title: Pericardial adipose tissue and the metabolic syndrome is increased in patients with chronic major depressive disorder compared to acute depression and controls.
abstract: Major depressive disorder (MDD) is associated with an estimated fourfold risk for premature death, largely attributed to cardiovascular disorders. Pericardial adipose tissue (PAT), a fat compartment surrounding the heart, has been implicated in the development of coronary artery disease. An unanswered question is whether people with chronic MDD are more likely to have elevated PAT volumes versus acute MDD and controls (CTRL).
  
  
  
  The study group consists of sixteen patients with chronic MDD, thirty-four patients with acute MDD, and twenty-five CTRL. PAT and adrenal gland volume were measured by magnetic resonance tomography. Additional measures comprised factors of the metabolic syndrome, cortisol, relative insulin resistance, and pro-inflammatory cytokines (interleukin-6; IL-6 and tumor necrosis factor-α, TNF-α).
  
  
  
  PAT volumes were significantly increased in patients with chronic MDD>patients with acute MDD>CTRL. Adrenal gland volume was slightly enlarged in patients with chronic MDD>acute MDD>CTRL, although this difference failed to reach significance. The PAT volume was correlated with adrenal gland volume, and cortisol concentrations were correlated with depression severity, measured by BDI-2 and MADRS. Group differences were found concerning the rate of the metabolic syndrome, being most frequent in chronic MDD>acute MDD>CTRL. Further findings comprised increased fasting cortisol, increased TNF-α concentration, and decreased physical activity level in MDD compared to CTRL.
  
  
  
  Our results extend the existing literature in demonstrating that patients with chronic MDD have the highest risk for developing cardiovascular disorders, indicated by the highest PAT volume and prevalence of metabolic syndrome. The correlation of PAT with adrenal gland volume underscores the role of the hypothalamus-pituitary-adrenal system as mediator for body-composition changes. Metabolic monitoring, health advices and motivation for the improvement of physical fitness may be recommended in depressed patients, in particular in chronic depression.
authors.affiliation: Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School (MHH), Hannover, Germany. Electronic address: kahl.kai@mh-hannover.de.
authors.forename: K G
authors.initials: KG
authors.lastname: Kahl
authors.affiliation: Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School (MHH), Hannover, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Herrmann
authors.affiliation: Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom; Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, United Kingdom.
authors.forename: B
authors.initials: B
authors.lastname: Stubbs
authors.affiliation: Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School (MHH), Hannover, Germany.
authors.forename: T H C
authors.initials: TH
authors.lastname: Krüger
authors.affiliation: Department of Psychiatry and Psychotherapy, Heinrich-Heine University, Düsseldorf, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Cordes
authors.affiliation: Central Institute of Mental Health, Mannheim, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Deuschle
authors.affiliation: Dep. of Psychiatry and Psychotherapy, University of Lübeck, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Schweiger
authors.affiliation: Institute for Diagnostic and Interventional Radiology, MHH, Hannover, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Hüper
authors.affiliation: Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School (MHH), Hannover, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Helm
authors.affiliation: Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School (MHH), Hannover, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Birkenstock
authors.affiliation: Institute for Diagnostic and Interventional Radiology, MHH, Hannover, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Hartung
mesh_terms: D000273:Adipose Tissue / Q000473:pathology*; D000328:Adult; D000704:Analysis of Variance; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D016207:Cytokines / Q000378:metabolism; D003865:Major Depressive Disorder / Q000145:classification / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology*; D004562:Electrocardiography; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008659:Metabolic Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D008875:Middle Aged; D010496:Pericardium / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology*; D011569:Psychiatric Status Rating Scales
chemical_list: D016207:Cytokines
keywords: Body composition; Cardio-vascular disorder; Chronic major depressive disorder; Hypothalamus-pituitary-adrenal system; Pericardial adipose tissue