Association of non-HDL-C and depression: a cross-sectional analysis of the NHANES data

The joint and interactive effects of the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and body mass index on the risk of depression, as well as the mediating role of NHHR: results from NHANES 2005-2023

BACKGROUND

Various research in the past has indicated that the NHHR, which represents the ratio of non-high-density lipoprotein cholesterol (non-HDL-C) to high-density lipoprotein cholesterol (HDL-C), and body mass index (BMI) each act independently as contributors to depression risk. Nonetheless, studies exploring the combination of NHHR with BMI in relation to depression are limited. Consequently, the central aim of this study is investigating the joint and interactive effects of NHHR and BMI on depression risk, as well as the mediating role of NHHR.

METHODS

Encompassing participants aged 20 years or over, this research incorporated a total of 39,704 individuals from the National Health and Nutrition Examination Survey (NHANES), which covered the period of 2005 to 2023. To analyze the impact of NHHR and its combination with BMI on depression, our analytical approach included multivariate logistic regression, restricted cubic spline modeling, interaction testing and subgroup analyses. Additionally, we studied the joint effects of NHHR and BMI. Finally, we applied a four-way decomposition analysis method to examine the interactions and mediating effects within the aforementioned relationships.

RESULTS

Among all participants in this study, the prevalence of depressive disorder (Patient Health Questionnaire-9 score ≥ 10) was 9.2%. Both the NHHR and BMI were associated with depression, which remained significant even after full adjustment for covariates [NHHR, OR (95% CI): 1.07 (1.04-1.09); BMI, OR (95% CI): 1.02 (1.02-1.03)]. Compared with the reference group, the OR (95% CI) for the highest groups of NHHR, BMI, and their product term NHHR-BMI were 1.41 (1.24-1.61), 1.35 (1.18-1.54), and 1.59 (1.37-1.84), respectively. Participants with NHHR in the fourth quartile and BMI exceeding 30 kg/m², had higher depression risk compared to other participants with NHHR in the first quartile and BMI below 25 kg/m² [OR (95% CI): 1.64 (1.34-2.00)]. Results of the four-way decomposition analyses indicated that NHHR played a mediating role in the association between BMI and depression, with the mediating effect accounting for 17.6%. Similarly, NHHR also mediated 11.0% of the mediating effect between BMI and PHQ-9 score. However, no interaction between NHHR and BMI related to depression was found in the general population. After stratifying by gender, it was found that the mediated interaction between NHHR and BMI had a statistically significant effect on depression and PHQ-9 score in males.

CONCLUSIONS

Depression risk is linked to both NHHR and BMI, and NHHR has a significant mediating impact on the association between BMI and depression. Notably, there is a non-negligible mediated interaction effect between BMI and NHHR in male participants. Compared to considering NHHR or BMI individually, participants had a higher risk of depression when the combined terms of the two were in the higher quartiles. These findings suggest that the combined assessment of these two indicators may help deepen the understanding and evaluation of depression, enhance the accuracy of risk stratification, and is worthy of further research.

Association between depression and liver function biomarkers among US cancer survivors in NHANES 2005-2020

Depression frequently comorbidities with cancer, adversely affecting survivors' quality of life. Liver dysfunction is also prevalent among cancer survivors. However, the association between these two conditions remains unclear. This study aimed to explore the relationship between depression and liver function biomarkers in US cancer survivors. A cross-sectional study was conducted utilizing data from the National Health and Nutrition Examination Survey (NHANES) 2005-2020. Cancer survivors were screened and depression was assessed using the Patient Health Questionnaire-9 (PHQ-9), and 18 liver function biomarkers were included. Survey-weighted generalized linear models with multiple covariables adjusted were employed to examine the associations between depression and liver function biomarkers. A total of 4118 cancer survivors were included, representing a weighted population of 21 501 237. After adjusted with age, gender, race, marital status, education level, family income-to-poverty ratio, and number of cancer types, 8 biomarkers demonstrated positive correlations with depression in cancer survivors, included alanine aminotransferase (ALT, OR = 1.007, 95% CI: 1.000 to 1.013), alkaline phosphatase (ALP, 1.006 [1.002, 1.010]), gamma glutamyl transferase (GGT, 1.004 [1.001, 1.007]), lactate dehydrogenase (LDH, 1.004 [1.000, 1.009]), total protein (TP, 1.040 [1.009, 1.072]), globulin (GLB, 1.060 [1.030, 1.091]), total cholesterol (TC) to high-density lipoprotein cholesterol (HDL-C) ratio (1.162 [1.050, 1.286]), and low-density lipoprotein cholesterol (LDL-C) to HDL-C ratio (1.243 [1.012, 1.526]); while 4 other biomarkers exhibited negative correlations, included HDL-C (0.988 [0.980, 0.997]), total bilirubin (TBi, 0.501 [0.284, 0.883]), aspartate aminotransferase (AST) to ALT ratio (0.588 [0.351, 0.986]), albumin (ALB) to GLB ratio (0.384 [0.229, 0.642]). Following sensitivity analysis, 5 biomarkers included LDH, HDL-C, TBi, AST/ALT and LDL-C/HDL-C lost their statistical significance for the association. This study identified certain associations between 7 liver function biomarkers and depression in US cancer survivors. Further research, particularly prospective longitudinal studies, is warranted to elucidate the causal relationships and explore the potential of improving liver function for the management of depression in cancer patients.

Association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) with depressive symptoms: recent findings from NHANES 2005-2018

Background

The ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol (NHHR) index is a relatively new composite lipid index, the relationship between NHHR and depression is unclear from the current study. The primary aim of our study was to examine the association between the prevalence of depression and NHHR in a US population.

Methods

The National Health and Nutrition Examination Survey (NHANES) provided the data for our investigation from 2005 to 2018. and primarily included participants who contained complete data on NHHR and depression in U.S. adults (age ≥20 years). Associations between NHHR and depression were assessed using multifactorial logistic regression analysis, subgroup analysis, and smoothed curve fitting.

Results

In our study, 29,561 subjects in total showed a mean NHHR index of 3.12± 1.58,A noteworthy positive correlation was observed between NHHR and depression in multifactorial logistic regression analysis. Subgroup analyses and tests of interaction showed that gender, age, ethnicity, PIR, smoking, alcohol consumption, coronary heart disease, diabetes mellitus, hypertension, and stroke did not influence the NHHR and the association between depression (P for interaction > 0.05), whereas two stratification factors, BMI and sleep disturbance, may be potential factors in the association between NHHR and depression (P for interaction < 0.05).

Conclusion

According to our present study, if the level of NHHR rises in American adults, their likelihood of developing depression also increases.

Association between depression and infertility risk among American women aged 18-45 years: the mediating effect of the NHHR

BACKGROUND/OBJECTIVE

Depression and infertility are major medical and social problems. The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) serves as an innovative and reliable lipid marker for cardiovascular disease risk assessment. Previous research has indicated a potential correlation among lipid metabolism, depression, and infertility. Nonetheless, the exact involvement of lipid metabolism in modulating the pathological mechanisms associated with depression-induced infertility remains to be fully elucidated. The aim of this study was to explore the connection between depression and infertility and to assess whether the NHHR mediates this association.

METHODS

A cross-sectional analysis was performed utilizing data from there cycles (2013-2018) of the National Health and Nutrition Examination Survey (NHANES) database. Female infertility was assessed according to the responses to the RHQ074 question in the reproductive health questionnaire module. Depression states were evaluated using the Patient Health Questionnaire-9 and classified into three grades based on the total scores: no depression (0-4 points), minimal-to-mild depression (5-9 points) and moderate-to-severe depression (10 or more points). The NHHR was calculated from laboratory cholesterol test results. Baseline population characteristics were compared, and subgroup analyses were carried out based on the stratification of age and body mass index (BMI). Weighted multivariable logistic regression and linear regression models, with adjustments for various covariables, were employed to examine the associations among depression, infertility and the NHHR. Finally, mediation analysis was utilized to explore the NHHR's potential mediating role in depression states and female infertility.

RESULTS

Within this cross-sectional study, 2,668 women aged 18 to 45 years residing in the United States were recruited, 305 (11.43%) of whom experienced infertility. The study revealed a markedly higher prevalence of depression (P = 0.040) and elevated NHHR (P < 0.001) among infertile women compared to the control cohort. Furthermore, moderate-to-severe depression states independently correlated with increased infertility risk, irrespective of adjustments for various covariables. Subgroup analysis indicated a positive association between depression and infertility risk within certain age categories, although no such relationship was observed within subgroups stratified by BMI. The findings from the weighted logistic regression analysis demonstrated that the elevated NHHR is positively associated with heightened infertility risk. Additionally, the weighted linear regression analysis indicated that moderate-to-severe depression is positively linked to the NHHR levels as well. Finally, the association between depression states and female infertility was partially mediated by the NHHR, with the mediation proportion estimated at 6.57%.

CONCLUSION

In the United States, depression is strongly correlated with an increased likelihood of infertility among women of childbearing age, with evidence suggesting that this relationship is mediated by the NHHR. Subsequent research efforts should further explore the underlying mechanisms connecting depression and infertility.

Depression and cognition are associated with lipid dysregulation in both a multigenerational study of depression and the National Health and Nutrition Examination Survey

Chronic dysregulation of peripheral lipids has been found to be associated with depression and cognition, but their interaction has not been investigated. Growing evidence has highlighted the association between peripheral lipoprotein levels with depression and cognition with inconsistent results. We assessed the association between peripheral lipids, depression, and cognition while evaluating their potential interactions using robust clinically relevant predictors such as lipoprotein levels and chronic medical disorders that dysregulate lipoproteins. We report an association between peripheral lipids, depression, and cognition, suggesting a common underlying biological mechanism driven by lipid dysregulation in two independent studies. Analysis of a longitudinal study of a cohort at high or low familial risk for major depressive disorder (MDD) (n = 526) found metabolic diseases, including diabetes, hypertension, and other cardiovascular diseases, were associated with MDD and cognitive outcomes. Investigating a cross-sectional population survey of adults in the National Health and Nutrition Examination Survey 2011-2014 (NHANES) (n = 2377), depression was found to be associated with high density lipoprotein (HDL) and cognitive assessments. In the familial risk study, medical conditions were found to be associated with chronic lipid dysregulation and were significantly associated with MDD using the structural equation model. A positive association between chronic lipid dysregulation and cognitive scores was found in an exploratory analysis of the familial risk study. In a complementary study, analysis of NHANES revealed a positive association of HDL levels with cognition. Further analysis of the NHANES cohort indicated that depression status mediated the interaction between HDL levels and cognitive tests. Importantly, the protective effect of HDL on cognition was absent in those with depressive symptoms, which may ultimately result in worse outcomes leading to cognitive decline. These findings highlight the potential for the early predictive value of medical conditions with chronic lipid dyshomeostasis for the risk of depression and cognitive decline.