To Örebro University

BACKGROUND: The prospective association between body roundness index (BRI) and depression in the general population remains unclear.

METHODS: This retrospective cohort study was conducted leveraging UK Biobank. The primary outcome was new-onset depression. Cox regression models were used to assess the association between BRI quartiles and depression, while restricted cubic splines were applied to explore the relationship between continuous BRI and depression. Mediation analyses were conducted to elucidate the role of educational, alcohol consumption, smoking, and physical activity.

RESULTS: A total of 201,813 eligible participants with a mean age of 52.71 years were included. Over a mean follow-up period of 12.90 years, 7232 participants (3.58 %) developed depression. The cumulative incidence of depression differed significantly across the four BRI quartiles, with higher quartiles showing a progressively greater incidence of depression (P < 0.0001). In the fully adjusted Cox regression model, participants in the highest BRI quartile had a 30 % increased risk of developing depression (HR: 1.30, 95 % CI: 1.17-1.45; P < 0.0001) compared to those in the lowest quartile. Several lifestyle factors partly mediated the BRI-depression association, with smoking as the strongest mediator and physical activity conferring protection. LIMITATIONS: Residual or unmeasured confounding cannot be completely excluded, and caution is warranted when generalizing our findings to diverse ethnic populations.

CONCLUSIONS: This study demonstrated a positive association between BRI and the incidence of depression. While lifestyle factors partially mediate the relationship between BRI and depression, the risk is primarily driven by the direct effects of BRI.