Systemic inflammation mediates the association between environmental tobacco smoke and depressive symptoms: A cross-sectional study of NHANES 2009-2018

Guochen Ma; Ye Tian; Jing Zi; Yifan Hu; Haoqi Li; Yaxian Zeng; Hang Luo; Jingyuan Xiong

doi:10.1016/j.jad.2023.12.060

Systemic inflammation mediates the association between environmental tobacco smoke and depressive symptoms: A cross-sectional study of NHANES 2009-2018

J Affect Disord. 2024 Mar 1:348:152-159. doi: 10.1016/j.jad.2023.12.060. Epub 2023 Dec 28.

Authors

Guochen Ma¹, Ye Tian¹, Jing Zi¹, Yifan Hu¹, Haoqi Li¹, Yaxian Zeng¹, Hang Luo¹, Jingyuan Xiong²

Affiliations

¹ Department of Occupational and Environmental Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China.
² Department of Occupational and Environmental Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China; Healthy Food Evaluation Research Center, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China; Food Safety Monitoring and Risk Assessment Key Laboratory of Sichuan Province, Chengdu 610041, China. Electronic address: jzx0004@tigermail.auburn.edu.

PMID: 38158048
DOI: 10.1016/j.jad.2023.12.060

Abstract

Background: Depression is associated with both environmental tobacco smoke (ETS) and inflammation. However, whether systemic inflammation mediates the ETS-depression relationship is unclear.

Methods: We analyzed 19,612 participants from the 2009-2018 National Health and Nutrition Examination Survey (representing approximately 206,284,711 USA individuals), utilizing data of depressive symptoms (assessed by Patient Health Questionnaire-9), blood cotinine level (an ETS biomarker), dietary inflammatory index (DII, assessed by 24-h dietary recall) and inflammation, represented by immune-inflammation index (SII) and systemic inflammation response index (SIRI).

Results: Weighted multivariable logistic regression showed that a higher blood cotinine level is significantly associated with a higher depressive symptoms risk (OR = 1.79, 1.35-2.38). After adjusting for covariates, the effect in smokers (OR = 1.220, 95 % CI: 1.140-1.309) is larger than that in non-smokers (OR = 1.150, 95 % CI: 1.009-1.318). Compared to the lowest level, depressive symptoms risks in participants with the highest level of SII, SIRI and DII are 19 % (OR = 1.19, 1.05-1.35), 15 % (OR = 1.15, 1.01-1.31) and 88 % (OR = 1.88, 1.48-2.39) higher, respectively. Weighted linear regression demonstrated positive correlations of SII (β = 0.004, 0.001-0.006), SIRI (β = 0.009, 0.005-0.012) and DII (β = 0.213, 0.187-0.240) with blood cotinine level. Restricted cubic splines model showed a linear dose-response relationship between blood cotinine and depressive symptoms (P_non-linear = 0.410), with decreasing risk for lower DII. And SII and SIRI respectively mediate 0.21 % and 0.1 % of the association between blood cotinine and depressive symptoms.

Limitation: Cross-sectional design, and lack of medication data for depression.

Conclusions: Positive association of ETS (blood cotinine) with depressive symptoms risk is partly mediated by systemic inflammation, and anti-inflammatory diet could be beneficial.

Keywords: Cotinine; DII; Depressive symptoms; Environmental tobacco smoke; Inflammation; SII.

MeSH terms

Cotinine / analysis
Cross-Sectional Studies
Depression / epidemiology
Humans
Inflammation / epidemiology
Nutrition Surveys
Tobacco Smoke Pollution* / adverse effects

Substances

Tobacco Smoke Pollution
Cotinine