Objective: The role of vascular risk factors in age-related brain degeneration has long been the subject of intense study, but the role of obesity remains understudied. Given known sex differences in fat storage and usage, this study investigates sex differences in the association between adiposity and white matter microstructural integrity, an important early marker of brain degeneration.Methods: This study assesses the associations between adiposity (abdominal fat ratio and liver proton density fat fraction) and brain health (measures of intelligence and white matter microstructure using diffusion-tensor imaging [DTI]) in a group of UK Biobank participants.Results: This study finds that intelligence and DTI metrics are indeed associated with adiposity differently in males and females. These sex differences are distinct from those in the associations of DTI metrics with age and blood pressure.Conclusions: Taken together, these findings suggest that there are inherent sexdriven differences in how brain health is associated with obesity.

A previously healthy, active duty 37-year-old male experienced recurrent cardiac arrests because of ventricular fibrillation and polymorphic ventricular tachycardia. Initial evaluation did not reveal a clear ischemic, structural, toxic, or metabolic cause. Close monitoring of telemetry before his third cardiac arrest revealed the cause to be early repolarization syndrome (ERS). In this case, we review the diagnosis, epidemiology, and prognostic significance of early repolarization pattern as it relates to ERS. We also discuss acute and long-term treatment strategies for patients with ERS.

The role of vascular risk factors in age-related brain degeneration has long been the subject of intense study. As its own sub-category of vascular risk, obesity has an increasingly recognized role in influencing brain health and health-care strategies, but its association with brain health remains under-studied. Notably, no prior study has addressed sex differences in the association between metrics of obesity and white-matter microstructural integrity, an important early marker of brain degeneration, despite known sex differences in fat storage and usage. This study focuses on the associations between markers of body fat (abdominal fat ratio: AFR, and liver proton density fat fraction: PDFF) and brain microstructural health (measures of white-matter microstructure using diffusion-tensor imaging, DTI). We found that fluid intelligence and reaction time are indeed associated with body fat differently in men and women. We also found significant differences in the associations of AFR with DTI metrics between sexes. These sex differences are mirrored in the associations of SBP and age with DTI metrics. Moreover, these sex differences in the AFR and SBP associations with DTI metrics persist when controlling for age. Taken together, these findings suggest that there are inherent sex-driven differences in how brain health is associated with vascular risk factors such as obesity.

White matter microstructural degeneration is an early marker of declining brain health, and vascular risk factors such as high blood pressure and adipose fat deposition have been found to be significantly associated with white matter microstructural degeneration in healthy adults. In this study, using diffusion tensor imaging, we find that the vascular-risk influences on white matter are more pronounced in women than in men. This study therefore calls attention to the consideration of sex differences in studying brain vulnerability to vascular risk factors.