Association of depression with body mass index classification, metabolic disease, and lifestyle: A web-based survey involving 11,876 Japanese people

https://doi.org/10.1016/j.jpsychires.2018.02.009Get rights and content

Highlights

  • Six-item Kessler scale (K6) score was higher in underweight and obese people.

  • K6 cut-off score was associated with hyperlipidemia and extra meals in patients.

  • K6 cut-off score was negatively associated with breakfast.

  • Self-reported depression was associated with metabolic diseases and extra meals.

  • Self-reported depression was negatively associated with breakfast.

Abstract

Body mass index (BMI) and lifestyle-related physical illnesses have been implicated in the pathology of depression. We aimed to investigate the association of depression wih BMI classification (i.e., underweight, normal, overweight, and obese), metabolic disease, and lifestyle using a web-based survey in a large cohort. Participants were 1000 individuals who have had depression (mean age: 41.4 ± 12.3 years, 501 men) and 10,876 population-based controls (45.1 ± 13.6 years, 5691 men). The six-item Kessler scale (K6) test was used as a psychological distress scale. Compared to in the controls, obesity and hyperlipidemia were more common and frequency of a snack or night meal consumption was higher, whereas frequencies of breakfast consumption and vigorous and moderate physical activities were lower in the patients. K6 test scores were higher for underweight or obese people compared to normal or overweight people. A logistic regression analysis showed that the K6 test cut-off score was positively associated with being underweight, hyperlipidemia, and the frequency of a snack or night meal consumption, whereas it was negatively associated with the frequency of breakfast consumption in the patients. Logistic regression analyses showed that self-reported depression was positively associated with metabolic diseases and the frequency of a snack or night meal consumption, whereas it was negatively associated with the frequency of breakfast consumption. The observed associations of depression with BMI classification, metabolic disease, and lifestyle suggest that lifestyle and related physical conditions are involved in at least a portion of depressive disorders.

Introduction

Depression is a mental illness characterized by psychic and somatic symptoms or relevant social dysfunctions (American Psychiatric Association, 2013). The pathology of depression has been discussed in terms of biological mechanisms from systemic viewpoints (Kunugi et al., 2015, Roy and Campbell, 2013), including the involvement of the nutritional state (Lang et al., 2015). Consequently, among body mass index (BMI) classifications (i.e., underweight, normal, overweight, and obese), obesity has recently been deemed as a part of the spectrum of neuropsychological diseases related to depression (Jauch-Chara and Oltmanns, 2014) and has been demonstrated to increase the risk of depression (Atlantis and Baker, 2008, Luppino et al., 2010).

In addition to obesity, a variety of physical illnesses are common in patients with severe mental illnesses (Hert et al., 2011), including those with depression (Katon, 2011). Associations between physical and mental illnesses have previously been discussed, particularly in the psychosomatics literature (Jaremka et al., 2013). Among physical illnesses, metabolic abnormalities have been reported as a risk factor for depression (Vancampfort et al., 2014). Type 2 diabetes, dyslipidemia, hypertension, hyperuricemia, and central obesity are all components of metabolic syndrome (Hanefeld et al., 2016, Yadav et al., 2013). Type 2 diabetes, in particular, has been shown to be significantly comorbid with depression and has a bidirectional relationship with depression (Anderson et al., 2001, Renn et al., 2011).

Apart from the association with depression, obesity has been found to be influenced by genetic predisposition and lifestyles, including dietary habits and levels of physical activity (Marti et al., 2004). In addition, it has been suggested that drinking and smoking habits are associated with the development of obesity (Sturm and Wells, 2001) and metabolic syndrome (Zhu et al., 2004).

The association between obesity and being underweight and depression prevalence was reported in 177,047 American participants (Zhao et al., 2009), whereas the association between metabolic syndrome and its components with depressive symptoms was reported in 1186 Japanese male workers (Kamezaki et al., 2011). Subsequently, the association of metabolic disturbances, particularly lipid abnormalities as well as several lifestyle factors (i.e., decreased exercise, frequent alcohol drinking, and current smoking) with depressive symptoms has been reported in a 13,745 retrospective cohort involving Korean middle-aged people (Kim et al., 2015). Additionally, the association of lifestyle factors such as breakfast consumption, exercise, current smoking and drinking habits (Xu et al., 2016), as well as unhealthy eating habits such as snacking after dinner (Huang et al., 2017) with depressive symptoms has been reported in 1907 Chinese college students and in a 376 Japanese prospective cohort without depression (at baseline), respectively.

Although a few prior studies have investigated the associations of BMI classification, metabolic disease, and lifestyle with depression, evidence has not been well established, nor have they analyzed their results by distinguishing patients with depression from control subjects. Although one previous telephone survey by Zhao et al. (2009) has attempted to achieve this (Zhao et al., 2009), prior studies have rarely been conducted with a large sample of both patients with depression and control subjects, dealing with the three factors and their sub-elements. In this study, we aimed to evaluate each of the three factors associated with depression by comparing their total contributions in a cohort containing 11,876 Japanese individuals with depression and population-based controls using a web-based survey.

Section snippets

Participants

Among the 11,880 people who have participated, four were excluded because they opted out. All participants were the customers of Japanese Direct-to-consumer genetic testing service users. Participants were consisted of 1000 patients with depression (mean age: 41.4 ± 12.3 years, 501 men) and 10,876 population-based controls (45.1 ± 13.6 years, 5691 men). Participants were enrolled onto the database based on questionnaires provided by the Genequest Inc., Tokyo, Japan. Test scores from the

Results

Demographic and clinical characteristics of the participants are shown in Table 1. The K6 test scores were significantly higher in the depression group compared to the control group (p < 0.0001). With respect to BMI variables, obese individuals were significantly more common (p = 0.0002), whereas individuals with normal weight were significantly less frequent (p < 0.0001) in the depression group compared to the control group. Among metabolic diseases, hyperlipidemia was significantly more

Discussion

The present study examined the association of depression with BMI classification, metabolic disease, and lifestyle in patients with depression and population-based controls. From the overall effects of these factors, and to our knowledge, we have revealed that self-reported depression has been assoiated with BMI classifications (i.e., being underweight and obese), metabolic diseases, and lifestyles (e.g., meal consumption and exercise patterns). While a part of such associations has been

Contributors

Hidese S. designed, and Kunugi H. supervised the study. Genequest Inc. provided the questionnaire responses data used in the present study. Asano S. is a researcher and Saito K. is a director of Genequest Inc. Sasayama D. was involved in supporting the intellectual content. Hidese S. performed statistical analyses and wrote the manuscript which was revised and approved by all authors.

Conflicts of interest

Asano S. is an employee and Saito K. is a board member of Genequest Inc.

Role of funding source

This work was supported by internal funding from Genequest Inc. and grants from an Intramural Research Grant (27-1) for Neurological and Psychiatric Disorders of NCNP (Kunugi H.). The funding sources were solely involved in the provision of financial support.

Acknowledgements

Proofreading of this paper was performed by a professional English editor at Editage Co., Ltd. (Editage Japan, Tokyo, Japan).

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