title: Alternative Pathway Analyses Indicate Bidirectional Relations between Depressive Symptoms, Diet Quality, and Central Adiposity in a Sample of Urban US Adults.
abstract: Temporality between socioeconomic status (SES), depressive symptoms (DS), dietary quality (DQ), and central adiposity (CA) is underexplored.
  
  
  
  Alternative pathways linking SES to DQ, DS, and CA were tested and models compared, stratified by race and sex.
  
  
  
  With the use of data from the Healthy Aging in Neighborhoods of Diversity across the Life Span (baseline age: 30-64 y; 2 visits; mean follow-up: 4.9 y), 12 structural equation models (SM) were conducted and compared. Time-dependent factors included the Center for Epidemiologic Studies-Depression [CES-D total score, baseline or visit 1 (v1), follow-up or visit 2 (v2), mean across visits (m), and annual rate of change (Δ)], 2010 Healthy Eating Index (HEI) (same notation), and central adiposity principal components' analysis score of waist circumference and trunk fat (kg) (Adipcent) (same notation). Sample sizes were white women (WW, n = 236), white men (WM, n = 159), African American women (AAW, n = 395), and African American men (AAM, n = 274), and a multigroup analysis within the SM framework was also conducted.
  
  
  
  In the best-fitting model, overall, ∼31% of the total effect of SES→Adipcent(v2) (α ± SE: -0.10 ± 0.03, P < 0.05) was mediated through a combination of CES-D(v1) and ΔHEI. Two dominant pathways contributed to the indirect effect: SES→(-)CES-D(v1)→(+)Adipcent(v2) (-0.015) and SES→(+) ΔHEI→(-)Adipcent(v2) (-0.017), with a total indirect effect of -0.031 (P < 0.05). In a second best-fitting model, SES independently predicted Adipcent(v1, -0.069), ΔHEI(+0.037) and CES-D(v2, -2.70) (P < 0.05), with Adipcent(v1) marginally predicting ΔHEI(-0.014) and CES-D(v2, +0.67) (P < 0.10). These findings were indicative of DS's and CA's marginally significant bidirectional association (P < 0.10). Although best-fit-selected models were consistent across race × sex categories, path coefficients differed significantly between groups. Specifically, SES→Adipcent[v1(+0.11), v2(+0.14)] was positive among AAM (P < 0.05), and the overall positive association of Adipcent(v1)→CES-D(v2) was specific to AAW (+0.97, P < 0.10).
  
  
  
  Despite consistent model fit, pathways linking SES to DQ, DS, and CA differed markedly among the race × sex groups. Our findings can inform the potential effectiveness of various mental health and dietary interventions.
authors.affiliation: Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIH, Intramural Research Program, Baltimore, MD; baydounm@mail.nih.gov.
authors.forename: May A
authors.identifier: 0000-0002-1050-4523
authors.initials: MA
authors.lastname: Beydoun
authors.affiliation: Department of Health, Nutrition and Exercise Sciences, University of Delaware, Newark, DE;
authors.forename: Marie T
authors.initials: MT
authors.lastname: Fanelli-Kuczmarski
authors.affiliation: Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIH, Intramural Research Program, Baltimore, MD; Department of Psychology, University of Maryland, Baltimore County, Catonsville, MD; and.
authors.forename: Danielle
authors.initials: D
authors.lastname: Shaked
authors.affiliation: Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIH, Intramural Research Program, Baltimore, MD;
authors.forename: Greg A
authors.initials: GA
authors.lastname: Dore
authors.affiliation: Graduate Program in Public Health, Eastern Virginia Medical School, Norfolk, VA.
authors.forename: Hind A
authors.initials: HA
authors.lastname: Beydoun
authors.affiliation: Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIH, Intramural Research Program, Baltimore, MD;
authors.forename: Ola S
authors.initials: OS
authors.lastname: Rostant
authors.affiliation: Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIH, Intramural Research Program, Baltimore, MD;
authors.forename: Michele K
authors.initials: MK
authors.lastname: Evans
authors.affiliation: Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIH, Intramural Research Program, Baltimore, MD;
authors.forename: Alan B
authors.initials: AB
authors.lastname: Zonderman
mesh_terms: D050154:Adiposity; D000328:Adult; D001741:Black or African American; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology*; D000072001:Diet, Healthy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D008297:Male; D011939:Mental Recall; D008875:Middle Aged; D015596:Nutrition Assessment; D056128:Obesity, Abdominal / Q000453:epidemiology*; D012307:Risk Factors; D018401:Sample Size; D012923:Social Class; D013997:Time Factors; D014505:Urban Population; D044465:White People
keywords: central adiposity; depression; dietary quality; socioeconomic status; urban adults