Depression and Perceived Stress, but Not Anxiety, are Associated with Elevated Inflammation in an Obese Adult Population

Figures & data

Figure 1 A detailed flow chart of describing the participants included in this study.

Figure 2 (A) The relationship between BMI and anxiety scores. (B) The relationship between BMI and depression scores. (C) The relationship between BMI and perceived stress scores.

Table 1 Participants’ Characteristics

Variables	M (IQR) or N (%)
Age (years)	54.00 (45.00–63.00)
Gender (male), n (%)	505 (43.16%)
Race (white), n (%)	1106 (94.53%)
Education (with bachelor’s degree or higher), n (%)	451 (38.55%)
BMI	28.50 (25.13–32.85)
Currently married, n (%)	250 (21.37%)
Current smoker, n (%)	171 (14.62%)
Current drinker, n (%)	21 (1.79%)
Systolic BP (mmHg)	130.00 (119.00–143.00)
Diastolic BP (mmHg)	75.00 (68.00–82.00)
Anxiety scores	1.80 (1.40–2.20)
Depression scores	6.00 (3.00–12.00)
Perceived stress scores	22.00 (18.00–26.00)
Medications
Antidepressants, n (%)	161 (13.76%)
Antihypertension, n (%)	434 (37.09%)
Antihyperlipidemic agents, n (%)	348 (29.74%)
ACEI, n (%)	113 (9.66%)
Beta adrenergic blocking agents, n (%)	159 (13.59%)
Calcium channel blocker, n (%)	97 (8.29%)
Diuretics, n (%)	117 (10.00%)
Blood samples
Total cholesterol (mg/dL)	183.00 (159.00–211.00)
Triglycerides (mg/dL)	106.00 (77.00–154.00)
HDL cholesterol (mg/dL)	53.00 (43.00–66.00)
LDL cholesterol (mg/dL)	101.00 (80.00–127.25)
Fasting glucose levels (mg/dL)	96.00 (90.00–105.00)
Hemoglobin A1c %	5.82 (5.60–6.20)
Fasting insulin levels (uIU/mL)	10.00 (6.00–16.00)
HOMA-IR	2.39 (1.42–4.31)
Serum IL6 (pg/mL)	0.80 (0.56–1.21)
Serum IL8 (pg/mL)	12.36 (9.13–15.76)
Serum IL10 (pg/mL)	0.22 (0.16–0.32)
Serum TNF-ɑ (pg/mL)	2.05 (1.69–2.50)
C-reactive protein (ug/mL)	1.43 (0.69–3.63)
Serum E-selectin (ng/mL)	38.83 (28.03–51.73)
Serum ICAM-1 (ng/mL)	272.11 (217.72–334.47)

Abbreviations: BMI, body mass index; BP, blood pressure; ACEI, angiotensin-converting enzyme inhibitors; HDL, high-density lipoprotein; LDL, low-density lipoprotein; HOMA-IR, homeostasis model assessment of insulin resistance; IL, interleukin; TNF-ɑ, tumor necrosis factor-ɑ; ICAM-1, intercellular adhesion molecule-1.

Table 2 Univariate Analysis of Relationships Between Inflammation and Anxiety, Depression and Perceived Stress Scores

Variables	Anxiety Scores		Depression Scores		Perceived Stress Scores
	Sβ	P value	Sβ	P value	Sβ	P value
Serum IL6 (pg/mL)	0.009	0.747	0.039	0.187	0.050	0.057
Serum IL8 (pg/mL)	−0.023	0.434	0028	0.330	−0.025	0.396
Serum IL10 (pg/mL)	−0.008	0.773	0.002	0.953	−0.020	0.505
Serum TNF-ɑ (pg/mL)	−0.009	0.771	0.028	0.333	−0.032	0.276
C-reactive protein (ug/mL)	0.004	0.894	0.109	<0.001	0.080	0.006
Serum E-selectin (ng/mL)	0.038	0.199	0.112	<0.001	0.094	0.001
Serum ICAM-1 (ng/mL)	0.030	0.309	0.098	<0.001	0.032	0.270

Note: Pearson correlation analysis was used.

Abbreviations: IL, interleukin; TNF-ɑ, tumor necrosis factor-ɑ; ICAM-1, intercellular adhesion molecule-1.

Table 3 Adjusted Associations of Inflammatory Markers with Anxiety, Depression and Perceived Stress Scores

Variables	Anxiety Scores				Depression Scores				Perceived Stress Scores
	R^2	Sβ	95% CI	P value	R^2	Sβ	95% CI	P value	R^2	Sβ	95% CI	P value
Model 1
IL-6	0.175	0.009	−0.006–0.008	0.760	0.172	0.040	−0.029–0.172	0.163	0.225	0.059	0.005–0.158	0.038
IL-8	0.176	−0.018	−0.003–0.001	0.533	0173	0.044	−0.007–0.051	0.132	0.217	−0.007	−0.025–0.020	0.812
IL-10	0.175	−0.009	−0.023–0.016	0.745	0.167	0.005	−0.265–0.314	0.866	0.217	−0.016	−0.284–0.159	0.578
CRP	0.175	−0.012	−0.009–0.006	0.682	0.197	0.105	0.090–0.301	<0.001	0.229	0.073	0.024–0.186	0.001
TNF-ɑ	0.176	0.024	−0.020–0.047	0.424	0.180	0.068	0.084–1.086	0.022	0.217	0.016	−0.280–0.488	0.595
E-selectin	0.179	0.037	0.000–0.002	0.204	0.194	0.099	0.015–0.057	<0.001	0.230	0.078	0.006–0.138	0.007
ICAM-1	0.180	0.041	0.000–0.000	0.155	0.204	0.117	0.004–0.012	<0.001	0.224	0.055	0.000–0.105	0.011
Model 2
IL-6	0.199	0.010	−0.009–0.008	0.740	0.288	0.038	−0.030–0.165	0.172	0.270	0.059	0.004–0.156	0.038
IL-8	0.200	−0.018	−0.003–0.001	0.541	0.287	0.029	−0.014–0.043	0.314	0.264	−0.015	−0.028–0.016	0.601
IL-10	0.199	−0.009	−0.022–0.016	0.754	0.286	0.010	−0.230–0.334	0.716	0.264	−0.013	−0.269–0.169	0.656
CRP	0.199	−0.011	−0.008–0.006	0.713	0.302	0.098	0.079–0.284	<0.001	0.272	0.070	0.021–0.181	0.002
TNF-ɑ	0.201	0.027	−0.018–0.049	0.360	0.294	0.072	0.139–1.114	0.042	0.264	0.020	−0.247–0.513	0.493
E-selectin	0.202	0.037	0.000–0.002	0.202	0.294	0.070	0.005–0.046	<0.001	0.270	0.061	0.011–0.133	0.009
ICAM-1	0.202	0.040	0.000–0.000	0.180	0.295	0.074	0.001–0.009	<0.001	0.265	0.027	0.002–0.085	0.019
Model 3
IL-6	0.199	0.010	−0.005–0.008	0.718	0.307	0.030	−0.044–0.151	0.279	0.288	0.051	−0.006–0.145	0.072
IL-8	0.200	−0.018	−0.003–0.001	0.530	0.307	0.034	−0.011–0.045	0.232	0.284	−0.010	−0.026–0.018	0.727
IL-10	0.199	−0.009	−0.023–0.016	0.746	0.306	0.014	−0.211–0.350	0.626	0.284	−0.009	−0.255–0.181	0.741
CRP	0.199	−0.008	−0.009–0.007	0.796	0.312	0.068	0.018–0.236	<0.001	0.286	0.067	0.020–0.139	0.009
TNF-ɑ	0.201	0.029	−0.017–0.051	0.332	0.311	0.059	0.021–1.000	0.069	0.284	0.006	−0.342–0.420	0.841
E-selectin	0.203	0.041	0.000–0.002	0.167	0.309	0.049	−0.003–0.038	<0.001	0.286	0.040	0.015–0.117	0.014
ICAM-1	0.203	0.041	0.000–0.000	0.168	0.312	0.064	0.001–0.008	<0.001	0.284	0.017	0.001–0.074	0.022

Notes: Model 1: Adjusted for age and gender. Model 2: Adjusted for age, gender, race, education, marital status, smoking status, drink alcohol and BP. Model 3: Adjusted for age, gender, race, education, marital status, smoking status, drink alcohol, BP and medications.

Abbreviations: IL, interleukin; TNF-ɑ, tumor necrosis factor-ɑ; ICAM-1, intercellular adhesion molecule-1; BP, blood pressure.

Table 4 Adjusted Associations of Inflammatory Markers with Anxiety, Depression and Perceived Stress Scores by Analysis of Stratified BMI

Variables	Anxiety Scores				Depression Scores				Perceived Stress Scores
	R^2	Sβ	95% CI	P value	R^2	Sβ	95% CI	P value	R^2	Sβ	95% CI	P value
BMI<25 (N=284)
IL-6	0.157	0.054	−0.024–0.063	0.372	0.419	0.150	0.220–1.450	0.808	0.313	0.113	−0.008–0.915	0.054
IL-8	0.150	0.025	−0.003–0.004	0.676	0.403	0.093	−0.007–0.085	0.099	0.296	0.044	−0.021–0.048	0.452
IL-10	0.153	−0.039	−0.115–0.057	0.511	0.393	−0.019	−1.454–1.024	0.733	0.298	−0.059	−1.399–0.445	0.309
CRP	0.153	−0.038	−0.035–0.018	0.532	0.394	0.031	−0.272–0.483	0.583	0.292	0.000	−0.282–0.281	0.110
TNF-ɑ	0.148	−0.005	−0.072–0.066	0.937	0.401	0.085	−0.237–1.746	0.136	0.293	−0.009	−0.800–0.685	0.879
E-Selectin	0.167	0.080	−0.001–0.006	0.196	0.403	0.095	−0.008–0.091	0.089	0.293	0.013	−0.033–0.041	0.113
ICAM-1	0.150	0.024	0.000–0.001	0.713	0.400	0.081	−0.003–0.014	0.178	0.301	0.075	−0.002–0.010	0.125
25≤BMI<30 (N=414)
IL-6	0.233	−0.058	−0.093–0.024	0.241	0.286	0.021	−0.638–0.992	0.670	0.252	−0.022	−0.840–0.529	0.656
IL-8	0.245	−0.094	−0.005–0.000	0.005	0.287	−0.029	−0.050–0.027	0.544	0.262	−0.075	−0.057–0.007	0.125
IL-10	0.227	−0.014	−0.022–0.016	0.776	0.286	0.022	−0.204–0.331	0.639	0.252	−0.009	−0.246–0.204	0.854
CRP	0.237	−0.071	−0.023–0.003	0.148	0.285	0.083	0.053–0.199	0.014	0.252	0.063	0.24–0.131	0.003
TNF-ɑ	0.227	0.017	−0.060–0.084	0.742	0.294	0.072	−0.261–1.740	0.235	0.253	0.033	−0.563–1.121	0.515
E-Selectin	0.227	0.021	−0.002–0.003	0.677	0.290	0.054	0.015–0.123	0.017	0.258	0.060	0.011–0.096	0.004
ICAM-1	0.234	0.060	0.000–0.001	0.228	0.291	0.060	0.023–0.112	0.004	0.252	0.021	0.005–0.047	0.009
BMI≥30 (N=472)
IL-6	0.241	0.009	−0.006–0.008	0.846	0.287	0.019	−0.081–0.125	0.677	0.310	0.060	−0.024–0.133	0.173
IL-8	0.244	0.041	−0.003–0.008	0.373	0.288	0.031	−0.051–0.107	0.485	0.305	0.016	−0.049–0.071	0.722
IL-10	0.252	0.077	−0.026–0.353	0.091	0.305	0.108	0.638–6.192	0.016	0.314	0.078	−0.214–4.018	0.078
CRP	0.241	0.015	−0.008–0.011	0.745	0.313	0.093	0.046–0.217	<0.001	0.316	0.089	0.051–0.215	0.001
TNF-ɑ	0.244	0.044	−0.024–0.070	0.340	0.288	0.036	−0.408–0.976	0.421	0.304	−0.005	−0.556–0.496	0.910
E-Selectin	0.243	0.033	−0.001–0.003	0.477	0.286	0.054	0.030–0.143	<0.001	0.305	0.070	0.018–0.129	0.002
ICAM-1	0.244	0.043	0.000–0.001	0.350	0.290	0.050	0.044–0.109	<0.001	0.305	0.035	0.005–0.094	0.007

Notes: Adjusted for age, gender, race, education, marital status, smoking status, drink alcohol, BP and medications. Normal-weight group (BMI <25), overweight group (25≤ BMI<30) and obese group (BMI≥30).

Abbreviations: BMI, body mass index; IL, interleukin; TNF-ɑ, tumor necrosis factor-ɑ; ICAM-1, intercellular adhesion molecule-1; BP, blood pressure.