Background: Evidence of associations between psychological symptoms and tumor necrosis factor (TNF)-α level is scant, as is evidence on sex differences in associations for children and adolescents with obesity. This study examined sex differences in associations between psychological symptoms (self-concept, anxiety, depression, anger, and disruptive behavior) and TNF-α level in Taiwanese children and adolescents with healthy weight, overweight, or obesity. Methods: In 2010, 564 first, fourth, and seventh graders—comprising 250 children with overweight or obesity (44.3 %), 330 adolescents (58.5 %), and 303 males (53.7 %)—underwent a health examination and blood sampling and completed a questionnaire. Results: A significantly higher TNF-α level was found in children and adolescents with healthy weight than in those with overweight or obesity (median: 14.5 vs. 4.1 (pg/mL); p < 0.001). In multiple linear regression models, anxiety was significantly positively associated with TNF-α level in female participants with healthy weight (β = 0.11 per 10 increments in anxiety, 95 % confidence interval = 0.01–0.22). Limitations: Given the cross-sectional nature of the study, no inferences of causal relationships among TNF-α level, obesity, and psychological symptoms could be made. Conclusions: The findings enrich the literature on the TNF-α–psychological symptom association. Sex differences were found in children and adolescents without obesity rather than in those without obesity, and a higher TNF-α level was associated with increased anxiety in girls without obesity. The role of sex differences in the complex associations among psychological symptoms, TNF-α level, and overweight or obesity requires further investigation.

Original languageEnglish
Pages (from-to)241-246
Number of pages6
JournalJournal of Affective Disorders
Publication statusPublished - Jan 1 2023


  • Adolescents
  • Anxiety
  • Children
  • Obesity
  • Sex differences
  • Tumor necrosis factor alpha (TNF-α)

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health


Dive into the research topics of 'Sex differences in the associations between psychological symptoms and tumor necrosis factor-alpha levels among obese and nonobese children aged 6–13 in Taiwan'. Together they form a unique fingerprint.

Cite this