation

Prospective study of C-reactive protein in relation to the development of diabetes and metabolic syndrome in the Mexico City Diabetes Study

Diabetes Care

Central obesity as a major determinant of increased high-sensitivity C-reactive protein in metabolic syndrome

Int J Obes (Lond)

Weight loss regulates inflammation-related genes in white adipose tissue of obese subjects

Faseb J

Adipokines: Inflammation and the pleiotropic role of white adipose tissue

Br J Nutr

Obesity-induced inflammatory changes in adipose tissue

J Clin Invest

Obesity is associated with macrophage accumulation in adipose tissue

J Clin Invest

Research Report
Depressive Symptoms and Metabolic Syndrome: Is Inflammation the Underlying Link?