Relationships of Clinical and Computed Tomography-Imaged Adiposity with Cognition in Middle-Aged and Older African Americans

Parker, Kirby G.; Lirette, Seth T.; Deardorff, David; Bielak, Lawrence F.; Peyser, Patricia A.; Carr, J. Jeffrey; Terry, James G.; Fornage, Myriam; Benjamin, Emelia J.; Turner, Stephen T.; Mosley, Thomas H.; Griswold, Michael; Windham, B. Gwen

doi:10.1093/gerona/glx163

Cited by 6 publications

(4 citation statements)

References 41 publications

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“…In addition, measures of adiposity and their relationship with cognition may differ by adiposity depot. 9 However, the assessment of the association between WC categories and cognitive function showed that high WC potentially attenuates declines in cognition, similar to our results using BMI. Although we excluded underweight participants and participants aged 65 years and older in sensitivity analyses, we did not examine whether weight loss was associated with attrition from the study and thus cannot completely rule out reverse causation or attrition bias as partly contributing to the paradoxical association of BMI and cognitive decline.…”

Section: Discussionsupporting

confidence: 88%

“…Some studies show no association or a mildly increased risk between midlife obesity and CID and no or decreased risk of late-life obesity with CID, likely due to the prodromal weight loss phenomenon that occurs up to 10 years before dementia diagnosis. [7][8][9][10] Less is known about differences in the relationship between obesity and CID in Black and White adults, and longitudinal studies with racial diversity are particularly sparse. Studies have found that the effect of vascular risk factors on the brain might differ between Black and White adults.…”

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confidence: 99%

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Association of Obesity With Cognitive Decline in Black and White Americans

et al. 2023

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Background and Objectives:There are disparities in the prevalence of obesity by race and the relationship between obesity and cognitive decline is unclear. The objective of this study was to determine whether obesity is independently associated with cognitive decline and if the association between obesity and cognitive decline differs in Black and White adults. We hypothesized that obesity is associated with greater cognitive decline compared to normal weight, and that the impact of obesity on cognitive decline is more pronounced in Black adults compared to their White counterparts.Methods:We pooled data from 28,867 participants free of stroke and dementia (mean, standard deviation [SD]: age 61 [10.7] years at the first cognitive assessment, 55% female, 24% Black, and 29% obese) from six cohorts. The primary outcome was annual change in global cognition. We performed linear mixed-effects models with and without time-varying cumulative mean systolic blood pressure (SBP) and fasting plasma glucose (FPG). Global cognition was set to a t-score metric (mean 50, standard deviation [SD] 10) at a participant's first cognitive assessment; a 1-point difference represents a 0.1 SD difference in global cognition across the six cohorts. The median follow-up was 6.5 years (25thpercentile, 75thpercentile: 5.03, 20.15).Results:Obese participants had lower baseline global cognition than normal-weight participants (difference in intercepts, -0.36 [95% CI, -0.46 to -0.17]; P<0.001). This difference in baseline global cognition was attenuated but was borderline significant after accounting for SBP and FPG (adjusted differences in intercepts, -0.19 [95% CI, -0.39 to 0.002]; P=0.05). There was no difference in the rate of decline in global cognition between obese and normal-weight participants (difference in slope, 0.009 points/year [95% CI, -0.009 to 0.03]; P=0.32). After accounting for SBP and FPG, obese participants had a slower decline in global cognition (adjusted difference in slope, 0.03 points/year slower [95% CI, 0.01 to 0.05]; P<0.001). There was no evidence that race modified the association between BMI and global cognitive decline (P=0.34).Discussion:These results suggest that obesity is associated with lower initial cognitive scores and may potentially attenuate declines in cognition after accounting for BP and FPG.

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Section: Discussionsupporting

confidence: 88%

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confidence: 99%

Association of Obesity With Cognitive Decline in Black and White Americans

et al. 2023

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“…3 Higher BMI has been associated with lower dementia risk in older age, likely due to the pre-clinical weight loss phenomenon that occurs prior to a dementia diagnosis. 4 However, waist circumference relationships to cognition are stronger in older age compared to body mass index (BMI), are more consistently associated with dementia risk across age than BMI, 5,6 and, compared to BMI, waist circumference is considered a more valid measure of obesity in older adults. 7 Obesity is more common in African American than White individuals 8 and may contribute to the disproportionate burden of dementia in African American individuals.…”

Section: Introductionmentioning

confidence: 99%

Mediation effects of diabetes and inflammation on the relationship of obesity to cognitive impairment in African Americans

Saleh

Lirette

Benjamin

et al. 2022

J American Geriatrics Society

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Background: Whether diabetes and adipokine-driven inflammation explain the association of obesity to cognitive impairment is unknown. Methods: Structural equation models estimated the total effects of waist circumference on cognitive outcomes among African American participants cross-sectionally (index exam) and longitudinally. Total effects were deconstructed into direct pathways of waist circumference to cognitive impairment and indirect mediation pathways through leptin, soluble tumor necrosis factor receptor 2 (sTNFR2), and diabetes. Waist circumference, leptin, and sTNFR2 were standardized. Cognitive impairment was defined as MMSE <21 or a z-score < À1.5 standard deviation (SD). Incident cognitive impairment was defined among those without cognitive impairment at the index exam as follow-up MMSE<21, z-score < À1.5, MMSE decline >1 point/year, or z-score decline of >0.1 SD/year.Results: Among 1008 participants (70% women, mean age 62.9 years, 14.5% with obesity, 26% with diabetes), 132 (13%) had baseline cognitive impairment. Each SD higher waist circumference was associated with higher odds of cognitive impairment, odds ratio (OR) = 1.63; (95% confidence interval: 1.17, 2.24), with mediating pathways explaining 65% of the total effect (58% from diabetes; 7% from inflammation). At follow-up (mean 6.8 years), 106 of 535 (19.8%) had developed cognitive impairment. Each SD higher waist circumference was associated with higher odds of developing cognitive

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“…Some cross-sectional studies showed that high-VFA individuals had a significantly higher prevalence of MCI [20,21]. However, others have shown that there is no significant association between VFA and MCI [22] or cognitive function [23]. Furthermore, a recent study of more than 5000 Japanese individuals showed that visceral fat accumulation was protective against MCI [24].…”

Section: Introductionmentioning

confidence: 99%

Association between Visceral Fat and Brain Structural Changes or Cognitive Function

et al. 2021

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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.

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Relationships of Clinical and Computed Tomography-Imaged Adiposity with Cognition in Middle-Aged and Older African Americans

Abstract: WC may be the simplest and most efficient measure of adiposity to assess with respect to cognition in clinical settings, although studies to determine mechanistic effects of subcutaneous and other adiposity depots on cognition are warranted.

Cited by 6 publications

References 41 publications

Association of Obesity With Cognitive Decline in Black and White Americans

Association of Obesity With Cognitive Decline in Black and White Americans

Mediation effects of diabetes and inflammation on the relationship of obesity to cognitive impairment in African Americans

Association between Visceral Fat and Brain Structural Changes or Cognitive Function

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