Association of overweight and obesity and abdominal obesity with cognitive impairment in older adults: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

ZHU Xinxin ¹ , XIE Xiangqi ² , WANG Qiuting ³ , LONG Lifang ¹ , XIE Jiaxin ⁴ , TANG Rou ¹ , ZHANG Yuqing ¹ ,  LIN Meizhen ⁵

1. College of Nursing, Hunan University of Traditional Chinese Medicine, Changsha 410208, P. R. China;
2. The Second Clinical Medical School of Guangzhou University of Chinese Medicine, Guangzhou 510006, P. R. China;
3. Department of Hepatobiliary Surgery, Guangdong Provincial Hospital of Traditional Chinese Medical, Guangzhou 510120, P. R. China;
4. Department of Gastrointestinal Surgery, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou 510120, P. R, China;
5. Hospital Infection Management Office, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou 510120, P. R. China;

Corresponding?author：

LIN Meizhen, Email: lmzmay@163.com

Keywords：

Overweight; Obesity; Abdominal obesity; Elderly; Cognitive impairment; Meta-analysis

DOI：

10.7507/1672-2531.202408022

Video：

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Objective To systematically review the association between overweight, obesity, abdominal obesity, and cognitive impairment (CI) in the elderly. Methods The CNKI, WanFang Data, VIP, CBM, PubMed, Web of Science, Embase, and Cochrane Library databases were electronically searched for studies on the relationship between overweight, obesity/abdominal obesity, and CI in the elderly from their inception to July 2024. Two researchers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was performed using Stata 15.0 software. Results A total of 38 studies involving 1 783 087 subjects were included. Meta-analysis results showed that compared with normal-weight individuals, overweight (OR=0.96, 95%CI 0.91 to 1.02, P=0.201) was not statistically significant in the risk of CI in the elderly. Obesity (OR=1.14, 95%CI 1.02 to 1.28, P=0.03) and abdominal obesity (OR=1.16, 95%CI 1.11 to 1.21, P<0.001) may be risk factors for CI in the elderly. Subgroup analysis was conducted based on study type, BMI standards, cognitive diagnostic standards, national development level, abdominal obesity diagnostic standards, and follow-up time. Among the subgroups analyzing the correlation between overweight and CI in the elderly, follow-up time ≤5 years (OR=0.68, 95%CI 0.58 to 0.80) showed a lower proportion of CI compared to other follow-up periods. In the subgroups analyzing the correlation between obesity and CI in the elderly, follow-up time ≤5 years (OR=0.71, 95%CI 0.50 to 1.01) was not statistically significant compared to other follow-up periods. For abdominal obesity, a significant association with increased CI risk in the elderly was found only in the subgroup with a follow-up time of 5-10 years (OR=1.21, 95%CI 1.15 to 1.27), compared with other follow-up periods. Conclusion Current evidence suggests that obesity and abdominal obesity may increase the risk of CI in the elderly. Proper weight management is crucial for preventing and delaying the progression of CI in the elderly.

Citation： ZHU Xinxin, XIE Xiangqi, WANG Qiuting, LONG Lifang, XIE Jiaxin, TANG Rou, ZHANG Yuqing, LIN Meizhen. Association of overweight and obesity and abdominal obesity with cognitive impairment in older adults: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2025, 25(2): 180-189. doi: 10.7507/1672-2531.202408022 Copy

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1. Vavasour G, Giggins OM, Doyle J, et al. How wearable sensors have been utilised to evaluate frailty in older adults: a systematic review. J Neuroeng Rehabil, 2021, 18(1): 112.
2. Updated-fact-sheet-Alzheimers-disease. 2021.
3. WHO. Global status report on the public health response to dementia. 2021.
4. National Center for Health Statistics Health. Health, United States, 2019. 2020.
5. 心潔. 《中國居民營養與慢性病狀況報告(2020年)》國務院新聞辦公室2020年12月23日新聞發布會(摘要). 中老年保健, 2021, (2): 14-21.
6. 唐倩, 黃琪, 梁鳳霞. 肥胖引起的胰島素抵抗對認知障礙的影響機制研究進展. 華中科技大學學報(醫學版), 2022, 51(5): 718-724.
7. 王志如, 賈小芳, 王志宏. 代謝性危險因素與認知功能障礙關聯的研究進展. 衛生研究, 2024, 53(2): 326-331.
8. Ma Y, Ajnakina O, Steptoe A, et al. Higher risk of dementia in English older individuals who are overweight or obese. Int J Epidemiol, 2020, 49(4): 1353-1365.
9. Kim YJ, Kim SM, Jeong DH, et al. Associations between metabolic syndrome and type of dementia: analysis based on the national health insurance service database of Gangwon province in South Korea. Diabetol Metab Syndr, 2021, 13(1): 4.
10. 徐佩茹, 魏嶸, 楊林勝, 等. 社區老年人BMI、腰圍與輕度認知障礙的關聯性研究. 現代預防醫學, 2019, 46(8): 1434-1438.
11. 耿新宇, 尚文璇, 李俐濤. 關于偏頭痛與腦血管病的相關性研究. 神經藥理學報, 2023, 13(5): 60-64.
12. 趙晨昭, 李嬌嬌, 張茗, 等. 老年人體質量指數與輕度認知功能障礙的關系. 中華老年心腦血管病雜志, 2019, 21(10): 1058-1062.
13. 中國肥胖問題工作組. 中國成人超重和肥胖癥預防與控制指南(節錄). 營養學報, 2004, (1): 1-4.
14. WHO. Obesity: preventing and managing the global epidemic. Report of a WHO consultation . World Health Organization technical report series, 2000, 894: i-xii, 1-253.
15. WHO regional office for the Western P. The Asia-Pacific perspective: redefining obesity and its treatment. Sydney: Health Communications Australia, 2000.
16. Alberti KG, Zimmet P, Shaw J. Metabolic syndrome--a new world-wide definition. A consensus statement from the International Diabetes Federation. Diabet Med, 2006, 23(5): 469-480.
17. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
18. Wu Z, Owen A, Woods RL, et al. Associations of body habitus and its changes with incident dementia in older adults. J Am Geriatr Soc, 2024, 72(4): 1023-1034.
19. Qureshi D, Collister J, Allen NE, et al. Association between metabolic syndrome and risk of incident dementia in UK Biobank. Alzheimers Dement, 2024, 20(1): 447-458.
20. Natale G, Zhang Y, Hanes DW, et al. Obesity in late-life as a protective factor against dementia and dementia-related mortality. Am J Alzheimers Dis Other Demen, 2023, 38: 15333175221111658.
21. Liang F, Fu J, Turner-McGrievy G, et al. Association of body mass index and plant-based diet with cognitive impairment among older Chinese adults: a prospective, nationwide cohort study. Nutrients, 2022, 14(15): 3132.
22. Lei Q, Tian H, Xiao Z, et al. Association between body mass index and incident dementia among community-dwelling older adults: the Shanghai aging study. J Alzheimers Dis, 2022, 86(2): 919-929.
23. Jacob L, Smith L, Koyanagi A, et al. Sex-differential associations between body mass index and the incidence of dementia. J Alzheimers Dis, 2022, 88(2): 631-639.
24. Cho SH, Jang M, Ju H, et al. Association of late-life body mass index with the risk of Alzheimer disease: a 10-year nationwide population-based cohort study. Sci Rep, 2022, 12(1): 15298.
25. Pitrou I, Vasiliadis HM, Hudon C. Body mass index and cognitive decline among community-living older adults: the modifying effect of physical activity. Eur Rev Aging Phys Act, 2022, 19(1): 3.
26. Pham ANQ, Lindeman C, Voaklander D, et al. Risk factors for incidence of dementia in primary care practice: a retrospective cohort study in older adults. Fam Pract, 2022, 39(3): 406-412.
27. Wu S, Lv X, Shen J, et al. Association between body mass index, its change and cognitive impairment among Chinese older adults: a community-based, 9-year prospective cohort study. Eur J Epidemiol, 2021, 36(10): 1043-1054.
28. Ren Z, Li Y, Li X, et al. Associations of body mass index, waist circumference and waist-to-height ratio with cognitive impairment among Chinese older adults: Based on the CLHLS. J Affect Disord, 2021, 295: 463-470.
29. Wu SE, Chen WL. Longitudinal trajectories of metabolic syndrome on different neurocognitive domains: a cohort study from the Taiwan biobank. Aging (Albany NY), 2021, 13(11): 15400-15412.
30. Yokomichi H, Kondo K, Nagamine Y, et al. Dementia risk by combinations of metabolic diseases and body mass index: Japan gerontological evaluation study cohort study. J Diabetes Investig, 2020, 11(1): 206-215.
31. Cho GJ, Hwang SY, Lee KM, et al. Association between waist circumference and dementia in older persons: a nationwide population-based study. Obesity (Silver Spring), 2019, 27(11): 1883-1891.
32. Singh-Manoux A, Dugravot A, Shipley M, et al. Obesity trajectories and risk of dementia: 28 years of follow-up in the Whitehall II Study. Alzheimers Dement, 2018, 14(2): 178-186.
33. Arnoldussen IAC, Sundh V, B?ckman K, et al. A 10-year follow-up of adiposity and dementia in Swedish adults aged 70 years and older. J Alzheimers Dis, 2018, 63(4): 1325-1335.
34. Wang F, Zhao M, Han Z, et al. Association of body mass index with amnestic and non-amnestic mild cognitive impairment risk in elderly. BMC Psychiatry, 2017, 17(1): 334.
35. Neergaard JS, Dragsb?k K, Hansen HB, et al. Late-life risk factors for all-cause dementia and differential dementia diagnoses in women: a prospective cohort study. Medicine (Baltimore), 2016, 95(11): e3112.
36. Ng TP, Feng L, Nyunt MS, et al. Metabolic syndrome and the risk of mild cognitive impairment and progression to dementia: follow-up of the Singapore longitudinal ageing study cohort. JAMA Neurol, 2016, 73(4): 456-463.
37. Albala C, Angel B, Lera L, et al. Low leptin availability as a risk factor for dementia in Chilean older people. Dement Geriatr Cogn Dis Extra, 2016, 6(2): 295-302.
38. Papachristou E, Ramsay SE, Lennon LT, et al. The relationships between body composition characteristics and cognitive functioning in a population-based sample of older British men. BMC Geriatr, 2015, 15: 172.
39. Tolppanen AM, Ngandu T, K?reholt I, et al. Midlife and late-life body mass index and late-life dementia: results from a prospective population-based cohort. J Alzheimers Dis, 2014, 38(1): 201-209.
40. Ravona-Springer R, Schnaider-Beeri M, Goldbourt U. Body weight variability in midlife and risk for dementia in old age. Neurology, 2013, 80(18): 1677-1683.
41. Power BD, Alfonso H, Flicker L, et al. Body adiposity in later life and the incidence of dementia: the health in men study. PLoS One, 2011, 6(3): e17902.
42. Xu WL, Atti AR, Gatz M, et al. Midlife overweight and obesity increase late-life dementia risk: a population-based twin study. Neurology, 2011, 76(18): 1568-1574.
43. Solfrizzi V, Scafato E, Capurso C, et al. Metabolic syndrome and the risk of vascular dementia: the Italian longitudinal study on ageing. J Neurol Neurosurg Psychiatry, 2010, 81(4): 433-440.
44. Forti P, Pisacane N, Rietti E, et al. Metabolic syndrome and risk of dementia in older adults. J Am Geriatr Soc, 2010, 58(3): 487-492.
45. West NA, Haan MN. Body adiposity in late life and risk of dementia or cognitive impairment in a longitudinal community-based study. J Gerontol A Biol Sci Med Sci, 2009, 64(1): 103-109.
46. Fitzpatrick AL, Kuller LH, Lopez OL, et al. Midlife and late-life obesity and the risk of dementia: cardiovascular health study. Arch Neurol, 2009, 66(3): 336-342.
47. Gustafson DR, B?ckman K, Waern M, et al. Adiposity indicators and dementia over 32 years in Sweden. Neurology, 2009, 73(19): 1559-1566.
48. Raffaitin C, Gin H, Empana JP, et al. Metabolic syndrome and risk for incident Alzheimer's disease or vascular dementia: the three-city study. Diabetes Care, 2009, 32(1): 169-174.
49. Whitmer RA, Gunderson EP, Quesenberry CP, et al. Body mass index in midlife and risk of Alzheimer disease and vascular dementia. Curr Alzheimer Res, 2007, 4(2): 103-109.
50. Muller M, Tang MX, Schupf N, et al. Metabolic syndrome and dementia risk in a multiethnic elderly cohort. Dement Geriatr Cogn Disord, 2007, 24(3): 185-192.
51. Hayden KM, Zandi PP, Lyketsos CG, et al. Vascular risk factors for incident Alzheimer disease and vascular dementia: the Cache County study. Alzheimer Dis Assoc Disord, 2006, 20(2): 93-100.
52. Kivipelto M, Ngandu T, Fratiglioni L, et al. Obesity and vascular risk factors at midlife and the risk of dementia and Alzheimer disease. Arch Neurol, 2005, 62(10): 1556-1560.
53. Whitmer RA, Gundersen EP, Barrett-conner E, et al. Obesity in middle age and future risk of dementia: a 27 year longitudinal population based study. BMJ (Clinical research ed), 2005, 330(7504): 1360.
54. 李雅萍, 李霞. 代謝綜合征與阿爾茨海默病的相關性及機制研究進展. 中國全科醫學, 2024, 27(3): 268-272.
55. Albanese E, Launer LJ, Egger M, et al. Body mass index in midlife and dementia: systematic review and meta-regression analysis of 589, 649 men and women followed in longitudinal studies. Alzheimers Dement (Amst), 2017, 8: 165-178.
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Chinese Journal of Evidence-Based Medicine

Association of overweight and obesity and abdominal obesity with cognitive impairment in older adults: a meta-analysis

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