背景:越来越多的证据支持体重指数(BMI),老年痴呆症,和血管标记。最近,据报道,代谢不健康的疾病会影响这些标志物的表达。我们的目的是研究BMI状态对与代谢健康状况相关的阿尔茨海默病和血管标志物的影响。
方法:我们招募了1,736名没有痴呆的亚洲人(71.6±8.0岁)。参与者被归类为体重不足,正常体重,或肥胖群体基于他们的BMI。根据国际糖尿病基金会对代谢综合征的定义,将每组进一步分为代谢健康(MH)和不健康(MU)组。主要结果是Aβ阳性,定义为20.0或以上的Centiloid值以及血管标志物的存在,定义为严重的白质高信号(WMH)。对Aβ阳性和严重WMH进行Logistic回归分析,以BMI状态或BMI与代谢健康状况之间的相互作用项作为预测因子。以海马体积(HV)和基线迷你精神状态检查(MMSE)评分作为结果进行中介分析,MMSE评分的纵向变化采用线性混合模型.
结果:体重过轻会增加Aβ阳性的风险(比值比[OR]=2.37,95%置信区间[CI]1.13-4.98),而肥胖降低了Aβ阳性风险(OR=0.63,95%CI0.50-0.80)。尤其是,肥胖降低了MH组Aβ阳性的风险(OR=0.38,95%CI0.26-0.56),但不是MU组。肥胖会增加严重WMH的风险(OR=1.69,1.16-2.47)。Aβ阳性降低介导肥胖与较高HV和MMSE评分之间的关系,特别是在MH组中。与正常体重相比,肥胖的MMSE下降较慢(β=1.423,p=0.037),尤其是MH组。
结论:我们的发现提供了新的证据,表明代谢健康对肥胖和阿尔茨海默病标志物之间的关系有显著影响。which,反过来,导致更好的临床结果。
BACKGROUND: Increasing evidence supports the association between body mass index (BMI), Alzheimer\'s disease, and vascular markers. Recently, metabolically unhealthy conditions have been reported to affect the expression of these markers. We aimed to investigate the effects of BMI status on Alzheimer\'s and vascular markers in relation to metabolic health status.
METHODS: We recruited 1,736 Asians without dementia (71.6 ± 8.0 years). Participants were categorized into underweight, normal weight, or obese groups based on their BMI. Each group was further divided into metabolically healthy (MH) and unhealthy (MU) groups based on the International Diabetes Foundation definition of metabolic syndrome. The main outcome was Aβ positivity, defined as a Centiloid value of 20.0 or above and the presence of vascular markers, defined as severe white matter hyperintensities (WMH). Logistic regression analyses were performed for Aβ positivity and severe WMH with BMI status or interaction terms between BMI and metabolic health status as predictors. Mediation analyses were performed with hippocampal volume (HV) and baseline Mini-Mental State Examination (MMSE) scores as the outcomes, and linear mixed models were performed for longitudinal change in MMSE scores.
RESULTS: Being underweight increased the risk of Aβ positivity (odds ratio [OR] = 2.37, 95% confidence interval [CI] 1.13-4.98), whereas obesity decreased Aβ positivity risk (OR = 0.63, 95% CI 0.50-0.80). Especially, obesity decreased the risk of Aβ positivity (OR = 0.38, 95% CI 0.26-0.56) in the MH group, but not in the MU group. Obesity increased the risk of severe WMH (OR = 1.69, 1.16-2.47). Decreased Aβ positivity mediate the relationship between obesity and higher HV and MMSE scores, particularly in the MH group. Obesity demonstrated a slower decline in MMSE (β = 1.423, p = 0.037) compared to being normal weight, especially in the MH group.
CONCLUSIONS: Our findings provide new evidence that metabolic health has a significant effect on the relationship between obesity and Alzheimer\'s markers, which, in turn, lead to better clinical outcomes.