Sle Koo; Kyong Park

doi:10.4163/jnh.2014.47.1.113

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Koo and Park: Associations of serum 25(OH)D levels with depression and depressed condition in Korean adults: results from KNHANES 2008–2010∗

Research Article

J Nutr Health 2014;47(2):113-123.

Published online: 20 January 2014

DOI: https://doi.org/10.4163/jnh.2014.47.1.113

Associations of serum 25(OH)D levels with depression and depressed condition in Korean adults: results from KNHANES 2008–2010∗

Sle Koo, Kyong Park

Department of Food & Nutrition, Yeungnam University, Gyeongsan, Gyeongbuk 712–749, Korea

Received 19 November 2013 Revised 14 January 2014 Accepted 17 February 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Vitamin D has been known to play an important role in the central nervous system and brain functions in the human body, and cumulative evidence has shown that vitamin D deficiency might be linked with various mental health conditions. Epidemiologic studies have shown that vitamin D deficiency may be associated with higher risk of depression in the US and European populations. However, limited information is available regarding the association between vitamin D status and depression in the Korean population. The objective of this study was to examine the associations between vitamin D levels and prevalence of depression. Methods: We conducted a cross-sectional analysis using nationally representative data from the 2008–2010 Korean National Health and Nutrition Examination Survey from which serum 25-hydroxyvitamin D concentrations were available. A total of 18,735 adults who had available demographic, dietary, and lifestyle information were included in our analysis. We defined “depression” with a diagnosis by a physician. “Depressed condition” was defined as having feelings of sadness or depression without diagnosis by a physician. Results: The prevalence of depression was 1.63% and 5.43% in Korean men and women, respectively; 12.5% of men and 26.1% of women were defined as the group having depressed conditions. In multivariate logistic regression models, no significant associations were observed between vitamin D status and prevalence of depression or depressed conditions in Korean men and women. Conclusion: We found no association between vitamin D insufficiency and depression/depressed conditions in Korean adults. Future large prospective studies and randomized controlled trials are needed to confirm this relationship.

Keywords: depression, depressed condition, 25-hydroxyvitamin D, Korean adults.

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Table 1.

Characteristics of subjects by depression status in men

	Depression status			p value
	Depression (n = 134)	Depressed condition (n = 1,027)	Normal (n = 7,054)	p value
Serum 25(OH)D concentrations (ng/ml)	19.0 ± 0.7	19.4 ± 0.3	19.4 ± 0.2	0.8
Vitamin D status 1)
Severe deficiency	3 (2.2)	47 (5.6)	315 (5.4)	0.7
Deficiency	70 (58.7)	517 (53.4)	3,510 (53.0)
Insufficiency	49 (32.5)	351 (31.6)	2,542 (33.3)
Sufficiency	12 (6.6)	112 (9.3)	687 (8.4)
Age (years)	47.0 ± 1.8^a	46.6 ± 0.6^a	43.0 ± 0.3^b	< 0.001
Age group (years)
19–29	18 (22.9)	102 (17.4)	984 (21.8)	< 0.001
30–39	12 (11.3)	159 (17.7)	1,462 (23.6)
40–49	20 (17.3)	177 (21.6)	1,472 (23.1)
50–59	29 (24.4)	211 (22.4)	1,191 (16.4)
60–69	27 (13.3)	201 (12.3)	1,122 (9.4)
70–79	24 (9.4)	149 (7.2)	700 (4.8)
≥ 80	4 (1.4)	28 (1.3)	123 (1.0)
Married (yes)	108 (70.2)	872 (77.3)	5,818 (74.2)	0.2
Employed (yes)	69 (55.1)	670 (70.8)	5,416 (79.3)	< 0.001
Area of residence (% rural)	34 (19.1)	290 (22.8)	1,684 (18.9)	0.03
Household income level
Low	38 (22.4)	299 (23.7)	1,136 (12.9)	< 0.001
Mid-low	35 (24.5)	253 (25.4)	1,703 (24.4)
Mid-high	29 (28.0)	232 (25.5)	2,032 (31.1)
High	32 (25.1)	219 (25.4)	2,073 (31.5)
Educational level
Middle school graduation or less	62 (37.6)	458 (35.9)	1,986 (20.8)	< 0.001
High school graduation	44 (39.7)	321 (39.2)	2,640 (42.4)
College or more	28 (22.7)	227 (24.9)	2,418 (36.8)
Walking (yes)	54 (46.7)	474 (47.2)	3,322 (46.6)	0.9
Moderate physical activity (yes)	19 (15.3)	145 (13.9)	977 (13.4)	0.9
Vigorous physical activity (yes)	34 (28.9)	165 (18.1)	1,362 (20.5)	0.07
Current smoker (yes)	50 (42.5)	483 (53.1)	3,076 (47.4)	0.01
Alcohol intake (n/week)	1.32 ± 0.16^b	1.69 ± 0.06^a	1.48 ± 0.02^b	0.004
Dietary supplement use (yes)	34 (28.5)	159 (19.9)	1,343 (22.8)	0.1
Prevalent chronic disease (yes) 2)	35 (21.2)	242 (18.5)	1,028 (10.9)	< 0.001

Different letters represent statistical difference by tukey multiple comparison test.

1) Vitamin D status was categorized into groups, according to serum 25(OH)D concentrations < 10 ng/ml, 10–19 ng/ml, 20–29 ng/ ml, ≥ 30 ng/ml, indicating severe deficiency, deficiency, insufficiency and sufficiency accordingly. 2) Chronic diseases included degenerative arthritis or rheumatoid arthritis, renal failure, myocardial infarction or angina pectoris, and diabetes mellitus.

Table 2.

Characteristics of subjects by depression status in women Depression status

	Depression status			p value
	Depression (n = 571)	Depressed condition (n = 2,744)	Normal (n = 7,205)	p value
Serum 25(OH)D concentrations (ng/ml)	17.4 ± 0.4^a	17.2 ± 0.2^a	16.8 ± 0.2^b	0.02
Vitamin D status 1)
Severe deficiency	58 (11.0)	267 (10.4)	758 (11.5)	0.04
Deficiency	331 (58.6)	1,621 (61.3)	4,360 (62.2)
Insufficiency	146 (24.7)	682 (22.6)	1,750 (22.1)
Sufficiency	36 (5.7)	174 (5.7)	337 (4.1)
Age (year)	51.0 ± 0.9^a	47.8 ± 0.4^b	44.6 ± 0.3^c	< 0.001
Age group (years)
19–29	34 (10.3)	284 (15.9)	1,018 (20.4)	< 0.001
30–39	78 (16.1)	470 (17.7)	1,501 (21.4)
40–49	86 (16.5)	485 (21.2)	1,524 (23.6)
50–59	150 (28.2)	555 (20.1)	1,213 (15.8)
60–69	143 (17.2)	514 (13.5)	1,059 (9.8)
70–79	74 (10.1)	363 (9.6)	730 (7.2)
≥ 80	6 (1.6)	73 (2.1)	160 (1.9)
Married (yes)	539 (92.2)	2,477 (86.3)	6,181 (80.3)	< 0.001
Employed (yes)	205 (36.8)	1,275 (47.5)	3,672 (52.6)	< 0.001
Area of residence (% rural)	112 (16.1)	694 (19.9)	1,729 (19.7)	0.2
Household income level
Low	151 (23.4)	751 (23.5)	1,350 (15.9)	< 0.001
Mid-low	156 (29.1)	705 (26.7)	1,713 (25.1)
Mid-high	139 (24.4)	666 (26.4)	1,923 (28.1)
High	116 (23.0)	576 (23.5)	2,095 (30.8)
Educational level
Middle school graduation or less	339 (52.7)	1,423 (44.7)	2,853 (32.5)	< 0.001
High school graduation	162 (34.5)	779 (33.0)	2,521 (39.2)
College or more	69 (12.8)	519 (22.3)	1,826 (28.2)
Walking (yes)	230 (41.0)	1,120 (41.4)	3,146 (44.3)	0.06
Moderate physical activity (yes)	70 (11.2)	433 (14.9)	940 (12.4)	0.02
Vigorous physical activity (yes)	90 (16.8)	417 (16.1)	961 (13.8)	0.03
Current smoker (yes)	50 (11.4)	219 (9.6)	385 (6.1)	< 0.001
Alcohol intake (n/week)	0.54 ± 0.05	0.61 ± 0.03	0.54 ± 0.01	0.1
Dietary supplement use (yes)	186 (32.8)	727 (30.0)	1,996 (31.2)	0.5
Prevalent chronic disease (yes) 2)	214 (32.8)	896 (27.0)	1,629 (18.4)	< 0.001
Postmenopausal (yes)	328 (58.4)	1,264 (45.8)	2,724 (35.8)	< 0.001
Oral contraceptive agent (% user)	130 (23.2)	493 (18.2)	1,089 (15.1)	< 0.001
Hormone replacement therapy (% user)	110 (17.8)	236 (8.8)	529 (6.7)	< 0.001

Different letters represent statistical difference by tukey multiple comparison test.

Table 3.

Association between vitamin D status and depression by sex

	Vitamin D status 1)				p trend
	Severe deficiency	Deficiency	Insufficiency	Sufficiency
	OR	Odds ratio (95% CI)	Odds ratio (95% CI)	Odds ratio (95% CI)
All
n	1,134	8,271	4,487	1,072
No. of events	61	401	195	48
Model 1	1	0.87 (0.63–1.20)	0.78 (0.56–1.09)	0.80 (0.50–1.27)	0.1
Model 2	1	1.02 (0.74–1.41)	0.99 (0.71–1.38)	1.03 (0.64–1.67)	0.9
Model 3	1	0.99 (0.72–1.37)	0.99 (0.71–1.40)	1.05 (0.65–1.70)	0.9
Model 4	1	1.03 (0.74–1.43)	1.04 (0.74–1.46)	1.20 (0.74–1.95)	0.7
Men
n	318	3,580	2,591	699
No. of events	3	70	49	12
Model 1	1	1.66 (0.42–6.52)	1.38 (0.33–5.70)	1.16 (0.26–5.23)	0.5
Model 2	1	1.62 (0.41–6.32)	1.24 (0.30–5.11)	0.99 (0.22–4.38)	0.3
Model 3	1	1.71 (0.43–6.83)	1.31 (0.31–5.56)	1.08 (0.24–4.88)	0.4
Model 4	1	1.62 (0.40–6.53)	1.20 (0.28–5.10)	1.05 (0.23–4.82)	0.3
Women
n	816	4,691	1,869	373
No. of events	58	331	146	36
Model 1	1	0.96 (0.69–1.34)	1.15 (0.82–1.63)	1.53 (0.91–2.58)	0.06
Model 2	1	0.94 (0.67–1.32)	0.99 (0.70–1.41)	1.19 (0.70–2.04)	0.6
Model 3	1	0.90 (0.64–1.26)	1.01 (0.71–1.43)	1.21 (0.71–2.06)	0.4
Model 4	1	0.95 (0.68–1.33)	1.07 (0.75–1.53)	1.43 (0.84–2.45)	0.3
Model 5	1	1.05 (0.68–1.64)	1.19 (0.74–1.91)	1.67 (0.91–3.07)	0.4

Model 1: Unadjusted

Model 2: Adjustment for age (and sex)

Model 3: Additional adjustments for income, smoking, drinking, and obesity

Model 4: Additional adjustments for prevalent chronic disease (such as degenerative arthritis or rheumatoid arthritis, renal failure, myocardial infarction or angina pectoris, and diabetes mellitus), area of residence, walking, moderate physical activity and vigorous physical activity

Model 5 (women only): Additional adjustment for menopausal status, oral contraceptive agent, and hormone replacement therapy use

Table 4.

Association between vitamin D status and depressed conditions by sex

	Vitamin D status 1)				p trend
	Severe deficiency	Deficiency	Insufficiency	Sufficiency
	OR	Odds ratio (95% CI)	Odds ratio (95% CI)	Odds ratio (95% CI)
All
n	1,387	10,008	5,325	1,310
No. of cases	314	2,138	1,033	286
Model 1	1	0.92 (0.78–1.10)	0.80 (0.66–0.96)	0.92 (0.75–1.14)	0.01
Model 2	1	1.04 (0.87–1.24)	0.95 (0.78–1.15)	1.12 (0.90–1.40)	0.9
Model 3	1	1.05 (0.88–1.25)	0.96 (0.79–1.17)	1.13 (0.91–1.42)	0.9
Model 4	1	1.06 (0.89–1.27)	0.97 (0.80–1.18)	1.13 (0.89–1.42)	0.9
Men
n	362	4,027	2,893	799
No. of cases	47	517	351	112
Model 1	1	0.96 (0.65–1.42)	0.89 (0.59–1.32)	1.03 (0.68–1.56)	0.9
Model 2	1	0.93 (0.62–1.38)	0.78 (0.52–1.18)	0.85 (0.55–1.32)	0.1
Model 3	1	0.95 (0.63–1.42)	0.81 (0.54–1.23)	0.86 (0.55–1.33)	0.3
Model 4	1	0.95 (0.63–1.44)	0.81 (0.53–1.25)	0.83 (0.52–1.31)	0.2
Women
n	1,025	5,981	2,432	511
No. of cases	267	1,621	682	174
Model 1	1	1.08 (0.90–1.29)	1.11 (0.91–1.37)	1.51 (1.15–1.98)	0.01
Model 2	1	1.06 (0.88–1.28)	1.03 (0.83–1.28)	1.32 (1.00–1.75)	0.3
Model 3	1	1.08 (0.90–1.30)	1.04 (0.84–1.29)	1.38 (1.04–1.82)	0.2
Model 4	1	1.11 (0.92–1.33)	1.05 (0.85–1.30)	1.39 (1.05–1.85)	0.3
Model 5	1	1.07 (0.87–1.33)	1.02 (0.80–1.31)	1.32 (0.97–1.80)	0.5

Model 1: Unadjusted

Model 2: Adjustment for age (and sex)

Model 3: Additional adjustment for income, smoking, drinking, and obesity

Model 4: Additional adjustment for prevalent chronic disease (such as degenerative arthritis or rheumatoid arthritis, renal failure, myocardial infarction or angina pectoris, and diabetes mellitus), area of residence, walking, moderate physical activity and vigorous physical activity

Model 5 (women only): Additional adjustment for menopausal status, oral contraceptive agent, and hormone replacement therapy use

Table 5.

Adjusted least-square means of serum 25(OH)D concentrations (ng/ml) by depression status and sex

	Depression status			p value
	Depression (n = 705)	Depressed condition (n = 3,771)	Normal (n = 14,259)	p value
All
Model 1	17.8 ± 0.3^b	17.9 ± 0.2^b	18.3 ± 0.2^a	0.01
Model 2	18.4 ± 0.3	18.5 ± 0.2	18.6 ± 0.2	0.9
Model 3	18.3 ± 0.3	18.4 ± 0.2	18.3 ± 0.2	0.9
Model 4	19.7 ± 0.4	19.7 ± 0.3	19.7 ± 0.2	0.9
Men
Model 1	19.0 ± 0.7	19.4 ± 0.3	19.4 ± 0.2	0.8
Model 2	19.3 ± 0.7	19.6 ± 0.3	20.0 ± 0.2	0.2
Model 3	19.2 ± 0.7	19.6 ± 0.3	19.9 ± 0.2	0.3
Model 4	20.4 ± 0.7	20.9 ± 0.3	21.3 ± 0.3	0.2
Women
Model 1	17.4 ± 0.4^a	17.2 ± 0.2^a	16.8 ± 0.2^b	0.02
Model 2	17.3 ± 0.3	17.3 ± 0.2	17.1 ± 0.2	0.5
Model 3	17.0 ± 0.4	16.9 ± 0.3	16.7 ± 0.2	0.4
Model 4	18.4 ± 0.4	18.2 ± 0.3	18.0 ± 0.3	0.3
Model 5	19.1 ± 0.5	19.0 ± 0.4	18.8 ± 0.3	0.7

Different letters represent statistical difference by tukey multiple comparison test.

Model 1: Unadjusted

Model 2: Adjustment for age (and sex)

Model 3: Additional adjustment for income, smoking, drinking, and obesity

Model 5 (women only): Additional adjustment for menopausal status, oral contraceptive agent, and hormone replacement therapy use

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