Skip to main content
SpringerLink
Log in

Obesity and cognitive decline in adults: Effect of methodological choices and confounding by age in a longitudinal study

The journal of nutrition, health & aging Aims and scope Submit manuscript

Cite this article

Abstract

Background and Objectives

Obesity has been associated with increased risk of cognitive impairment or dementia, but recent findings are contradictory, possibly due to methodological differences. The present study tries to clarify these inconsistencies by following the cognitive trajectories of individuals with obesity over 12 years and studying the effect of obesity status (obesity at baseline versus incident obesity at follow-up), chronicity, definition, potential confounding (e.g. age, cardiovascular factors), and non-linear associations.

Design

Longitudinal study with 12 years follow-up.

Setting

Community based.

Participants

1,807 cognitively healthy individuals (aged 24-83) from the Maastricht Aging Study (1992-2004).

Measurements

Memory, executive function and processing speed were assessed at baseline and at 6- and 12-year follow-up. Obesity was defined as having a body mass index (BMI) of ≥ 30.0 kg/m2 or waist circumference (WC) of > 102 cm for men and > 88 cm for women.

Results

At baseline, 545 persons were obese (BMI: 329 (18%); WC: 494 (27%); both: 278 (15%). They showed faster decline in memory, executive function, and processing speed. Chronic obese showed less widespread impairment than those who regained normal weight. Associations across cognitive domains were weaker for obesity defined by BMI than for WC. At follow-up, 190 developed obesity, and they performed worse on executive function at baseline, but showed less decline compared with participants with normal weight. Yet, age-stratification and post-hoc analyses showed that most of these associations were confounded by age.

Conclusions

This study shows that the association between obesity and cognitive decline was confounded by the effect of age on rate of decline. Future studies should take this into account.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table 1
Table 2
Table 3
Figure 1
Figure 2

Similar content being viewed by others

References

  1. Ferri CP, Prince M, Brayne C, Brodaty H, Fratiglioni L, Ganguli M, et al. Global prevalence of dementia: a Delphi consensus study. Lancet 2005;366:2112–7. doi: 10.1016/s0140-6736(05)67889-0.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Alzheimer’s Disease International. Dementia and risk reduction: an analysis of protective and modifiable factors. London: Alzheimer’s Disease International, 2014.

    Google Scholar 

  3. Barnes DE, Yaffe K. The projected effect of risk factor reduction on Alzheimer’s disease prevalence. Lancet Neurol 2011;10:819–28. doi: 10.1016/s1474-4422(11)70072-2.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ, et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 countryyears and 9.1 million participants. Lancet 2011;377:557–67. doi: 10.1016/s0140-6736(10)62037-5.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Norton S, Matthews FE, Barnes DE, Yaffe K, Brayne C. Potential for primary prevention of Alzheimer’s disease: an analysis of population-based data. Lancet Neurol 2014;13:788–94. doi: 10.1016/s1474-4422(14)70136-x.

    Article  PubMed  Google Scholar 

  6. Stevens G, Singh G, Lu Y, Danaei G, Lin J, Finucane M, et al. National, regional, and global trends in adult overweight and obesity prevalences. Population Health Metrics 2012;10:22. doi: 10.1186/1478-7954-10-22.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Deckers K, van Boxtel MP, Schiepers OJ, de Vugt M, Munoz Sanchez JL, Anstey KJ, et al. Target risk factors for dementia prevention: a systematic review and Delphi consensus study on the evidence from observational studies. Int J Geriatr Psychiatry 2015;30:234–46. doi: 10.1002/gps.4245.

    Article  PubMed  Google Scholar 

  8. Albanese E, Davis B, Jonsson PV, Chang M, Aspelund T, Garcia M, et al. Overweight and Obesity in Midlife and Brain Structure and Dementia 26 Years Later: The AGES-Reykjavik Study. American Journal of Epidemiology 2015;181:672–9. doi: 10.1093/aje/kwu331.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Aslan AK, Starr JM, Pattie A, Deary I. Cognitive consequences of overweight and obesity in the ninth decade of life? Age Ageing 2015;44:59–65. doi: 10.1093/ageing/afu108.

    Article  PubMed  Google Scholar 

  10. de Bruijn RF, Bos MJ, Portegies ML, Hofman A, Franco OH, Koudstaal PJ, et al. The potential for prevention of dementia across two decades: the prospective, populationbased Rotterdam Study. BMC Med 2015;13:132. doi: 10.1186/s12916-015-0377-5.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Qizilbash N, Gregson J, Johnson ME, Pearce N, Douglas I, Wing K, et al. BMI and risk of dementia in two million people over two decades: a retrospective cohort study. Lancet Diabetes Endocrinol 2015;3:431–6. doi: 10.1016/s2213-8587(15)00033-9.

    Article  PubMed  Google Scholar 

  12. Profenno LA, Porsteinsson AP, Faraone SV. Meta-analysis of Alzheimer’s disease risk with obesity, diabetes, and related disorders. Biol Psychiatry 2010;67:505–12. doi: 10.1016/j.biopsych.2009.02.013.

    Article  PubMed  Google Scholar 

  13. Whitmer RA, Gunderson EP, Quesenberry CP, Jr., Zhou J, Yaffe K. Body mass index in midlife and risk of Alzheimer disease and vascular dementia. Curr Alzheimer Res 2007;4:103–9.

    Article  CAS  PubMed  Google Scholar 

  14. Jolles J, Houx PJ, van Boxtel MPJ, Ponds RWHM. Maastricht Aging Study. Maastricht: Neuropsych Publishers; 1995.

    Google Scholar 

  15. Metsemakers JF, Hoppener P, Knottnerus JA, Kocken RJ, Limonard CB. Computerized health information in The Netherlands: a registration network of family practices. Br J Gen Pract 1992;42:102–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  16. World Health Organization. Waist circumference and waist–hip ratio: Report of a WHO expert consultation. Geneva, Switzerland 2008.

    Google Scholar 

  17. Van der Elst W, van Boxtel MP, van Breukelen GJ, Jolles J. Rey’s verbal learning test: normative data for 1855 healthy participants aged 24-81 years and the influence of age, sex, education, and mode of presentation. J Int Neuropsychol Soc 2005;11:290–302. doi: 10.1017/s1355617705050344.

    PubMed  Google Scholar 

  18. Van der Elst W, Van Boxtel MP, Van Breukelen GJ, Jolles J. The Concept Shifting Test: adult normative data. Psychol Assess 2006;18:424–32. doi: 10.1037/1040-3590.18.4.424.

    Article  PubMed  Google Scholar 

  19. van der Elst W, van Boxtel MP, van Breukelen GJ, Jolles J. The Letter Digit Substitution Test: normative data for 1,858 healthy participants aged 24-81 from the Maastricht Aging Study (MAAS): influence of age, education, and sex. J Clin Exp Neuropsychol 2006;28:998–1009. doi: 10.1080/13803390591004428.

    Article  PubMed  Google Scholar 

  20. Guidelines Subcommittee. 1999 World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension.. J Hypertens 1999;17:151–83.

    Google Scholar 

  21. Arrindell WA, Ettema JHM. Handleiding Bij Een Multidimensionele Psychopathologie-Indicator [SCL-90. Manual of a Multidimensional Psychopathology Indicator] Lisse, The Netherlands: Swets Test Publishers; 2003.

    Google Scholar 

  22. World Health Organization. Problems Related to Alcohol Consumption: Report of WHO Expert Committee. Geneva, Switzerland 1980.

    Google Scholar 

  23. Dahl AK, Hassing LB. Obesity and Cognitive Aging. Epidemiologic Reviews 2013;35:22–32. doi: 10.1093/epirev/mxs002.

    Article  PubMed  Google Scholar 

  24. Dahl A, Hassing LB, Fransson E, Berg S, Gatz M, Reynolds CA, et al. Being overweight in midlife is associated with lower cognitive ability and steeper cognitive decline in late life. J Gerontol A Biol Sci Med Sci 2010;65:57–62. doi: 10.1093/gerona/glp035.

    Article  PubMed  Google Scholar 

  25. Debette S, Seshadri S, Beiser A, Au R, Himali JJ, Palumbo C, et al. Midlife vascular risk factor exposure accelerates structural brain aging and cognitive decline. Neurology 2011;77:461–8. doi: 10.1212/WNL.0b013e318227b227.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Hassing LB, Dahl AK, Pedersen NL, Johansson B. Overweight in midlife is related to lower cognitive function 30 years later: a prospective study with longitudinal assessments. Dement Geriatr Cogn Disord 2010;29:543–52. doi: 10.1159/000314874.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Hughes TF, Ganguli M. Modifiable Midlife Risk Factors for Late-Life Cognitive Impairment and Dementia. Curr Psychiatry Rev 2009;5:73–92.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Kiliaan AJ, Arnoldussen IAC, Gustafson DR. Adipokines: a link between obesity and dementia? The Lancet Neurology 2014;13:913–23. doi: http://dx.doi.org/10.1016/S1474-4422(14)70085-7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Debette S, Wolf C, Lambert JC, Crivello F, Soumare A, Zhu YC, et al. Abdominal obesity and lower gray matter volume: a Mendelian randomization study. Neurobiol Aging 2014;35:378–86. doi: 10.1016/j.neurobiolaging.2013.07.022.

    Article  PubMed  Google Scholar 

  30. Gustafson D. Adiposity indices and dementia. Lancet Neurol 2006;5:713–20. doi: 10.1016/s1474-4422(06)70526-9.

    Article  PubMed  Google Scholar 

  31. Whitmer RA. The epidemiology of adiposity and dementia. Curr Alzheimer Res 2007;4:117–22.

    Article  CAS  PubMed  Google Scholar 

  32. Plassman BL, Williams JW, Jr., Burke JR, Holsinger T, Benjamin S. Systematic review: factors associated with risk for and possible prevention of cognitive decline in later life. Ann Intern Med 2010;153:182–93. doi: 10.7326/0003-4819-153-3-201008030-00258.

    Article  PubMed  Google Scholar 

  33. Singh-Manoux A, Czernichow S, Elbaz A, Dugravot A, Sabia S, Hagger-Johnson G, et al. Obesity phenotypes in midlife and cognition in early old age: the Whitehall II cohort study. Neurology 2012;79:755–62. doi: 10.1212/WNL.0b013e3182661f63.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Smith E, Hay P, Campbell L, Trollor JN. A review of the association between obesity and cognitive function across the lifespan: implications for novel approaches to prevention and treatment. Obes Rev 2011;12:740–55. doi: 10.1111/j.1467-789X.2011.00920.x.

    Article  CAS  PubMed  Google Scholar 

  35. Handing EP, Small BJ, Reynolds SL, Kumar NB. Impact of dietary factors and inflammation on cognition among older adults. J Prev Alz Dis 2015;2:220–6. doi: http://dx.doi.org/10.14283/jpad.2015.50.

    Google Scholar 

  36. Kesse-Guyot E, Andreeva VA, Touvier M, Jeandel C, Ferry M, Hercberg S, et al. Overall and abdominal adiposity in midlife and subsequent cognitive function. J Nutr Health Aging 2015;19:183–9. doi: 10.1007/s12603-014-0508-2.

    Article  CAS  PubMed  Google Scholar 

  37. do Nascimento Jacinto de Souza BF, Marín-León L. Living and health conditions associated with overweight and obesity among elderly. J Frailty Aging 2015;4:198–206. doi: http://dx.doi.org/10.14283/jfa.2015.55.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Maastricht University, School for Mental Health and Neuroscience, Alzheimer Centrum Limburg, Maastricht, the Netherlands

    Kay Deckers, M. P. J. van Boxtel, F. R. J. Verhey & S. Köhler

  2. Maastricht University, School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, P.O. Box 616, 6200 MD, Maastricht, the Netherlands

    Kay Deckers

Authors
  1. Kay Deckers
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. P. J. van Boxtel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. F. R. J. Verhey
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Köhler
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kay Deckers.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Deckers, K., van Boxtel, M.P.J., Verhey, F.R.J. et al. Obesity and cognitive decline in adults: Effect of methodological choices and confounding by age in a longitudinal study. J Nutr Health Aging 21, 546–553 (2017). https://doi.org/10.1007/s12603-016-0757-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12603-016-0757-3

Key words

search

Navigation