Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea.
Endocrinol Metab (Seoul). 2021 Apr;36(2):424-435. doi: 10.3803/EnM.2020.935. Epub 2021 Apr 14.
Metabolic disturbances are modifiable risk factors for dementia. Because the status of metabolic syndrome (MetS) and its components changes over time, we aimed to investigate the association of the cumulative exposure to MetS and its components with the risk of dementia.
Adults (n=1,492,776; ≥45-years-old) who received health examinations for 4 consecutive years were identified from a nationwide population-based cohort in Korea. Two exposure-weighted scores were calculated: cumulative number of MetS diagnoses (MetS exposure score, range of 0 to 4) and the composite of its five components (MetS component exposure score, range of 0 to 20). Hazard ratio (HR) and 95% confidence interval (CI) values for dementia were analyzed using the multivariable Cox proportional-hazards model.
Overall, 47.1% of subjects were diagnosed with MetS at least once, and 11.5% had persistent MetS. During the mean 5.2 years of follow-up, there were 7,341 cases (0.5%) of incident dementia. There was a stepwise increase in the risk of all-cause dementia, Alzheimer's disease, and vascular dementia with increasing MetS exposure score and MetS component exposure score (each P for trend <0.0001). The HR of all-cause dementia was 2.62 (95% CI, 1.87 to 3.68) in subjects with a MetS component exposure score of 20 compared with those with a score of 0. People fulfilling only one MetS component out of 20 already had an approximately 40% increased risk of all-cause dementia and Alzheimer's disease.
More cumulative exposure to metabolic disturbances was associated with a higher risk of dementia. Of note, even minimal exposure to MetS components had a significant effect on the risk of dementia.
代谢紊乱是痴呆的可改变的危险因素。由于代谢综合征（MetS）及其组成部分的状态随时间而变化，我们旨在研究累积暴露于 MetS 及其组成部分与痴呆风险的关系。
从韩国一项全国性基于人群的队列中，确定了连续 4 年接受健康检查的成年人（n=1,492,776；≥45 岁）。计算了两个暴露加权评分：MetS 诊断的累积数量（MetS 暴露评分，范围 0 至 4）和其五个组成部分的综合评分（MetS 组成部分暴露评分，范围 0 至 20）。使用多变量 Cox 比例风险模型分析痴呆的风险比（HR）和 95%置信区间（CI）值。
总体而言，47.1%的受试者至少被诊断出一次 MetS，11.5%的受试者持续存在 MetS。在平均 5.2 年的随访期间，有 7,341 例（0.5%）发生了新发痴呆症。随着 MetS 暴露评分和 MetS 组成部分暴露评分的增加，全因痴呆、阿尔茨海默病和血管性痴呆的风险呈逐步增加（各趋势 P 值均<0.0001）。与 MetS 组成部分暴露评分为 0 的受试者相比，评分为 20 的受试者全因痴呆的 HR 为 2.62（95%CI，1.87 至 3.68）。在 20 个 MetS 组成部分中仅满足一个组成部分的人群，其全因痴呆和阿尔茨海默病的风险已增加约 40%。
更多的代谢紊乱累积暴露与痴呆风险增加相关。值得注意的是，即使对 MetS 组成部分的最低程度的暴露也对痴呆风险有显著影响。
