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Diabetes Care 28:1265-1266, 2005
© 2005 by the American Diabetes Association, Inc.

Letters: Comments and Responses

Depressive Symptoms, Insulin Resistance, and Risk of Diabetes in Women at Midlife

Response to Everson-Rose et al.

Frans Pouwer, PHD1 and Peter de Jonge, PHD2,3

1 Diabetes Research Group, EMGO Institute, VU University Medical Center (FP), Amsterdam, the Netherlands
2 Department of Internal Medicine, University Groningen (PdJ), Groningen, the Netherlands
3 Department of Psychiatry, University Groningen (PdJ), Groningen, the Netherlands

Address correspondence to Dr. F. Pouwer, Diabetes Research Group, EMGO Institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, Netherlands. E-mail: f.pouwer{at}vumc.nl

We read with interest the article by Everson-Rose et al. (1), which indicated that depressive symptoms were associated with a greater risk of diabetes at 3-year follow-up. The authors discussed several mechanisms by which depression may contribute to subsequent insulin resistance and type 2 diabetes, in particular, excess cortisol and central adiposity, altered immune function, and behavioral factors such as compliance and physical activity.

In this letter, we would like to suggest two additional explanations for the findings of Everson-Rose et al. First, patients with and without significant depressive symptoms clearly differed at baseline in the homeostasis model assessment of insulin resistance, a difference that remained fairly constant over time instead of accelerating for the depressed group. Therefore, the reverse hypothesis suggesting that insulin resistance results in a higher risk for depression seems more likely.

Second, there may be shared factors that increase the risk for both type 2 diabetes and depression. Notably, an impaired fatty acid metabolism is related to depression and to features of the metabolic syndrome (2). Low consumption of {omega}-3 fatty acids is associated with hypertriglyceridemia, cardiovascular disease, insulin resistance, and type 2 diabetes (3–5). Moreover, lowered {omega}-3 levels have been reported in erythrocytes of patients with depression (6). {omega}-3 fatty acids also have anti-inflammatory effects, and three recent placebo-controlled trials have found {omega}-3 acid, in particular eicosapentaenoic acid, to be effective in reducing depression (7).

We conclude that in this intriguing field of research, careful attention should be given to accurate controlling for confounders. Specifically, the assessment of fatty acid intake and metabolism should be included in future studies on the associations between depression and features of the metabolic syndrome.

References

  1. Everson-Rose SA, Meyer PM, Powell LH, Pandey D, Torrens JI, Kravitz HM, Bromberger JT, Matthews KA: Depressive symptoms, insulin resistance, and risk of diabetes in women at midlife. Diabetes Care 27:2856–2862, 2004[Abstract/Free Full Text]
  2. Horrobin DF, Bennett CN: Depression and bipolar disorder: relationships to impaired fatty acid and phospholipid metabolism and to diabetes, cardiovascular disease, immunological abnormalities, cancer, ageing and osteoporosis. Possible candidate genes (Review). Prostaglandins Leukot Essent Fatty Acids 60:217–234, 1999[Medline]
  3. Weber P, Raederstorff D: Triglyceride-lowering effect of omega-3 LC-polyunsaturated fatty acids: a review. Nutr Metab Cardiovasc Dis 10:28–37, 2000[Medline]
  4. Kris-Etherton PM, Harris WS, Appel LJ: Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Circulation 106:2747–2757, 2002[Free Full Text]
  5. Hu FB, van Dam RM, Liu S: Diet and risk of type II diabetes: the role of types of fat and carbohydrate. Diabetologia 44:805–817, 2001[Medline]
  6. Maes M, Smith R, Christophe A, Cosyns P, Desnyder R, Meltzer H: Fatty acid composition in major depression: decreased omega 3 fractions in cholesteryl esters and increased C20: 4 omega 6/C20:5 omega 3 ratio in cholesteryl esters and phospholipids. J Affect Disord 38:35–46, 1996[Medline]
  7. Pouwer F, Nijpels G, Beekman ATF, Dekker JM, van Dam RM, Heine RJ, Snoek FJ: Fat food for a bad mood: could we treat and prevent depression in type 2 diabetes by means of omega-3 polyunsaturated fatty acids? A review. Diabet Med. In press

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This Article
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Right arrow Articles by de Jonge, P.
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