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Cognitive decline

Metabolic patients experience faster cognitive decline

Study dispells the myth of metabolically healthy obesity

Patients who have metabolic risk factors could experience a faster decline in their cognitive skills, according to a study published in the journal Neurology.

“This study provides evidence against the concept of metabolically healthy obesity,” said study author Dr Archana Singh-Manoux, INSERM the French research institute in Paris and University College London, UK. “This concept has suggested that obese people without metabolic risk factors do not show negative cardiac and cognitive results compared with obese people with metabolic risk factors. “

The aim of the study was to examine the association of BMI and metabolic status with cognitive function and decline. The researcher define metabolic abnormality as having two or more of the following risk factors: systolic blood pressure >130 mm Hg, diastolic blood pressure >85 mm Hg or taking antihypertensive drugs; high-density lipoprotein cholesterol (<1.04mmol/L for men and <1.29 mmol/L for women); glucose >5.6 mmol/L or taking medications for diabetes; and high triglycerides (>1.69mmol/L) or taking lipid-lowering medication.

The study involved 6,401 patients (71.2% men) between 1991-93. The age range was 39-63 (mean age 50) and their BMI and metabolic status were recorded. The participants were required to take four cognitive tests (memory, reasoning, semantic, and phonemic fluency) in 1997-1999, 2002-2004 and 2007-2009, standardized to z scores, and averaged to yield a global score.


The outcomes revealed that 31.0% had metabolic abnormalities, 52.7% were normal weight, 38.2% were overweight and 9.1% were obese. Among the obese, the global cognitive score at baseline (p=0.82) and decline (p=0.19) over ten years was similar in the metabolically normal and abnormal groups.  

However, in the metabolically abnormal group, the decline on the global score was faster among obese (-0.49; 95% CI -0.55 to -0.42) than among normal weight individuals (-0.42; 95% CI -0.50 to -0.34), (p = 0.03). Patients who were both obese and metabolically abnormal experienced a 22.5% faster decline on their cognitive test scores, than those who were of normal weight without metabolic abnormalities.

In these analyses the fastest cognitive decline was observed in those with both obesity and metabolic abnormality and more research is needed to look at the effects of genetic factors,” said Singh-Manou. “We also need to take into account how long people have been obese and how long they have had these metabolic risk factors and also to look at cognitive test scores spanning adulthood to give us a better understanding of the link between obesity and cognitive function, such as thinking, reasoning and memory.”

The study was supported by the National Institutes of Health, the Academy of Finland, the Bupa Foundation and the British Medical Research Council.

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