Copyright
©The Author(s) 2026. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Feb 19, 2026; 16(2): 113063
Published online Feb 19, 2026. doi: 10.5498/wjp.v16.i2.113063
Published online Feb 19, 2026. doi: 10.5498/wjp.v16.i2.113063
L-shaped association between fasting blood glucose and comorbid anxiety in Chinese patients with first-episode untreated major depressive disorder
Lian Yuan, Department of Mood Disorders, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu Province, China
Jun-Jun Liu, Department of Psychiatry, Nanjing Meishan Hospital, Nanjing 210000, Jiangsu Province, China
Zhe Li, Xue-Li Zhao, Department of Sleep Disorders, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu Province, China
Ying-Zhao Zhu, Wei Ren, Department of Psychiatry, Medical College of Soochow University, Suzhou 215000, Jiangsu Province, China
Ying-Zhao Zhu, Wei Ren, Yao-Zhi Liu, Xiang-Dong Du, Department of Psychiatry, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu Province, China
Yao-Zhi Liu, School of Psychiatry, North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
Xiang-Yang Zhang, Department of Psychiatry, Hefei Fourth People's Hospital, Anhui Mental Health Center, Affiliated Psychological Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
Co-first authors: Lian Yuan and Jun-Jun Liu.
Co-corresponding authors: Xiang-Dong Du and Xiang-Yang Zhang.
Author contributions: Yuan L and Liu JJ performed the data analysis; Yuan L drafted and revised the manuscript; Liu JJ and Li Z revised the manuscript; Zhu YZ and Ren W contributed to data curation and visualization; Liu YZ and Zhao XL contributed to data curation and investigation; Du XD contributed to funding acquisition, supervision, validation, and manuscript revision; Zhang XY was responsible for study design, project administration, and supervision. All authors reviewed and approved the final version of the manuscript for publication. Yuan L and Liu JJ contributed equally to this work as co-first authors. Du XD obtained the project funding, provided senior oversight of the study, supervised data validation procedures, and guided critical revisions of the manuscript, ensuring financial support, methodological rigor, and integrity of the reported findings. Zhang XY conceived the study, developed the protocol, and conducted project administration and operational supervision, directing study design, implementation, and coordination of research personnel. Their contributions are complementary and partly overlapping: Du XD provided resource stewardship and quality assurance, while Zhang XY led the study’s scientific design and execution. Consequently, both share responsibility for the study’s conceptualization, conduct, data integrity, and final manuscript approval. Accordingly, Du XD and Zhang XY are designated as joint corresponding authors to ensure unified external communication and accountability.
Supported by Medical Research Key Project of Jiangsu Provincial Health Commission, No. K2023015/MR-32-25-009505; Suzhou Major Diseases Clinical Multi-Center Research Project, No. DZXYJ202414/MR-32-25-054379; Scientific and Technological Key Program of Suzhou, No. SYW2024008/MR-32-25-012227; Key Discipline of Psychiatry in Suzhou, No. SZXK202521; and Suzhou Science and Technology Tackling Key Problems Program Healthcare Innovation Project, No. SYWD2025154.
Institutional review board statement: The study was approved by the Institutional Review Board of Shanxi Medical University (No. 2016-Y27) and conducted in accordance with the Declaration of Helsinki.
Informed consent statement: Written informed consent was obtained from all participants prior to their inclusion in the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items-and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The data are available from the corresponding author on reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiang-Yang Zhang, MD, PhD, Department of Psychiatry, Hefei Fourth People's Hospital, Anhui Mental Health Center, Affiliated Psychological Hospital of Anhui Medical University, No. 316 Huangshan Road, Shushan District, Hefei 230022, Anhui Province, China. zhangxy99@tsinghua.edu.cn.
Received: August 15, 2025
Revised: October 7, 2025
Accepted: November 12, 2025
Published online: February 19, 2026
Processing time: 168 Days and 15.2 Hours
Revised: October 7, 2025
Accepted: November 12, 2025
Published online: February 19, 2026
Processing time: 168 Days and 15.2 Hours
Core Tip
Core Tip: Insights into the relationship between metabolic factors and psychiatric comorbidities in major depressive disorder (MDD) are limited. We conducted a cross-sectional analysis of 1718 Chinese patients with first-episode untreated MDD using advanced statistical modeling to investigate the association between fasting blood glucose (FBG) levels and comorbid anxiety. An L-shaped nonlinear relationship was revealed with a critical inflection point at 4.8 mmol/L, where FBG levels below this threshold significantly increased anxiety comorbidity risk (OR = 0.20, 95%CI: 0.06-0.67, P = 0.009), while levels above showed no association. These findings demonstrate that lower-normal FBG ranges may serve as a novel biomarker for anxiety risk stratification in MDD patients. With this knowledge, clinicians can incorporate routine FBG assessment into clinical evaluations to identify high-risk patients and optimize treatment strategies for MDD with anxiety comorbidity.