Depression but not anxiety is associated with metabolic syndrome in primary care based community sample☆
Introduction
Metabolic syndrome (MetS) is a constellation of cardiovascular disease risk factors, including central obesity, hyperglycemia, dyslipidemia, and arterial hypertension (Eckel et al., 2005). MetS is strongly associated with type 2 diabetes mellitus and cardiovascular disease morbidity and mortality (Eckel et al., 2005). Increasing age is a strong risk factor for Mets. For example, it is estimated that the prevalence of MetS doubles in individuals of 40 years of age older, and more than a half of elderly population suffer from MetS (Ford et al., 2002, Gupta et al., 2004, Horakova et al., 2005).
Most prevalent presentations of mental distress are symptoms of depression or anxiety. It is well-established that depression is associated with increases risk for diabetes mellitus (Mezuk et al., 2008) and cardiovascular disease (Musselman et al., 1998) in apparently healthy individuals, and it has been suggested that MetS should be considered as pre-morbid condition that precedes the development of clinically overt diabetes mellitus and cardiovascular disease in depressed patients (Pan et al., 2012). Indeed, a number of studies have consistently document that depressive symptoms or disorders are an important risk factor for MetS (Kinder et al., 2004, Heiskanen et al., 2006, Goldbacher et al., 2009, Foley et al., 2010, Pan et al., 2012). However, to the best of our knowledge, studies evaluating the association of depressive symptoms and disorders with MetS in the same cohort are lacking.
The results of the studies on association between anxiety and MetS remain mixed. Some authors have reported more anxiety disorders (Carroll et al., 2009) and greater anxiety symptoms severity (Roohafza et al., 2012) in MetS patients, while others failed to replicate such associations (Skilton et al., 2007, Takeuchi et al., 2009). Depression, a common comorbidity of anxiety disorders, may be an important confounder evaluating an association between anxiety and MetS. Towards this end, further studies delineating an association between anxiety and MetS are warranted, since anxiety symptoms and disorders are common in general population (Kessler et al., 2005).
Three major sets of MetS diagnostic criteria are commonly used across research studies and in clinical practice. According to the World Health Organization (WHO), the diagnosis of the MetS requires the presence of insulin resistance plus any two additional risk factors (Alberti and Zimmet, 1998). However, assessment of insulin resistance can be challenging in routine clinical settings. As a consequence, the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP III) (Expert Panel, 2001) has emphasized other metabolic and cardiovascular risk factors, and excluded insulin resistance from the MetS diagnostic criteria. Finally, according to the International Diabetes Federation (IDF), abdominal obesity is the required feature of the MetS (International Diabetes Federation, 2005). The NCEP/ATP III and IDF MetS diagnostic criteria can be more readily applied in routine clinical setting, since they do not require assessment of insulin resistance. As a consequence, the NCEP/ATP III and IDF criteria are the most widely employed. Studies simultaneously employing three major sets of MetS diagnostic criteria when evaluating an association between psychological distress and MetS could potentially fortify significance of such association and contribute to the literature exploring reliability of different MetS criteria.
Therefore, the primary aim of the study was to investigate the association of depressive and anxiety disorders with MetS, diagnosed according to the WHO criteria in a large primary care based community sample of middle aged and elderly individuals. The secondary aim was to replicate these findings using depression and anxiety scores of the standard scale as well as less sophisticated MetS criteria.
Section snippets
Procedures and subjects
From February 2003 until January 2004 the study subjects were recruited from a Primary Health Care Centre (PHCC). The PHCC employs 24 family physicians and covers all inhabitants at Raseiniai district that includes 6 towns and 19 villages. Men and women of 45 years of age and older were randomly selected (using probability systematic method – step of selection from list every fourth subject) from the database of inhabitants registered at the PHCC. There were no exclusion criteria. Invitation
Statistical analysis
Data were analyzed with the SPSS for Windows. Continuous variables are presented as mean and standard deviation (m ± SD) and categorical variables, as numbers (percentages) P-value of <0.05 was considered statistically significant.
First, we employed univariate binary logistic regression analyses to explore associations of depressive and anxiety disorders (current MDE, lifetime MDE and current GAD) and symptoms (HADS-D and HADS-A scores >7, respectively) with MetS diagnosed using three sets of
Results
Socio-demographic, clinical and psychiatric characteristics of the study sample are presented in Table 1. Mean age of the study subjects was 62.0 ± 9.6 years. The majority of participants had high school or lower education (48%), were living in rural area (70%), were married (71%), and were retired (52%). Thirty-three percent of subjects were current smokers and 52%, were considered as non-physically active. The majority of subjects (53%) consumed alcohol at least several times per year. Six
Discussion
Current MDE, lifetime MDE, and elevated depressive symptoms severity were associated with greater prevalence of MetS independently from socio-demographic characteristics, clinical factors, and anxiety. Current GAD and elevated anxiety symptoms were not associated with MetS after adjusting for current MDE and depressive symptoms, respectively.
Our major findings were that current MDE and lifetime MDE were associated with nearly 4-fold increased risk for MetS independently from socio-demographic
Conclusions
In middle aged and older adult general population, current and lifetime MDE and depressive symptoms are associated with increased prevalence of MetS independently from socio-demographic factors, clinical factors and anxiety symptoms or disorders. GAD and anxiety symptoms are not associated with MetS after adjusting for MDE and depressive symptoms, respectively. Depressed individuals should be screened for the components of MetS, which should be appropriately treated where indicated to reduce
Role of the funding source
No pharmaceutical company or commercial organization had any role in the writing of this paper for publication. The original study, including collection, management, analysis and interpretation of the data was supported by funding from the Research Council of Lithuania.
Conflicts of interest
Authors have no conflicts of interest.
Acknowledgement
This research was funded by a grant (LIG-03/2011) from the Research Council of Lithuania.
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Grant support: Research Council of Lithuania (grant# LIG-03/2011).