title: Metabolically healthy obesity and depressive symptoms: 16-year follow-up of the Gazel cohort study.
abstract: OBJECTIVE
  The health correlates of the metabolically healthy obese (MHO) phenotype, particularly in relation to depressive symptoms remains unclear. Accordingly, we examined the risk of depressive symptoms in this phenotype using a 16-year follow-up prospective study.
  
  
  METHODS
  A sample of 14 475 participants (75% men), aged 44-59 years in 1996, was drawn from the Gazel cohort. Obesity was defined as body mass index (BMI) ≥ 30 kg/m2 and metabolic health as having none of the self-reported following cardiovascular risk factors: hypertension, type 2 diabetes and dyslipidemia. Depressive symptoms were assessed by the Center for Epidemiologic Studies Depression (CES-D) scale in 1996, 1999, 2002, 2005, 2008 and 2012. Generalized Estimating Equations (GEE) were used to estimate the risk of depressive symptoms during a follow-up of 16 years.
  
  
  RESULTS
  In multivariate analyses, metabolically unhealthy normal weight [Odds Ratio (OR) = 1.37; 95% Confidence Interval (CI): 1.25-1.51], overweight [1.44 (1.31-1.59)] and obese [1.30 (1.10-1.54)] but not MHO participants [1.04 (0.81-1.32)] had higher risk of depressive symptoms at the start of follow-up compared to metabolically healthy normal weight individuals. Depressive symptoms decreased over time in metabolically healthy normal weight individuals [0.52 (0.50-0.55)], this decrease was less marked only in metabolically unhealthy obese participants [1.22 (1.07-1.40)]. Compared to MHO participants, metabolically unhealthy obese individuals were at increased risk of depression at the start of follow-up, but with a similar reduction of this risk over time.
  
  
  CONCLUSIONS
  Poor metabolic health, irrespective of BMI was associated with greater depressive symptoms at the start of follow-up, whereas a poorer course of depressive symptoms over time was observed only in those with both obesity and poor metabolic health.
authors.affiliation: Inserm, UMS 011, Villejuif, France.|Inserm, U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France.|University Versailles St-Quentin en Yvelines, Versailles, France.
authors.forename: Guy-Marino
authors.identifier: http://orcid.org/0000-0002-9123-6726
authors.initials: GM
authors.lastname: Hinnouho
authors.affiliation: Inserm, U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France.|University Versailles St-Quentin en Yvelines, Versailles, France.|Department of Epidemiology and Public Health, University College London, London, United Kingdom.
authors.forename: Archana
authors.initials: A
authors.lastname: Singh-Manoux
authors.affiliation: Inserm, UMS 011, Villejuif, France.
authors.forename: Alice
authors.initials: A
authors.lastname: Gueguen
authors.affiliation: Inserm, UMS 011, Villejuif, France.|Department of Nutrition, Holy Spirit University, Jounieh, Lebanon.
authors.forename: Joane
authors.initials: J
authors.lastname: Matta
authors.affiliation: Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, Paris, France.|AP-HP, Hôpitaux Universitaires Paris Ouest, Service de Psychiatrie de l'adulte et du sujet âgé, Paris, France.|Inserm U894, Centre Psychiatrie et Neurosciences, Paris, France.
authors.forename: Cedric
authors.initials: C
authors.lastname: Lemogne
authors.affiliation: Inserm, UMS 011, Villejuif, France.|University Versailles St-Quentin en Yvelines, Versailles, France.
authors.forename: Marcel
authors.initials: M
authors.lastname: Goldberg
authors.affiliation: Inserm, UMS 011, Villejuif, France.|University Versailles St-Quentin en Yvelines, Versailles, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Zins
authors.affiliation: Inserm, UMS 011, Villejuif, France.|Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, Paris, France.|Department of Nutrition, European Hospital Georges Pompidou, Paris, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Czernichow
mesh_terms: D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D003863:Depression / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D000067329:Obesity, Metabolically Benign / Q000150:complications*