Association Between Estimated Head Non-Lean Mass and the Risk of Major Mental Disorders: Nationwide Cohort Study in Korea

초록

Background: Mental disorders are a major contributor to global disease burden. Current screening strategies rely on subjective assessments and costly neuroimaging techniques. Estimated head non-lean mass (eHNLM), a dual-energy X-ray absorptiometry (DXA)-derived cranial body-composition metric, was evaluated as a non-invasive risk-associated marker for major mental disorders, including depression, anxiety, sleep, and psychotic disorders. Methods: A nationwide retrospective cohort of 9,210,691 South Korean adults aged ≥ 20 years who underwent standardized health examinations in 2013–2014 was analyzed. eHNLM was calculated using anthropometric data and validated against DXA. Participants were followed from 2015 to 2021 for the first onset of depressive, anxiety, sleep, and psychotic disorders, with death treated as a competing risk. Subdistribution hazard ratios (SHRs) and 95% confidence intervals were estimated across sex-specific eHNLM quartiles using Fine-Gray models. Restricted cubic splines assessed nonlinear trends, and sensitivity and subgroup analyses evaluated robustness. Results: During a median 6.8-year follow-up, higher eHNLM was consistently associated with significantly lower risk of all disorders studied. Fully adjusted SHRs (Q4 vs. Q1) were 0.91 for depression, 0.93 for anxiety, 0.87 for sleep disorders, and 0.82 for psychotic disorders. Spline curves revealed a nonlinear inverse relationship without plateau; findings remained consistent across sex, age groups, and analytic approaches. Conclusion: eHNLM may serve as a non-invasive, cost-effective, and scalable risk-associated marker that is inversely associated with psychiatric risks. Its biological plausibility and compatibility with routine health data support its potential utility for population-level risk stratification and epidemiologic surveillance. Further external validation across diverse populations is warranted before any clinical implementation. © 2026 The Korean Academy of Medical Sciences.

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