1. Results from the Health, Aging, and Body Composition Study Nicole Vogelzangs 1, Brenda Penninx 1, Aartjan Beekman 1, Gretchen Brenes 2, Anne Newman 3, Tamara Harris 4, Suzanne Satterfield 5, Kristine Yaffe 6, Stephen Kritchevsky 2 1 Psychiatry and EMGO institute, VU University Medical Center, Amsterdam, The Netherlands 2 Wake Forest University, NC, 3 University of Pittsburgh, PA, 4 NIA, Bethesda, MD, 5 University of Tennessee, TN, 6 University of California, CA Longitudinal Associations between Abdominal Obesity and Depression

2. Background oStudies show a link between obesity and depression (e.g. Roberts et al, Am J Epidemiol, 2000; Lincinio, Rev Bras Psiquiatr, 2003) oAbdominal obesity is associated with poorer health outcome than overall obesity (e.g. Goodpaster et al, Diabetes Care, 2003; Nicklas et al, Am J Epidemiol, 2004) oThis may be due to specific properties of visceral fat (e.g. Bjorntorp, GH & IGF Res, 1998; Park et al, Diab Res Clin Prac, 2005) oThese mechanisms also play a role in depression (e.g. Bjorntorp, Obesity Rev, 2001; Kahl et al, Psychosom Med, 2005) => depression might be specifically associated with abdominal obesity, independent of overall obesity

3. Background Cross-sectional studies show an association between abdominal obesity and depression (e.g. Thakore et al, Biol Psychiatry, 1997; Weber-Hamann et al, Psychosom Med, 2002; Lee et al, Obesity Res, 2005) Abdominal obesity Depression ? life-style behaviors, self-image, co-morbid diseases, inflammation life-style behaviors, sex steroid hormones, cortisol

4. Research questions 1.Is abdominal obesity associated with depressed mood, independent of overall obesity? 2.What is the direction of such a link: a.Does abdominal obesity predict the incidence of depressed mood in non-depressed persons at baseline? b.Does depressed mood at baseline predict an increase in abdominal visceral fat over time?

5. oPopulation-based prospective cohort study with 5 years of annual follow-up o3075 well-functioning black and white older men and women, aged 70-79 years Health ABC Study

6. Depressed mood oCenter for Epidemiological Studies-Depression Scale (CES-D-20 and CES-D-10) oDepressed mood at baseline: CES-D-20 ≥ 16 oIncident depressed mood: CES-D-10 ≥ 10 on any of the annual follow-up assessments in persons without baseline depressed mood oMean follow-up: 4.4 ± 1.0 years

7. Obesity Baseline and 5-year follow-up oOverall obesity: oBody Mass Index: weight / height 2 (kg/m 2 ) o% body fat (dual X-ray absorptiometry scan) oAbdominal obesity: oWaist circumference (cm) oSagittal diameter (cm) oAbdominal visceral fat (CT scan at L4-L5 level; cm 2 )

8. Statistical analyses 1.Cox regression: N=2528 Covariates: age, sex, race, site, education, smoking, alcohol use, physical activity, cardiovascular disease, diabetes Additional adjustment: overall obesity (BMI) baseline abdominal obesity incident depressed mood 2.Linear regression: N=1733 baseline depressed mood 5-year change in abdominal obesity

9. Sample characteristics (mean (SD) or %) Men N=1275Women N=1379 Age (years)73.7 (2.8)73.5 (2.9) Black35.544.7 Baseline depressed mood2.32.9 Incident depressed mood a 18.124.8 BMI (kg/m 2 ) 27.1 (3.9)27.7 (5.4) % body fat29.4 (4.9)40.7 (5.7) Waist circumference (cm) 101.1 (10.6)98.2 (13.4) Sagittal diameter (cm) 22.6 (3.1)21.9 (3.4) Abdominal visceral fat (cm 2 ) 156.0 (71.6)131.9 (60.3) Change in BMI (kg/m 2 ) -0.5 (1.6)0.0 (2.0) Change in % body fat0.9 (2.5)-0.1 (2.8) Change in waist circumference (cm) 0.7 (6.1)-1.7 (11.6) Change in sagittal diameter (cm) 0.4 (2.1)0.8 (2.0) Change in abd. visceral fat (cm 2 ) -1.0 (46.2)-11.6 (33.9) a among non-depressed at baseline

10. Risk of incident depressed mood (21.6%) N=2528HR a 95%CIP BMI1.030.94-1.12.54 % body fat1.060.94-1.21.35 Waist circumference1.050.97-1.15.23 Sagittal diameter1.080.99-1.17.11 Abdominal visceral fat1.101.01-1.20.04 a Adjusted for sociodemographics, life-style behaviors and diseases b Additionally adjusted for BMI HR b 95%CIP 1.100.95-1.28.21 1.191.01-1.40.04 1.141.01-1.27.03

11. HR Risk a of incident depressed mood by abdominal visceral fat Quintiles of abdominal visceral fat a Adjusted for sociodemographics, life-style behaviors, diseases, and BMI

12. Depressed mood and 5-year change in obesity N=1733 CES-D ScoreCES-D≥16 β aβ a Pβ aβ a P BMI.049.04.054.03 % body fat.029.24.023.34 Waist circumference.029.14.043.03 Sagittal diameter.043.06.062.006 Abdominal visceral fat b.046.05.082<.001 Men.073.04.147<.001 Women.027.38.035.24 a Adjusted for sociodemographics, life-style behaviors, diseases, and BMI (for abdominal obesity measures) b A sex interaction was observed for CES-D≥16: p=.02

13. Adjusted a mean 5-year change in abdominal visceral fat cm 2 a Adjusted for sociodemographics, life-style behaviors, diseases, and BMI No depressed mood Depressed mood Men p=.001 Women p=.14

14. oIn an older population, abdominal visceral obesity is independently and more strongly associated with depressed mood than overall obesity oThe association between abdominal obesity and depressed mood is bidirectional: oAbdominal obesity predicts the onset of depressed mood oIn older men only, depressed mood predicts an increase in abdominal visceral fat over time Conclusions