Association of Inflammatory and Liver Markers with Cardiometabolic Risk Factors in Patients with Depression

  • Naresh Nebhinani
  • Praveen Sharma
  • Vrinda Pareek
  • Navratan Suthar
  • Shobhan Jakhotia
  • Mukesh Gehlot
  • Purvi Purohit
Original Research Article


Metabolic syndrome (MS) is found to be more prevalent in patients with psychiatric disorders including depression. This study aimed to assess the association of inflammatory and liver markers with cardiometabolic risk factors in patients with Depressive disorders. Prevalence of MS by using Modified NCEP ATP-III Criteria and liver enzymes and CRP were assessed in 382 patients with depressive disorders. MS prevalence was 27.7% and lower HDL level was the commonest metabolic abnormality. ALT, GGT, and CRP levels were positively correlated with weight and BMI. ALT, GGT, and CRP levels were significantly greater in patients with abnormal waist circumference, triglyceride levels and raised blood pressure, compared to patients with normal indices. Such association was not found with abnormal HDL cholesterol and hyperglycemia. Levels of GGT and CRP were significantly greater in patients with MS compared to patients without MS and CRP was significant predictor for MS. To conclude, one-fourth of depressed patients had MS. MS and metabolic abnormalities were associated with inflammatory marker and liver enzymes. Patients with depression should be regularly evaluated for cardiovascular risk factors, liver enzymes, and inflammatory markers.


Metabolic syndrome Liver enzymes Inflammatory markers Depression India 



This project has received intramural grant from All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan.

Compliance with Ethical Standards

Conflict of interest

The authors report no conflict of interest.


  1. 1.
    Murray CJ, Lopez AD. Measuring the global burden of disease. N Engl J Med. 2013;369:448–57.CrossRefPubMedGoogle Scholar
  2. 2.
    Goldbacher EM, Bromberger J, Matthews KA. Lifetime history of major depression predicts the development of the metabolic syndrome in middle-aged women. Psychosom Med. 2009;71:266–72.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Vancampfort D, Stubbs B, Mitchell AJ, De Hert M, Wampers M, Ward PB, et al. Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis. World Psychiatry. 2015;14:339–47.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Devers MC, Campbell S, Shaw J, Zimmet P, Simmons D. Should liver function tests be included in definitions of metabolic syndrome? Evidence from the association between liver function tests, components of metabolic syndrome and prevalent cardiovascular disease. Diabet Med. 2008;25:523–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Ahn HR, Shin MH, Nam HS, Park KS, Lee YH, Jeong SK. The association between liver enzymes and risk of type 2 diabetes: the Namwon study. Diabetol Metab Syndr. 2014;6:14.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Nannipieri M, Gonzales C, Baldi S, Posadas R, Williams K, Haffner SM, et al. Liver enzymes, the metabolic syndrome, and incident diabetes. Diabetes Care. 2005;28:1757–62.CrossRefPubMedGoogle Scholar
  7. 7.
    Zelber-Sagi S, Toker S, Armon G, Melamed S. Elevated alanine aminotransferase independently predicts new onset of depression in employees undergoing health screening examinations. Psychol Med. 2013;43:2603–13.CrossRefPubMedGoogle Scholar
  8. 8.
    Schindhelm RK, Dekker JM, Nijpels G, Bouter LM, Stehouwer CD, Heine RJ, et al. Alanine aminotransferase predicts coronary heart disease events: a 10-year follow-up of the Hoorn Study. Atherosclerosis. 2007;191:391–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Topic R, Milicic D, Stimac Z, Loncar M, Velagic V, Marcinko D, et al. Somatic comorbidity, metabolic syndrome, cardiovascular risk, and CRP in patients with recurrent depressive disorders. Croat Med J. 2013;54:453–9.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    World Health Organization. The ICD-10 classification of mental and behavioural disorders—clinical descriptions and diagnostic guidelines. Geneva: WHO; 1992.Google Scholar
  11. 11.
    Lecrubier Y, Sheehan D, Weiller E, Amorim P, Bonora I, Sheehan KH, et al. The Mini International Neuropsychiatric Interview (M.I.N.I.) a short diagnostic structured interview: reliability and validity according to the CIDI. Eur Psychiatry. 1997;12:224–31.CrossRefGoogle Scholar
  12. 12.
    Nebhinani N, Sharma P, Pareek V. Associations of metabolic syndrome with elevated liver enzymes and C-reactive protein in drug-naive patients with depressive disorders. J Ment Health Hum Behav. 2016;21:91–7.CrossRefGoogle Scholar
  13. 13.
    Hamilton M. Hamilton Psychiatric Rating Scale for primary depressive illness. Br J Soc Clin Psychol. 1967;6:278–96.CrossRefPubMedGoogle Scholar
  14. 14.
    Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: a joint interim statement of the international diabetes federation task force on epidemiology and prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of obesity. Circulation. 2009;120:1640–5.CrossRefPubMedGoogle Scholar
  15. 15.
    Pan A, Keum N, Okereke OI, Sun Q, Kivimaki M, Rubin RR, et al. Bidirectional association between depression and metabolic syndrome: a systematic review and meta-analysis of epidemiological studies. Diabetes Care. 2012;35:1171–80.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Mattoo SK, Singh SM. Prevalence of metabolic syndrome in psychiatric inpatients in a tertiary care centre in north India. Indian J Med Res. 2010;131:46–52.PubMedGoogle Scholar
  17. 17.
    Aggarwal M, Grover S, Chakrabarti S, Dutt A, Avasthi A, Kulhara P. Prevalence of metabolic syndrome in depression. J Ment Health Hum Behav. 2012;17:15–24.Google Scholar
  18. 18.
    Grover S, Nebhinani N, Chakrabarti S, Avasthi A, Kulhara P. Metabolic syndrome in drug naïve patient’s with depression. Indian J Psychol Med. 2013;35:167–73.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Rathi A, Jhanjee A, Bhatia MS. A study of the prevalence, socio-demographic and clinical correlates of metabolic syndrome (MS) in drug-naive patients of anxiety and depressive disorders. Delhi Psychiatry J. 2013;16:7–14.Google Scholar
  20. 20.
    Agarwal A, Agarwal M, Garg K, Dalal PK, Trivedi JK, Srivastava JS. Metabolic syndrome and central obesity in depression: a cross-sectional study. Indian J Psychiatry. 2016;58:281–6.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Vancampfort D, Correll CU, Wampers M, Sienaert P, Mitchell AJ, De Herdt A, et al. Metabolic syndrome and metabolic abnormalities in patients with major depressive disorder: a meta-analysis of prevalences and moderating variables. Psychol Med. 2014;44:2017–28.CrossRefPubMedGoogle Scholar
  22. 22.
    Music M, Dervisevic A, Pepic E, Lepara O, Fajkic A, Ascic-Buturovic B, Tuna E. Metabolic syndrome and serum liver enzymes level at patients with type 2 diabetes mellitus. Med Arch. 2015;69:251–5.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Zhang L, Ma X, Jiang Z, Zhang K, Zhang M, Li Y, et al. Liver enzymes and metabolic syndrome: a large-scale case-control study. Oncotarget. 2015;6:26782–8.PubMedPubMedCentralGoogle Scholar
  24. 24.
    Zhang X, Mu Y, Yan W, Ba J, Li H. Alanine aminotransferase within reference range is associated with metabolic syndrome in middle-aged and elderly Chinese men and women. Int J Environ Res Public Health. 2014;11:12767–76.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Chen S, Guo X, Yu S, Zhou Y, Li Z, Sun Y. Metabolic syndrome and serum liver enzymes in the general chinese population. Int J Environ Res Public Health. 2016;13:223.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Kälsch J, Bechmann LP, Heider D, Best J, Manka P, Kälsch H. Normal liver enzymes are correlated with severity of metabolic syndrome in a large population based cohort. Sci Rep. 2015;5:13058.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Labayen I, Ruiz JR, Ortega FB, Davis CL, Rodríguez G, González-Gross M, et al. Liver enzymes and clustering cardiometabolic risk factors in European adolescents: the HELENA study. Pediatr Obes. 2015;10:361–70.CrossRefPubMedGoogle Scholar
  28. 28.
    Clement K, Viguerie N, Poitou C, Carette C, Pelloux V, Curat CA, et al. Weight loss regulates inflammation-related genes in white adipose tissue of obese subjects. FASEB J. 2004;18:1657–69.CrossRefPubMedGoogle Scholar
  29. 29.
    Rethorst CD, Bernstein I, Trivedi MH. Inflammation, obesity, and metabolic syndrome in depression: analysis of the 2009–2010 National Health and Nutrition Examination Survey (NHANES). J Clin Psychiatry. 2014;75:e1428–32.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Association of Clinical Biochemists of India 2018

Authors and Affiliations

  • Naresh Nebhinani
    • 1
  • Praveen Sharma
    • 2
  • Vrinda Pareek
    • 1
  • Navratan Suthar
    • 1
  • Shobhan Jakhotia
    • 1
  • Mukesh Gehlot
    • 1
  • Purvi Purohit
    • 2
  1. 1.Department of PsychiatryAll India Institute of Medical ScienceJodhpurIndia
  2. 2.Department of BiochemistryAll India Institute of Medical ScienceJodhpurIndia

Personalised recommendations