Department of Epidemiology and Biostatistics, University at Albany School of Public Health State University of New York, Rensselaer, NY, United States.
Department of Neurology, Johns Hopkins University, Baltimore, MD, United States.
Front Endocrinol (Lausanne). 2023 Jul 7;14:1108313. doi: 10.3389/fendo.2023.1108313. eCollection 2023.
Observations of overweight and obesity in association with neuropsychological performance (NP) vary over the adult life course depending on baseline levels, biological sex, age, race, temporality of measurements, and other factors. Therefore, similar published analyses across cohorts are inconsistent. In our sample of women living with HIV (WLWH) and women without HIV (WWOH), we conducted comparable analyses as those published in men with and without HIV. We examined cross-sectional and longitudinal associations between body mass index (BMI) and waist circumference (WC) and NP.
Four hundred thirty two 432 virologically-suppressed WLWH and 367 WWOH, ≥40 years in the Women's Interagency HIV Study (WIHS) with anthropometry and NP assessments every two years from 2009-2019 were included in the study. Demographically-adjusted T-scores were calculated for six NP domains: learning, memory, executive function, processing speed, attention and working memory, and motor function. Multivariable linear regression models stratified by HIV status were used to examine cross-sectional associations of BMI and WC by NP domain; repeated measures analyses assessed baseline BMI and WC in association with longitudinal change in NP. Covariates included sociodemographic, behavioral, and HIV-related characteristics.
At baseline among all women, the median age was 45 years, 65% were Non-Latinx Black women, and 45% were obese women. Obese WLWH (BMI≥30.0 kg/m) had poorer executive function (β=-2.27, 95%CI [-4.46, -0.07]) versus WLWH with healthy BMI (18.5-24.9 kg/m). Longitudinally over ~8 years, obese versus overweight WWOH improved on memory (β=2.19, 95%CI [0.13, 4.26]), however overweight versus healthy WWOH experienced declining memory (β= -2.67, 95%CI [-5.40, -0.07]). Increasing WC was associated with declining executive, processing speed, and motor function (p's<0.05); an at-risk WC was associated with improved memory (β=1.81, 95%CI [0.19, 3.44]) among WWOH. Among WLWH, increasing BMI was associated with improved learning (β=0.07, 95%CI [0.00, 0.15].
Our cross-sectional and longitudinal analyses evaluating the associations of BMI and WC and NP were mixed compared to previous reports. This illustrates the importance of sociodemographic characteristics, baseline levels of exposures and outcomes, HIV status, temporality of measurements, and other factors when evaluating aging HIV epidemiology study results.
超重和肥胖与神经认知表现（NP）的关联观察结果在整个成年期有所不同，具体取决于基线水平、生物性别、年龄、种族、测量的时间性以及其他因素。因此，类似的发表分析在不同队列中并不一致。在我们的 HIV 阳性妇女（WLWH）和无 HIV 妇女（WWOH）样本中，我们进行了与发表在有和无 HIV 男性中的类似分析。我们研究了身体质量指数（BMI）和腰围（WC）与 NP 之间的横断面和纵向关联。
在妇女艾滋病病毒研究（WIHS）中，有 432 名病毒学抑制的 WLWH 和 367 名 WWOH，年龄均在 40 岁以上，从 2009 年至 2019 年每两年进行一次人体测量和 NP 评估，纳入了这项研究。计算了六个 NP 领域的人口统计学调整 T 评分：学习、记忆、执行功能、处理速度、注意力和工作记忆以及运动功能。按 HIV 状态分层的多变量线性回归模型用于检查 BMI 和 WC 与 NP 领域的横断面关联；重复测量分析评估了基线 BMI 和 WC 与 NP 的纵向变化。协变量包括社会人口统计学、行为和与 HIV 相关的特征。
在所有女性中，基线时的中位年龄为 45 岁，65%是非拉丁裔黑人女性，45%为肥胖女性。与健康 BMI（18.5-24.9kg/m）的 WLWH 相比，肥胖的 WLWH（BMI≥30.0kg/m）的执行功能较差（β=-2.27，95%CI [-4.46，-0.07]）。在大约 8 年的时间里，与超重相比，肥胖的 WWOH 记忆得到改善（β=2.19，95%CI [0.13，4.26]），而超重与健康 WWOH 则出现记忆下降（β=-2.67，95%CI [-5.40，-0.07]）。WC 增加与执行功能、处理速度和运动功能下降有关（p<0.05）；在 WWOH 中，处于危险 WC 与记忆改善有关（β=1.81，95%CI [0.19，3.44]）。在 WLWH 中，BMI 增加与学习能力提高有关（β=0.07，95%CI [0.00，0.15]）。
与以前的报告相比，我们对 BMI 和 WC 与 NP 关联的横断面和纵向分析结果是混合的。这表明在评估衰老 HIV 流行病学研究结果时，社会人口统计学特征、暴露和结局的基线水平、HIV 状态、测量的时间性以及其他因素非常重要。
