Table 1 Characteristics of the studies on the association between obesity phenotypes with mental health and quality of life
From: Mental health and quality of life in different obesity phenotypes: a systematic review
First author (Reference No) | Year of publication | Study design | No of participants (sex) | Age of participants | Exposure assessment | Outcome assessment | Main finding |
|---|---|---|---|---|---|---|---|
Mehrabi [8] | 2021 | Cross-sectional | 2469 (male and female) | 46.2 ± 15.9 | Obesity was defined as BMI ≥ 30 kg/m2, and MUH status based on having MetS or T2DM | Emotional states were assessed by the Persian version of DASS-21 | Men and women with various obesity phenotypes experienced different anxiety and stress levels. While MUHO women and all MUH men experienced more anxiety and stress levels than MHNO individuals, none of the obesity phenotypes were associated with depression |
Portugal-Nunes [24] | 2021 | Cross-sectional | 101 (male and female) | 64 ± 8.46 | The anthropometric measures included weight (Kg), height (m), and abdominal perimeter (cm). FBG, fasting insulin, TG, and HDL were measured | Mood was assessed by the Geriatric Depression Scale (GDS, long-version) | The association of metabolic dysfunction with depressive mood is influenced by age |
Park and Lee [29] | 2021 | Cross-sectional | 288,044 (male and female) | ≥ 18 years | The MUH group was defined as those who have one of the following characteristics: FBG > 100 mg/dL or current use of hypoglycemic medication, BP ≥ 130/85 mmHg or current use of BP medication, TG ≥ 150 mg/dL or the use of antilipidemic medication, low HDL-C (< 40 mg/dL for men and < 50 mg/dL for women), and HOMA-IR score ≥ 2.5. MH was defined as those who do not meet the above criteria | Depression was assessed by the CES-D scale | The metabolic phenotype exerts a direct influence on emotional problems. Metabolic health may be used as an indicator of mental health |
Kim [1] | 2020 | Cross-sectional | 6057 (male and female) | ≥ 20 years | Normal weight or obese was assessed by BMI. MUH status was defined as the presence of any three or more of the revised NCEP-ATP III definitions of MetS | Psychiatric symptoms including sleep time, stress, depression, suicide thoughts, were assessed by asking the related questions. Health related quality of life was evaluated by the EQ-5D | With or without metabolic abnormalities, obesity is associated with mental health problems and decreased quality of life |
Seo [25] | 2020 | Longitudinal | 3,586,492 adult individuals (male and female) | 40–70 years | Obesity was defined as BMI ≥ 25 kg/m2 and MH as MetS risk < 2 | Depression was determined by a recording of ICD-10 codes F32.0 to F34.9 on health insurance data or the taking of antidepressant | MUHO has a higher risk of depressive symptoms than MHN. Furthermore, in women participants, MHO is also related to a higher risk of depressive symptoms. MHO is not a totally benign condition in relation to depression in women |
Imbiriba [26] | 2020 | Cross-sectional | 2371 (male and female) | 49.6 ± 7.1 years | Metabolic profile classification was based on the Third NHANES criteria for anthropometric–metabolic profiles | Mental health data were collected through the Portuguese version of the CIS-R | There was a significant association between low skill discretion and an adverse metabolic profile in models adjusted for age, sex and race. No associations were significant between job stress domains and the metabolic profile of obese individuals in full models |
Delgado [23] | 2018 | Cross-sectional | 125 (100 obese, 25 non-obese) (male and female) | Obese subjects: 39.5 (10.5) years Non-obese subjects: 39.9 (10.4) years | MUO was defined as obesity associated with two or more metabolic alterations, including low HDL, hypertriglyceridemia, high FBG and hypertension | Depression was assessed using the Montgomery-Asberg Depression Rating Scale (MADRS) and Mini-International Neuropsychiatric Interview (MINI) | Inclusion of inflammation in the definition of MUO drives the association found between poor metabolic health and depressive symptoms |
Amiri [32] | 2018 | Cross-sectional | 2880 (male and female) | > 19 years | Weight status was assessed by BMI. Based on the JIS definition, metabolic syndrome is defined as the presence of any 3 of the following five risk factors: (1) abdominal obesity; (2) reduced HDL-C < 50 mg/dl in women, < 40 in men or on drug treatment; (3) high TG levels ≥ 150 mg/dl or on drug treatment; (4) high BP or drug treatment; (5) high FBG ≥ 100 mg/dl or on drug treatment | HRQoL was assessed using the Short-Form 12-Item Health Survey version 2 (SF-12v2) | Compared to those with normal weight normal metabolic status, only obese dysmetabolic individuals were more likely to report poor physical HRQoL in both genders |
Yosaee [27] | 2018 | Cross-sectional | 157 adult subjects (male and female) | 20–55 years | MUHO, MHO and non-obese metabolically healthy, diagnosed according to the NCEP-ATP III criteria and BMI | Depressive symptoms assessed by BDI | MHO was a benign phenotype in relation to depression |
Truthmann [22] | 2017 | Cross-sectional | 3298 subjects (male and female) | 18–79 years | MHNO, MUNO, MHO, and MUO were defined by ATPIII criteria and BMI | Physical HRQoL was measured by the Short Form-36 version 2 PCS score | Obesity was significantly related to lower physical HRQoL, independent of metabolic health status, especially among women |
Hinnouho [30] | 2017 | Longitudinal | 14,475 subjects (male and female) | 44–59 years | Obesity was defined as BMI ≥ 30 kg/m2 and metabolic health as having none of the self-reported following CV risk factors: hypertension, T2DM and dyslipidemia | Depressive symptoms were assessed by the Center For CES-D scale | Poor metabolic health, irrespective of BMI was associated with more depression at the baseline, whereas a poorer course of depression over time was observed only in those with both obesity and poor metabolic health |
Lopez-Garcia [5] | 2017 | Longitudinal | 4397 individuals (male and female) | ≥ 18 years | Weight was assessed by BMI. Two metabolic statuses 9 were defined: healthy (0–1 CA) and unhealthy (≥ 2 CA) | HRQoL was measured with the PCS and the MCS of the SF-12 questionnaire | Both obesity and CA should be addressed to improve HRQoL |
Donini [4] | 2016 | Cross-sectional | 253 subjects (male and female) | 18–65 years | MHO and MUO were defined based on the absence or the presence of the MetS, respectively. PA was assessed by IPAQ questionnaire | HRQoL was measured with the SF-12 questionnaire | The metabolic comorbidity and the impairment of functional ability and psycho-social functioning may have a different timing in the natural history of obesity |
Yang [12] | 2016 | Cross-sectional | 6217 men and 8243 women | Over 30Â years | Metabolic abnormality was defined by the criteria of the NCEP-ATP III | HRQoL was evaluated using the EQ-5D questionnaire | The MANW is the least favorable state of HRQoL for men. In women, the MUHO and MHO groups had the most adversely affected HRQoL |
Phillips and Perry [7] | 2015 | Cross-sectional | 2047 middle-aged male and female | 50–69 years | MH was defined by three definitions based on a range of CA including MetS criteria, insulin resistance and inflammation | Depression, anxiety and well-being were assessed using the CES-D, the HADS and the WHO-5 Well Being Index | A favourable metabolic profile is positively related to mental health in obese middle-aged adults, but findings were dependent on MH definition |
Hamer [28] | 2012 | Longitudinal | 3851 subjects (male and female) | 63.0 ± 8.9 years | Based on BP, HDL, TG, glycated haemoglobin, and CRP, subjects were classified as ‘MH’ (0 or 1 metabolic abnormality) or ‘MU’ (≥ 2 metabolic abnormalities) | Depressive symptoms were assessed using the 8-item CES-D scale | The association between obesity and risk of depressive symptoms seems to be partly dependent on metabolic health |
Ul-Haq [31] | 2012 | Cross-sectional | 5608 subjects (male and female) | ≥ 20 years | Metabolic comorbidity was defined as the presence of one or more of these conditions: diabetes, HTN, hypercholesterolemia or CVD | HRQoL was evaluated using the Scottish Health Survey | The adverse impact of obesity on HRQoL is greater among individuals with metabolic comorbidity |
Tsai [6] | 2008 | Cross-sectional | 361 overweight and obese subjects (male and female) | No MetS: 44.9 ± 10.0 MetS: 48.2 ± 9.5 | The presence of MetS was assessed using the NCEP criteria | HRQoL was measured with the SF-36 questionnaire. Depression was assessed using the BDI | Individuals with MetS reported lower HRQoL. This appeared to be an effect of increased weight, rather than a unique effect of MetS |