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Psychosomatic Medicine 67:407-412 (2005)
© 2005 American Psychosomatic Society

ORIGINAL ARTICLES

Visceral Fat Deposition and Insulin Sensitivity in Depressed Women With and Without Comorbid Borderline Personality Disorder

Kai G. Kahl, MD, Maxim Bester, MD, Wiebke Greggersen, MD, Sebastian Rudolf, MD, Leif Dibbelt, MD, Beate M. Stoeckelhuber, MD, Hans-Björn Gehl, MD, Valerija Sipos, MD, Fritz Hohagen, MD and Ulrich Schweiger, MD

From the Department of Psychiatry and Psychotherapy (K.G.K., M.B., W.G., S.R., V.S., F.H., U.S.), Institute of Radiology (B.M.S.), Institute of Clinical Chemistry (L.D.), University of Luebeck, Germany.

Address correspondence and reprint requests to Kai G. Kahl, MD, Klinik für Psychiatrie und Psychotherapie, Universität zu Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany. E-mail: kahl.k{at}psychiatry.uni-luebeck.de

Objective: Major depressive disorder (MDD) is associated with increased intra-abdominal fat, an important antecedent of noninsulin-dependent diabetes mellitus (NIDDM) and cardiovascular disorders. Furthermore, MDD is commonly accompanied by endocrine and immune dysregulation that has also been discussed in connection with the pathogenesis of NIDDM and ischemic heart disease. In borderline personality disorder (BPD), a dysregulation of the hypothalamic–pituitary–adrenal system has also been described. Therefore, our study aimed at examining visceral fat, insulin resistance, and alterations of cortisol and cytokines in young depressed women with and without comorbid BPD.

Methods: Visceral fat was measured in 18 premenopausal women with MDD and in 18 women comorbid with MDD and BPD by means of magnetic resonance tomography at the level of the first lumbar vertebral body. Twelve BPD patients without MDD and 20 healthy women served as the comparison groups. Concentrations of fasting cortisol, tumor necrosis factor-{alpha}, and interleukin-6 were measured, and indicators of insulin resistance and ß-cell sensitivity were calculated according to the homeostasis assessment model.

Results: We found increased visceral fat in women comorbid with MDD and BPD, and to a lesser extent, in women with MDD but without BPD. Insulin sensitivity was reduced in comorbid patients. Serum interleukin-6 (IL-6) and tumor necrosis factor-{alpha} concentrations were significantly increased in both groups of depressed patients. Reduced insulin sensitivity correlated with the amount of visceral fat and with serum concentrations of IL-6.

Conclusion: Young depressed women with and without comorbid BPD display increased visceral fat and may constitute a risk group for the development of NIDDM and the metabolic syndrome. Our data support the hypothesis that the immune and endocrine alterations associated with MDD and BPD may contribute to the pathophysiologic processes associated with NIDDM.

Key Words: major depressive disorder • borderline personality disorder • hypothalamic–pituitary–adrenal system • interleukin-6 • tumor necrosis factor-{alpha}

Abbreviations: BMI = body mass index; BPD = borderline personality disorder; ES = effect size; HOMA = homeostasis model assessment (-IR: insulin resistance; –S: ß-cell sensitivity); IL-6 = interleukin-6; MDD = major depressive disorder; NIDDM = noninsulin-dependent diabetes mellitus; TNF-{alpha} = tumor necrosis factor-{alpha}; VF/L = visceral fat at the level of the first lumbar vertebral body (VF/L1-: 10 mm below L1; VF/L1+ = 10 mm above L1).




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