VU Research Portal Depression & Metabolic Syndrome Vogelzangs, N. 2010 document version Publisher's PDF, also known as Version of record Link to publication in VU Research Portal citation for published version (APA) Vogelzangs, N. (2010). Depression & Metabolic Syndrome. General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal ? Take down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. E-mail address: [email protected] Download date: 29. Sep. 2021 Depression & Metabolic Syndrome Nicole Vogelzangs This thesis was prepared within the EMGO Institute for Health and Care Research (EMGO+). EMGO+ participates in the Netherlands School of Primary Care Research (CaRe) which was re-acknowledged in 2005 by the Royal Netherlands Academy of Arts and Sciences (KNAW). Financial support by the Netherlands Heart Foundation for the publication of this thesis is gratefully acknowledged. Further financial support for the publication of this thesis was kindly provided by: Department of Psychiatry, VU University Medical Center, Amsterdam EMGO+, VU University Medical Center, Amsterdam Lundbeck B.V., Amsterdam Mediq Direct Diabetes, Didam Servier Nederland Farma B.V., Leiden Vrije Universiteit, Amsterdam Printed by Ipskamp drukkers, Enschede, the Netherlands ISBN: 978 90 8659 447 4 © 2010 by Nicole Vogelzangs, Maarssen, the Netherlands All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or any information storage and retrieval without prior permission of the holder of the copyright. VRIJE UNIVERSITEIT Depression & Metabolic Syndrome ACADEMISCH PROEFSCHRIFT ter verkrijging van de graad Doctor aan de Vrije Universiteit Amsterdam, op gezag van de rector magnificus prof.dr. L.M. Bouter, in het openbaar te verdedigen ten overstaan van de promotiecommissie van de faculteit der Geneeskunde op vrijdag 23 april 2010 om 13.45 uur in de aula van de universiteit, De Boelelaan 1105 door Nicole Vogelzangs geboren te Arcen en Velden promotoren: prof.dr. B.W.J.H. Penninx prof.dr. A.T.F. Beekman beoordelingscommissie: prof.dr.ir. J. Brug prof.dr.ir. J.M. Dekker prof.dr. P. de Jonge dr. R.C. Oude Voshaar prof.dr.ir. M. Visser prof.dr. F.G. Zitman Contents Chapter 1 General introduction 9 Chapter 2 Psychosocial risk factors and the metabolic syndrome in elderly 23 persons: findings from the Health, Aging and Body Composition study Chapter 3 Hypercortisolemic depression is associated with the metabolic 41 syndrome in late-life Chapter 4 Late-life depression, cortisol, and the metabolic syndrome 59 Chapter 5 Depressive symptoms and change in abdominal obesity in 71 older persons Chapter 6 Obesity and onset of significant depressive symptoms: 89 results from a prospective community-based cohort study of older men and women Chapter 7 Metabolic depression: a chronic depressive subtype 109 Chapter 8 Urinary cortisol and 6-year risk of all-cause and cardiovascular 125 mortality Chapter 9 Cardiovascular disease in persons with depressive and anxiety 139 disorders Chapter 10 General discussion 157 Summary 181 Samenvatting 187 Dankwoord 195 Curriculum Vitae 201 List of publications 207 List of co-authors 215 Chapter 1 General introduction Parts of this chapter were taken from: Brenda WJH Penninx Nicole Vogelzangs Aging and behavioral medicine In: Steptoe A et al. Handbook of Behavioral Medicine In press GENERAL INTRODUCTION | 11 Almost a century ago, in 1921, Ernst Kretschmer concluded in his publication ‘Körperbau und Charakter’ (Physique and Character),1 based on systematic observations, that depressive symptoms are more common among persons with a pyknic body build. He described the pyknic type as ”… characterized by the pronounced peripheral development of the body cavities (head, breast, and stomach), and a tendency to a distribution of fat around the trunk, with a more graceful construction of the motor apparatus (shoulders and extremities)”. Although the term pyknic build did not survive, the description he gave of this specific body build does closely resemble that of later observations. In 1956, Jean Vague wrote:2 “Android obesity, with upper body predominance and pronounced muscle-blood development, leads to metabolic disturbances. It not only is associated with premature atherosclerosis and diabetes, but it is also the usual cause of diabetes in the adult in 80 to 90 per cent of cases. … Overactivity of the pituitary-adrenal axis appears to be the most probable cause both of android obesity and it complications.” With this description Vague paved the way for what we now call the ‘metabolic syndrome’, a clustering of cardiovascular risk factors including abdominal obesity, unfavorable lipid profile, hypertension and hyperglycemia. Recent studies have abundantly confirmed that abdominal obesity and the metabolic syndrome are associated with increased risks of diabetes, atherosclerosis, and cardiovascular disease.3-9 These early perceptions are not only in agreement with the concept of the metabolic syndrome, but Kretschmer’s observations also indicate that the metabolic syndrome might be associated with depressive disorders and symptoms. Indeed, some recent studies have linked depressive symptoms to individual components of the metabolic syndrome, e.g. hypertension, obesity, or high blood glucose levels.10-12 Considering that both depression and cardiovascular disease might be linked to metabolic disturbances, it has been hypothesized that the metabolic syndrome could play an important mediating role in the frequently described association between depression and cardiovascular disease.13-15 Gaining more explicit knowledge on the association between depression and the metabolic syndrome could enhance insight into depression and cardiovascular disease comorbidity. However, until recently, only very few studies have investigated whether depressive disorders or symptoms are associated with the total metabolic syndrome package or have compared the relative influence of individual components. Besides, the temporal direction of the associations between depression and metabolic abnormalities remains unclear. Also, what exactly then causes these metabolic disturbances and their consequences? A hint for this was already given by Vague: hyperactivity of the hypothalamic-pituitary-adrenal (HPA)- axis, which indeed in the past decades has recurrently been linked with depressive disorders16,17 and some cardiovascular risk factors.18,19 Integrating the above presented, this thesis will focus on the reciprocal associations between depression and the metabolic syndrome in older persons, taking herein into account a possible role for the HPA-axis. 12 | CHAPTER 1 Focus is given to older populations as both depressive symptoms and cardiovascular conditions are highly prevalent among the aged.20,21 In the current chapter, background information on issues relevant for this thesis will be given, finishing with a thesis outline. Aging In the Western world, the old and especially the oldest of the old comprise the fastest growing segment of our population. This is due to a decreasing trend in the number of children born as well as to dramatic changes in mortality leading to increased life expectancy. In the Netherlands, 14% of the population in 2007 was 65 years or older, of whom 25% was 80 years or older. It is expected that in 2050 even 24% of the Dutch population will be 65 years or older.21 Of this 65-plus population, 57% are women and, as life expectancy has consistently been higher for women than for men, this percentage is increasingly higher in older age groups.21 Consequently, in absolute terms aging is affecting women more than men. Aging has a profound impact on the individual. For the most part, individual aging is associated with many adverse changes in human anatomy and physiology. For a large part of adult life, people are normally provided with ‘biological’ reserves. In later life, these reserves are reduced, which can cause weakening of one or another biological function essential to life. As a result, conditions such as heart disease, cancer, respiratory infection, or osteoarthritis may arise. The biological age-related changes and the consequent development of degenerative and chronic conditions, have a large impact on the physical functioning and behaviors of older persons. The most important cause of morbidity and mortality at older age is cardiovascular disease.21 Depression, depressive symptoms and other psychosocial factors In the Netherlands, yearly about 6% of the adult population suffers from a depressive disorder,21 which is comparable to other countries across the world.22 Although the prevalence of depressive disorders is rather stable over years, the relative impact of depressive disorders on public health is enormous and increasing. According to the World Health