Association of depressive symptoms and anti-depressants with body mass index and waist circumference in elderly men and women: The ARIC carotid MRI study

Background: Depressive symptoms are associated with obesity, a precursor to type 2 diabetes and cardiovascular disease, and might in part explain the association of depressive symptoms with adverse metabolic outcomes. We determined the cross-sectional association between depressive symptoms and body mass index (BMI) and waist circumference (WC) in 1,314 elderly men and women age 60 to 83 years in the Atherosclerosis Risk in Communities (ARIC) Carotid MRI Study. Methods: Depressive symptoms were assessed using the Center for Epidemiological Studies Depression (CES-D) Scale. Elevated depressive symptoms were defined as CES-D score ≥ 16 and/or anti-depressant medication use. CES-D score was also modeled continuously. Results: In unadjusted analyses, each 5-point higher CES-D score was associated with a 0.48 kg/m² higher BMI (95% CI: 0.24 to 0.69) and a 1.23 cm higher WC (95% CI: 0.67 to 1.82). Adjustment for potential confounders, including physical activity, attenuated the associations with BMI (0.16 kg/m²; 95% CI:-0.07 to 0.39) and WC (0.45 cm; 95% CI:-0.11 to 1.01). Compared to individuals without elevated depressive symptoms, those with elevated symptoms had significantly greater BMI (0.99 kg/m²; 95% CI: 0.07 to 1.90) and WC (3.22 cm; 95% CI: 1.04 to 5.40), even after multivariable adjustment. In a subsidiary analysis, compared to individuals not taking anti-depressants, those taking anti-depressants had significantly higher waist circumference (1.54 cm; 95% CI: 0.18 to 2.90) and BMI (4.23 kg/m²; 95% CI: 0.90 to 7.55) following multivariable adjustment. All results were similar when individuals with diabetes and coronary heart disease were excluded and when waist to height ratio was used an alternative measure of body fat. Conclusions: We found a significant cross-sectional association between depressive symptoms and BMI and WC in elderly individuals that was partially explained by health behaviors, particularly physical activity.