Mediating role of the weight-adjusted-waist index in the association between sedentary behavior and depression: A cross-sectional study

Abstract

Background Sedentary behavior and obesity are established risk factors for depression. The weight-adjusted-waist index (WWI) is a more accurate obesity measure than body mass index (BMI) or waist circumference (WC). This study aims to investigate if WWI mediates the effect of sedentary behavior on depression.

Methods Data on daily sitting times, WWI and depression symptoms assessed by the Patient Health Questionnaire-9 (PHQ-9) scores were analyzed for this study. WWI was calculated as WC divided by the square root of body weight. Depression was defined as a PHQ-9 score ≥ 10. We used weighted logistic regression and restricted cubic splines (RCS) to examine the linear and nonlinear effects of daily sitting time and WWI on depression. Mediation analysis was performed to determine if WWI mediates the relationship between daily sitting time and depression. Gender-stratified analysis was also conducted.

Results The study included 26,508 participants. Adjusted analyses showed positive associations of both daily sitting time (OR = 1.035, 95 % CI 1.015-1.056) and WWI (OR = 1.345, 95 % CI 1.226-1.476) with depression. Sitting > 8 h/day conferred higher depression risk versus < 4 h/day (OR = 1.268, 95 % CI 1.086-1.481). Similarly, the highest WWI quartile (Q4) had significantly greater risk than the lowest (Q1) (OR = 1.791, 95 % CI 1.429-2.245). WWI significantly mediated the sitting-depression relationship (proportion mediated: 0.075, 95 % CI 0.062-0.212, P < 0.001).

Conclusion Sedentary behavior and WWI both elevate depression likelihood. Furthermore, WWI partially mediates the effect of sedentary behavior on depression, and this mediation effect is independent of gender.

Keywords

Depression / Sedentary behavior / Weight-adjusted-waist index / Mediation analysis

CRediT authorship contribution statement

X.L. and W.J. conceptualized the project, developed the methodology, performed formal analysis, and wrote the original draft. Z.L. handled software development and data curation. P.Z. conducted formal analysis and created visualizations. Z.X. was responsible for validation. F.L. contributed to the investigation. W.Z. acquired funding. H.Z. provided supervision. L.L. managed writing, review and editing, project administration, and also acquired funding. All authors have read and approved the final version of the manuscript.

Consent for publication

Not applicable.

Ethics approval and consent to participate

The National Center for Health Statistics (NCHS) Research Ethics Review Board approved the NHANES survey protocol. All participants signed a written informed consent form. In addition, all information in the NHANES database is available to the public, and thus our research ethics review was exempt.

Funding

This work was supported by the Zhejiang Key Research Projects of Traditional Chinese Medicine (No. GZY-ZJ-KJ-23017) and “Pioneer” and “Leading Goose” R&D Programs of Zhejiang (No. 2024C03208).

Data availability

The datasets generated during the current study are available in database (https://www.cdc.gov/nchs/nhanes/).

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgements

Not applicable.

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