Rodríguez-Fernández Jorge Mario, Danies Emily, Martínez-Ortega José, Chen William C
1 Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA.
2 Department of Neurosurgery, University of California, San Francisco, CA, USA.
J Geriatr Psychiatry Neurol. 2017 Mar;30(2):67-76. doi: 10.1177/0891988716686832. Epub 2017 Jan 12.
The aim of this study was to explore the association of body mass index (BMI), waist circumference (WC), and BMI and WC changes over time with cognitive decline in a nationally representative sample.
A total of 5239 participants (≥65 years) were followed for 3 years as part of the National Health and Aging Trends Study. Cox proportional hazard regression was applied to model the risk of cognitive decline.
BMI, after adjusting for WC and main confounders, was associated with reduced risk of cognitive decline (hazard ratio [HR] 0.97 for each unit BMI increase, 0.95-0.99). After stratifying by gender and age, this effect remained significant among females and young elders ≤80 years. A BMI decrease and WC increase >10% over the study period were associated with increased risk of cognitive decline (HR 1.98, 1.16-3.38; HR 1.30, 1.04-1.62, respectively).
In the elderly individuals, lean mass, as measured by BMI adjusted for WC, was associated with reduced risk of cognitive decline. Loss of lean mass and gain of fat mass, as measured by WC adjusted for BMI, were associated with elevated risk of cognitive decline.
本研究旨在探讨在一个具有全国代表性的样本中，体重指数（BMI）、腰围（WC）以及BMI和WC随时间的变化与认知功能下降之间的关联。
作为国家健康与衰老趋势研究的一部分，对总共5239名年龄≥65岁的参与者进行了为期3年的随访。采用Cox比例风险回归模型来模拟认知功能下降的风险。
在对WC和主要混杂因素进行调整后，BMI与认知功能下降风险降低相关（每增加一个单位BMI，风险比[HR]为0.97，95%可信区间为0.95 - 0.99）。按性别和年龄分层后，这种效应在女性和年龄≤80岁的年轻老年人中仍然显著。在研究期间，BMI下降以及WC增加>10%与认知功能下降风险增加相关（HR分别为1.98，95%可信区间为1.16 - 3.38；HR为1.30，95%可信区间为1.04 - 1.62）。
在老年人中，经WC调整后的BMI所衡量的瘦体重与认知功能下降风险降低相关。经BMI调整后的WC所衡量的瘦体重减少和脂肪量增加与认知功能下降风险升高相关。
