Adiposity, Weight Change, and Risk of Cognitive Impairment: The Singapore Chinese Health Study

Article type: Research Article

Authors: Talaei, Mohammad^{a; b; *} | Feng, Lei^c | Barrenetxea, Jon^d | Yuan, Jian-Min^{e; f} | Pan, An^g | Koh, Woon-Puay^{d; h; *}

Affiliations: [a] National University Health System (NUHS) Centre for Healthy Ageing, Singapore | [b] Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore | [c] Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore | [d] Health Services and Systems Research, Duke-NUS Medical School, Singapore | [e] Division of Cancer Control and Population Sciences, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA | [f] Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA | [g] Department of Epidemiology and Biostatistics, MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China | [h] Saw Swee Hock School of Public Health, National University of Singapore, Singapore

Correspondence: [*] Correspondence to: Woon-Puay Koh, MBBS (Hons), PhD, Duke-NUS Medical School, Singapore. Tel.: +65 6601 3147; Fax: +65 6221 7372; E-mail: woonpuay.koh@duke-nus.edu.sg., and Mohammad Talaei, MD, MPH, PhD, Yvonne Carter Building, 58 Turner Street, London E1 2AB, UK. Tel.: +44 020 7882 2499; E-mail: mohammad.talaei@u.nus.edu.

Abstract: Background:Few prospective studies with long duration of follow-up have assessed the relations of body mass index (BMI) and weight change with cognitive function, especially in Asian populations. Objective:To investigate whether BMI and weight change in midlife are associated with cognitive impairment in old age. Methods:We used data from 14,691 participants in the Singapore Chinese Health Study and computed weight change as the difference between weight reported at baseline (1993–1998) at mean age of 53.0 years and follow-up 1 (1999–2004) at mean age of 58.6 years. Cognitive impairment was determined using education-specific cut-offs of the Singapore Modified Mini-Mental State Examination at follow-up 3 (2014–2016) at mean age of 72.9 years. We used multivariable logistic regression models to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for the associations. Results:Obesity (as defined BMI ≥27.5 kg/m2) was associated with a higher risk of cognitive impairment at baseline (OR 1.33, 95% CI 1.12–1.58) and follow-up 1 (OR 1.30, 95% CI 1.10–1.54) compared to BMI of 18.5–22.9 kg/m2. Underweight (BMI <18.5 kg/m2) was not associated with a significant risk either at baseline (OR 0.91, 95% CI 0.73–1.13) or follow-up 1 (OR 1.05, 95% CI 0.85–1.28). Compared to participants with <5% weight change, the ORs (95% CIs) of cognitive impairment were 1.20 (1.03–1.41) for those with 5–9.9% weight loss, 1.53 (1.29–1.81) for ≥10% weight loss, 1.00 (0.85–1.17) for 5–9.9% weight gain, and 1.50 (1.28–1.75) for ≥10% weight gain. Conclusion:Obesity, weight loss, and excessive weight gain at midlife were associated with an increased risk of cognitive impairment at old age.

Keywords: Body mass index, Chinese, cognitive impairment, cohort study, weight change

DOI: 10.3233/JAD-191052

Journal: Journal of Alzheimer's Disease, vol. 74, no. 1, pp. 319-329, 2020