Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada.
Department of Medicine and Epidemiology, McMaster University, Hamilton, Ontario, Canada.
JAMA Netw Open. 2022 Feb 1;5(2):e2146324. doi: 10.1001/jamanetworkopen.2021.46324.
Excess adipose tissue increases other cardiovascular risk factors, which may be associated with vascular brain injury and cognitive impairment. However, the extent to which the amount and distribution of adipose tissue may be associated with lower cognitive scores, independent of its association with cardiovascular risk factors, is not well characterized.
To investigate the association of adiposity on vascular brain injury and cognitive scores.
DESIGN, SETTING, AND PARTICIPANTS: A total of 9189 participants from the Canadian Alliance for Healthy Hearts and Minds (CAHHM) and the Prospective Urban Rural Epidemiological-Mind (PURE-MIND) cohort studies were included in this cross-sectional analysis. Of these adults, 9166 underwent bioelectrical impedance analysis to assess body fat (BF) percentage, and 6773 underwent magnetic resonance imaging to assess vascular brain injury and measure visceral adipose tissue (VAT) volume. Participants from CAHHM were recruited from January 1, 2014, to December 31, 2018, and PURE-MIND participants were recruited from January 1, 2010, to December 31, 2018. Both CAHHM and PURE-MIND comprise multisite, population-based cohorts. Participants from CAHHM are from Canada, and PURE-MIND participants are from Canada or Poland. Data analysis was performed from May 3 to November 24, 2021.
The percentage of BF and VAT were modeled as sex-specific quartiles. Vascular brain injury was defined as high white matter hyperintensities or silent brain infarction. Multivariable mixed models were used to examine factors associated with reduced cognitive scores.
Cognitive function was assessed using the Digital Symbol Substitution Test (DSST; scores range from 0 to 133, with lower scores indicating lower cognitive function) and Montreal Cognitive Assessment (scores range from 0 to 30, with a score of ≥26 denoting normal cognitive function). Reduced cognition was defined as a DSST score less than 1 SD below the mean. Cardiovascular risk was assessed using the INTERHEART Risk Score (IHRS; scores range from 0 to 48; low risk is defined as a score of 0 to 9, moderate risk as 10 to 16, and high risk as 17 or higher).
A total of 9189 adults (mean [SD] age, 57.8 [8.8] years; 5179 [56.4%] women; and 1013 [11.0%] East and Southeast Asian; 295 [3.2%] South Asian; 7702 [83.8%] White European; and 179 [1.9%] other, including Black, Indigenous, mixed, and unknown ethnicity) participated in the study. Visceral adipose tissue was highly correlated with body adiposity measured by BF percentage (r = 0.76 in women; r = 0.70 in men). Cardiovascular risk factors increased with increasing BF percentage with the fourth quartile IHRS at 13.8 (95% CI, 13.5-14.0; P < .001 for trend) and with VAT with the fourth quartile IHRS at 13.3 (95% CI, 13.0-13.5; P < .001 for trend). Vascular brain injury increased with increasing BF percentage with the fourth quartile value at 8.6% (95% CI, 7.5%-9.8%; P = .007 for trend) and with increasing VAT with fourth quartile value at 7.2% (95% CI, 6.0-8.4; P = .05 for trend). Cognitive scores were lower with increasing BF percentage with the fourth quartile score of 70.9 (95% CI, 70.4-71.5; P < .001 for trend) and for VAT with the fourth quartile score of 72.8 (95% CI, 72.1-73.4; P < .001 for trend). For every 1-SD increase in BF percentage (9.2%) or VAT (36 mL), the DSST score was lower by 0.8 points (95% CI, 0.4-1.1; P < .001) for BF percentage and lower by 0.8 points (95% CI, 0.4-1.2; P < .001) for VAT, adjusted for cardiovascular risk factors and vascular brain injury. The population attributable risk for reduced DSST score for higher BF percentage was 20.5% (95% CI, 7.0%-33.2%) and for VAT was 19.6% (95% CI, 2.0%-36.0%). Higher BF percentage and VAT were not associated with Montreal Cognitive Assessment scores.
In this cross-sectional study, generalized and visceral adiposity were associated with reduced cognitive scores, after adjustment for cardiovascular risk factors, educational level, and vascular brain injury. These results suggest that strategies to prevent or reduce adiposity may preserve cognitive function.
过多的脂肪组织会增加其他心血管风险因素，这些因素可能与血管性脑损伤和认知障碍有关。然而，脂肪组织的数量和分布与认知评分降低的相关性，在多大程度上与其与心血管风险因素的相关性独立，目前还没有很好地描述。
研究肥胖与血管性脑损伤和认知评分的关系。
设计、地点和参与者：本横断面分析共纳入了来自加拿大健康心脏与思维联盟（CAHHM）和前瞻性城市农村流行病学-思维（PURE-MIND）队列研究的 9189 名参与者。这些成年人中，9166 人接受了生物电阻抗分析，以评估体脂肪（BF）百分比，6773 人接受了磁共振成像，以评估血管性脑损伤和测量内脏脂肪组织（VAT）体积。CAHHM 的参与者于 2014 年 1 月 1 日至 2018 年 12 月 31 日招募，PURE-MIND 的参与者于 2010 年 1 月 1 日至 2018 年 12 月 31 日招募。CAHHM 和 PURE-MIND 都包含多地点、基于人群的队列。CAHHM 的参与者来自加拿大，而 PURE-MIND 的参与者来自加拿大或波兰。数据分析于 2021 年 5 月 3 日至 11 月 24 日进行。
BF 和 VAT 的百分比作为性别特异性四分位数进行建模。血管性脑损伤定义为高脑白质高信号或无症状性脑梗死。使用多变量混合模型来研究与认知评分降低相关的因素。
使用数字符号替代测试（DSST；分数范围为 0 至 133，分数越低表示认知功能越低）和蒙特利尔认知评估（分数范围为 0 至 30，分数为 26 表示认知功能正常）来评估认知功能。认知功能减退定义为 DSST 评分低于平均值 1 个标准差。心血管风险使用 INTERHEART 风险评分（IHRS；分数范围为 0 至 48；低风险定义为 0 至 9，中风险为 10 至 16，高风险为 17 或更高）进行评估。
共有 9189 名成年人（平均[标准差]年龄为 57.8[8.8]岁；5179[56.4%]为女性；1013[11.0%]为东亚和东南亚人；295[3.2%]为南亚人；7702[83.8%]为白种欧洲人；179[1.9%]为其他人种，包括黑种人、原住民、混血和未知种族）参与了这项研究。内脏脂肪组织与 BF 百分比（女性 r = 0.76；男性 r = 0.70）高度相关。心血管风险因素随 BF 百分比的增加而增加，第四四分位 IHRS 值为 13.8（95%CI，13.5-14.0；P <.001 趋势），VAT 第四四分位 IHRS 值为 13.3（95%CI，13.0-13.5；P <.001 趋势）。血管性脑损伤随 BF 百分比的增加而增加，第四四分位值为 8.6%（95%CI，7.5%-9.8%；P =.007 趋势），随 VAT 第四四分位值增加而增加，第四四分位值为 7.2%（95%CI，6.0-8.4%；P =.05 趋势）。随着 BF 百分比的增加，认知评分也随之降低，第四四分位值为 70.9（95%CI，70.4-71.5；P <.001 趋势），VAT 第四四分位值为 72.8（95%CI，72.1-73.4；P <.001 趋势）。BF 百分比每增加 1%（9.2%）或 VAT 增加 36 毫升，DSST 评分降低 0.8 分（95%CI，0.4-1.1；P <.001），BF 百分比的 DSST 评分降低 0.8 分（95%CI，0.4-1.2；P <.001），VAT 调整后的心血管风险因素和血管性脑损伤。较高的 BF 百分比与较低的 DSST 评分之间的人群归因风险为 20.5%（95%CI，7.0%-33.2%），而 VAT 的风险为 19.6%（95%CI，2.0%-36.0%）。较高的 BF 百分比和 VAT 与蒙特利尔认知评估分数无关。
在这项横断面研究中，全身性和内脏肥胖与认知评分降低有关，调整了心血管风险因素、教育程度和血管性脑损伤。这些结果表明，预防或减少肥胖可能有助于保护认知功能。
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