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. 2025 Jul;31(7):e70496.
doi: 10.1111/cns.70496.

Association Between Weight-Adjusted Waist Index and Depressive Symptoms Among Middle-Aged and Older Adults: Evidence From Two Prospective Longitudinal Cohort Studies

Xingjun Chen  1 , Jianming Xu  1 , Li Wen  1 , Haiyan Deng  1 , Xiaoxi Lu  1 , Guangyan Liu  1
Affiliations

Association Between Weight-Adjusted Waist Index and Depressive Symptoms Among Middle-Aged and Older Adults: Evidence From Two Prospective Longitudinal Cohort Studies

Xingjun Chen et al. CNS Neurosci Ther. 2025 Jul.

Abstract

Aim: The association between obesity and depression has been debated. This study aimed to explore the long-term relationship between the weight-adjusted waist index (WWI) and depression in different ethnic groups.

Methods: This prospective cohort study analyzed data from English Longitudinal Study on Aging (ELSA) and Health and Retirement Study (HRS). The exposure variable was the WWI at baseline, calculated by dividing the waist circumference (cm) by the square root of weight (kg). Depressive symptoms were assessed using the CESD-8. The longitudinal relationship between WWI and depression was analyzed using Cox proportional hazards and restricted cubic spline (RCS) regression models.

Results: During the 12-year follow-up period, depressive symptoms were observed in 55.1% of HRS patients (1851/3359) and 54.8% of ELSA patients (1810/3303). In fully adjusted Cox regression analysis, participants in the 4th quartile of the WWI exhibited a 33% elevated risk of depression (HR = 1.33, 95% CI: 1.15-1.54). Furthermore, the fully adjusted RCS regression model revealed a positive linear association between WWI and the risk of depression.

Conclusion: Our studies demonstrated a positive linear correlation between WWI and elevated risk of depression. Alterations in WWI have the potential to predict the occurrence of depression in middle-aged and elderly individuals.

Keywords: ELSA; HRS; aging; depression; prospective cohort study; weight‐adjusted waist index.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Flowchart of the screening of the study populations for HRS (A) and ELSA (B).
FIGURE 2
FIGURE 2
Subgroup analysis of the association between weight‐adjusted waist index and depression risk in the HRS (A) and ELSA (B) cohorts. Subgroups were defined based on sex, age, BMI, education level, smoking status, alcohol consumption, marital status, hypertension, and diabetes.
FIGURE 3
FIGURE 3
RCS regression analysis of the association between WWI and depression for HRS (A) and ELSA (B). The regression model adjusted for age, gender, smoking status, alcohol consumption, education level, marital status, height, systolic blood pressure, diastolic blood pressure, and diabetes.
See this image and copyright information in PMC

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