Annals of Behavioral Medicine

, Volume 34, Issue 3, pp 240–252 | Cite as

Are psychological characteristics related to risk of the metabolic syndrome? A review of the literature

  • Edie M. Goldbacher
  • Karen A. Matthews


Backround: We evaluate the evidence that depression, anger, hostility, and anxiety are related to risk for the metabolic syndrome, focusing as well on its components of central adiposity and insulin resistance. In addition, we identify possible moderators of these associations and summarize plausible underlying biobehavioral pathways.Methods: Medline, PsycINFO, PubMed, and Web of Science searches were conducted using the keywords metabolic syndrome, syndrome x, central adiposity/obesity, visceral adiposity/obesity, body fat distribution, waist circumference, waist hip ratio, insulin resistance/sensitivity, glucose tolerance, psychological, depression, hostility, anger, cynicism, and anxiety.Results: The current literature provides cross-sectional evidence for an association between psychological characteristics and the metabolic syndrome. Prospective data, though limited, suggest that depression, hostility, and anger predict increased risk for the metabolic syndrome. Data on modifiers are too limited to permit definitive conclusions. Negative health behaviors and hypothalamic and sympathetic dysregulation are identified as plausible underlying pathways.Conclusions: More prospective studies, conducted with diverse samples, are needed to delineate the direction of this relationship and the proposed biobehavioral mechanisms; experimental investigations are needed to test for causality. Nevertheless, findings suggest that psychological characteristics, especially depression, hostility, and anger, may increase risk for the metabolic syndrome, providing a novel direction for prevention and treatment interventions.


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  1. (1).
    Alberti KG, Zimmet P: Definition, diagnosis, and classification of diabetes mellitus and its complications. Part I: Diagnosis and classification of diabetes mellitus provisional report of a WHO consultation.Diabetic Medicine. 1998,15:539–553.PubMedCrossRefGoogle Scholar
  2. (2).
    Grundy S, Cleeman J, Daniels S, et al.: Diagnosis and management of the metabolic syndrome. An American Heart Association/National Heart, Lung, and Blood Institute scientific statement.Circulation. 2005,112:2735–2752.PubMedCrossRefGoogle Scholar
  3. (3).
    Alberti KG, Zimmet P, Shaw J: The metabolic syndrome—A new worldwide definition.Lancet. 2005,366:1059–1062.PubMedCrossRefGoogle Scholar
  4. (4).
    Despres J, Lemieux S: Abdominal obesity and metabolic syndrome.Nature. 2006,444:881–887.PubMedCrossRefGoogle Scholar
  5. (5).
    Egan BM, Greene EL, Goodfriend TL: Insulin resistance and cardiovascular disease.American Journal of Hypertension. 2001,14:116S-125S.PubMedCrossRefGoogle Scholar
  6. (6).
    Engeli S, Schling P, Gorzelniak K, et al.: The adiposetissue renin-angiotensin-aldosterone system: Role in the metabolic syndrome?The International Journal of Biochemistry & Cell Biology. 2003,35:807–825.CrossRefGoogle Scholar
  7. (7).
    Gami A, Witt B, Howard D, et al.: Metabolic syndrome and risk of incident cardiovascular events and death.Journal of the American College of Cardiology. 2007,49:403–414.PubMedCrossRefGoogle Scholar
  8. (8).
    Shen B-J, Todaro JF, Niaura R, et al.: Are metabolic risk factors one unified syndrome? Modeling the structure of the Metabolic Syndrome X.American Journal of Epidemiology. 2003,157:701–711.PubMedCrossRefGoogle Scholar
  9. (9).
    Pladevall M, Singal B, Williams L, et al.: A single factor underlies the metabolic syndrome. A confirmatory factor analysis.Diabetes Care. 2006,29:113–122.PubMedCrossRefGoogle Scholar
  10. (10).
    Ford ES: Prevalence of the metabolic syndrome defined by the international diabetes federation among adults in the U.S.Diabetes Care. 2005,28:2745–2749.PubMedCrossRefGoogle Scholar
  11. (11).
    Everson-Rose S, Lewis T: Psychosocial factors and cardiovascular diseases.Annual Review of Public Health. 2005,26:469–500.PubMedCrossRefGoogle Scholar
  12. (12).
    Musselman DL, Betan E, Larsen H, Phillips LS: Relationship of depression to diabetes types 1 and 2: Epidemiology, biology, and treatment.Biological Psychiatry. 2003,54:317–329.PubMedCrossRefGoogle Scholar
  13. (13).
    Vicennati V, Pasquali R: Abnormalities of the hypothalamic-pituitary-adrenal axis in nondepressed women with abdominal obesity and relations with insulin resistance: Evidence for a central and a peripheral alteration.Journal of Clinical Endocrinology and Metabolism. 2000,85:4093–4098.PubMedCrossRefGoogle Scholar
  14. (14).
    Giorgino F, Laviola L, Eriksson JW: Regional differences of insulin action in adipose tissue: Insights from in vivo and in vitro studies.Acta Physiologica Scandinavia. 2005,183:13–30.CrossRefGoogle Scholar
  15. (15).
    Brunner EJ, Hemingway H, Walker BR, et al.: Adrenocortical, autonomic, and inflammatory causes of the metabolic syndrome: Nested case-control study.Circulation. 2002,106:2659–2665.PubMedCrossRefGoogle Scholar
  16. (16).
    Bjorntorp P, Rosmond R: Hypothalamic origin of the metabolic syndrome X.Annals of the New York Academy of Sciences. 1999,892:297–307.PubMedCrossRefGoogle Scholar
  17. (17).
    Bjorntorp P: Do stress reactions cause abdominal obesity and comorbidities?Obesity Reviews. 2001,2:73–86.PubMedCrossRefGoogle Scholar
  18. (18).
    Samaras K, Campbell LV: The non-genetic determinants of central adiposity.International Journal of Obesity. 1997,21:839–845.PubMedCrossRefGoogle Scholar
  19. (19).
    Han TS, Bijnen FCH, Lean MEJ, Seidell JC: Separate associations of waist and hip circumference with lifestyle factors.International Journal of Epidemiology. 1998,27:422–430.PubMedCrossRefGoogle Scholar
  20. (20).
    Marshall JA, Bessesen DH, Hamman RF: High saturated fat and low starch and fiber are associated with hyperinsulinemia in a non-diabetic population: The San Luis Valley Diabetes Study.Diabetologica. 1997,40:430–438.CrossRefGoogle Scholar
  21. (21).
    Godsland IF, Leyvan F, Walton C, Worthington M, Stevenson JC: Associations of smoking, alcohol and physical activity with risk factors for coronary heart disease and diabetes in the first follow-up cohort of the Heart Disease and Diabetes Risk Indicators in a Screened Cohort study (HDDRISC-1).Journal of Internal Medicine. 1998,244:33–41.PubMedCrossRefGoogle Scholar
  22. (22).
    Mensink M, Blaak EE, Corpeleijn E, et al.: Lifestyle intervention according to general recommendations improves glucose tolerance.Obesity Research. 2003,11:1588–1596.PubMedCrossRefGoogle Scholar
  23. (23).
    Park YW, Zhu S, Palaniappa L, et al.: The metabolic syndrome: prevalence and associated risk factor findings in the US population from the Third National Health and Nutrition Examination Survey.Archives of Internal Medicine. 2003,163:427–436.PubMedCrossRefGoogle Scholar
  24. (24).
    Orchard TJ, Temprosa M, Goldberg R, et al.: The effect of metformin and intensive lifestyle intervention on the metabolic syndrome: The Diabetes Prevention Program randomized trial.Annals of Internal Medicine. 2005,142:611–619.PubMedGoogle Scholar
  25. (25).
    Schneiderman N, Skyler JS: Insulin metabolism, sympathetic nervous system regulation, and coronary heart disease prevention. In Orth-Gomer K, Schneiderman N (eds),Behavioral Medicine Approaches to Cardiovascular Disease Prevention. Mahwah, NJ: Lawrence Erlbaum, 1995, 105–134.Google Scholar
  26. (26).
    Smith TW: Concepts and methods in the study of anger, hostility, and health. In Siegman AW, Smith TW (eds),Anger, Hostility, and the Heart. Hillsdale, NJ: Lawrence Erlbaum Associates, 1994, 23–42.Google Scholar
  27. (27).
    Gallo LC, Smith TW: Construct validation of health-relevant personality traits: Interpersonal circumplex and five-factor model analyses of the Aggression Questionnaire.International Journal of Behavioral Medicine. 1997,5:129–147.CrossRefGoogle Scholar
  28. (28).
    Barlow DH:Anxiety and Its Disorders. New York: Guilford, 1988.Google Scholar
  29. (29).
    Kubzansky LD, Kawachi I, Weiss ST, Sparrow D: Anxiety and coronary heart disease: A synthesis of epidemiological, psychological, and experimental evidence.Annals of Behavioral Medicine. 1998,20:47–58.PubMedCrossRefGoogle Scholar
  30. (30).
    Rubin RR, Peyrot M: Psychological issues and treatments for people with diabetes.Journal of Clinical Psychology. 2001,57:457–478.PubMedCrossRefGoogle Scholar
  31. (31).
    Raikkonen K, Matthews KA, Kuller LH: The relationship between psychological risk attributes and the metabolic syndrome in healthy women: Antecedent or consequence?Metabolism. 2002,51:1573–1577.PubMedCrossRefGoogle Scholar
  32. (32).
    Raikkonen K, Matthews KA, Kuller LH: Depressive symptoms and stressful life events predict metabolic syndrome among middle-aged women.Diabetes Care. 2007,30:872–877.PubMedCrossRefGoogle Scholar
  33. (33).
    McCaffery JM, Niaura R, Todaro JF, Swan GE, Carmelli D: Depressive symptoms and metabolic risk in adult male twins enrolled in the National Heart, Lung, and Blood Institute Twin Study.Psychosomatic Medicine. 2003,65:490–497.PubMedCrossRefGoogle Scholar
  34. (34).
    Skilton M, Moulin P, Terra J, Bonnet F: Associations between anxiety, depression, and the metabolic syndrome.Biological Psychiatry (in press, 2007).Google Scholar
  35. (35).
    Kinder LS, Carnethon MR, Palaniappa L, King AC, Fortman SP: Depression and the metabolic syndrome in young adults: Findings from the Third National Health and Nutrition Examination Survey.Psychosomatic Medicine. 2004,66:316–322.PubMedCrossRefGoogle Scholar
  36. (36).
    Heiskanen TH, Niskanen LK, Hintikka JJ, et al.: Metabolic syndrome and depression: A cross-sectional analysis.Journal of Clinical Psychiatry. 2006,67:1422–1427.PubMedCrossRefGoogle Scholar
  37. (37).
    Herva A, Rasanen P, Miettunen J, et al.: Co-occurrence of metabolic syndrome with depression and anxiety in young adults: The Northern Finland 1966 Birth Cohort Study.Psychosomatic Medicine. 2006,68:213–216.PubMedCrossRefGoogle Scholar
  38. (38).
    Weber-Hamann B, Werner M, Hentschel F, et al.: Metabolic changes in elderly patients with major depression: Evidence for increased accumulation of visceral fat a follow-up.Psychoneuroendocrinology. 2006,31:347–354.PubMedCrossRefGoogle Scholar
  39. (39).
    Miller GE, Freedland KE, Carney RM, Stetler CA, Banks WA: Pathways linking depression, adiposity, and inflammatory markers in healthy young adults.Brain, Behavior, and Immunity. 2003,17:276–285.PubMedCrossRefGoogle Scholar
  40. (40).
    Eskandari F, Mistry S, Martinez P, et al.: Younger, premenopausal women with major depressive disorder have more abdominal fat and increased serum levels of prothrombotic factors: Implications for greater cardiovascular risk. The POWER Study.Metabolism Clinical and Experimental. 2005,54:918–924.PubMedGoogle Scholar
  41. (41).
    Kahl KG, Bester M, Greggersen W, et al.: Visceral fat deposition and insulin sensitivity in depressed women with and without comorbid borderline personality disorder.Psychosomatic Medicine. 2005,67:407–412.PubMedCrossRefGoogle Scholar
  42. (42).
    Hach I, Ruhl U, Klotsche J, Klose M, Jacobi F: Associations between waist circumference and depressive disorders.Journal of Affective Disorders. 2006,92:305–308.PubMedCrossRefGoogle Scholar
  43. (43).
    Weber-Hamann B, Hentschel F, Kniest A, et al.: Hypercortisolemic depression is associated with increased intra-abdominal fat.Psychosomatic Medicine. 2002,64:274–277.PubMedGoogle Scholar
  44. (44).
    Amsterdam JD, Schweizer E, Winokur A: Multiple hormonal responses to insulin-induced hypoglycemia in depressed patients and normal volunteers.American Journal of Psychiatry. 1987,144:170–175.PubMedGoogle Scholar
  45. (45).
    Amsterdam JD, Maislin G: Hormonal responses during insulin-induced hypoglycemia in manic-depressed, unipolar depressed, and healthy control subjects.Journal of Clinical Endocrinology and Metabolism. 1991,73:541–548.PubMedCrossRefGoogle Scholar
  46. (46).
    Koslow SH, Stokes PE, Mendels J, Ramsey A, Casper R: Insulin tolerance test: Human growth hormone response and insulin resistance in primary unipolar depressed, bipolar depressed and control subjects.Psychological Medicine. 1982,12:45–55.PubMedCrossRefGoogle Scholar
  47. (47).
    Weber B, Schweiger U, Deuschle M, Heuser I: Major depression and impaired glucose tolerance.Experimental and Clinical Endocrinology and Diabetes. 2000,3:187–190.CrossRefGoogle Scholar
  48. (48).
    Nelson TL, Palmer RF, Pedersen NL, Miles TP: Psychological and behavioral predictors of body fat distribution: Age and gender effects.Obesity Research. 1999,7:199–207.PubMedGoogle Scholar
  49. (49).
    Raikkonen K, Matthews KA, Kuller LH: Anthropometric and psychosocial determinants of visceral obesity in healthy postmenopausal women.International Journal of Obesity. 1999,23:775–782.PubMedCrossRefGoogle Scholar
  50. (50).
    Herva A, Laitinen J, Miettunen J, et al.: Obesity and depression: results from the longitudinal Northern Finland 1996 Birth Cohort Study.International Journal of Obesity. 2006,30:520–527.PubMedCrossRefGoogle Scholar
  51. (51).
    Ahlberg A, Ljung T, Rosmond R, et al.: Depression and anxiety symptoms in relation to anthropometry and metabolism in men.Psychiatry Research. 2002,112:101–110.PubMedCrossRefGoogle Scholar
  52. (52).
    Haukkala A, Uutela A: Cynical hostility, depression, and obesity: The moderating role of education and gender.International Journal of Eating Disorders. 2000,27:106–109.PubMedCrossRefGoogle Scholar
  53. (53).
    Wing RR, Matthews KA, Kuller LH, Meilahn EN, Plantinga P: Waist to hip ratio in middle-aged women. Associations with behavioral and psychosocial factors and with changes in cardiovascular risk factors.Arteriosclerosis and Thrombosis. 1991,11:1250–1257.PubMedGoogle Scholar
  54. (54).
    Lee E, Kim Y, Beck S, Lee S, Oh S: Depressive mood and abdominal fat distribution in overweight premenopausal women.Obesity Research. 2005,13:320–325.PubMedCrossRefGoogle Scholar
  55. (55).
    Cota D, Vicennati V, Ceroni AM, Morselli-Labate AM, Pasquali R: Relationship between socio-economic and cultural status, psychological factors and body fat distribution in middle-aged women living in Northern Italy.Eating and Weight Disorders. 2001,6:205–213.PubMedGoogle Scholar
  56. (56).
    Everson-Rose SA, Meyer PM, Powell LH, et al.: Depressive symptoms, insulin resistance, and risk for diabetes in women at mid-life.Diabetes Care. 2004,27:2856–2862.PubMedCrossRefGoogle Scholar
  57. (57).
    Suarez EC: Sex differences in the relation of depressive symptoms, hostility, and anger expression to indices of glucose metabolism in nondiabetic adults.Health Psychology. 2006,25:484–492.PubMedCrossRefGoogle Scholar
  58. (58).
    Raikkonen K, Keltikangas-Jarvinen L, Hautanen A: The role of psychological coronary risk factors in insulin and glucose metabolism.Journal of Psychosomatic Research. 1994,38:705–713.PubMedCrossRefGoogle Scholar
  59. (59).
    Timonen M, Rajala U, Jokelainen J, et al.: Depressive symptoms and insulin resistance in young adult males: Results from the Northern Finland 1966 birth cohort.Molecular Psychiatry. 2006,11:929–933.PubMedCrossRefGoogle Scholar
  60. (60).
    Raikkonen K, Matthews KA, Sutton-Tyrrell K, Kuller LH: Trait anger and the metabolic syndrome predict progression of carotid atherosclerosis in healthy middle-aged women.Psychosomatic Medicine. 2004,66:903–908.PubMedCrossRefGoogle Scholar
  61. (61).
    Vitaliano PP, Scanlan JM, Zhang J, et al.: A path model of chronic stress, the metabolic syndrome, and coronary heart disease.Psychosomatic Medicine. 2002,64:418–435.PubMedGoogle Scholar
  62. (62).
    Raikkonen K, Matthews KA, Kuller LH, Reiber C, Bunker CH: Anger, hostility, and visceral adipose tissue in healthy postmenopausal women.Metabolism. 1999,48:1146–1151.PubMedCrossRefGoogle Scholar
  63. (63).
    Naerde A, Roysamb E, Tambs K: Temperament in adults—reliability, stability, and factor structure of the EAS Temperament Survey.Journal of Personality Assessment. 2004,82:71–79.PubMedCrossRefGoogle Scholar
  64. (64).
    Vitaliano PP, Scanlan JM, Krenz C, Fujimoto W: Insulin and glucose: Relationships with hassles, anger, and hostility in nondiabetic older adults.Psychosomatic Medicine. 1996,58:489–499.PubMedGoogle Scholar
  65. (65).
    Mueller WH, Meininger JC, Liehr P, Chandler PS, Chan W: Adolescent blood pressure, anger expression and hostility: Possible links with body fat.Annals of Human Biology. 1998,25:295–307.PubMedCrossRefGoogle Scholar
  66. (66).
    Raikkonen K, Matthews KA, Salomon K: Hostility predicts the metabolic syndrome risk factors in children and adolescents.Health Psychology. 2003,22:279–286.PubMedCrossRefGoogle Scholar
  67. (67).
    Ravaja N, Keltikangas-Jarvinen L, Keskivaara P: Type A factors as predictors of changes in the metabolic syndrome precursors in adolescents and young adults: A 3-year follow-up.Health Psychology. 1996,15:18–29.PubMedCrossRefGoogle Scholar
  68. (68).
    Nelson TL, Palmer RF, Pedersen NL: The metabolic syndrome mediates the relationship between cynical hostility and cardiovascular disease.Experimental Aging Research. 2004,30:163–177.PubMedCrossRefGoogle Scholar
  69. (69).
    Niaura R, Banks SM, Ward KD, et al.: Hostility and the metabolic syndrome in older males: The Normative Aging Study.Psychosomatic Medicine. 2000,62:7–16.PubMedGoogle Scholar
  70. (70).
    Scherwitz LW, Perkins LL, Chesney MA, et al.: Hostility and health behaviors in young adults: The CARDIA study.American Journal of Epidemiology. 1992,136:136–145.PubMedGoogle Scholar
  71. (71).
    Kaye SA, Folsom AR, Jacobs DR, Hughes GH, Flack JM: Psychosocial correlates of body fat distribution in Black and White young adults.International Journal of Obesity. 1993,17:271–277.PubMedGoogle Scholar
  72. (72).
    Niaura R, Todaro JF, Stroud L, et al.: Hostility, the metabolic syndrome, and incident coronary heart disease.Health Psychology. 2002,21:588–593.PubMedCrossRefGoogle Scholar
  73. (73).
    Surwit RS, Williams RB, Siegler IC, et al.: Hostility, race, and glucose metabolism in nondiabetic individuals.Diabetes Care. 2002,25:835–839.PubMedCrossRefGoogle Scholar
  74. (74).
    Cooper D, Waldstein S: Hostility differentially predicts cardiovascular risk factors in African American and White young adults.Journal of Psychosomatic Research. 2004,57:491–499.PubMedCrossRefGoogle Scholar
  75. (75).
    Philip P, Facchini FS: Self-perceived stress, hostility, and insulin resistance: Lack of association.Diabetes Care. 1995,18:1198–1199.PubMedGoogle Scholar
  76. (76).
    Zhang J, Niaura R, Dyer J, et al.: Hostility and urine norepinephrine interact to predict insulin resistance: The VA normative aging study.Psychosomatic Medicine. 2006,68:718–726.PubMedCrossRefGoogle Scholar
  77. (77).
    Landen M, Baghaei F, Rosmond R, et al.: Dyslipidemia and high waist-hip ratio in women with self-reported social anxiety.Psychoneuroendocrinology. 2004,29:1037–1046.PubMedCrossRefGoogle Scholar
  78. (78).
    Tanaka S, Togashi K, Rankinen T, et al.: Sex differences in the relationships of abdominal fat to cardiovascular disease risk among normal-weight white subjects.International Journal of Obesity. 2004,28:320–323.PubMedGoogle Scholar
  79. (79).
    Miller TQ, Smith TW, Turner CW, Guijarro ML, Hallet AJ: A meta-analytic review of research on hostility and physical health.Psychological Bulletin. 1996,119:322–348.PubMedCrossRefGoogle Scholar
  80. (80).
    Perry AC, Appelgate EB, Jackson ML, et al.: Racial differences in visceral adipose tissue but not anthropometric markers of health-related variables.Journal of Applied Physiology. 2000,89:636–643.PubMedGoogle Scholar
  81. (81).
    Blazer DG, Moody-Ayers S, Craft-Morgan J, Burchett B: Depression in diabetes and obesity: Recial/ethnic/gender issues in older adults.Journal of Psychosomatic Research. 2002,53:913–916.PubMedCrossRefGoogle Scholar
  82. (82).
    Brunner EJ, Marmot MG, Nanchahal K, et al.: Social inequality in coronary risk: Central obesity and the metabolic syndrome. Evidence from the Whitehall II study.Diabetologica. 1997,40:1341–1349.CrossRefGoogle Scholar
  83. (83).
    Roux AVD, Jacobs DR, Kiefe CI: Neighborhood characteristics and components of the insulin resistance syndrome in young adults.Diabetes Care. 2002,25:1976–1982.CrossRefGoogle Scholar
  84. (84).
    Evans D, Charney D, Lewis L, et al.: Mood disorders in the medically ill: Scientific review and recommendations.Biological Psychiatry. 2005,58:175–189.PubMedCrossRefGoogle Scholar
  85. (85).
    Katon WJ: Clinical and health services relationships between major depression, depressive symptoms, and general medical illness.Biological Psychiatry. 2003,54:216–226.PubMedCrossRefGoogle Scholar
  86. (86).
    Suarez E, Boyle S, Lewis J, Hall R, Young K: Increases in stimulated secretion of proinflammatory cytokines by blood monocytes following arousal of negative affect: The role of insulin resistance as moderator.Brain, Behavior, and Immunity. 2006,20:331–338.PubMedCrossRefGoogle Scholar
  87. (87).
    Eckel RH, Grundy SM, Zimmet PZ: The metabolic syndrome.Lancet. 2005,16:1415–1428.CrossRefGoogle Scholar
  88. (88).
    Plotsky PM, Owens MJ, Nemeroff CB: Psychoneuroendocrinology of depression hypothalamic-pituitary-adrenal axis.Psychiatric Clinics of North America. 1998,21:293–307.PubMedCrossRefGoogle Scholar
  89. (89).
    Pope MK, Smith TW: Cortisol excretion in high and low cynically hostile men.Psychosomatic Medicine. 1991,53:382–392.Google Scholar
  90. (90).
    Suarez EC, Kuhn CM, Schanberg SM, Williams RB, Zimmermann EA: Neuroendocrine, cardiovascular, and emotional responses of hostile men: The role of interpersonal challenge.Psychosomatic Medicine. 1998,60:78–88.PubMedGoogle Scholar
  91. (91).
    Rosmond R, Bjorntorp P: Endocrine and metabolic aberrations in men with abdominal obesity in relation to anxiodepressive infirmity.Metabolism. 1998,47:1187–1193.PubMedCrossRefGoogle Scholar
  92. (92).
    Volgelzangs N, Suthers K, Ferrucci L, et al.: Hypercortisolemic depression is associated with the metabolic syndrome in late-life.Psychoneuroendocrinology. 2007,32:151–159.CrossRefGoogle Scholar
  93. (93).
    Suls J, Bunde J: Anger, anxiety, and depression as risk factors for cardiovascular disease: the problems and implications of overlapping affective dispositions.Psychological Bulletin. 2005,131:260–300.PubMedCrossRefGoogle Scholar
  94. (94).
    Kahn R: The metabolic syndrome (emperor) wears no clothes.Diabetes Care. 2006,29:1693–1696.CrossRefGoogle Scholar
  95. (95).
    Grundy S: Does the metabolic syndrome exist.Diabetes Care. 2006,29:1689–1692.PubMedCrossRefGoogle Scholar
  96. (96).
    Shen B, Goldberg R, Llabre M, Schneiderman N: Is the factor structure of the metabolic syndrome comparable between men and women and across three ethnic groups: The Miami Community Health Study.Annals of Epidemiology. 2006,16:131–137.PubMedCrossRefGoogle Scholar
  97. (97).
    Jennings JR, Muldoon MF, Hall M, Buysee DJ, Manuck SB: Self-reported sleep quality is associated with the metabolic syndrome.Sleep. 2007,30:219–223.PubMedGoogle Scholar
  98. (98).
    Tsuno N, Besset A, Ritchie K: Sleep and depression.Journal of Clinical Psychiatry. 2005,66:1254–1269.PubMedCrossRefGoogle Scholar
  99. (99).
    Horacek J, Kuzmiakova M, Hoschl C, Andel M, Bahbonh R: The relationship between central serotonergic activity and insulin sensitivity in healthy volunteers.Psychoneuroendocrinology. 1999,24:785–797.PubMedCrossRefGoogle Scholar
  100. (100).
    Muldoon MF, Mackey RH, et al.: Low central nervous system serotonergic responsivity is associated with the metabolic syndrome and physical inactivity.Journal of Clinical Endocrinology and Metabolism. 2004,89:266–271.PubMedCrossRefGoogle Scholar
  101. (101).
    Muldoon MF, Mackey RH, Korytkowski MT, et al.: The metabolic syndrome is associated with reduced central serotonergic responsivity in healthy community volunteers.Journal of Clinical Endocrinology & Metabolism. 2006,91:718–721.CrossRefGoogle Scholar
  102. (102).
    Dunn A, Trivedi M, Kampert J, Clark C, Chambliss H: Exercise treatment for depression: Efficacy and dose response.American Journal of Preventive Medicine. 2005,28:1–8.PubMedCrossRefGoogle Scholar
  103. (103).
    Balkau B, Vierron E, Vernay M, et al.: The impact of 3-year changes in lifestyle habits on metabolic syndrome parameters: The D.E.S.I.R. study.European journal of Cardiovascular Prevention and Rehabilitation. 2006,13:334–340.PubMedCrossRefGoogle Scholar
  104. (104).
    Todaro JF, Con A, Niaura R, et al.: Combined effect of the metabolic syndrome and hostility on the incidence of myocardial infarction (The Normative Aging Study).American Journal of Cardiology. 2005,96:221–226.PubMedCrossRefGoogle Scholar

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© The Society of Behavioral Medicine 2007

Authors and Affiliations

  • Edie M. Goldbacher
    • 1
  • Karen A. Matthews
    • 1
  1. 1.Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburgh

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