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. 2022 Feb 1;5(2):e2146324.
doi: 10.1001/jamanetworkopen.2021.46324.

Evaluation of Adiposity and Cognitive Function in Adults

Sonia S Anand  1   2 , Matthias G Friedrich  3 , Douglas S Lee  4   5 , Phillip Awadalla  6 , J P Després  7 , Dipika Desai  1 , Russell J de Souza  8 , Trevor Dummer  9   10 , Grace Parraga  11 , Eric Larose  12 , Scott A Lear  13 , Koon K Teo  1 , Paul Poirier  14 , Karleen M Schulze  1 , Dorota Szczesniak  15 , Jean-Claude Tardif  16 , Jennifer Vena  17 , Katarzyna Zatonska  18 , Salim Yusuf  1 , Eric E Smith  19   20   21 ; Canadian Alliance of Healthy Hearts and Minds (CAHHM) and the Prospective Urban and Rural Epidemiological (PURE) Study Investigators
Affiliations

Evaluation of Adiposity and Cognitive Function in Adults

Sonia S Anand et al. JAMA Netw Open. .

Abstract

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.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Anand reported receiving grants from Canadian Partnership Against Cancer, Heart and Stroke Foundation of Canada, and Canadian Institutes of Health Research, and a Canadian Institutes of Health Research Foundation grant during the conduct of the study and serving as the Tier 1 Canada Research Chair Ethnicity and Cardiovascular Disease and as the Michael G Degroote Heart and Stroke Foundation Chair in Population Helath Research, and receiving grants from Heart and Stroke Foundation of Canada and Canadian Institutes of Health Research, and receiving personal fees from Bayer outside the submitted work. Dr Friedrich reported receiving personal fees from Circle CVI Inc for serving as a board member and adviser and being a shareholder outside the submitted work. Dr Després reported receiving grants from the Canadian Institutes of Health Research outside the submitted work. Dr de Souza reported receiving grants from the Canadian Institutes of Health Research during the conduct of the study; receiving grants from the Canadian Institutes of Health Research, Population Health Research Institute, and Hamilton Health Sciences Corporation outside the submitted work; and serving as a member of the Nutrition Science Advisory Committee to Health Canada (Government of Canada), a co-opted member of the Scientific Advisory Committee on Nutrition Subgroup on the Framework for the Evaluation of Evidence (Public Health England), and as an independent director of the Helderleigh Foundation (Canada). Dr Dummer reported receiving grants from Canadian Partnership Against Cancer during the conduct of the study. Dr Parraga reported receiving grants from the Canadian Institutes of Health Research Canadian Alliance Study during the conduct of the study and grants from Astra Zeneca and Novartis and personal fees from Astra Zeneca and Polarean outside the submitted work. Dr Lear reported receiving grants from the Canadian Institutes of Health Research and grants from Michael Smith Foundation for Health Research during the conduct of the study and personal fees from Curatio Inc outside the submitted work. Dr Szczesniak reported receiving grants from the National Science Centre during the conduct of the study. Dr Tardif reported receiving grants from Amarin, Ceapro, Esperion, Ionis, Novartis, Pfizer, RegenXBio, Sanofi, AstraZeneca, and DalCor Pharmaceuticals, receiving personal fees from AstraZeneca, HLS Pharmaceuticals, Pendopharm, and DalCor Pharmaceuticals, and having a minor equity interest in DalCor Pharmaceuticals Minor outside the submitted work. In addition, Dr Tardif had a patent for Pharmacogenomics-Guided CETP Inhibition issued by DalCor Pharmaceuticals, a patent for Use of Colchicine After Myocardial Infarction pending, and a patent for Genetic Determinants of Response to Colchicine pending. Dr Vena reported receiving grants from Alberta Health, Alberta Cancer Foundation and Canadian Partnership Against Cancer (provides program funding for Alberta’s Tomorrow Project) during the conduct of the study. Dr Zatonska reported receiving grants from the National Science Center outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Body Fat and Visceral Adipose Tissue Association With Digital Symbol Substitution Test (DSST) Stratified by Sex
A, The fully adjusted model shows lower cognitive scores measured by DSST with higher body fat percentage in men and women. B, The fully adjusted model shows lower cognitive scores measured by DSST with higher visceral adipose tissue in men and women.
Figure 2.
Figure 2.. Population Attributable Risk (PAR) of Key Exposures on Reduced Cognitive Scores
The greatest PAR on low Digital Symbol Substitution Test (DSST) score is the cardiovascular risk score, followed by adiposity, low educational level, and vascular injury. Error bars indicate 95% CIs. IHRS indicates INTERHEART Risk Score.
See this image and copyright information in PMC

References

    1. Wormser D, Kaptoge S, Di Angelantonio E, et al. ; Emerging Risk Factors Collaboration . Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease: collaborative analysis of 58 prospective studies. Lancet. 2011;377(9771):1085-1095. doi:10.1016/S0140-6736(11)60105-0 - DOI - PMC - PubMed
    1. Yusuf S, Hawken S, Ounpuu S, et al. ; INTERHEART Study Investigators . Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries: a case-control study. Lancet. 2005;366(9497):1640-1649. doi:10.1016/S0140-6736(05)67663-5 - DOI - PubMed
    1. Timpson NJ, Nordestgaard BG, Harbord RM, et al. . C-reactive protein levels and body mass index: elucidating direction of causation through reciprocal Mendelian randomization. Int J Obes (Lond). 2011;35(2):300-308. doi:10.1038/ijo.2010.137 - DOI - PMC - PubMed
    1. Elks CM, Francis J. Central adiposity, systemic inflammation, and the metabolic syndrome. Curr Hypertens Rep. 2010;12(2):99-104. doi:10.1007/s11906-010-0096-4 - DOI - PubMed
    1. Després JP, Carpentier AC, Tchernof A, Neeland IJ, Poirier P. Management of obesity in cardiovascular practice: JACC focus seminar. J Am Coll Cardiol. 2021;78(5):513-531. doi:10.1016/j.jacc.2021.05.035 - DOI - PMC - PubMed

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