Dietary energy density: a mediator of depressive symptoms and abdominal obesity or independent predictor of abdominal obesity?

• Authors: Daurice Grossniklaus, Emory University; Sandra B Dunbar, Emory University; Rebecca A Gary, Emory University; Beth C. Tohill, Flagstaff; Jennifer K. Frediani, Emory University; Melinda K Higgins, Emory University
• Journal Title: European Journal of Cardiovascular Nursing
• Volume: Volume 11, Number 4
• Publisher: SAGE Publications | 2012-12-01, Pages 423-431
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.ejcnurse.2011.03.008
• Subjects: Health Sciences, Nursing; Health Sciences, General; Health Sciences, Nutrition
• Keywords: Science & Technology; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; Nursing; Cardiovascular System & Cardiology; Depressive symptoms; dietary energy density; waist circumference; abdominal obesity; BODY-MASS INDEX; UNITED-STATES; WAIST CIRCUMFERENCE; CLINICAL-PRACTICE; PRIMARY-CARE; US ADULTS; FOOD; ASSOCIATION; POPULATION; DISORDERS

Abstract

In the U.S., Europe, and throughout the world, abdominal obesity prevalence is increasing. Depressive symptoms may contribute to abdominal obesity through the consumption of diets high in energy density. To test dietary energy density ([DED]; kilocalories/gram of food and beverages consumed) for an independent relationship with abdominal obesity or as a mediator between depressive symptoms and abdominal obesity. This cross-sectional study included 87 mid-life, overweight adults; 73.6% women; 50.6% African-American. Variables and measures: Beck depression inventory-II (BDI-II) to measure depressive symptoms; 3-day weighed food records to calculate DED; and waist circumference, an indicator of abdominal obesity. Hierarchical regression tested if DED explained waist circumference variance while controlling for depressive symptoms and consumed food and beverage weight. Three approaches tested DED as a mediator. Nearly three-quarters of participants had abdominal obesity, and the mean waist circumference was 103.2 (SD 14.3) cm. Mean values: BDI-II was 8.67 (SD 8.34) which indicates that most participants experienced minimal depressive symptoms, and 21.8% reported mild to severe depressive symptoms (BDI-II ≥ 14); DED was 0.75 (SD 0.22) kilocalories/gram. Hierarchical regression showed an independent association between DED and waist circumference with DED explaining 7.0% of variance above that accounted for by BDI-II and food and beverage weight. DED did not mediate between depressive symptoms and abdominal obesity. Depressive symptoms and DED were associated with elevated waist circumference, thus a comprehensive intervention aimed at improving depressive symptoms and decreasing DED to reduce waist circumference is warranted.