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Depressive Symptoms and Increased Visceral Fat in Middle-Aged Women

Everson-Rose, Susan A. PhD; Lewis, Tené T. PhD; Karavolos, Kelly MS; Dugan, Sheila A. MD; Wesley, Deidre MPA; Powell, Lynda H. PhD

doi: 10.1097/PSY.0b013e3181a20c9c
Original Articles

Objective: To examine whether depressive symptoms are differentially associated with visceral adipose tissue (VAT), which is more metabolically active and confers greater cardiovascular risk than subcutaneous fat (SAT). Prior research has shown an association between depression and central adiposity. Mechanisms underlying the association between depression and increased cardiovascular risk remain poorly understood. Central adiposity is one potential pathway.

Methods: We investigated the cross-sectional association between depressive symptoms, assessed by the Center for Epidemiological Studies Depression Scale (CES-D), and VAT and SAT, assessed by computed tomography, in a sample of 409 middle-aged women (44.7% African-Americans, 55.3% Whites; mean age = 50.4 years) participating in the Chicago site of the Study of Women's Health Across the Nation (SWAN).

Results: With adjustments for age, race, total percent fat, and sex hormone binding globulin (SHBG), each 1-point higher score on the CES-D was associated with 1.03-cm2 greater VAT (p < .001). Women with a CES-D score of ≥16, indicative of clinically relevant depressive symptomatology, had 24.5% more VAT than women with lower CES-D scores (p < .001). Further adjustment for Framingham Risk Score and physical activity did not alter the findings, and associations did not vary by race. Associations were strongest in obese and overweight women. Depressive symptoms were unrelated to SAT.

Conclusions: Increased visceral fat may be one pathway by which depression contributes to excess risk for cardiovascular disease and diabetes. Further research is needed to examine whether depressive symptoms influence accumulation of VAT over time.

BMI = body mass index; CES-D = Center for Epidemiological Studies Depression Scale; CT = computed tomography; CVD = cardiovascular disease; DXA = dual energy x-ray absorptiometry; FRS = Framingham Risk Score; Health ABC = Dynamics of Health, Aging and Body Composition; HDL-C = high-density lipoprotein cholesterol; HPA = hypothalamic-pituitary-adrenal; KPAS = Kaiser Physical Activity Survey; SAT = subcutaneous adipose tissue; SHBG = sex hormone binding globulin; SWAN = Study of Women's Health Across the Nation; VAT = visceral adipose tissue.

From the Department of Medicine and Program in Health Disparities Research (S.A.E.-R.), University of Minnesota, Minneapolis, Minnesota; Department of Epidemiology and Public Health (T.T.L.), Yale University School of Medicine, New Haven, Connecticut; Department of Preventive Medicine (K.K.), Rush University Medical Center, Chicago, Illinois; Departments of Preventive Medicine and Physical Medicine and Rehabilitation (S.A.D.), Rush University Medical Center, Chicago, Illinois; College of Nursing (D.W.), Rush University Medical Center, Chicago, Illinois; Departments of Preventive Medicine (L.H.P.), Medicine (Cardiology), Behavioral Sciences, and Pharmacology, Rush University Medical Center, Chicago, Illinois.

Dr. Everson-Rose was affiliated with Rush University Medical Center when this work was initiated but completed the work after relocation to the University of Minnesota.

Address correspondence and reprint requests to Susan A. Everson-Rose, University of Minnesota, 717 Delaware Street SE, Room 166, Minneapolis, MN 55414. E-mail:

Portions of this work were presented at the 64th annual meeting of the American Psychosomatic Society, Denver, Colorado, March 4, 2006, and are published in abstract form (Psychosom Med 2006;68:A-27).

The Study of Women's Health Across the Nation (SWAN) has grant support from the National Institutes of Health (NIH), DHHS, through the National Institute on Aging (NIA), the National Institute of Nursing Research (NINR), and the NIH Office of Research on Women's Health (ORWH) (Grants NR004061; AG012505, AG012535, AG012531, AG012539, AG012546, AG012553, AG012554, AG012495). The SWAN Fat Patterning Study is supported by Grant HL067128 from the National Heart, Lung and Blood Institute (NHLBI) and the Charles J. and Margaret Roberts Trust. In addition, Dr. Lewis was supported by Grant MH075625 from the National Institute of Mental Health (NIMH) and Dr. Everson-Rose received support from the Program in Health Disparities Research, University of Minnesota Medical School. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the NHLBI, NIMH, NIA, NINR, ORWH, or the NIH.

Received for publication April 9, 2008; revision received December 19, 2008.

Copyright © 2009 by American Psychosomatic Society
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