Associations between metabolic syndrome and depression, and the mediating role of inflammation: Based on the NHANES database

Xudong Meng; Liuhu Han; Jiajing Fu; Chengyang Hu; Yao Lu

doi:10.1016/j.jad.2025.01.108

Associations between metabolic syndrome and depression, and the mediating role of inflammation: Based on the NHANES database

J Affect Disord. 2025 Jan 23:S0165-0327(25)00128-4. doi: 10.1016/j.jad.2025.01.108. Online ahead of print.

Authors

Xudong Meng¹, Liuhu Han¹, Jiajing Fu¹, Chengyang Hu², Yao Lu³

Affiliations

¹ Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
² Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei 230032, China. Electronic address: cy.hu@ahmu.edu.cn.
³ Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China; Ambulatory Surgery Center, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China. Electronic address: luyao@ahmu.edu.cn.

PMID: 39862983
DOI: 10.1016/j.jad.2025.01.108

Abstract

Background: Individuals with metabolic syndrome (MetS) are at a higher risk of developing depressive symptoms, with inflammation hypothesized to mediate this association. This study used data from the National Health and Nutrition Examination Survey (NHANES) (2015-2020) to investigate the relationship between MetS and depression and assess the mediating role of inflammatory markers.

Methods: This cross-sectional study included 20,520 participants. MetS was defined using the NCEP ATP III criteria. Depressive symptoms were assessed with the Patient Health Questionnaire-9 (PHQ-9), with scores ≥10 indicating clinical significance. Inflammatory markers evaluated included C-reactive protein (CRP), white blood cell count (WBC), and neutrophil-to-lymphocyte ratio (NLR), among others. Multivariable linear and logistic regression models were applied to examine associations, and mediation analysis was conducted to evaluate the potential mediating effects.

Results: Overall, 7.64 % of participants exhibited depressive symptoms. MetS was associated with an increased risk of depression in both females (OR: 1.49, 95 % CI: 1.28-1.74) and males (OR: 1.32, 95 % CI: 1.09-1.60) after adjusting for confounders. Among MetS components, central obesity, hypertension, and dyslipidemia demonstrated the strongest associations with depression. Inflammatory markers mediated 26.79 % of the MetS-depression relationship, with CRP contributing the largest proportion (17.24 %).

Conclusion: MetS and its components significantly increase the risk of depressive symptoms, with the relationship partially mediated by inflammatory markers. Chronic inflammation may play a critical role in linking MetS to depression, underscoring the importance of integrated management strategies targeting both metabolic and mental health.