The association of physical illness and low-grade inflammatory markers with depressive symptoms in a large NHANES community sample: Dissecting mediating and moderating effects

The association between C-reactive protein-albumin-lymphocyte index and depression in adults with type 2 diabetes mellitus: A cross-sectional study from NHANES

OBJECTIVE

Inflammation and nutrition are interrelated, and both are related to depression. This study explored the association between the C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index, a novel immunonutrition scoring system, and depression in patients with type 2 diabetes mellitus (T2DM).

METHODS

We included 3517 patients with T2DM from the National Health and Nutrition Examination Survey 2005-2010 and 2015-2018. The Patient Health Questionnaire-9 was used to evaluate depression. The CALLY index was based on a comprehensive assessment of serum CRP, serum albumin, and the lymphocyte counts from whole blood. Weighted multivariate logistic regression models were used to examine the relationship between the CALLY index and depression. The restricted cubic spline was applied to explore the nonlinear relationship.

RESULTS

Compared with the non-depressed group, CALLY index and albumin in the depressed group were significantly reduced, while CRP and lymphocytes were significantly increased (P < 0.05). After adjusting for covariates, only the CALLY index significantly decreased (the highest quartile vs the lowest quartile, odds ratio = 0.58, 95 % confidence interval: 0.38-0.89, P = 0.014). The non-linear association between the CALLY index and depression was not significant (P for nonlinear=0.69). The results of subgroup analysis were basically consistent (P for interaction > 0.05).

CONCLUSION

The CALLY index was significantly negatively correlated with depression in American patients with diabetes and served as a potential marker for early identification.

On the pursuit of reproducibility: the importance of large sample sizes in psychoimmunology

Peripheral inflammatory markers (PIMs), such as C-reactive protein (CRP) or white blood cell count (WBC), have been associated with depression severity in meta-analyses and large cohort studies. However, in typically-sized psychoimmunology studies (N < 200) that explore associations between PIMs and neurobiological/psychosocial constructs related to depression and studies that examine less-studied PIMs (e.g., interferon gamma), significant concerns about reproducibility of results exist. For the well-characterized association between PIMs (CRP/WBC) and depression severity, we examined statistical errors as a function of sample size in a large community cohort (n = 24,550). We further assessed how statistical errors varied as related to analytic decisions (e.g., number of covariates) and characteristics related to study design (e.g., relationships within subgroups of patients). Only large samples (e.g., n = 1000 to n = 10,000) were sufficiently powered to detect PIM-depression associations and minimized overestimation of effect sizes (e.g., effect size inflation), and greater sample sizes were required as more covariates were included in analytic models. Moderately sized samples (n > 500) generally ensured the correct directionality of effect sizes (e.g., low rates of sign reversal). Sample sizes required for 80% power also varied widely depending on study design characteristics (e.g., N = 350 to N = 10,000+). Typically-sized psychoimmunology studies examining PIM-depression associations (N < 200) are likely underpowered and at high risk of overestimation of effect sizes. Study design characteristics also notably influence power and statistical error rates. Use of large sample sizes (e.g., N > 7000) and consideration of analytic decisions (e.g., number/choice of covariates) will maximize reproducibility of psychoimmunology studies related to depression to enhance development of treatments for depression or to help understand pathophysiological mechanisms of depression.

Exposure to acrylamide and increased risk of depression mediated by inflammation, oxidative stress, and alkaline phosphatase: Evidence from a nationally representative population-based study

BACKGROUND

The health risk associated with acrylamide exposure has emerged as a significant issue of public health, attracting global attention. However, epidemiologic evidence on whether and how daily acrylamide exposure increases depression risk of the general population is unclear.

METHODS

The study included 3991 adults from the National Health and Nutrition Examination Survey. The urinary metabolites of acrylamide (N-Acetyl-S-(2-carbamoylethyl)-L-cysteine [AAMA] and N-Acetyl-S-(2-carbamoyl-2-hydroxyethyl)-L-cysteine [GAMA]) identified as reliable indicators of acrylamide exposure were examined to determine their relationships with depressive symptoms that were evaluated using the 9-item Patient Health Questionnaire. Besides, the measurements of alkaline phosphatase (ALP) and biomarkers of inflammation (white blood cell [WBC] count) and anti-oxidative stress (albumin [ALB]) were conducted to investigate their mediation roles in above relationships.

RESULT

AAMA, GAMA, and ΣUAAM (AAMA+GAMA) were linearly associated with increased risk of depressive symptoms. Each 2.7-fold increase in AAMA, GAMA, or ΣUAAM was associated with a 30 % (odds ratio: 1.30; 95 % confidence interval: 1.09, 1.55), 47 % (1.47; 1.16, 1.87), or 36 % (1.36; 1.13, 1.63) increment in risk of depressive symptoms, respectively. Increased WBC count (mediated proportion: 4.48-8.00 %), decreased ALB (4.88-7.78 %), and increased ALP (4.93-5.23 %) significantly mediated the associations between acrylamide metabolites and depressive symptoms.

CONCLUSIONS

Acrylamide exposure of the general adult population was related to increased risk of depressive symptoms, which was mediated in part by inflammation, oxidative stress, and increased ALP. Our findings provided pivotal epidemiologic evidence for depression risk increment from exposure to acrylamide.

Association between C-reactive protein, Life's Essential 8, and mortality in American adults: Insights from NHANES 2005-2010 data analysis

OBJECTIVE

To evaluate the independent, mediating, interactive, and associated effects of C-reactive protein (CRP) and Life's Essential 8 (LE8) on all-cause and cardiovascular mortality.

METHODS

Utilizing data from 10,043 participants in the NHANES 2005-2010, we employed Cox proportional hazards regression models and causal mediation analysis to investigate the joint and interactive effects of Life's Essential 8 (LE8) and C-reactive protein (CRP) on mortality risk.

RESULTS

During an average follow-up of 137.10 months, there were 1591 all-cause deaths and 485 cardiovascular deaths. Weighted linear regression showed that for patients with low cardiovascular health (CVH), the adjusted β was -0.22 (95 % CI: -0.27 to -0.17) for moderate cardiovascular health (CVH) and -0.36 (95 % CI: -0.43 to -0.30) for high cardiovascular health (CVH). Mediation analysis revealed that C-reactive protein (CRP) mediated 10.43 % of all-cause mortality and 9.20 % of cardiovascular mortality for moderate cardiovascular health (CVH) compared to low cardiovascular health (CVH), and 9.95 % and 8.32 % respectively for high cardiovascular health (CVH) compared to low cardiovascular health (CVH). No significant multiplicative or additive interactions between Life's Essential 8 (LE8) and C-reactive protein (CRP) were found in all-cause mortality or cardiovascular mortality. Individuals with high cardiovascular health (CVH) and the first quartile of C-reactive protein (CRP) had HRs of 0.30 (95 % CI 0.18-0.48) for all-cause mortality and 0.31 (95 % CI 0.13-0.74) for cardiovascular mortality compared to those with low cardiovascular health (CVH) and the fourth quartile of C-reactive protein (CRP).

CONCLUSION

These findings suggest that CRP could significantly influence the relationship between cardiovascular health (CVH) and mortality. Interventions that target both lifestyle factors and CRP levels may improve cardiovascular health and potentially lower mortality risks.

C-reactive protein-albumin-lymphocyte index as a feasible nutrition-immunity-inflammation marker of the outcome of all-cause and cardiovascular mortality in elderly

BACKGROUND & AIMS

The imbalance of nutrition-immunity-inflammation status might be associated with the mortality risk in the elderly. This study aimed to assess the relationship between the C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index and all-cause and cardiovascular disease (CVD) mortality in the elderly.

METHODS

The data from records of older adults (≥ 60 years) were derived from 1999 to 2010 and 2015-2018 National Health and Nutrition Examination Survey. Weighted Cox proportional hazard regression was used to analyze the relationship between CALLY and all-cause mortality and CVD mortality in three different models, and the linear trend was analyzed. A restricted cubic spline model was used to evaluate the nonlinear dose-response relationship and determine the critical threshold of CALLY to divide the population into two groups. Kaplan-Meier analysis and log-rank test were used to evaluate the cumulative survival rates of different groups. Subgroup analyses and sensitivity analyses were performed to ensure robustness.

RESULTS

Compared to the first quartile of natural log-transformation (ln) CALLY, the highest quartile of ln CALLY was negatively correlated with the risk of all-cause mortality (HR = 0.67, 95% CI: 0.56-0.79. P < 0.05) and CVD mortality (HR = 0.65, 95% CI: 0.47-0.89. P < 0.05) in model 3. Ln CALLY was linear dose-response correlated with mortality. We determined that the critical threshold for ln CALLY in elderly was 1.00. Elderly with higher ln CALLY (≥ 1.00) had significantly increased survival rates (P < 0.05).

CONCLUSION

CALLY showed a significant negative linear association with the risk of all-cause mortality and CVD mortality, and higher CALLY was beneficial to the survival outcomes of the elderly.

The association between dietary quality, sleep duration, and depression symptoms in the general population: findings from cross-sectional NHANES study

BACKGROUND

Unhealthy lifestyles, which include unhealthy diet and unhealthy sleep duration, have been widely recognized as modifiable risk factors for depressive symptoms. This study aims to explore the associations between dietary quality, sleep duration, and depression symptoms, as well as their combined effects.

METHODS

The NHANES 2007 to 2014 cycles provided the data for this study, in which 19,134 adults aged 20 years and older were included. Unhealthy diet, measured using an average Healthy Eating Index (HEI)-2015 score below the 60th percentile, and unhealthy sleep duration, measured as sleep duration at night less than 7 h or greater than/equal to 9 h, were the primary exposures. Then participants were divided into four different lifestyles. A weighted-multivariable logistic regression was employed, controlling for relevant variables. Furthermore, stratified analyses were conducted to assess the robustness of the findings and identify potential high-risk groups.

RESULTS

The overall prevalence of depressive symptoms among all participants was 8.44%. Among the participants, 56.58% met the criteria for healthy sleep duration, and 24.83% scored at or above the 60th percentile on the HEI-2015. Unhealthy diet (OR: 1.40, 95% CI: 1.18-1.67, p < 0.001) and unhealthy sleep duration (OR: 1.94, 95% CI: 1.63-2.31, p < 0.001) exhibited positive associations with depression symptoms. Individuals who maintained an unhealthy diet but healthy sleep duration (OR: 1.60, 95% CI: 1.20-2.13, p = 0.002), healthy diet but unhealthy sleep duration (OR: 2.50, 95% CI: 1.64-3.80, p < 0.001), or an unhealthy diet and unhealthy sleep duration (OR: 2.91, 95% CI: 2.16-3.92, p < 0.001) were significantly associated with depressive symptoms compared to those with a healthy diet and healthy sleep duration, respectively. In stratified analyses, females, middle-aged individuals, those with a college degree or higher education, and individuals who do not meet the recommended level of physical activity exhibit heightened susceptibility to depressive symptoms when exposed to unhealthy diet and unhealthy sleep duration.

CONCLUSION

In summary, our study suggests that individuals affected by the individual and synergistic effect of an unhealthy diet and unhealthy sleep duration are more susceptible to experiencing depressive symptoms.

Associations of iron metabolism and inflammation with all-cause and cardiovascular mortality in a large NHANES community sample: Moderating and mediating effects

BACKGROUND AND AIMS

This study aimed to assess the associations between serum iron concentration, C-reactive protein (CRP) concentration and the risk of all-cause mortality and cardiovascular mortality in the general population and to explore potential mediating and moderating effects.

METHODS AND RESULTS

This study analyzed data from the National Health and Nutrition Examination Survey spanning the years 1999-2010, encompassing 23,634 participants. Cox proportional hazards regression models were employed to investigate the independent associations of serum iron and CRP with all-cause and cardiovascular mortality. Moderation and mediation analyses explored the moderating effect of CRP on the association between the serum iron concentration and all-cause and cardiovascular mortality, and the mediating role of the serum iron concentration in the association between the CRP concentration and all-cause and cardiovascular mortality. After multivariate adjustments in the Cox model, serum iron and CRP levels were independently correlated with both all-cause and cardiovascular mortality risk. Moderation analyses revealed a more pronounced correlation between the serum iron concentration and both all-cause and cardiovascular mortality in participants with higher CRP levels. Mediation analysis indicated that the serum iron concentration partly mediated the impact of CRP on the risk of all-cause mortality (13.79%) and cardiovascular mortality (24.12%).

CONCLUSION

Serum iron and CRP are independently associated with all-cause and cardiovascular mortality. Moreover, the associations between serum iron concentrations and both all-cause and cardiovascular mortality are more pronounced in individuals with elevated CRP. Serum iron partially mediates the effect of CRP on all-cause and cardiovascular mortality.

Allostatic Load and Depression Symptoms in Cancer Survivors: A National Health and Nutrition Examination Survey Study

BACKGROUND

Individuals with cancer often experience stress throughout the cancer trajectory and have a high risk of experiencing depression.

OBJECTIVE

The aim of this study was to examine the relationship between allostatic load (AL), a measure of cumulative stress-related physiologic dysregulation of different body systems, and symptoms of depression in cancer survivors.

METHODS

Participants were 294 adult cancer survivors from the US National Health and Nutrition Examination Survey (NHANES 2007-2018). Allostatic load was measured using 14 indicators representing cardiometabolic risk, glucose metabolism, cardiopulmonary functioning, parasympathetic functioning, and inflammation. Depressive symptoms were measured with the Patient Health Questionnaire-9. The relationship between AL and depressive symptoms was investigated using multiple regression adjusted for diverse sociodemographic and diagnosis variables.

RESULTS

Higher AL was associated with higher depressive symptom scores. The higher risk of depression was concentrated among those survivors in the highest AL quartile, with 21% (95% confidence interval, 11%-32%) of survivors presenting a high risk of depression compared with 8% to 11% of survivors in the lower quartiles. In exploratory analyses, the relationship between AL and depressive symptoms was only significant among survivors with a lower income. In contrast, in survivors in the highest income group, depressive symptoms were lower and unrelated to AL.

CONCLUSION

High AL is associated with more depressive symptoms among cancer survivors.

IMPLICATIONS FOR PRACTICE

Nurses have an important role in identifying psychological distress in cancer patients and survivors. Further research is needed to investigate the usefulness of AL as a marker in the context of cancer follow-up care and screening for psychological distress.