Associations Among Body Mass Index, Cortical Thickness, and Executive Function in Children

Abstract

total of 13.7 million children in the United States younger than 18 years are obese, and an additional 12 million children are classified as overweight. 1 The percentage of extreme obesity among children has continued to increase in the past decade and is now estimated to be approximately 750 000, or 6%, of children who meet the diagnostic threshold for obesity. 2 The negative metabolic and cardiovascular sequelae of increasing adiposity, obesity, and chronic obesity in children is well established. Children with obesity are more likely to develop early-onset type 2 diabetes and heart disease, [3][4][5] tend to have more severe risk factors and disease burden, 6 and are at greater risk for premature mortality than their healthy weight peers. 7,8 Higher body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) has also been associated with poorer cognitive performance across the lifespan, particularly in the domain of higher executive functions. [9][10][11][12] Less is known about the effects of obesity and being overweight on brain development and how this might interact with cognitive ability. Many neuroimaging studies [13][14][15][16] have found structural alterations in cortical regions involved in executive control in obese children compared with lean children. However, limited sample sizes, insufficient statistical power, differences in sample populations, and differing magnetic resonance imaging (MRI) modalities have yielded mixed results. Maayan et al 13 reported that obese children performed worse on working memory tasks compared with healthy control individuals and had less orbitofrontal cortical volume, a brain region associated with appetite control. By contrast, Saute et al 14 found an association between IMPORTANCE A total of 25.7 million children in the United States are classified as overweight or obese. Obesity is associated with deficits in executive function, which may contribute to poor dietary decision-making. Less is known about the associations between being overweight or obese and brain development.OBJECTIVE To examine whether body mass index (BMI) is associated with thickness of the cerebral cortex and whether cortical thickness mediates the association between BMI and executive function in children. DESIGN, SETTING, AND PARTICIPANTSIn this cross-sectional study, cortical thickness maps were derived from T1-weighted structural magnetic resonance images of a large, diverse sample of 9-and 10-year-old children from 21 US sites. List sorting, flanker, matrix reasoning, and Wisconsin card sorting tasks were used to assess executive function. MAIN OUTCOMES AND MEASURESA 10-fold nested cross-validation general linear model was used to assess mean cortical thickness from BMI across cortical brain regions. Associations between BMI and executive function were explored with Pearson partial correlations. Mediation analysis examined whether mean prefrontal cortex thickness mediated the association between BMI and executive function.RESULTS Among 3190 individuals (me...

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