Abstract
AimsThe health correlates of the metabolically healthy obese (MHO) phenotype, particularly in relation to depressive symptoms remains unclear. Accordingly, we examined the risk of depressive symptoms in this phenotype using a 16-year follow-up prospective study.MethodsA sample of 14 475 participants (75% men), aged 44–59 years in 1996, was drawn from the Gazel cohort. Obesity was defined as body mass index (BMI) ≥ 30 kg/m2 and metabolic health as having none of the self-reported following cardiovascular risk factors: hypertension, type 2 diabetes and dyslipidemia. Depressive symptoms were assessed by the Center for Epidemiologic Studies Depression (CES-D) scale in 1996, 1999, 2002, 2005, 2008 and 2012. Generalized Estimating Equations (GEE) were used to estimate the risk of depressive symptoms during a follow-up of 16 years.ResultsIn multivariate analyses, metabolically unhealthy normal weight [Odds Ratio (OR) = 1.37; 95% Confidence Interval (CI): 1.25–1.51], overweight [1.44 (1.31–1.59)] and obese [1.30 (1.10–1.54)] but not MHO participants [1.04 (0.81–1.32)] had higher risk of depressive symptoms at the start of follow-up compared to metabolically healthy normal weight individuals. Depressive symptoms decreased over time in metabolically healthy normal weight individuals [0.52 (0.50–0.55)], this decrease was less marked only in metabolically unhealthy obese participants [1.22 (1.07–1.40)]. Compared to MHO participants, metabolically unhealthy obese individuals were at increased risk of depression at the start of follow-up, but with a similar reduction of this risk over time.ConclusionPoor metabolic health, irrespective of BMI was associated with greater depressive symptoms at the start of follow-up, whereas a poorer course of depressive symptoms over time was observed only in those with both obesity and poor metabolic health.
Highlights
Obesity is often accompanied by the metabolic syndrome [1], which is a cluster of cardiometabolic abnormalities such as raised fasting blood glucose, high blood pressure and dyslipidemia
Depressive symptoms decreased over time in metabolically healthy normal weight individuals [0.52 (0.50–0.55)], this decrease was less marked only in metabolically unhealthy obese participants [1.22 (1.07–1.40)]
Compared to metabolically healthy obese (MHO) participants, metabolically unhealthy obese individuals were at increased risk of depression at the start of follow-up, but with a similar reduction of this risk over time
Summary
Obesity is often accompanied by the metabolic syndrome [1], which is a cluster of cardiometabolic abnormalities such as raised fasting blood glucose, high blood pressure and dyslipidemia. Not all obese persons have metabolic abnormalities and such individuals constitute the metabolically healthy obese (MHO) phenotype [2] with some evidence that the impact of obesity on health can be avoided in these individuals [3]. Assessment of the association between MHO phenotype and depressive symptoms is likely to shed light on the relationships between obesity and depression. Only two studies have examined the association between MHO phenotype and depressive symptoms [18,19] with one showing no increased risk of depressive symptoms in MHO individuals followed for 2 years compared with healthy non-obese individuals [18]. In the second report, a pooled analysis of eight cross-sectional studies, obese individuals with a favorable metabolic profile had a slightly increased risk of depressive symptoms compared with healthy non-obese persons [19]
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