Research report
Lifetime psychiatric disorders and body composition: A population-based study

https://doi.org/10.1016/j.jad.2009.02.001Get rights and content

Abstract

Background

This study aimed to investigate the relationship between depressive and anxiety disorders and indices of adiposity, including body fat mass and percent body fat, as measured by dual energy X-ray absorptiometry.

Methods

In this observational study of 979 randomly-selected women aged 20–93 years, psychiatric history was ascertained using a structured clinical interview (SCID-I/NP). Total body fat was assessed using dual-energy X-ray absorptiometry and weight, height and waist circumference were measured. Medication use and lifestyle factors were self-reported.

Results

Those with a lifetime history of depression had increased fat mass (+ 7.4%) and percent body fat (+ 4.3%), as well as greater mean weight (+ 3.3%), waist circumference (+ 2.9%) and BMI (+ 3.5%) after adjustment for age, anxiety, alcohol consumption, physical activity and past smoking. Furthermore, those meeting criteria for a lifetime history of depression had a 1.7-fold increased odds of being overweight or obese (BMI  25), a 2.0-fold increased odds of being obese (BMI  30) and a 1.8-fold increased odds of having a waist circumference ≥ 80 cm. These patterns persisted after further adjustment for psychotropic medication use, smoking status and energy intake. No differences in any measures of adiposity were observed among those with anxiety disorders compared to controls.

Limitations

There is potential for unrecognised confounding, interpretations are limited to women and a temporal relationship could not be inferred.

Conclusions

Depression was associated with greater adiposity. The difference in body fat mass was numerically greater than differences in indirect measures of adiposity, suggesting that the latter may underestimate the extent of adiposity in this population.

Introduction

Although the adverse impact of obesity on a host of chronic physical ailments and all causes mortality have been well characterised (Kopelman, 2000), less is known about the relationship between body composition and psychiatric disorders. Given the public health implications of obesity, the association with psychiatric illness is of significant importance.

Cross-sectional studies have reported increased body mass index (BMI) and waist circumference among women with depression (Kloiber et al., 2007, Carpenter et al., 2000). However, others have found no association (Hach et al., 2006), or a gender-specific relationship, with either no association or lower BMI seen only in men with major depression disorder (MDD) (Mcintyre et al., 2006, Carpenter et al., 2000, Raikkonen et al., 1994). Previous studies have suggested that 40% to 70% of individuals with depressive disorders or symptoms are overweight or obese (Simon et al., 2008, Papakostas et al., 2005, Johnston et al., 2004, Onyike et al., 2003). Moreover, depression has been shown to be associated with increased odds of obesity (Scott et al., 2008a, Scott et al., 2008b, Simon et al., 2006). Several prospective studies (Anderson et al., 2007, Kasen et al., 2007, Herva et al., 2006, Mustillo et al., 2003, Roberts et al., 2000) have found depression to be an outcome of increased weight and obesity, suggesting that obesity may be a clinical condition that predisposes to the development of clinically relevant depressive disorders. Less certain is whether depression predicts weight changes and is associated with increases or decreases in adiposity.

Limited data exist examining the relationship between anxiety and body weight, and the results are inconclusive. Some cross-sectional studies have reported increased waist-to-hip ratio (WHR) and BMI among those with anxiety in comparison to controls (Scott et al., 2008a, Scott et al., 2008b, Simon et al., 2006, Landen et al., 2004, Ahlberg et al., 2002), while others have found either no association (Landen et al., 2004, Berlin and Lavergne, 2003); lower BMI among clinical patients with obsessive compulsive disorder (Henninghausen et al., 1999); or evidence that obesity is associated with an increased odds of anxiety disorders (Jorm et al., 2003, Becker et al., 2001).

Previous studies in this area have investigated the association between psychiatric disorders and adiposity using indirect measures, such as weight, BMI, waist circumference and waist-to-hip ratio and the findings are inconsistent. Increased fat mass, particularly central adiposity, is associated with increased numbers of macrophages and resulting systemic inflammation (Weisberg et al., 2003). Pro-inflammatory cytokines are thought to play an aetiological role in depression (Schiepers et al., 2005) and anxiety (Pitsavos et al., 2006), and for this reason, body fat itself, rather than simple measures of overweight, may be of relevance in psychiatric disorders.

We are not aware of any community based studies that have investigated psychiatric disorders and body fat mass using imaging techniques across the full adult age range, and we were thus interested to investigate this association using a direct measure of adiposity, fat mass and percent body fat as measured by dual energy X-ray absorptiometry.

Section snippets

Participants

This study examined data collected from participants in the Geelong Osteoporosis Study (GOS), a large epidemiological study involving a population-based sample of women developed to investigate predictors and consequences of osteoporosis, although recently expanded to examine psychiatric illness and other non-communicable diseases.

Originally, an age-stratified, random, population-based sample of women (ages 20–94 years) was recruited from the electoral rolls for the Barwon Statistical Division

Depressive disorders and body composition

Two hundred and eighty women (28.6%) were identified as having a lifetime history of depression (past or current). Of this group, 21 (7.5%) were identified with bipolar disorder, 222 (79.3%) with MDD, 26 (9.3%) with minor depression, eight (2.9%) with dysthymia, six (2.1%) with a mood disorder due to a general medical condition and two (0.7%) with a substance induced mood disorder. Those with a lifetime history of depression were younger, taller, more likely to be a current or past cigarette

Discussion

In this study, independently of age, anxiety disorders, alcohol consumption, physical activity, smoking status, psychotropic use and energy intake, a lifetime history of depression was associated with significantly greater adiposity, with mean differences of + 7.4% body fat mass, + 4.3% percent body fat, + 3.3% weight, + 2.9% waist circumference and + 3.5% BMI compared to those with no such history. Depression was associated with a doubling of the odds for being overweight or obese, and having a

Role of the funding source

Funding for this study was provided by the National Health and Medical Research Council of Australia (251638) and supported by an unrestricted educational grant from Eli Lilly. Postgraduate scholarships were provided by the University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences and the Australian Rotary Health Research Fund. The funding bodies had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in

Conflict of interest

Lana Williams, Julie Pasco, Felice Jacka, Seetal Dodd and Michael Berk have received research support from an unrestricted educational grant from Eli Lilly. Margaret Henry, Mark Kotowicz and Geoffrey Nicholson have no conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript.

Acknowledgments

The study was funded by the National Health and Medical Research Council of Australia (251638) and supported by an unrestricted educational grant from Eli Lilly. Postgraduate scholarships were provided by the University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences and the Australian Rotary Health Research Fund.

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