From the Departments of Neurology (L.H.R., C.A.M., N.S.), Psychiatry (C.A.M.), and Medicine (T.T.B.), Johns Hopkins University School of Medicine; Department of Epidemiology (L.H.R., L.Z., L.P.J.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Neurology (D.G.), State University of New York Downstate Medical Center, Brooklyn; University of Colorado (K.L.H., K.M.E.), Aurora; Denver Public Health (K.L.H.), CO; Department of Neurology (J.T.B.), University of Pittsburgh, PA; Department of Medicine (J.E.L.), University of Texas Health Science Center at Houston; Department of Psychiatry (E.M.), Rush University Medical Center, Chicago, IL; and Department of Neurology (A.L.), David Geffen School of Medicine at the University of California, Los Angeles.
Neurology. 2019 Jul 16;93(3):e261-e271. doi: 10.1212/WNL.0000000000007779. Epub 2019 Jun 14.
Obesity is a common, modifiable cardiovascular and cerebrovascular risk factor. Among people with HIV, obesity may contribute to multisystem dysregulation including cognitive impairment. We examined body mass index (BMI) and central obesity (waist circumference [WC]) in association with domain-specific cognitive function and 10-year cognitive decline in men with HIV infection (MWH) vs HIV-uninfected (HIV-) men.
A total of 316 MWH and 656 HIV- Multicenter AIDS Cohort Study participants ≥40 years at baseline, with neuropsychological testing every 2 years and concurrent BMI and WC measurements, were included. MWH were included if taking ≥2 antiretroviral agents and had HIV-1 RNA <400 copies/mL at >80% of visits. Mixed-effects models included all visits from 1996 to 2015, stratified by HIV serostatus, and adjusted for sociodemographic, behavioral, and clinical characteristics. At baseline and follow-up, 8% of MWH and 15% of HIV- men and 41% of MWH and 56% of HIV- men were ≥60 years, respectively.
Cross-sectionally, higher BMI was inversely associated with motor function in MWH and HIV- men, and attention/working memory in HIV- men. WC was inversely associated with motor function in MWH and HIV- men. Longitudinal associations indicated an obese BMI was associated with a less steep decline in motor function in MWH whereas in HIV- men, obesity was associated with a greater decline in motor function, learning, and memory. WC, or central obesity, showed similar patterns of associations.
Higher adiposity is associated with lower cognition cross-sectionally and greater cognitive decline, particularly in HIV- men. Overweight and obesity may be important predictors of neurologic outcomes and avenues for prevention and intervention.
肥胖是一种常见的、可改变的心血管和脑血管危险因素。在 HIV 感染者中，肥胖可能导致包括认知障碍在内的多系统失调。我们研究了身体质量指数（BMI）和中心性肥胖（腰围[WC]）与 HIV 感染者（MWH）与 HIV 未感染者（HIV-）男性特定认知功能领域和 10 年认知衰退的相关性。
共纳入 316 名 MWH 和 656 名 HIV-多中心 AIDS 队列研究参与者，他们在基线时年龄均≥40 岁，每 2 年进行一次神经心理学测试，并同时测量 BMI 和 WC。如果 MWH 接受≥2 种抗逆转录病毒药物治疗，并且在≥80%的就诊时 HIV-1 RNA<400 拷贝/mL，则将其纳入研究。混合效应模型包括从 1996 年到 2015 年的所有就诊，按 HIV 血清状态分层，并调整了社会人口统计学、行为和临床特征。在基线和随访时，分别有 8%的 MWH 和 15%的 HIV-男性以及 41%的 MWH 和 56%的 HIV-男性年龄≥60 岁。
横断面研究显示，较高的 BMI 与 MWH 和 HIV-男性的运动功能呈负相关，与 HIV-男性的注意力/工作记忆呈负相关。WC 与 MWH 和 HIV-男性的运动功能呈负相关。纵向关联表明，MWH 中肥胖 BMI 与运动功能下降速度较慢有关，而在 HIV-男性中，肥胖与运动功能、学习和记忆下降速度较快有关。WC 或中心性肥胖表现出类似的关联模式。
较高的肥胖程度与认知功能的横断面水平较低和认知衰退较大有关，尤其是在 HIV-男性中。超重和肥胖可能是神经结局的重要预测因素，也是预防和干预的途径。
