Visceral Fat Accumulation Is Associated with Mild Cognitive Impairment in Community-Dwelling Older Japanese Women

Metabolic score for visceral fat is correlated with all-cause and cardiovascular mortality among individuals with non-alcoholic fatty liver disease

BACKGROUND

Metabolic score for visceral fat (METS-VF) as an effective marker of visceral obesity has been correlated with non-alcoholic fatty liver disease (NAFLD). This study aims to explore the correlation between METS-VF and both all-cause mortality and cardiovascular disease (CVD)-related mortality among individuals with NAFLD.

METHODS

A cohort of 6,759 subjects diagnosed with NAFLD was selected from the NHANES during the period from 1999 to 2018. Within this cohort, the prognostic utility of METS-VF for predicting CVD-related and all-cause mortality was assessed.

RESULTS

There was a total of 1254 all-cause deaths (18.6%) and 418 CVD-related deaths (6.2%) at a median follow-up for 9.3 years. Multivariate Cox regression analysis and restricted cubic splines analysis indicated that METS-VF can exhibit a positive non-linearly correlation with CVD mortality (HR: 4.15, 95% CI: 2.31-7.44, p < 0.001) and all-cause mortality (HR: 5.27, 95% CI: 3.75-7.42, p < 0.001), with an identified inflection point at 7.436. Subgroup analyses further revealed a stronger correlation between METS-VF and all-cause mortality among subjects without diabetes. Furthermore, the areas under the curve (AUC) for 1-, 3-, 5-, and 10-year survival rates were 0.756, 0.740, 0.747 and 0.746 for all-cause mortality, and 0.774, 0.751, 0.746 and 0.758 for CVD mortality, respectively, which performs better than the other obesity and IR related index.

CONCLUSION

Elevated METS-VF independently contributes to an increased risk of both all-cause and CVD mortality in individuals with NAFLD.

CLINICAL TRIAL NUMBER

Not applicable.

Development and validation of Galectin-3 and CVAI-based model for predicting cognitive impairment in type 2 diabetes

OBJECTIVE

The objective of this study is to develop a predictive model combining multiple indicators to quantify the risk of mild cognitive impairment (MCI) in T2DM patients.

METHODS

This study included Chinese T2DM patients who were hospitalized at Zhongda Hospital between November 2021 and May 2023. Clinical data, including demographics, medical history, biochemical tests, and cognitive status, were collected. Cognitive assessment was performed using neuropsychological tests, and MCI was diagnosed based on the Montreal Cognitive Assessment (MoCA) scores. The dataset was randomly divided into a training set and a validation set in a 7:3 ratio. Logistic regression analysis was conducted to identify factors influencing MCI in the training set. A nomogram-based scoring model was then developed by integrating these findings with high-risk clinical variables, and its performance was validated in the validation set.

RESULTS

In this study, T2DM patients were divided into a training set and a validation set in a 7:3 ratio. There were no significant differences in MCI incidence, demographics, or clinical characteristics between the two groups, confirming the appropriateness of model construction. In the training set, Galectin-3 and CVAI were significantly negatively correlated with cognitive function (MoCA and MMSE scores), and this negative correlation remained after adjusting for confounding variables. Logistic regression analysis revealed that age, CVAI, and Galectin-3 significantly increased the risk of MCI, while years of education had a protective effect. The constructed nomogram model, which integrated age, sex, education level, hypertension, CVAI, and Galectin-3 levels, exhibited high predictive performance (C-index of 0.816), with AUCs of 0.816 in the training set and 0.858 in the validation set, outperforming single indicators. PR curve analysis further validated the superiority of the nomogram model.

CONCLUSION

The straightforward, highly accurate, and interactive nomogram model developed in this study facilitate the early risk prediction of MCI in individuals with T2DM by incorporating Galectin-3, CVAI, and other common clinical risk factors.

Role of obesity-related anthropometric indicators on cognitive function in obese older adults: A systematic review and meta-analysis

OBJECTIVES

The association between obesity and cognitive function in older adults remains inconsistent due to the use of various anthropometric indicators, such as body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR). More conclusive evidence is warranted. The aim of this study was to systematically summarize and synthesize the association between specific obesity-related anthropometric indicators (BMI, WC, and WHR) and cognitive function in obese older adults. Higher BMI, WC, or WHR is linked to cognitive decline in this population.

STUDY DESIGN

Systematic review and meta-analysis.

METHODS

A comprehensive literature search was carried out using PubMed, CINAHL, Scopus, Embase, and the Cochrane Library (from their inception to October 2023). Studies investigating the association between obesity indicators, including BMI, WC, WHR, and cognitive performance in older adults were included. The weighted mean difference (WMD), Odds Ratio, and 95 % confidence interval (CI) were used to estimate the pooled effect size. A random-effects model was employed as the main method. Subgroup analyses and the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach were assessed (registered number: CRD42023461770).

RESULTS

Thirty-three eligible studies, involving 83,251 participants, were included. Obese older adults, as assessed by WC, had lower Mini-Mental State Examination (MMSE) scores than non-obese counterparts (WMD -0.84, 95 % CI -1.64 to -0.05, very low certainty). Those measured by WHR had a 31 % higher risk of cognitive impairment (OR 1.31, 95 % CI 1.12 to 1.53, moderate certainty). Subgroup analysis revealed a lower Montreal Cognitive Assessment (MoCA) score in obese group classified by WHO criteria compared to controls (WMD -1.67, 95 % CI -2.94 to -0.39).

CONCLUSION

This review suggests an association between obesity, as measured by WHR and WC, and poorer cognitive performance in older adults. WHR is moderately recommended for identifying cognitive impairment-related obesity, while WC recommendations are limited by very low evidence certainty.

Association between body roundness index and stroke results from the 1999-2018 NHANES

IMPORTANCE

Obesity, especially visceral obesity, is a controllable risk factor associated with the incidence of stroke. The body roundness index (BRI) bridges the gap between traditional anthropometric methods of assessing fat distribution to predict the percentage of body fat and visceral adipose tissue, which can be used to decipher its population-based characteristics and potential association with stroke.

OBJECTIVE

The negative impact of accumulated visceral obesity on cerebrovascular health has been widely documented. However, the association between BRI and stroke has never been reported before. The purpose of this study was to elucidate the connection between BRI and the general incidence of stroke in the US population.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study extracted cross-sectional data from 39,454 U.S. adults (aged ≥20 years) from documents related to the National Health and Nutrition Examination Survey (NHANES) from 1999 through 2018.

METHODS

We evaluated the relationship between BRI and stroke using weighted logistic regression analysis, and we looked at any possible nonlinear relationships using restricted cubic spline (RCS) regression. Additionally, subgroup analysis and interaction tests were carried out.

RESULTS

The study involved 39,454 participants, of whom 1,427 (3.6 %) had a stroke. Fully adjusted logistic regression models showed that BRI was positively associated with stroke, with a 5.7 % increase in stroke incidence per unit increase in BRI (OR = 1.057, 95 % CI = 1.009,1.108, P = 0.020). RCS analysis revealed a nonlinear association, suggesting an elevated risk of stroke before the inflection point of 8.489. This positive correlation was consistent across settings, according to subgroup analyses and interaction tests (P > 0.05 for all interactions).

CONCLUSIONS AND RELEVANCE

There is a nonlinear positive correlation between BRI and stroke, according to this national cohort study. These results support the use of the BRI as a screening tool for assessing stroke risk; yet, because cross-sectional studies have inherent limitations, more thorough research is required until the BRI has been consistently validated in additional independent cohorts.

Associations of dynapenic abdominal obesity and its components with cognitive impairment among hemodialysis patients

OBJECTIVE

Cognitive impairment (CI) is a prevalent and significant health concern among patients undergoing maintenance hemodialysis (MHD). Recent studies have highlighted the growing interest in dynapenic abdominal obesity (DAO), which combines both low muscle strength and excess abdominal fat. Despite the increasing recognition of DAO, its association with CI in MHD patients remains uncertain. The objective of this study was to investigate the relationship between DAO and CI in MHD patients.

METHODS

We conducted a multicenter, cross-sectional study in twenty dialysis centers, encompassing 3767 adult MHD patients. Participants were categorized into four distinct groups based on the criteria for abdominal obesity (AO), defined as waist circumference (WC) ≥ 90 cm for men and ≥ 85 cm for women, and dynapenia, characterized by handgrip strength (HGS) < 28 kg in men and < 18 kg in women. The groups were: non-dynapenic/non-abdominal obesity (NDNAO), non-dynapenic/abdominal obesity (NDAO), dynapenic/non-abdominal obesity (DNAO), and dynapenic/abdominal obesity (DAO). Cognitive function was assessed using the Mini-Mental State Examination (MMSE), with a score below 27 indicating cognitive impairment (CI). Multivariate logistic models were used to investigate the correlations between DAO and its components with the risk of CI. Smooth curve fittings were used to identify the potential nonlinear relationship between WC and the MMSE scores. The piecewise regression model was used for fitting while the log-likelihood ratio test was used to determine whether a significant inflection point existed. Additionally, we conducted a series of subgroup analyses to test the robustness of our results.

RESULTS

The multi-variable adjusted odds ratios (ORs) of CI for DNAO and DAO were 2.10 (1.68-2.62, P < 0.001) and 1.81 (1.40-2.33, P < 0.001), respectively. These findings were consistently observed across subgroup analyses, indicating robustness in our results. AO was associated with increased risk of CI in the crude model (OR 1.22, 95%CI 1.05-1.41; P = 0.008), however, it became a protective factor after adjusting for potential confounders (OR 0.84, 95%CI 0.71-0.98; P = 0.03). We identified a significant nonlinear relationship between WC, HGS, and MMSE scores (P for non-linearity < 0.05). Notably, an inflection point at 23.29 kg for HGS was determined through threshold effect analysis. Below a WC threshold of 101 cm, MMSE scores demonstrated a positive correlation with WC (β = 0.03, 95% CI 0.01-0.04, P < 0.001). However, this relationship did not achieve statistical significance for WC values above 101 cm.

CONCLUSIONS

Both DAO and DNAO are associated with increased odds of CI in MHD patients, with dynapenia being the major factor contributing to the increased odds of CI, while AO appears to play a protective role against CI.

Health Behaviors and Executive Function in Late Adulthood: A Time-Varying Effect Modeling Analysis

OBJECTIVE

Cognitive decline in older adults is a public health issue, with modifiable factors like obesity and sleep potentially influencing this trajectory. Previous research on their relationship with executive function has shown mixed results, particularly across older adulthood.

METHODS

This study utilized time-varying effect modeling (TVEM) to assess the impact of body mass index (BMI) and sleep on executive function in older adults aged 60 to 79, using data from the National Health and Nutrition Examination Survey (NHANES) 2011-2012 and 2013-2014 cycles (N = 2543). Executive function was evaluated using the Digit Symbol Substitution Test (DSST).

RESULTS

Findings indicated that while BMI did not significantly affect cognition, adequate sleep (7-8 hours) was linked to better executive function, especially in individuals aged 63 to 65.

CONCLUSION

These results highlight sleep's importance for cognitive health and suggest interventions focusing on sleep and weight management to mitigate age-related cognitive decline.

Association of metabolic score for visceral fat with all-cause mortality, cardiovascular mortality, and cancer mortality: A prospective cohort study

AIM

Our study aimed to evaluate the association between the metabolic score for visceral fat (METS-VF) and mortality.

METHODS

We conducted a cohort study comprising 11,120 participants. We employed weighted multivariable Cox regression analysis to assess the relationship between METS-VF and mortality. Restricted cubic spline analyses were used to investigate potential non-linear associations. Receiver operating characteristic curves were used to evaluate the predictive value of METS-VF and other obesity-related indicators for mortality. Subgroup analysis and sensitivity analysis were performed to confirm the robustness of the results. Mendelian randomization analysis was utilized to assess potential causality.

RESULTS

Over a median follow-up duration of 83 months, a total of 1014 all-cause deaths, 301 cardiovascular deaths, and 262 cancer deaths occurred. For every 0.2-unit increase in METS-VF, the hazard ratios(HRs) of all-cause mortality, cardiovascular mortality, and cancer mortality were 1.13 [95% confidence interval (CI): 1.06, 1.20], 1.18 (95% CI: 1.06, 1.31), and 1.13 (95% CI: 1.03, 1.25), respectively. In addition, restricted cubic spline analyses revealed no significant non-linear associations between METS-VF and all-cause mortality, cardiovascular mortality, and cancer mortality. In multivariate Cox regression models, hazard ratios of all-cause mortality, cardiovascular mortality and cancer mortality were higher in the highest METS-VF group compared to the reference group. Subgroup and sensitivity analyses confirmed that our results were robust. Receiver operating characteristic curves indicated that METS-VF predicted mortality better than other obesity-related indicators. Mendelian randomization analysis confirmed significant causal relationships.

CONCLUSIONS

METS-VF was positively associated with all-cause mortality, cardiovascular mortality, and cancer mortality. These findings suggest that METS-VF could serve as a straightforward, reliable, and cost-effective marker for identifying individuals at high risk of mortality.

Association between abdominal adiposity and cognitive decline in older adults: a 10-year community-based study

OBJECTIVES

This study aimed to investigate the association between abdominal adiposity and change in cognitive function in community-dwelling older adults.

DESIGN, SETTING, AND PARTICIPANTS

This longitudinal study included older adults aged ≥60 years without cognitive impairment who participated in the National Institute for Longevity Sciences - Longitudinal Study of Aging.

MEASUREMENTS

Cognitive function was evaluated biennially using the Mini-Mental State Examination (MMSE) over 10 years. Waist circumference (WC) was measured at the naval level, and subcutaneous fat area (SFA) and visceral fat area (VFA) were assessed using baseline computed tomography scans. WC, SFA, and VFA areas were stratified into sex-adjusted tertiles. A linear mixed model was applied separately for men and women.

RESULTS

This study included 873 older adults. In men, the groups with the highest levels of WC, SFA, and VFA exhibited a greater decline in MMSE score than the groups with the lowest levels (β [95% confidence interval]: WC, -0.12 [-0.23 to -0.01]; SFA, -0.13 [-0.24 to -0.02]; VFA, -0.11 [-0.22 to -0.01]). In women, the group with the highest level of WC and SFA showed a greater decline in MMSE score than the group with the lowest level (WC, -0.12 [-0.25 to -0.01]; SFA, -0.18 [-0.30 to -0.06]), but VFA was not associated with cognitive decline.

CONCLUSION

Higher WC, SFA, and VFA in men and higher WC and SFA in women were identified as risk factors for cognitive decline in later life, suggesting that abdominal adiposity involved in cognitive decline may differ according to sex.

The role of cognitive function in the relationship between surrogate markers of visceral fat and depressive symptoms in general middle-aged and elderly population: A nationwide population-based study

BACKGROUND

The relationship between obesity and depressive symptoms is well documented, but not visceral fat, especially among Chinese adults are scarce. We aimed to investigate the association between visceral fat and depressive symptoms and the mediation of cognitive function.

METHODS

A total of 19,919 and 5555 participants from the China Health and Retirement Longitudinal Study were enrolled in the cross-sectional and follow-up analyses. Depressive symptoms were measured by the Center of Epidemiological studies depression scale (CES-D). Visceral fat measured by the waist circumference triglyceride (WT) index [calculated as waist circumference (cm)* triglyceride (mmol/L)]. The relationship between the WT index and depressive symptoms was analyzed by binary logistics and Poisson regression. The mediated role of cognitive ability was examined by intermediary analysis.

RESULTS

In the cross-sectional study, higher visceral fat was associated with a lower risk of depressive symptoms. But in the follow-up study, individuals in quintile 2 to quintile 4 of the WT index have a reduced risk of depressive symptoms after four years. Compared with the lower index, quintile 2 of the WT index protected from difficulty concentrating (RR [95%CI]: 0.90 [0.82,0.98], p = 0.023), feeling scared (RR [95%CI]: 0.86 [0.73,0.98], p = 0.030) and feeling that life could not go on (RR [95%CI]: 0.85 [0.74,0.98], p = 0.023). Moreover, cognitive ability explained 11.52 % of the association between visceral fat and depressive symptoms.

CONCLUSIONS

Our findings show that moderate visceral fat was associated with a lower risk of depressive symptoms in middle-aged and older Chinese, partly mediated by cognitive function.

Recent Updates on Associations among Various Obesity Metrics and Cognitive Impairment: from Body Mass Index to Sarcopenic Obesity

Obesity and obesity-associated morbidity continues to be a major public health issue worldwide. Dementia is also a major health concern in aging societies and its prevalence has increased rapidly. Many epidemiologic studies have shown an association between obesity and cognitive impairment, but this relationship is not as well established as other comorbidities. Conflicting results related to the age and sex of participants, and the methodology used to define obesity and dementia may account for the uncertainty in whether obesity is a modifiable risk factor for dementia. More recently, sarcopenia and sarcopenic obesity have been reported to be associated with cognitive impairment. In addition, new mediators such as the muscle-myokine-brain axis and gut-microbiota-brain axis have been suggested and are attracting interest. In this review, we summarize recent evidence on the link between obesity and cognitive impairment, especially dementia. In particular, we focus on various metrics of obesity, from body mass index to sarcopenia and sarcopenic obesity.

Adipose Tissue Aging and Metabolic Disorder, and the Impact of Nutritional Interventions

Adipose tissue is the largest and most active endocrine organ, involved in regulating energy balance, glucose and lipid homeostasis and immune function. Adipose tissue aging processes are associated with brown adipose tissue whitening, white adipose tissue redistribution and ectopic deposition, resulting in an increase in age-related inflammatory factors, which then trigger a variety of metabolic syndromes, including diabetes and hyperlipidemia. Metabolic syndrome, in turn, is associated with increased inflammatory factors, all-cause mortality and cognitive impairment. There is a growing interest in the role of nutritional interventions in adipose tissue aging. Nowadays, research has confirmed that nutritional interventions, involving caloric restriction and the use of vitamins, resveratrol and other active substances, are effective in managing adipose tissue aging’s adverse effects, such as obesity. In this review we summarized age-related physiological characteristics of adipose tissue, and focused on what nutritional interventions can do in improving the retrogradation and how they do this.

Segmental Bioimpedance Variables in Association With Mild Cognitive Impairment

Objective

To examine the changes in body composition, water compartment, and bioimpedance in mild cognitive impairment (MCI) individuals.

Methods

We obtained seven whole-body composition variables and seven pairs of segmental body composition, water compartment, and impedance variables for the upper and lower extremities from the segmental multi-frequency bioelectrical impedance analysis (BIA) of 939 elderly participants, including 673 cognitively normal (CN) people and 266 individuals with MCI. Participants’ characteristics, anthropometric information, and the selected BIA variables were described and statistically compared between the CN participants and those with MCI. The correlations between the selected BIA variables and neuropsychological tests such as the Korean version of the Mini-Mental State Examination and Seoul Neuropsychological Screening Battery – Second Edition were also examined before and after controlling for age and sex. Univariate and multivariate logistic regression analyses with estimated odds ratios (ORs) were conducted to investigate the associations between these BIA variables and MCI prevalence for different sexes.

Results

Participants with MCI were slightly older, more depressive, and had significantly poorer cognitive abilities when compared with the CN individuals. The partial correlations between the selected BIA variables and neuropsychological tests upon controlling for age and sex were not greatly significant. However, after accounting for age, sex, and the significant comorbidities, segmental lean mass, water volume, resistance, and reactance in the lower extremities were positively associated with MCI, with ORs [95% confidence interval (CI)] of 1.33 (1.02–1.71), 1.33 (1.03–1.72), 0.76 (0.62–0.92), and 0.79 (0.67–0.93), respectively; with presumably a shift of water from the intracellular area to extracellular space. After stratifying by sex, resistance and reactance in lower extremities remained significant only in the women group.

Conclusion

An increase in segmental water along with segmental lean mass and a decrease in body cell strength due to an abnormal cellular water distribution demonstrated by reductions in resistance and reactance are associated with MCI prevalence, which are more pronounced in the lower extremities and in women. These characteristic changes in BIA variables may be considered as an early sign of cognitive impairment in the elderly population.

The Potential Crosstalk Between the Brain and Visceral Adipose Tissue in Alzheimer's Development

The bidirectional communication between the brain and peripheral organs have been widely documented, but the impact of visceral adipose tissue (VAT) dysfunction and its relation to structural and functional brain changes have yet to be fully elucidated. This review initially examines the clinical evidence supporting associations between the brain and VAT before visiting the roles of the autonomic nervous system, fat and glucose metabolism, neuroinflammation, and metabolites. Finally, the possible effects and potential mechanisms of the brain-VAT axis on the pathogenesis of Alzheimer's disease are discussed, providing new insights regarding future prevention and therapeutic strategies.

Evaluation of Adiposity and Cognitive Function in Adults

IMPORTANCE

Excess adipose tissue increases other cardiovascular risk factors, which may be associated with vascular brain injury and cognitive impairment. However, the extent to which the amount and distribution of adipose tissue may be associated with lower cognitive scores, independent of its association with cardiovascular risk factors, is not well characterized.

OBJECTIVE

To investigate the association of adiposity on vascular brain injury and cognitive scores.

DESIGN, SETTING, AND PARTICIPANTS

A total of 9189 participants from the Canadian Alliance for Healthy Hearts and Minds (CAHHM) and the Prospective Urban Rural Epidemiological-Mind (PURE-MIND) cohort studies were included in this cross-sectional analysis. Of these adults, 9166 underwent bioelectrical impedance analysis to assess body fat (BF) percentage, and 6773 underwent magnetic resonance imaging to assess vascular brain injury and measure visceral adipose tissue (VAT) volume. Participants from CAHHM were recruited from January 1, 2014, to December 31, 2018, and PURE-MIND participants were recruited from January 1, 2010, to December 31, 2018. Both CAHHM and PURE-MIND comprise multisite, population-based cohorts. Participants from CAHHM are from Canada, and PURE-MIND participants are from Canada or Poland. Data analysis was performed from May 3 to November 24, 2021.

EXPOSURES

The percentage of BF and VAT were modeled as sex-specific quartiles. Vascular brain injury was defined as high white matter hyperintensities or silent brain infarction. Multivariable mixed models were used to examine factors associated with reduced cognitive scores.

MAIN OUTCOMES AND MEASURES

Cognitive function was assessed using the Digital Symbol Substitution Test (DSST; scores range from 0 to 133, with lower scores indicating lower cognitive function) and Montreal Cognitive Assessment (scores range from 0 to 30, with a score of ≥26 denoting normal cognitive function). Reduced cognition was defined as a DSST score less than 1 SD below the mean. Cardiovascular risk was assessed using the INTERHEART Risk Score (IHRS; scores range from 0 to 48; low risk is defined as a score of 0 to 9, moderate risk as 10 to 16, and high risk as 17 or higher).

RESULTS

A total of 9189 adults (mean [SD] age, 57.8 [8.8] years; 5179 [56.4%] women; and 1013 [11.0%] East and Southeast Asian; 295 [3.2%] South Asian; 7702 [83.8%] White European; and 179 [1.9%] other, including Black, Indigenous, mixed, and unknown ethnicity) participated in the study. Visceral adipose tissue was highly correlated with body adiposity measured by BF percentage (r = 0.76 in women; r = 0.70 in men). Cardiovascular risk factors increased with increasing BF percentage with the fourth quartile IHRS at 13.8 (95% CI, 13.5-14.0; P < .001 for trend) and with VAT with the fourth quartile IHRS at 13.3 (95% CI, 13.0-13.5; P < .001 for trend). Vascular brain injury increased with increasing BF percentage with the fourth quartile value at 8.6% (95% CI, 7.5%-9.8%; P = .007 for trend) and with increasing VAT with fourth quartile value at 7.2% (95% CI, 6.0-8.4; P = .05 for trend). Cognitive scores were lower with increasing BF percentage with the fourth quartile score of 70.9 (95% CI, 70.4-71.5; P < .001 for trend) and for VAT with the fourth quartile score of 72.8 (95% CI, 72.1-73.4; P < .001 for trend). For every 1-SD increase in BF percentage (9.2%) or VAT (36 mL), the DSST score was lower by 0.8 points (95% CI, 0.4-1.1; P < .001) for BF percentage and lower by 0.8 points (95% CI, 0.4-1.2; P < .001) for VAT, adjusted for cardiovascular risk factors and vascular brain injury. The population attributable risk for reduced DSST score for higher BF percentage was 20.5% (95% CI, 7.0%-33.2%) and for VAT was 19.6% (95% CI, 2.0%-36.0%). Higher BF percentage and VAT were not associated with Montreal Cognitive Assessment scores.

CONCLUSIONS AND RELEVANCE

In this cross-sectional study, generalized and visceral adiposity were associated with reduced cognitive scores, after adjustment for cardiovascular risk factors, educational level, and vascular brain injury. These results suggest that strategies to prevent or reduce adiposity may preserve cognitive function.

Association between Visceral Fat and Brain Structural Changes or Cognitive Function

Visceral fat accumulation is an independent risk factor for cardiovascular disease and mortality. Visceral fat is a causal risk factor for hypertension and type 2 diabetes, which was reported as one of the risk factors for dementia. Visceral fat areas (VFA) might be clinically important to prevent dementia; however, the association between VFA and cognitive function in the elderly remains unknown. We aimed to evaluate the association between brain structural abnormalities using magnetic resonance imaging (MRI) and VFA, and the association between cognitive function and VFA, in the elderly. A total of 2364 healthy individuals were enrolled, and we excluded those diagnosed with dementia. Participants were divided into a high-VFA and a low-VFA group based on median VFA. The high-VFA group had significantly lower cognitive function than the low-VFA group (p = 0.025), after adjustment for related factors using a linear regression model. Regarding brain structure in MRI, VFA remained significantly associated with white matter lesions (odds ratio (OR), 1.90; 95% confidence interval (1.33-2.70); adjusted p < 0.001) and perivascular space (OR, 1.28; 95% confidence interval (1.02-1.61); adjusted p = 0.033). Further follow-up studies are needed, but reducing visceral fat might be important, not only to prevent cardiovascular disease but also to prevent dementia.

Cognitive Function Changes in Older People. Results of Second Wave of Cognition of Older People, Education, Recreational Activities, NutritIon, Comorbidities, fUnctional Capacity Studies (COPERNICUS)

Background

Cognitive reserve explains why subjects with more years of education, professional achievement, or participation in recreational activities show less cognitive decline with aging. We hypothesize that levels of recreational travel, education, occupation, systemic health, physical performance, and current cognitive activity levels affect the trajectory of cognitive function in older, healthy people in Poland.

Materials and Methods

Healthy, older people (N = 205) were examined and followed-up at 2 years. Participants completed physical and cognitive function assessments: including the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) and its two subtests Delayed Recall (DR) and Verbal Fluency (VF), and Trail Making Test Part B (TMT B). Factors associated with cognitive functioning were also examined.

Results

The MMSE result significantly decreased over 2 years. No significant decrease in other cognitive tests was noted. However, the trajectory of cognitive tests results varied between individual participants. Percentage of variance of change was explained by the following predictors: 21 in MMSE, 24 in MoCA, 8 in DR, 25 in VF, and 24 in TMT B. Age and the presence of varicose veins were significantly linked to negative changes in MMSE and MoCA scores, while working in a professional occupational status associated with a higher score. The subgroup with varicose veins did worse on the Delayed Recall subtest of MoCA.

Conclusion

Cognitive reserve could be extended by proxies of reserve that are related to systemic health and travel activity. The latter is a combination of social, physical, and cognitive activity and potentially might serve as an intervention to improve cognitive function in older people. However, due to the limitations of this study, results should be interpreted with caution and needs to be replicated in the further studies.

Associations of Body Mass Index, Visceral Fat Area, Waist Circumference, and Waist-to-Hip Ratio with Cognitive Function in Western China: Results from WCHAT Study

OBJECTIVES

This study examined the relationship between cognitive performance and obesity parameters, such as body mass index (BMI), visceral fat area (VFA), waist circumference (WC), and waist-to-hip ratio (WHR) in western China.

STUDY DESIGN

A cross-sectional study.

METHODS

3914 participants, aged ≥50 years, were recruited in this study. Anthropometrics measurements, life-style factors, chronic disease comorbidities, and sleep qualities were recorded for each participant. Among the anthropometrics, BMI, WC, and WHR were assessed using standard procedures, while VFA was calculated using bioelectrical impedance analysis. Cognitive performance was estimated using the Short Portable Mental Status Questionnaire (SPMSQ). Finally, relationships between cognitive abilities and BMI, VFA, WC, and WHR were evaluated using univariate and multivariate regression analyses.

RESULTS

Cognitive decline (CD) occurred at a rate of 13.29% among the 3914 participants. A strong correlation was observed between cognitive abilities and BMI of male patients aged 50-59 yrs (OR 1.116,95% CI1.002-1.242), in the adjusted model. Alternately, WHR was shown to be significantly related to CD in females aged ≥70 years (OR 0.041, 95% CI0.002-0.671). WC was shown to have a strong association with CD in males (OR 1.023,95% CI1.003-1.024). Lastly, WHR was closely connected to CD in participants with BMI < 25 kg/m2 (OR 0.022,95% CI0.002-0.209).

CONCLUSIONS

Our findings suggest that a higher middle age BMI is associated with CD, whereas, in the elderly population, a higher WHR is related to improved cognitive performance. Further investigation is warranted to elucidate a relationship between VFA and CD.