Lazzaris Coelho Paulo Henrique, Gomes Gonçalves Natalia, Santos Itamar S, Goulart Alessandra C, Barreto Sandhi Maria, Giatti Luana, Lotufo Paulo Andrade, Bensenor Isabela Martins, Suemoto Claudia Kimie
Division of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil.
Center for Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, São Paulo, Brazil.
Int J Obes (Lond). 2025 Apr 13. doi: 10.1038/s41366-025-01781-x.
While midlife obesity is linked to cognitive decline, this association is inconsistent in older adults, possibly due to the limitations of body mass index (BMI) in accurately assessing adiposity at older ages. Most studies focused on White or Asian populations, did not include other adiposity measures besides BMI, adjusted the analyses for mediators, and did not investigate potential subgroup-specific associations. We compared the associations of adiposity measured by anthropometrical and bioelectrical impedance analysis (BIA) with cognitive performance in a diverse population, examining modifications by age, sex, and race, and investigating the mediating effects of obesity-related comorbidities.
Cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort (n = 12,636). Adiposity was evaluated using BMI, waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), and body fat percentage (BFP). A composite global cognition score was derived from immediate, delayed recall, and word recognition word list, phonemic and semantic verbal fluency, and trail-making tests. Adjusted linear regression models were used to investigate associations. We included an interaction term in the regression models to verify if age, sex, and race were modifiers of these associations and used causal mediation methods to assess the mediating role of obesity-related comorbidities.
Among 10,725 participants [mean age (SD): 58.9 (8.6) years; 55.8% women, 54.4% White], larger WHR and WHtR were associated with worse global cognitive performance. These associations were not modified by age, sex, or race. An association of BFP with cognition was observed only in younger adults. Mediation analysis identified only indirect effects of these adiposity measures on cognitive performance and no direct effects.
WHR and WHtR were more consistently associated with cognitive performance than BMI. BIA measures of adiposity were associated with cognition only in younger adults. Obesity-related comorbidities fully mediated the associations of adiposity with cognition.
虽然中年肥胖与认知能力下降有关，但这种关联在老年人中并不一致，这可能是由于体重指数（BMI）在准确评估老年人肥胖程度方面存在局限性。大多数研究集中在白人或亚洲人群，除BMI外未纳入其他肥胖测量指标，对中介因素进行了分析调整，且未调查潜在的亚组特异性关联。我们比较了通过人体测量和生物电阻抗分析（BIA）测量的肥胖与不同人群认知表现之间的关联，研究了年龄、性别和种族的影响，并调查了肥胖相关合并症的中介作用。
对巴西成人健康纵向研究（ELSA-Brasil）队列（n = 12,636）进行横断面分析。使用BMI、腰臀比（WHR）、腰高比（WHtR）和体脂百分比（BFP）评估肥胖程度。综合全球认知评分来自即时、延迟回忆、单词识别单词列表、音素和语义语言流畅性以及连线测验。使用调整后的线性回归模型研究关联。我们在回归模型中纳入交互项，以验证年龄、性别和种族是否为这些关联的修饰因素，并使用因果中介方法评估肥胖相关合并症的中介作用。
在10,725名参与者中[平均年龄（标准差）：58.9（8.6）岁；55.8%为女性，54.4%为白人]，较高的WHR和WHtR与较差的全球认知表现相关。这些关联不受年龄、性别或种族的影响。仅在年轻人中观察到BFP与认知的关联。中介分析仅确定了这些肥胖测量指标对认知表现的间接影响，未发现直接影响。
与BMI相比，WHR和WHtR与认知表现的关联更为一致。BIA测量的肥胖仅在年轻人中与认知相关。肥胖相关合并症完全介导了肥胖与认知之间的关联。
