A cross-sectional study published in the Journal of Cancer Research and Clinical Oncology reports an association between skeletal muscle-to-visceral fat ratio and depression symptom severity among adult cancer survivors. The research utilized data from the National Health and Nutrition Examination Survey, specifically covering the years 2011 through 2018. The primary objective was to determine whether body composition metrics, specifically the ratio of skeletal muscle to visceral fat, correlate with the severity of depressive symptoms in this population. Additionally, the study investigated whether inflammatory biomarkers and behavioral factors serve as mediating pathways in this relationship.
The analysis included 541 adult cancer survivors identified within the survey dataset. Body composition was indexed using the skeletal muscle-to-visceral fat ratio, which was derived from dual-energy X-ray absorptiometry scans. Inflammation was assessed through white blood cell counts and high-sensitivity C-reactive protein levels. Depression symptom severity was measured using the Patient Health Questionnaire-9, a standardized tool for evaluating the presence and severity of depressive symptoms. The researchers employed complex sample generalized linear models to examine the associations between these predictors and the depression scores.
In unadjusted models, the skeletal muscle-to-visceral fat ratio was significantly and inversely associated with Patient Health Questionnaire-9 scores. The regression coefficient was negative 0.501, with a 95 percent confidence interval ranging from negative 0.937 to negative 0.064, and a p-value of 0.025. This indicates that higher ratios of skeletal muscle to visceral fat were associated with lower depression symptom severity. In partially adjusted models, the association remained significant, with a coefficient of negative 0.590 and a 95 percent confidence interval from negative 1.102 to negative 0.077, also with a p-value of 0.025.
However, the strength of this association changed when the model was fully adjusted for additional variables. After full adjustment, the regression coefficient was negative 0.423, with a 95 percent confidence interval ranging from negative 0.980 to 0.134. The p-value for this fully adjusted model was 0.134, indicating that the association was no longer statistically significant. This attenuation suggests that other factors included in the full model may account for part of the observed relationship between body composition and depression severity.
The study also examined potential mediators of this association, including white blood cell count, high-sensitivity C-reactive protein, and physical activity. White blood cell count showed no association with Patient Health Questionnaire-9 scores at any stage of the analysis. High-sensitivity C-reactive protein displayed a similar pattern to the skeletal muscle-to-visceral fat ratio in its association with depression severity. While the skeletal muscle-to-visceral fat ratio was significantly associated with both white blood cell count and high-sensitivity C-reactive protein, mediation analyses did not find significant indirect effects through white blood cell count or physical activity.
The researchers noted that pathway estimates were not fully identified due to a hypothesized causal link between physical activity and white blood cell count. This limitation affects the ability to draw definitive conclusions about the specific mechanisms linking body composition to depression. The study design is cross-sectional, which means it captures data at a single point in time, limiting the ability to establish causal relationships or determine the direction of the association between body composition and depressive symptoms.
The authors concluded that favorable body composition, as indicated by a higher skeletal muscle-to-visceral fat ratio, was associated with lower depressive symptom severity and lower biomarkers of inflammation in this population of cancer survivors. However, they emphasized that these relationships attenuate after adjustment for other factors. The lack of clear evidence for mediation by high-sensitivity C-reactive protein, physical activity, or white blood cell count suggests that other or more complex mechanisms may underpin the link between body composition and depression severity in cancer survivors.
This study contributes to the understanding of physiological factors associated with depression in cancer survivors. While the cross-sectional nature of the data limits causal inference, the findings highlight the potential importance of body composition in the context of mental health outcomes for this group. The results underscore the complexity of the relationship between physical health and mental well-being in individuals living with a history of cancer.
Subject of Research: Associations between skeletal muscle-to-visceral fat ratio and depression symptom severity among cancer survivors: an examination of mediation pathways using the National Health and Nutrition Examination Survey (NHANES) 2011–2018
Article Title: Associations between skeletal muscle-to-visceral fat ratio and depression symptom severity among cancer survivors: an examination of mediation pathways using the National Health and Nutrition Examination Survey (NHANES) 2011–2018
Article References: Calder, J., Toohey, K., Kavanagh, P. S., McKune, A., Taesuwan, S., & Semple, S. (2026). Associations between skeletal muscle-to-visceral fat ratio and depression symptom severity among cancer survivors: an examination of mediation pathways using the National Health and Nutrition Examination Survey (NHANES) 2011–2018. Journal of Cancer Research and Clinical Oncology. https://doi.org/10.1007/s00432-026-06658-8
Image Credits: AI Generated
DOI: 10.1007/s00432-026-06658-8
Keywords: Associations, between, skeletal, muscle-to-visceral, ratio, depression, symptom, severity, cancer, survivors, examination, mediation
