Association of Estradiol and Visceral Fat With Structural Brain Networks and Memory Performance in Adults

Abstract

Importance: Changes in estradiol during aging are associated with increased dementia risk. It remains unclear how estradiol supports cognitive health and whether risk factors, such as midlife obesity, are exacerbated by estrogen loss.

Objectives: To assess whether visceral adipose tissue (VAT) moderates the association between age and brain network structure and to investigate whether estradiol moderates the association between VAT and brain network structure.

Design, setting, and participants: Cross-sectional study of data from 974 cognitively healthy adults in Germany who participated in the Health Study of the Leipzig Research Centre for Civilization Diseases, a previously described population-based cohort study. Two moderation analyses were performed, including VAT as the moderator variable between age and brain network structure and estradiol as the moderator variable between VAT and brain network structure. The study was conducted from August 1, 2011, to November 23, 2014. Analyses were conducted from August 2017 to September 2018.

Exposures: Serum estradiol levels from fasting blood and visceral adipose tissue volume from T1-weighted magnetic resonance imaging (MRI).

Main outcomes and measures: Brain network covariance (individual loading on structural network derived from T1-weighted MRI) and memory performance (composite score from the Consortium to Establish a Registry for Alzheimer Disease [CERAD] verbal episodic memory test on learning [score range, 0-30], recall [score range, 0-10], and recognition [score range, 0-20]).

Results: Final analyses included data from 473 women (mean [SD] age, 50.10 [15.63] years) and 501 men (mean [SD] age, 51.24 [15.67] years). Visceral adipose tissue was associated with an exacerbation of the negative association of aging with network covariance for women (interaction term β = -0.02; 95% bias-corrected bootstrap CI, -0.03 to -0.01; P = .001) and men (interaction term β = -0.02; 95% bias-corrected bootstrap CI, -0.03 to -0.01; P < .001). Estradiol level was associated with a reduction in the negative association of VAT with network covariance in women (interaction term β = 0.63; 95% bias-corrected bootstrap CI, 0.14-1.12; P = .01), with no significant association in men. In the female midlife subgroup (age range, 35-55 years, when menopause transition occurs), low estradiol levels were associated with lower memory network covariance (Cohen d = 0.61; t80 = 2.76; P = .007) and worse memory performance (Cohen d = 0.63; t76 = 2.76; P = .007).

Conclusions and relevance: This study reports a novel association between VAT, estradiol, and structural brain networks as a potential mechanism underlying cognitive decline in women. These findings appear to highlight the need for sex-specific strategies, including VAT and hormonal screening during midlife, to support healthy cognitive aging.

Figure 1.. Brain Network Covariance and Memory Performance

Color bars indicate z-scored positive (red/yellow) or negative (blue/light-blue) covariations within the network.

Figure 2.. Sex Differences in the Association Between Visceral Adipose Tissue and Age

A, Representative visceral adipose tissue segmentations in 2 women and 2 men. Participants of the same sex, age, and body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) can have vastly different fat distribution profiles. B, Nonlinear correlation between visceral adipose tissue and age in women and men. For women, the dashed line shows the inflection point.

Figure 3.. Visceral Adipose Tissue (VAT) and Structural Network Covariance

A, The plot shows simple slopes of VAT and structural network covariance for each sex, which differ significantly. The VAT values were height standardized and log-transformed. B, Moderation analysis of interaction of VAT and age on network covariance in both sexes.

Figure 4.. Estradiol and Structural Network Covariance in Women Only

A, The plot shows a simple slope of estradiol and structural network covariance. B, Moderation analysis of interaction of visceral adipose tissue and estradiol on network covariance. C and D, The inner box plot shows the median (centers) and interquartile range (borders), with whiskers extending 1.5 times the interquartile range. The width of the shaded area shows the proportion of data located there. To convert estradiol level to picograms per milliliter, divide by 3.671.