Cumulative effects of excess weight, sleep quality, and depressive and anxiety symptoms in Chinese adolescents.

BACKGROUND

Little is known about the association of the cumulative effects of excess weight with depressive and anxiety symptoms in Chinese adolescents and the role of sleep quality in the above-mentioned association. This study aimed to assess this issue.

METHODS

A cohort study was conducted annually during 2021 (wave 1), 2022 (wave 2) and 2023 (wave 3). The cumulative effects of excess weight, based on body mass index, from wave 1 to wave 3 were calculated using the trapezoid rule. We evaluated sleep quality, depressive symptoms, and anxiety symptoms based on the Pittsburgh Sleep Quality Index, 9-item Patient Health Questionnaire, and 7-item Generalized Anxiety Disorder Questionnaire in wave 3, respectively. We performed sensitivity analyses using overweight/obesity-years to define the cumulative effects of excess weight.

RESULTS

This study included 39,442 participants (male: 51.6%; mean age: 13.7 years) without depressive and anxiety symptoms in wave 1 and 2. Logistic models with restricted cubic splines showed a significant linear association between the cumulative effect of excess weight and depressive symptoms. We noted a mediating role of sleep quality in the above-mentioned association (percentage of mediation = 9.7%; P < 0.001). Compared with participants without the incident cumulative effect of excess weight and sleep disturbance, those with the above-mentioned two conditions were more likely to have anxiety symptoms (odds ratio = 5.94; P < 0.001). The sensitivity analyses yielded similar results.

CONCLUSION

Our results indicate that the cumulative effect of excess weight may directly affect depressive symptoms, and indirectly affect anxiety symptoms through sleep quality.