Depressive symptoms and change in abdominal obesity in older persons.

CONTEXT Depression has been hypothesized to result in abdominal obesity through the accumulation of visceral fat. No large study has tested this hypothesis longitudinally. OBJECTIVE To examine whether depressive symptoms predict an increase in abdominal obesity in a large population-based sample of well-functioning older persons. DESIGN The Health, Aging, and Body Composition Study, an ongoing prospective cohort study with 5 years of follow-up. SETTING Community-dwelling older persons residing in the areas surrounding Pittsburgh, Pennsylvania, and Memphis, Tennessee. PARTICIPANTS A total of 2088 well-functioning white and black persons aged 70 to 79 years. MAIN OUTCOME MEASURES Baseline depression was defined as a Center for Epidemiological Studies Depression score of 16 or higher. At baseline and after 5 years, overall obesity measures included body mass index (calculated as weight in kilograms divided by height in meters squared) and percentage of body fat (measured by dual-energy x-ray absorptiometry). Abdominal obesity measures included waist circumference, sagittal diameter, and visceral fat (measured by computed tomography). RESULTS After adjustment for sociodemographics, lifestyle, diseases, and overall obesity, baseline depression was associated with a 5-year increase in sagittal diameter (beta = .054; P = .01) and visceral fat (beta = .080; P = .001). CONCLUSIONS This study shows that depressive symptoms result in an increase in abdominal obesity independent of overall obesity, suggesting that there may be specific pathophysiological mechanisms that link depression with visceral fat accumulation. These results might also help explain why depression increases the risk of diabetes and cardiovascular disease.