Abstract
The longitudinal relationship between depression and the risk of non-alcoholic fatty liver disease is uncertain. We examined: (a) the association between depressive symptoms and incident hepatic steatosis (HS), both with and without liver fibrosis; and (b) the influence of obesity on this association. A cohort of 142 005 Korean adults with neither HS nor excessive alcohol consumption at baseline were followed for up to 8.9 years. The validated Center for Epidemiologic Studies-Depression score (CES-D) was assessed at baseline, and subjects were categorised as non-depressed (a CES-D < 8, reference) or depression (CES-D ⩾ 16). HS was diagnosed by ultrasonography. Liver fibrosis was assessed by the fibrosis-4 index (FIB-4). Parametric proportional hazards models were used to estimate the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). During a median follow-up of 4.0 years, 27 810 people with incident HS and 134 with incident HS plus high FIB-4 were identified. Compared with the non-depressed category, the aHR (95% CIs) for incident HS was 1.24 (1.15-1.34) for CES-D ⩾ 16 among obese individuals, and 1.00 (0.95-1.05) for CES-D ⩾ 16 among non-obese individuals (p for interaction with obesity <0.001). The aHR (95% CIs) for developing HS plus high FIB-4 was 3.41 (1.33-8.74) for CES-D ⩾ 16 among obese individuals, and 1.22 (0.60-2.47) for CES-D ⩾ 16 among non-obese individuals (p for interaction = 0.201). Depression was associated with an increased risk of incident HS and HS plus high probability of advanced fibrosis, especially among obese individuals.
Highlights
Non-alcoholic fatty liver disease (NAFLD) is a global health problem with a prevalence of approximately 25% worldwide (Maurice and Manousou, 2018)
In obese and non-obese subjects without hepatic steatosis (HS) who had a low probability of liver fibrosis at baseline, we examined whether depression is associated with: (a) an increased risk of incident HS and (b) HS plus high probability of advanced fibrosis
We evaluated whether or not the associations between depressive symptoms and the risk of HS or HS plus high fibrosis score differed by the presence of obesity (World Health Organization and Regional Office for the Western Pacific, 2000), because the effect of depression on various clinical outcomes appears to be increased by the presence of obesity (Ladwig et al, 2006; Yakar and Ertekin, 2018)
Summary
Non-alcoholic fatty liver disease (NAFLD) is a global health problem with a prevalence of approximately 25% worldwide (Maurice and Manousou, 2018). A growing body of evidence suggests that depression is associated with increased risk of mortality, as well as various chronic diseases including obesity, hypertension, diabetes, coronary artery disease and stroke All of these comorbidities are commonly accompanied by NAFLD (Luppino et al, 2010; Dong et al, 2012; Cuijpers et al, 2014; Lichtman et al, 2014). The specific relationship between depression and NAFLD remains uncertain Previous studies addressing this subject have reported inconsistent results, varying from a positive association (Jung et al, 2019; Kim et al, 2019b) to no evidence of an association (Surdea-Blaga and Dumitrascu, 2011; Lee et al, 2013).
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