Increased Dipeptidyl Peptidase-4 Activity Is Associated With High Prevalence of Depression in Middle-Aged and Older Adults: A Cross-Sectional Study

Objective: Obesity, inflammation, and decreased neuropeptide Y (NPY) are risk factors for depression. Dipeptidyl peptidase-4 (DPP4), a newly identified adipokine, has been proved to promote inflammation and NPY degradation. Hence, we aimed to investigate the association between plasma DPP4 activity and depression symptoms in middle-aged and older adults.

Methods: We cross-sectionally assessed 1,335 Chinese adults aged 45-76 years recruited from the Medical Examination Center, Guilin, China, between 2013 and 2014. The main outcome measures were plasma DPP4 activity, inflammatory markers, and NPY. Depression symptoms were determined by the score on the 9-item Patient Health Questionnaire (PHQ-9). Each of the 9 depression items of the PHQ-9 correspond to 1 of the DSM-IV diagnostic criteria for symptoms of major depressive disorder.

Results: Subjects in the highest quartile of DPP4 activity had higher body mass index (BMI), interleukin-6 (IL-6), high-sensitivity C-reactive protein (hs-CRP), and PHQ-9 score compared with subjects in the lowest quartile (P < .05). Compared to patients without depression symptoms, patients with depression symptoms had higher BMI, waist-to-hip ratio, IL-6, hs-CRP, and DPP4 activity (P < .05). DPP4 activity was associated positively with IL-6, hs-CRP, and PHQ-9 score and negatively with NPY after adjustment for potential confounders (P < .05). The risk for depression symptoms increased with higher levels of DPP4 activity and inflammation and lower levels of NPY.

Conclusions: Increased DPP4 activity is independently associated with depression symptoms in middle-aged and older adults. The mechanisms might be partly explained by mutual influence among inflammation, NPY, and DPP4. These observations raise further interest in DPP4 activity for the potential effect on inflammation and NPY metabolism, as a risk biomarker, or even a possible therapeutic target for depression.

Trial Registration: Chinese Clinical Trial Registry (ChiCTR-EPC-14005273).