Background
The aging population in the United States is increasing with a concurrent increase in the prevalence of cognitive impairment. Modifiable and non-modifiable risk factors play a role in the pathogenesis of cognitive impairment, including obesity. The association between obesity and cognitive function in older adults is not well characterized. This study aims to examine the longitudinal effect of obesity defined by both Body Mass Index (BMI) and waist circumference (WC) on cognitive function in older adults.
Methods
This study utilized 10 years of data from the National Health and Aging Trends Survey (NHATS), a nationally representative survey of US adults aged ≥ 65. Participants with missing anthropometric data or a diagnosis of dementia at baseline were excluded. Cognitive function was assessed using standardized tests in the cognitive subdomains of memory, orientation, and executive function, as well as an overall cognitive domain. Obesity and overweight were defined as a BMI ≥ 30 and ≥ 25 respectively. High WC was defined as ≥ 88 cm in women or ≥ 102 cm in men. Proportional hazards modeling was used to assess the relationship between obesity and incident cognitive impairment with adjustment for demographic characteristics and comorbidities.
Results
The study included a total of 10,735 participants in the BMI cohort and 10,023 participants in the WC cohort after exclusion criteria were applied. The incidence rate of overall cognitive impairment increased over 10 years of study data in both BMI and WC cohorts from 19.1 to 25.6 and 18.5 to 25.1 per hundred person-years respectively. Higher BMI was associated with a decreased risk of cognitive impairment - participants with obesity-range BMI had an adjusted HR of 0.8 (0.73-0.88), participants with overweight-range BMI had adjusted HR of 0.9 (0.83-0.97), and participants with high WC had adjusted HR of 0.96 (0.89-1.03) for overall cognitive impairment. These associations were consistent across all cognitive subdomains.
Conclusion
This study provides evidence of a protective effect of higher BMI on the development of cognitive impairment in older adults in a dose-dependent fashion. Higher WC did not demonstrate a significant protective cognitive effect. The relationships demonstrated in this study suggest a complex interplay between body composition and neurological decline in this population. Further study is needed into the mechanisms underpinning these findings. These findings have implications for weight management guidelines and interventions in the geriatric population.


Trajectories of Cognitive Decline by Obesity Status in Older Adults

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