Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, Hospital Del Mar Medical Research Institute (IMIM), 08003, Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra, 08003, Barcelona, Spain.
Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, Hospital Del Mar Medical Research Institute (IMIM), 08003, Barcelona, Spain; CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 28029, Madrid, Spain.
Clin Nutr. 2021 Sep;40(9):5221-5237. doi: 10.1016/j.clnu.2021.07.020. Epub 2021 Aug 5.
BACKGROUND & AIMS: Some cognitive profiles might facilitate successful weight loss and its maintenance. Also, weight reductions may result in cognitive benefits. However, little work to date has examined the interactions between cognition and weight changes in the context of interventions with the Mediterranean diet (MedDiet). We studied the within-subject longitudinal relationships between cognition, body mass index (BMI), physical activity (PA), and quality of life (QoL), in older adults following a MedDiet. METHODS: The PREDIMED-Plus is a primary prevention trial testing the effect of a lifestyle intervention program with an energy-restricted MedDiet (er-MedDiet), weight-loss goals and PA promotion on cardiovascular disease. The PREDIMED-Plus-Cognition sub-study included 487 participants (50% women, mean age 65.2 ± 4.7 years), with overweight/obesity, metabolic syndrome and normal cognitive performance at baseline. A comprehensive neurocognitive test battery was administered at baseline and after 1 and 3 years. RESULTS: Baseline higher performance in verbal memory (OR = 1.5; 95%CI 1.0, 2.1), visuoconstructive praxis and attention (OR = 1.5; 95%CI 0.9, 2.3), and inhibition (OR = 1.3; 95%CI 0.9, 1.9) were associated with a higher odd of achieving at least 8% weight loss after 3 years follow-up in participants randomized to the intervention group. There were moderate improvements in specific tests of memory and executive functions during follow-up. Higher adherence to the er-MedDiet was associated with greater improvements in memory. Women exhibited lower rates of change in global cognition, PA and QoL. Moreover, improvements in memory correlated with reductions in BMI after 1 year (β = -0.14) and with improvements in PA after 3 years (β = 0.13). Finally, participants who experienced greater improvements in executive functions and global cognition also experienced greater improvements in their QoL. CONCLUSIONS: This study refines the understanding of the determinants and mutual interrelationships between longitudinally-assessed cognitive performance and weight loss, adding further evidence to the cognitive benefits associated with better adherence to a MedDiet. Our results also suggest that weight loss interventions tailored to the cognitive profile and gender of participants are promising avenues for future studies.
背景与目的：某些认知特征可能有助于成功减轻体重并维持体重。此外，体重减轻可能会带来认知益处。然而，迄今为止，很少有研究在以地中海饮食（MedDiet）进行干预的背景下，检查认知与体重变化之间的相互作用。我们研究了在接受 MedDiet 的老年人中，认知、体重指数（BMI）、身体活动（PA）和生活质量（QoL）之间的个体内纵向关系。
方法：PREDIMED-Plus 是一项初级预防试验，旨在测试能量限制的 MedDiet（er-MedDiet）、减肥目标和促进身体活动的生活方式干预计划对心血管疾病的影响。PREDIMED-Plus-Cognition 子研究包括 487 名参与者（50%为女性，平均年龄 65.2±4.7 岁），基线时超重/肥胖、代谢综合征和认知表现正常。基线和 1 年和 3 年后进行了全面的神经认知测试。
结果：基线时，在语言记忆（OR=1.5；95%CI 1.0，2.1）、视空间构建和注意力（OR=1.5；95%CI 0.9，2.3）以及抑制方面表现较好（OR=1.3；95%CI 0.9，1.9）的参与者，在随机分组到干预组后，3 年随访时体重减轻至少 8%的可能性更高。在随访期间，记忆和执行功能的特定测试有中度改善。更高的 er-MedDiet 依从性与记忆改善更大相关。女性的总体认知、PA 和 QoL 的变化率较低。此外，1 年后，记忆力的改善与 BMI 的降低呈负相关（β=-0.14），3 年后，与 PA 的改善呈正相关（β=0.13）。最后，在执行功能和总体认知方面改善更大的参与者，他们的 QoL 也得到了更大的改善。
结论：本研究细化了对纵向评估认知表现和体重减轻之间的决定因素和相互关系的理解，为与更好地遵循 MedDiet 相关的认知益处提供了更多证据。我们的结果还表明，针对参与者的认知特征和性别量身定制的体重减轻干预措施是未来研究的有前途的途径。
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