The more severe depressive symptoms are, the higher the risk of developing fatty liver, according to a large-scale study. In particular, among women under 45, severe depressive symptoms were associated with up to a 20% increase in fatty liver risk, leading to calls for integrated management of both mental and liver health.

On 1 July, a research team led by Professors Cho Sung-jun and Kim Eun-su of the Department of Psychiatry and Professor Son Won of the Division of Gastroenterology at Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, announced that they had identified this association after analyzing the link between depressive symptoms and the risk of developing metabolic dysfunction-associated steatotic liver disease (MASLD) in 170,981 adults who underwent health checkups at the Kangbuk Samsung Hospital Total Healthcare Center between 2003 and 2022.

MASLD is a chronic liver disease that occurs in connection with metabolic abnormalities such as obesity, diabetes, and hyperlipidemia. If left untreated, it can increase the risk not only of cirrhosis and liver cancer but also of cardiovascular disease, making early management crucial.

The research team classified individuals with no fatty liver on liver ultrasound and no history of metabolic disease or psychiatric medication use into three groups based on their scores on the depressive symptom screening test (CES-D): ▲ normal group (less than 8 points) ▲ mild depression group (8–15 points) ▲ depression group (16 points or higher), and followed them for an average of 5.4 years.

As a result, both men and women showed a trend of increasing fatty liver risk as depressive symptoms worsened, but the effect was more pronounced in women.

Compared with the normal group, men showed a 3% higher fatty liver risk in the mild depression group and 6% higher in the depression group. In contrast, women showed a 5% higher risk in the mild depression group and 18% higher in the depression group.

In particular, among women under 45, the increase in fatty liver risk associated with depressive symptoms was most distinct. Even with only mild depressive symptoms, the risk of fatty liver was 5% higher than in the normal group, and in the depression group the risk increased by up to 20%.

Professor Son Won stated, “Previous attention has focused on the sharp increase in the risk of metabolic diseases such as fatty liver in postmenopausal women due to reduced estrogen,” adding, “The significance of this study lies in being the first, using large-scale data, to show that even young premenopausal women with depression may have vulnerable metabolic health.”

● Why is the risk higher in younger women?

The research team explained that in premenopausal women, who are generally metabolically healthier, the impact of depression on liver health may manifest more clearly.

Professor Kim Eun-su said, “Estrogen in premenopausal women plays a role in suppressing fat accumulation in the liver,” and added, “Because women in this stage are metabolically healthy, the impact of depression on liver health can appear more pronounced.”

In addition, women are known to exhibit a stronger inflammatory response than men when exposed to depressive symptoms. The research team analyzed that increases in inflammatory markers such as CRP, TNF-α, and IL-6 may promote fat accumulation in the liver.

Furthermore, it was suggested that women’s relatively stronger tendency to choose emotion-focused coping strategies in stressful situations could lead to reduced physical activity or unhealthy eating habits.

● “It was not because of the medications”… Depressive symptoms themselves raise fatty liver risk

The research team excluded from the analysis individuals who were taking antidepressants or antipsychotics, because some psychiatric medications can cause metabolic side effects such as weight gain or worsening of insulin resistance.

Through this study design, the researchers sought to determine whether depressive symptoms themselves are an independent risk factor that increases the risk of fatty liver.

Professor Kim said, “The results of this study indicate that depressive symptoms alone can increase the risk of fatty liver,” adding, “Depression is not merely a form of psychological distress; it is an independent risk factor that disrupts hormonal secretion systems and the immune system, thereby threatening overall physical health.”

The research team explained that depression can cause abnormalities in the HPA axis, which increases the secretion of cortisol, a stress hormone, thereby promoting visceral fat accumulation, heightening inflammatory responses and insulin resistance, and ultimately leading to fat buildup in the liver.

● Those with depressive symptoms should also consider liver tests

The research team advised that, in particular, women under 45 with moderate or more severe depressive symptoms should consider regular liver ultrasound examinations from the time of depression diagnosis.

They added that fatty liver risk can be reduced through ▲ moderate-intensity exercise ▲ dietary interventions ▲ blood glucose, lipid, and blood pressure management ▲ and regular liver function tests.

Professor Kim said, “This study reaffirms that depression is not merely a mental illness but a disease that affects systemic metabolism,” and emphasized, “There is a need for integrated implementation of psychiatric treatment together with screening and early management of liver health.”

The findings of this study were published in the latest issue of the international journal Journal of Korean Medical Science.

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