Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut.
University of Regensburg, Regensburg, Germany.
JAMA Netw Open. 2023 May 1;6(5):e2314193. doi: 10.1001/jamanetworkopen.2023.14193.
Aside from widely known cardiovascular implications, higher weight in children may have negative associations with brain microstructure and neurodevelopment.
To evaluate the association of body mass index (BMI) and waist circumference with imaging metrics that approximate brain health.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from the Adolescent Brain Cognitive Development (ABCD) study to examine the association of BMI and waist circumference with multimodal neuroimaging metrics of brain health in cross-sectional and longitudinal analyses over 2 years. From 2016 to 2018, the multicenter ABCD study recruited more than 11 000 demographically representative children aged 9 to 10 years in the US. Children without any history of neurodevelopmental or psychiatric disorders were included in this study, and a subsample of children who completed 2-year follow-up (34%) was included for longitudinal analysis.
Children's weight, height, waist circumference, age, sex, race and ethnicity, socioeconomic status, handedness, puberty status, and magnetic resonance imaging scanner device were retrieved and included in the analysis.
Association of preadolescents' BMI z scores and waist circumference with neuroimaging indicators of brain health: cortical morphometry, resting-state functional connectivity, and white matter microstructure and cytostructure.
A total of 4576 children (2208 [48.3%] female) at a mean (SD) age of 10.0 years (7.6 months) were included in the baseline cross-sectional analysis. There were 609 (13.3%) Black, 925 (20.2%) Hispanic, and 2565 (56.1%) White participants. Of those, 1567 had complete 2-year clinical and imaging information at a mean (SD) age of 12.0 years (7.7 months). In cross-sectional analyses at both time points, higher BMI and waist circumference were associated with lower microstructural integrity and neurite density, most pronounced in the corpus callosum (fractional anisotropy for BMI and waist circumference at baseline and second year: P < .001; neurite density for BMI at baseline: P < .001; neurite density for waist circumference at baseline: P = .09; neurite density for BMI at second year: P = .002; neurite density for waist circumference at second year: P = .05), reduced functional connectivity in reward- and control-related networks (eg, within the salience network for BMI and waist circumference at baseline and second year: P < .002), and thinner brain cortex (eg, for the right rostral middle frontal for BMI and waist circumference at baseline and second year: P < .001). In longitudinal analysis, higher baseline BMI was most strongly associated with decelerated interval development of the prefrontal cortex (left rostral middle frontal: P = .003) and microstructure and cytostructure of the corpus callosum (fractional anisotropy: P = .01; neurite density: P = .02).
In this cross-sectional study, higher BMI and waist circumference among children aged 9 to 10 years were associated with imaging metrics of poorer brain structure and connectivity as well as hindered interval development. Future follow-up data from the ABCD study can reveal long-term neurocognitive implications of excess childhood weight. Imaging metrics that had the strongest association with BMI and waist circumference in this population-level analysis may serve as target biomarkers of brain integrity in future treatment trials of childhood obesity.
重要提示：除了众所周知的心血管影响外，儿童体重增加可能与大脑微观结构和神经发育呈负相关。
目的：评估体重指数（BMI）和腰围与近似大脑健康的影像指标的关系。
设计、地点和参与者：本横断面研究使用来自青少年大脑认知发育（ABCD）研究的数据，在横断面和 2 年的纵向分析中，研究 BMI 和腰围与大脑健康的多模态神经影像学指标的关系。在 2016 年至 2018 年期间，多中心的 ABCD 研究招募了美国超过 11000 名年龄在 9 至 10 岁之间的具有代表性的儿童。本研究纳入了没有神经发育或精神疾病病史的儿童，并且纳入了完成 2 年随访（34%）的儿童亚组进行纵向分析。
暴露因素：儿童的体重、身高、腰围、年龄、性别、种族和民族、社会经济地位、惯用手、青春期状态和磁共振成像扫描仪设备被检索并纳入分析。
主要结果和测量：青少年 BMI z 评分和腰围与大脑健康的神经影像学指标的关系：皮质形态、静息态功能连接以及白质微观结构和细胞结构。
结果：共有 4576 名（2208[48.3%]名女性）平均（标准差）年龄为 10.0 岁（7.6 个月）的儿童纳入基线横断面分析。其中有 609 名（13.3%）为黑人，925 名（20.2%）为西班牙裔，2565 名（56.1%）为白人。其中，1567 名儿童在平均（标准差）年龄为 12.0 岁（7.7 个月）时有完整的 2 年临床和影像学信息。在两个时间点的横断面分析中，较高的 BMI 和腰围与较低的微观结构完整性和神经丝密度相关，在胼胝体中最为明显（BMI 和腰围的各向异性分数基线和第二年：P<0.001；BMI 的神经丝密度基线：P<0.001；腰围的神经丝密度基线：P=0.09；BMI 的神经丝密度第二年：P=0.002；腰围的神经丝密度第二年：P=0.05），与奖励和控制相关网络的功能连接减少（例如，基线和第二年的 BMI 和腰围的显著网络内：P<0.002），以及大脑皮层变薄（例如，对于基线和第二年的 BMI 和腰围的右侧额中回：P<0.001）。在纵向分析中，较高的基线 BMI 与前额叶皮质（左侧额中回：P=0.003）和胼胝体的微观结构和细胞结构的发育速度减慢最相关（各向异性分数：P=0.01；神经丝密度：P=0.02）。
结论和相关性：在这项横断面研究中，9 至 10 岁儿童较高的 BMI 和腰围与较差的大脑结构和连接的影像学指标以及间隔发育受阻有关。ABCD 研究的未来随访数据可以揭示儿童期超重的长期神经认知影响。在人群水平分析中与 BMI 和腰围关系最密切的影像学指标可能成为未来儿童肥胖治疗试验中大脑完整性的目标生物标志物。
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