Metabolic Syndrome May Predict Depressive Symptoms

Laurie Barclay, MD

January 06, 2009

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January 6, 2009 — The presence of the metabolic syndrome predicts depressive symptoms in middle-aged adults, according to the results from the prospective Whitehall II cohort study reported in the December 23 Online First issue of Diabetes Care.

"Although it is possible that the association between depression and the metabolic syndrome is a 'two-way street,' the metabolic syndrome as a predictor of depression has been little investigated," write Tasnime N. Akbaralya, PhD, from the University College London, in London, United Kingdom, and colleagues. "We examined whether the metabolic syndrome is associated with the onset of depressive symptoms in a cohort of middle-aged British civil servants."

The study cohort consisted of 5232 participants, aged 41 to 61 years, in whom depressive symptoms were evaluated from 1991 to 1993 and again 6 years later, with use of the depression subscale from the 30-item General Health Questionnaire. At baseline, metabolic syndrome was evaluated based on National Cholesterol Education Program criteria.

After adjustment for potential confounders, the presence of the metabolic syndrome was associated with an increased risk for future depressive symptoms (odds ratio, 1.38; 95% confidence interval, 1.02 - 1.96). Central obesity, high triglyceride levels, and low high-density lipoprotein (HDL) cholesterol levels, but not other components of the metabolic syndrome, predicted depressive symptoms and accounted for most of the association between the metabolic syndrome and the onset of depressive symptoms.

"Our results suggest that the metabolic syndrome, in particular the obesity and dyslipidemia components, is predictive of depressive symptoms," the study authors write. "Our findings are consistent with the hypothesis that depressive symptoms may be a consequence rather than a cause of the metabolic syndrome."

Potential limitations include measurement of depressive symptoms with use of a short scale that is not a measure of clinically recognized psychiatric disorder; limited generalizability of the findings because Whitehall II study participants are mainly white, office-based civil servants; and possible unmeasured confounders.

"This is apparently the first study to show that the probability of new onset depressive symptoms 6 years later is higher amongst men and women with the metabolic syndrome; an association that remains after taking into account a large range of potential confounders," the study authors conclude. "Further research is needed to examine whether prevention of the metabolic syndrome, in particular its obesity and dyslipidemia components, might reduce the onset of depressive symptoms."

The Whitehall II study has been supported by the British Medical Research Council; the British Heart Foundation; the British Health and Safety Executive; the British Department of Health; the National Heart, Lung, and Blood Institute; the National Institute on Aging; the Agency for Health Care Policy and Research; and the John D. and Catherine T. MacArthur Foundation Research Networks on Successful Midlife Development and Socioeconomic Status and Health. Three of the study authors have received support from the Academy of Finland, the European Science Foundation, the Medical Research Council research professorship, and the Medical Research Council. The other study authors have disclosed no relevant financial relationships.

Diabetes Care. Published online December 23, 2008.

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