Qureshi Danial, Luben Robert, Hayat Shabina, Talarico Robert, Allen Naomi E, Kuźma Elżbieta, Littlejohns Thomas J
Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
Lancet Healthy Longev. 2024 Dec;5(12):100652. doi: 10.1016/j.lanhl.2024.100652. Epub 2024 Nov 26.
Metabolic syndrome could be a modifiable risk factor for dementia. However, the effects of age and duration of exposure to metabolic syndrome on dementia risk remains underexplored. The aim of this study was to determine whether the association between metabolic syndrome and risk of dementia differs across mid-life versus late-life, and to explore how duration of metabolic syndrome affects this risk.
We conducted a population-based prospective study using data from the European Prospective Investigation into Cancer in Norfolk (EPIC-Norfolk) cohort. Metabolic syndrome was defined as having at least three of the following: elevated waist circumference, triglycerides, blood pressure, or glycated haemoglobin, or reduced HDL cholesterol. Incident all-cause dementia was ascertained through hospital inpatient, death, and mental health-care records. In full-cohort analyses, we studied 20 150 adults without dementia aged 50-79 years who attended baseline assessments. Cox proportional hazards models were used to estimate the association between metabolic syndrome and dementia in the full sample, and in mid-life (50-59 years and 60-69 years) and late-life (70-79 years). To assess duration of metabolic syndrome, group-based trajectory analysis was performed on 12 756 participants who attended at least two health assessments over 20 years.
The mean age of participants was 62·6 years (SD 7·5), and 10 857 (54%) were female. Over 25 years of follow-up (mean 18·8 years [SD 6·3]), 2653 (13%) participants developed dementia. In the full cohort, metabolic syndrome was associated with an increased risk of dementia (hazard ratio 1·11, 95% CI 1·01-1·21). In age-specific analyses, the association was similar for participants in late mid-life (age 60-69 years: 1·21, 1·05-1·39) and, although non-significant, in early mid-life (age 50-59 years: 1·12, 0·87-1·43), but attenuated for participants in late-life (age 70-79 years: 0·96, 0·81-1·14). A linear trend was observed between the number of metabolic syndrome components and dementia risk in those aged 60-69 years (p=0·0040), but not in other age groups. In trajectory analysis, a prolonged duration of metabolic syndrome was associated with a significantly increased risk of developing dementia (1·26, 1·13-1·40) when compared to those with consistently low metabolic syndrome. No association was found for increasing metabolic syndrome (1·01, 0·88-1·17).
These findings provide insights into how certain age windows and time periods might differentially affect dementia risk in the context of metabolic syndrome, and highlight the importance of considering age and duration of exposure to metabolic syndrome when devising dementia prevention strategies.
Canadian Institutes of Health Research-Institute of Aging, Oxford Population Health, and the Nicolaus and Margrit Langbehn Foundation.
代谢综合征可能是痴呆症的一个可改变的风险因素。然而，年龄和代谢综合征暴露持续时间对痴呆症风险的影响仍未得到充分研究。本研究的目的是确定代谢综合征与痴呆症风险之间的关联在中年与老年人群中是否存在差异，并探讨代谢综合征的持续时间如何影响这种风险。
我们利用来自诺福克欧洲癌症前瞻性调查（EPIC - 诺福克）队列的数据进行了一项基于人群的前瞻性研究。代谢综合征的定义为具备以下至少三项：腰围增加、甘油三酯升高、血压升高、糖化血红蛋白升高或高密度脂蛋白胆固醇降低。通过医院住院患者、死亡和精神卫生保健记录确定全因性痴呆症发病情况。在全队列分析中，我们研究了20150名年龄在50 - 79岁且无痴呆症的成年人，他们参加了基线评估。使用Cox比例风险模型来估计全样本以及中年（50 - 59岁和60 - 69岁）和老年（70 - 79岁）人群中代谢综合征与痴呆症之间的关联。为了评估代谢综合征的持续时间，对在20年期间至少参加过两次健康评估的12756名参与者进行了基于组的轨迹分析。
参与者的平均年龄为62.6岁（标准差7.5），其中10857名（54%）为女性。在超过25年的随访期间（平均18.8年[标准差6.3]），2653名（13%）参与者患上了痴呆症。在全队列中，代谢综合征与痴呆症风险增加相关（风险比1.11，95%置信区间1.01 - 1.21）。在按年龄分层的分析中，中晚年（60 - 69岁：1.21，1.05 - 1.39）参与者的关联相似，尽管在中年早期（50 - 59岁：1.12，0.87 - 1.43）不显著，但在晚年（70 - 79岁：0.96，0.81 - 1.14）参与者中这种关联减弱。在60 - 69岁人群中观察到代谢综合征成分数量与痴呆症风险之间存在线性趋势（p = 0.0040），但在其他年龄组中未观察到。在轨迹分析中与代谢综合征持续处于低水平的人群相比，代谢综合征持续时间延长与患痴呆症风险显著增加相关（1.26，1.13 - 1.40）。未发现代谢综合征加重与痴呆症风险增加之间存在关联（1.01，0.88 - 1.17）。
这些发现为在代谢综合征背景下特定年龄阶段和时间段如何不同程度地影响痴呆症风险提供了见解，并强调在制定痴呆症预防策略时考虑年龄和代谢综合征暴露持续时间的重要性。
加拿大卫生研究院老龄化研究所、牛津人口健康研究所、尼古劳斯和玛格丽特·朗贝恩基金会。
