BMI Modifies the Association Between Depression Symptoms and Serum Copper Levels

Depression is one of the most common mental disorders which dramatically threatens public health and wellness. Copper has been known to be involved in many biological processes that could help explaining the occurrence of depression. However, studies focusing on its effect have yielded mixed results. The present study aims to evaluate the association between serum copper levels and depression symptoms. It also investigates the effect of modification of BMI (body mass index) on depression symptoms. A total of 5419 US adults aged 20 years or older from the National Health and Nutrition Examination Survey (NHANES) 2011-2016 participated in the cross-sectional study. Logistic regression models were applied using depression levels as the outcome and serum cooper/selenium/zinc categories as the main predictor, with the adjustments of gender, age, marital status, race, education, family income level, alcohol drinking, cigarette smoking, diabetes, pressure, stroke, and BMI. The interaction terms for copper levels and other covariates were further incorporated into the model to assess their roles in predicting depression symptoms. The prevalence of depression symptoms was significantly higher in samples with a high copper level. Among the levels of serum copper, selenium, and zinc, only the association between depression symptoms and serum copper levels was observed to be significant in the unadjusted model (P = 0.002). Individuals with a high copper level (114-134 μg/dL) and a very high copper level (≥ 134 μg/dL) had 1.85 (95% CI 1.24, 2.77)- and 1.72 (95% CI 1.21, 2.44)-fold higher odds ratio of depression symptoms, respectively, compared to those with a normal serum copper level. Although the association was not significant in the adjusted models, in which confounders were added, the interaction of copper level, including high and very high copper levels, and obesity (BMI ≥ 30 kg/m²) exhibited significantly higher odds ratio (4.12 (95% CI 1.38, 12.27) and 4.53 (95% CI 1.87, 10.96)) of having depression symptoms. The concentration of serum copper was positively associated with the prevalence of depression symptoms. Obesity exacerbated the risk of having depression symptoms in people with high serum copper levels.