Association between anthropometric indices and mortality risk among individuals with depression: A population-based cohort study

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Abstract
Background: Few studies have explored the associations of body mass index and waist circumference with mortality risk in patients with depression. In particular, the emergence of the obesity paradox in recent years has drawn renewed attention to the potential relationship between overweight or obesity and mortality across different populations. Objective: This study aimed to investigate the associations of body mass index and waist circumference with mortality risk in individuals with depression. Methods: This was a population-based retrospective cohort study, and participants with a body mass index 2 (underweight) were excluded from the analyses. Weighted Cox regression analyses were conducted to examine the associations of body mass index and waist circumference with mortality risk in individuals with depression. Restricted cubic spline models were applied to evaluate the dose–response relationships of body mass index and waist circumference with mortality. Subgroup analyses were further conducted to explore variations in these associations across different populations, along with interaction tests to assess potential effect modification. Results: Weighted Cox regression analysis showed that compared with individuals with a normal body mass index, those who were overweight or obese had a 53% (Model 3: hazard ratio = 0.47, 95% confidence interval: 0.29–0.76, p = 0.002) and 58% (hazard ratio = 0.42, 95% confidence interval: 0.27–0.67, p < 0.001) lower risk of all-cause mortality, respectively. Similar results were observed when waist circumference was used as the covariate for analysis, with participants in the abdominal obesity group showing a significantly lower risk of mortality than those with normal waist circumference (Model 3: hazard ratio = 0.58, 95% confidence interval: 0.37–0.89, p = 0.01). In the combined analysis of body mass index and waist circumference, compared with participants with normal values for these parameters, those who were overweight and had a high waist circumference had a 55% lower mortality risk (hazard ratio = 0.45, 95% confidence interval: 0.26–0.80, p = 0.01). Similarly, participants who were obese and had a high waist circumference had a 59% lower mortality risk (hazard ratio = 0.41, 95% confidence interval: 0.25–0.69, p < 0.001). Conclusions: We found that both body mass index and waist circumference were inversely associated with mortality risk in individuals with depression, and this inverse association remained robust even when body mass index and waist circumference were jointly analyzed according to their respective categories.

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