Moreover, our study has the biggest sample size (N ⩾ 2221) in comparison with the previous epidemiological longitudinal studies of the association between affective symptoms and metabolic syndrome, where the maximum number of participants is approximately 1300 participants

( Vanhala et al., Doxorubicin clinical trial 2009). Despite a large number of studies linking depression and anxiety to elevated CRP level ( Bankier et al., 2009, Howren et al., 2009 and Pitsavos et al., 2006), so far there has been only two studies investigating CRP genetic variants in depression ( Almeida et al., 2009 and Halder et al., 2010), and none investigating these CRP variants and the metabolic syndrome in those with affective symptoms. The results of the present analyses are consistent with previous longitudinal studies reporting that depression (Raikkonen et al., 2002, Raikkonen et selleck chemicals llc al., 2007, Vaccarino et al., 2008, Vanhala et al., 2009, Goldbacher et al., 2009, Pulkki-Raback et al., 2009 and Viinamaki et al., 2009) is a risk factor for the development of the metabolic syndrome. Four of these studies included women only (Raikkonen et al., 2002, Raikkonen et al., 2007, Vaccarino et al., 2008 and Goldbacher et al., 2009), and three others included both sexes (Viinamaki et al., 2009, Pulkki-Raback et al., 2009 and Vanhala et al., 2009). The three studies

including men and women observed sex differences in the association between depression and the metabolic syndrome. Consistent with our findings, two studies reported an association in women but not in men (Vanhala et al., 2009 and Pulkki-Raback

et al., 2009), while one study found an association in men but not in women (Viinamaki et al., 2009). In our study significant gender differences were revealed for the association with one metabolic component – hypertension; an association between higher affective symptoms and hypertension at age 53 years was observed in men, but not women. There Rho are several unique features of the metabolic syndrome in women (Scuteri et al., 2009), and depression is twice as high in women as in men, with the rate beginning to rise rapidly in adolescence. A large number of studies suggest that adolescent emotional problems in girls, but not in boys, lead to significant weight gain and/or obesity during the life course (Liem et al., 2008 and Blaine, 2008). Depressed women could be at increased risk for the metabolic syndrome through effects on adiposity, lipid metabolism and inflammation (Schneider et al., 2006). These associations could be due to poor dietary and exercise habits in depressed adolescent girls (Strine et al., 2008 and Fulkerson et al., 2004) and the tracking of these poor health behaviours into adulthood.