Review
Metabolically healthy status and BMI in relation to depression: A systematic review of observational studies

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Abstract

Aim

Findings of association between metabolically healthy status and BMI and risk of depression are controversial. This study aimed to assess the relation between metabolically healthy status and BMI and depression.

Methods

All published studies up to 25 June 2018 were searched by using the databases of PubMed, ISI Web of Science, SCOPUS and Google Scholar and following key words were used: metabolically AND (healthy OR unhealthy OR benign) AND (overweight OR obes* OR “over weight”) AND phenotype AND (depression OR depress* OR “depressive disorder”).

Results

After screening title and abstract and considering inclusion criteria, 5 studies were found to be included in our study. Metabolically unhealthy obesity was associated with 30%–83% increased risk of depression and metabolically unhealthy non-obesity was associated with 19%–60% increased risk of depression. Metabolically healthy obesity was not associated with the risk of depression in all studies.

Conclusions

In conclusion, metabolically health status and BMI are associated with risk of depression. Metabolically unhealthy situation increased risk of depression greater than metabolically healthy status.

Introduction

Depression, the common mental disorder, is a major public health problem across the globe [1]. Depression affects more than 300 million people worldwide [2]. It is estimated that depression is responsible for 50–70% of suicides. The World Health Organization (WHO) predicts that depression will become the second most prevalent disorder (after ischemic heart disease) by the year 2020 [3]. On the other hand, the prevalence of overweight and obesity are also increasing in the world [4]. In 2016, more than 1.9 billion adults, 18 years and older, were overweight and of these over 650 million were obese [5]. Obesity is an established risk factor for mental disorders and depression [6]. Previous publications support an increased risk of depression among the obese people [6,7]. (Fig. 1).

Obesity in most of people associated with an increased risk of insulin resistance, type 2 diabetes, hypertension, dyslipidemia, cardiovascular disease, cancers and inflammatory diseases [[8], [9], [10]]. Nevertheless, “metabolically healthy obesity” (MHO) is a complicated condition that obesity does not produce disturbed metabolic status [11].

Some studies have examined MHO in relation to mental disorders. In The English Longitudinal Study of Ageing (ELSA), unhealthy metabolic obese people in comparison with metabolically healthy obese people had higher risk of depression [12]. In a cross-sectional study in Ireland, depression was greater among the metabolically unhealthy obese subjects [13]. Although, some of the previous studies have reported the increased risk of depression in metabolically unhealthy obese people, the findings of all studies did not confirm this association. In a cross-sectional study in Korea, the risk of depression was not associated with MHO [14]. Due to conflict findings of the previous publications, we aimed to conduct a comprehensive systematic review to summarize available data on the association between depression and metabolic healthy obesity.

Section snippets

Methods

This systematic review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. Code of Pre-registration of systematic review protocols is 109371.

Search strategy: A computerized search strategy was implemented until 25 June 2018 using Pubmed, ISI Web of Science, SCOPUS and Google Scholar. The following key words were used in this search: metabolically AND (healthy OR unhealthy OR benign) AND (overweight OR obes* OR “over weight”) AND

Results

In total, 514 articles were found in our initial search. We excluded duplicated studies, letters, comments and animal studies from the analysis. After screening the title and abstract, 5 papers remained for systematic review in the current study. The characteristics of 5 studies in this systematic review are presented in Table 1. One meta-analysis was found in our search that included due to lack of access to assessed original studies.

Descriptive of studies: The studies were published between

Discussion

Findings from all observational studies assessed the association between metabolically healthy status and BMI and risk of depression did not confirm this relation. Some publications had reported significantly greater risk of depression in MUHO, MHO, MUHNO groups compared with MHNO. Other ones did not find any association.

Metabolically healthy obesity was reported up to 35% of obese people in previous publication [18]. Although, lower risk of chronic diseases was reported in MHO people, but MHO

Implications for behavioral health

Metabolically health status and BMI are associated with risk of depression. Metabolically unhealthy obesity was associated with 30%–83% increased risk of depression and metabolically unhealthy non-obesity was associated with 19%–60% increased risk of depression. Metabolically healthy obesity was not associated with the risk of depression in all studies.

Sources of support

None.

Acknowledgment

This study was supported by the Student`s Scientific Research Center, Tehran, Iran.

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