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Sex-related differences in the prevalence of cognitive impairment among overweight and obese adults with type 2 diabetes.

ABSTRACT: INTRODUCTION:Type 2 diabetes mellitus and obesity may increase risks for cognitive decline as individuals age. It is unknown whether this results in different prevalences of cognitive impairment for women and men. METHODS:The Action for Health in Diabetes, a randomized controlled clinical trial of a 10-year intensive lifestyle intervention, adjudicated cases of cross-sectional cognitive impairment (mild cognitive impairment or dementia) 10-13 years after enrollment in 3802 individuals (61% women). RESULTS:The cross-sectional prevalences of cognitive impairment were 8.3% (women) and 14.8% (men): adjusted odds ratio 0.55, 95% confidence interval [0.43, 0.71], P < .001. Demographic, clinical, and lifestyle risk factors varied between women and men but did not account for this difference, which was limited to individuals without apolipoprotein E (APOE)-?4 alleles (interaction P = .034). CONCLUSIONS:Among overweight and obese adults with type 2 diabetes mellitus, traditional risk factors did not account for the lower prevalence of cognitive impairment observed in women compared with men.

SUBMITTER: Espeland MA

PROVIDER: S-EPMC6338071 | biostudies-literature | 2018 Sep

REPOSITORIES: biostudies-literature

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Sex-related differences in the prevalence of cognitive impairment among overweight and obese adults with type 2 diabetes.

Espeland Mark A MA Carmichael Owen O Yasar Sevil S Hugenschmidt Christina C Hazzard William W Hayden Kathleen M KM Rapp Stephen R SR Neiberg Rebecca R Johnson Karen C KC Hoscheidt Siobhan S Mielke Michelle M MM

Alzheimer's & dementia : the journal of the Alzheimer's Association 20180705 9

<h4>Introduction</h4>Type 2 diabetes mellitus and obesity may increase risks for cognitive decline as individuals age. It is unknown whether this results in different prevalences of cognitive impairment for women and men.<h4>Methods</h4>The Action for Health in Diabetes, a randomized controlled clinical trial of a 10-year intensive lifestyle intervention, adjudicated cases of cross-sectional cognitive impairment (mild cognitive impairment or dementia) 10-13 years after enrollment in 3802 individ ...[more]

PMID: 30201101

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Project description:OBJECTIVE:We determined whether there are sex differences in the prevalence and profile of HIV-associated neurocognitive impairment, and whether sex moderates the effect of HIV-serostatus on neurocognitive impairment among HIV-positive and HIV-negative individuals. Secondarily, we assessed whether differences were explained by greater biopsychosocial risk factors in HIV-positive women. DESIGN:An observational cohort study. METHODS:Analyses included 1361 HIV-positive (204 women) and 702 HIV-negative (214 women) (ages?=?18-79 years) participants from the UCSD HIV Neurobehavioral Research Program. Demographically corrected standardized T-scores from 15 neuropsychological tests were used to calculate domain-specific and global deficit scores (GDS). GDS at least 0.5 defined neurocognitive impairment. Biopsychosocial risk factors included low education, low reading level (education quality), lifetime substance use disorders, depressed mood (clinically significant depressive symptoms and/or current major depressive disorder) and a cumulative syndemic count (sum of biopsychosocial risk factors, range?=?0-4). Race-stratified analyses were conducted. Analyses were adjusted for relevant demographic and clinical factors. RESULTS:HIV-associated neurocognitive impairment was more prevalent in women versus men; however, the difference was eliminated after adjustment for reading level. In sex-stratified logistic regressions, the association between HIV-seropositivity and higher likelihood of neurocognitive impairment was stronger in women versus men; however, the association was attenuated in women, but not men, after adjusting for reading level. These results in the overall sample were specific to blacks. Sex differences in the profile of HIV-associated neurocognitive impairment varied by race. CONCLUSION:Women, particularly black women, were most at-risk for HIV-associated neurocognitive impairment. Higher rates of HIV-associated neurocognitive impairment in women versus men may reflect differences in educational quality.

Project description:The relationship between body weight changes in late life and cognitive function is controversial.We investigated whether weight gain or loss in late life affected cognitive function in community-dwelling older adults over a 3-year period.Our study used data from the Survey of Living Conditions and Welfare Needs of Korean Older Persons and included 3859 subjects (aged ?65 years) with normal cognition at baseline. At baseline and the 3-year follow-up, body weight and height were measured, and cognitive function was assessed using the mini-mental state examination. Based on their body mass index (BMI) at baseline and follow-up, we divided the subjects into 4 groups: weight gain (baseline BMI <23?kg/m and follow-up BMI ?23?kg/m); weight loss (baseline BMI ?23?kg/m and follow-up BMI <23?kg/m); stable overweight/obese (BMI ?23?kg/m at both visits); and stable non-overweight/obese (BMI <23?kg/m at both visits). Incidence rates (IRs) of cognitive impairment per 100 persons and IR ratios (IRRs) were calculated for each group and adjusted for confounding variables.At the 3-year follow-up, 610 cases of cognitive impairment (15.8%) were identified. The stable overweight/obese group had the lowest IR (14.0, 95% confidence interval [CI] 12.45-15.71) and was therefore used as the reference group when calculating IRRs for cognitive impairment. When men and women were evaluated separately, IRs between groups were significantly different only for women. The stable non-overweight/obese group (IRR 1.65, 95% CI 1.22-2.22) and the weight gain group (IRR 1.93, 95% CI 1.24-3.01) had higher IRs than those in the stable overweight/obese group. As a gain or loss of adiposity, the IR of the weight gain group (IRR 1.17, 95% CI 0.74-1.84) was not different from that of the stable non-overweight/obese group. Also, the IR of weight loss group (IRR 1.09, 95% CI 0.71-1.67) was not significantly different from that of the stable overweight/obese group.We suggest that overweight or obese older women at baseline had cognitive benefits. However, additional gain or loss of adiposity in late life did not affect the risk of cognitive impairment.

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Sex-related differences in the prevalence of cognitive impairment among overweight and obese adults with type 2 diabetes.

Publications

Sex-related differences in the prevalence of cognitive impairment among overweight and obese adults with type 2 diabetes.

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