title: Difference by sex but not by race/ethnicity in the visceral adipose tissue-depressive symptoms association: the Multi-Ethnic Study of Atherosclerosis.
abstract: BACKGROUND
  Prior studies have investigated the association of clinical depression and depressive symptoms with body weight (i.e. body mass index (BMI) and waist circumference), but few have examined the association between depressive symptoms and intra-abdominal fat. Of these a limited number assessed the relationship in a multi-racial/ethnic population.
  
  
  METHODS
  Using data on 1017 men and women (45-84 years) from the Multi-Ethnic Study of Atherosclerosis (MESA) Body Composition, Inflammation and Cardiovascular Disease Study, we examined the cross-sectional association between elevated depressive symptoms (EDS) and CT-measured visceral fat mass at L2-L5 with multivariable linear regression models. EDS were defined as a Center for Epidemiological Studies Depression score ≥16 and/or anti-depressant use. Covariates included socio-demographics, inflammatory markers, health behaviors, comorbidities, and body mass index (BMI). Race/ethnicity (Whites [referent group], Chinese, Blacks and Hispanics) and sex were also assessed as potential modifiers.
  
  
  RESULTS
  The association between depressive symptoms and visceral fat differed significantly by sex (p=0.007), but not by race/ethnicity. Among men, compared to participants without EDS, those with EDS had greater visceral adiposity adjusted for BMI and age (difference=122.5 cm2, 95% CI=34.3, 210.7, p=0.007). Estimates were attenuated but remained significant after further adjustment by socio-demographics, inflammatory markers, health behaviors and co-morbidities (difference=94.7 cm2, 95% CI=10.5, 178.9, p=0.028). Among women, EDS was not significantly related to visceral adiposity in the fully adjusted model.
  
  
  CONCLUSIONS
  Sex, but not race/ethnicity, was found to modify the relationship between EDS and visceral fat mass. Among men, a significant positive association was found between depressive symptoms and visceral adiposity. No significant relationship was found among women.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; University of California, San Diego, La Jolla, CA, USA.
authors.forename: Rosemay A
authors.initials: RA
authors.lastname: Remigio-Baker
authors.affiliation: University of California, San Diego, La Jolla, CA, USA.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Allison
authors.affiliation: University of Minnesota School of Public Health, Minneapolis, MN, USA.
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Schreiner
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Moyses
authors.initials: M
authors.lastname: Szklo
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Rosa M
authors.initials: RM
authors.lastname: Crum
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Jeannie-Marie
authors.initials: JM
authors.lastname: Leoutsakos
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Manuel
authors.initials: M
authors.lastname: Franco
authors.affiliation: Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Mercedes R
authors.initials: MR
authors.lastname: Carnethon
authors.affiliation: The University of Texas School of Public Health, Houston, TX, USA.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Nettleton
authors.affiliation: University of California, Berkeley, School of Public Health, Berkeley, CA, USA.
authors.forename: Mahasin S
authors.initials: MS
authors.lastname: Mujahid
authors.affiliation: University of Michigan School of Public Health, Ann Arbor, MI, USA.
authors.forename: Ana V
authors.initials: AV
authors.lastname: Diez Roux
authors.affiliation: University of California, San Diego, La Jolla, CA, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Jensky
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Johns Hopkins School of Medicine, Baltimore, MD, USA. Electronic address: sahill@jhmi.edu.
authors.forename: Sherita H
authors.initials: SH
authors.lastname: Golden
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000150:complications / Q000208:ethnology / Q000378:metabolism; D001823:Body Composition / Q000502:physiology; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications / Q000208:ethnology* / Q000378:metabolism*; D005006:Ethnicity / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D050152:Intra-Abdominal Fat / Q000033:anatomy & histology*; D008297:Male; D008875:Middle Aged; D056128:Obesity, Abdominal / Q000150:complications / Q000378:metabolism / Q000523:psychology; D044469:Racial Groups / Q000523:psychology / Q000706:statistics & numerical data; D012737:Sex Factors; D055105:Waist Circumference / Q000208:ethnology
keywords: Antidepressant use; Elevated depressive symptoms; Race/ethnicity; Sex; Visceral adipose tissue; Visceral fat mass