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. 2025 May 8;20(5):e0322802.
doi: 10.1371/journal.pone.0322802. eCollection 2025.

Obesity and its associations with autonomic and cognitive functions in the general population

Battuvshin Lkhagvasuren  1   2   3 , Zhiping P Pang  4 , Tsolmon Jadamba  1 , Tetsuya Hiramoto  5 , Keely Cheslack-Postava  6 , George J Musa  6   7 , Christina W Hoven  7   8 , Nobuyuki Sudo  3
Affiliations

Obesity and its associations with autonomic and cognitive functions in the general population

Battuvshin Lkhagvasuren et al. PLoS One. .

Abstract

Background: Obesity poses a significant global health burden. This study aimed to investigate the prevalence of obesity in Mongolia and its associations with autonomic and cognitive functions while considering potential psychosocial risk factors.

Methods: This population-based, cross-sectional study included 382 participants who underwent physical examinations, completed health-related questionnaires, and participated in heart rate variability (HRV) testing for autonomic assessment and the mini-mental state examination for cognitive evaluation.

Results: Obesity prevalence was 28.1% (age-sex adjusted). Individuals with obesity were more likely to be older, married, have lower education, and engage in less physical activity. They exhibited autonomic imbalance, decreased autonomic nervous system activity, lower cognitive function, and sleep disturbances compared to the individuals without obesity. Body mass index, and waist circumference inversely correlated with HRV indices. Female sex, lower education, apartment living, alcohol consumption, sleep disturbances, and autonomic dysfunction emerged as significant risk factors for obesity. Independent predictors of autonomic dysfunction included systolic blood pressure, physical activity, and neck circumference, while age, education, height, sleep apnea, and autonomic dysfunction predicted cognitive decline. Furthermore, generalized linear mediation models revealed a partial mediation effect of autonomic dysfunction on the association between obesity and cognitive decline.

Conclusion: This study highlights a high prevalence of obesity in the general population (28.1%) and identifies distinct characteristics associated with the condition. Furthermore, our findings suggest a potential indirect effect of obesity on cognitive function, mediated by autonomic dysfunction. Further research is needed to elucidate the causal relationships and develop targeted interventions for high-risk groups (females, individuals with lower education) and promotion initiatives of healthy lifestyles (less alcohol, exercise, and sleep hygiene) to address both obesity and its associated health complications, including autonomic dysfunction.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Study flowchart.
a) Sampling sites across the country. The study consisted of 48 sampling centers, including 24 centers in Ulaanbaatar and 24 in 4 rural regions. b) Study flowchart: The required sample size was 385. We invited 540 individuals to participate in this study. Among them, 75 did not show up, 54 participants were excluded due to the missing data and 29 participants were inadequate HRV data recordings. A total of 382 participants were included in the final analysis.
Fig 2
Fig 2. ROC curve of the predictive factors for obesity.
The area under the receiver operating characteristic curve was 0.977, reflecting high predictive accuracy of 0.921, with a specificity of 0.946 and a sensitivity of 0.868.
See this image and copyright information in PMC

References

    1. Blüher M. Obesity: global epidemiology and pathogenesis. Nat Rev Endocrinol. 2019;15(5):288–98. doi: 10.1038/s41574-019-0176-8 - DOI - PubMed
    1. World Health Organization. Obesity and overweight. 2024. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight.
    1. NCD Risk Factor Collaboration. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet (London, England). 2017;390(10113):2627–42 - PMC - PubMed
    1. GBD 2017 Diet Collaborators. Health effects of dietary risks in 195 countries, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet (London, England). 2019;393(10184):1958–72. - PMC - PubMed
    1. Wong MCS, Huang J, Wang J, Chan PSF, Lok V, Chen X, et al.. Global, regional and time-trend prevalence of central obesity: a systematic review and meta-analysis of 13.2 million subjects. Eur J Epidemiol. 2020;35(7):673–83. doi: 10.1007/s10654-020-00650-3 - DOI - PMC - PubMed