The association between regional adiposity, cognitive function, and dementia-related brain changes: a systematic review

Background

Adiposity has been previously associated with cognitive impairment and Alzheimer's disease and related disorders (ADRD). Body mass index (BMI) is the most common measure of global adiposity, but inconsistent results were found since it is a global measurement. BMI does not represent regional fat distribution which differs between sexes, race, and age. Regional fat distribution may contribute differently to cognitive decline and Alzheimer's disease (AD)-related brain changes. Fat-specific targeted therapies could lead to personalized improvement of cognition. The goal of this systematic review is to explore whether regional fat depots, rather than central obesity, should be used to understand the mechanism underlying the association between adiposity and brain.

Methods

This systematic review included 33 studies in the English language, conducted in humans aged 18 years and over with assessment of regional adiposity, cognitive function, dementia, and brain measures. We included only studies that have assessed regional adiposity using imaging technics and excluded studies that were review articles, abstract only or letters to editor. Studies on children and adolescents, animal studies, and studies of patients with gastrointestinal diseases were excluded. PubMed, PsychInfo and web of science were used as electronic databases for literature search until November 2022.

Results

Based on the currently available literature, the findings suggest that different regional fat depots are likely associated with increased risk of cognitive impairment, brain changes and dementia, especially AD. However, different regional fat depots can have different cognitive outcomes and affect the brain differently. Visceral adipose tissue (VAT) was the most studied regional fat, along with liver fat through non-alcoholic fatty liver disease (NAFLD). Pancreatic fat was the least studied regional fat.

Conclusion

Regional adiposity, which is modifiable, may explain discrepancies in associations of global adiposity, brain, and cognition. Specific regional fat depots lead to abnormal secretion of adipose factors which in turn may penetrate the blood brain barrier leading to brain damage and to cognitive decline.

Relationships of adiponectin to regional adiposity, insulin sensitivity, serum lipids, and inflammatory markers in sedentary and endurance-trained Japanese young women

INTRODUCTION

This study aims to compare the differences in circulating adiponectin levels and their relationships to regional adiposity, insulin resistance, serum lipid, and inflammatory factors in young, healthy Japanese women with different physical activity statuses.

METHODS

Adipokines (adiponectin and leptin), full serum lipid, and inflammatory factors [white blood cell counts, C-reactive protein, tumor necrosis factor-α, tissue plasminogen activator inhibitor-1 (PAI-1)] were measured in 101 sedentary and 100 endurance-trained healthy Japanese women (aged 18-23 years). Insulin sensitivity was obtained through a quantitative insulin-sensitivity check index (QUICKI). Regional adiposity [trunk fat mass (TFM), lower-body fat mass (LFM), and arm fat mass (AFM)] was evaluated using the dual-energy X-ray absorptiometry method.

RESULTS

No significant difference was observed between the sedentary and trained women in terms of adiponectin levels. The LFM-to-TFM ratio and the high-density lipoprotein cholesterol (HDL-C) were the strong positive determinants for adiponectin in both groups. Triglyceride in the sedentary women was closely and negatively associated with adiponectin, as well as PAI-1 in the trained women. The QUICKI level was higher in the trained than sedentary women. However, no significant correlation between adiponectin and insulin sensitivity was detected in both groups. Furthermore, LFM was associated with a favorable lipid profile against cardiovascular diseases (CVDs) in the whole study cohort, but this association became insignificant when adiponectin was taken into account.

CONCLUSIONS

These findings suggest that adiponectin is primarily associated with regional adiposity and HDL-C regardless of insulin sensitivity and physical activity status in young, healthy women. The associations among adiponectin, lipid, and inflammatory factors are likely different in women with different physical activity statuses. The correlation of LFM and a favorable lipid profile against CVD and adiponectin is likely involved in this association.

Regional Adiposity and Risk of Heart Failure and Mortality: The Jackson Heart Study

Background Visceral adipose tissue (VAT) is associated with incident heart failure (HF) and HF with preserved ejection fraction, yet it is unknown how pericardial and abdominal adiposity affect HF and mortality risks in Black individuals. We examined the associations of pericardial adipose tissue (PAT), VAT, and subcutaneous adipose tissue (SAT) with incident HF hospitalization and all-cause mortality in a large community cohort of Black participants. Methods and Results Among the 2882 Jackson Heart Study Exam 2 participants without prevalent HF who underwent body computed tomography, we used Cox proportional hazards models to examine associations between computed tomography-derived regional adiposity and incident HF hospitalization and all-cause mortality. Fully adjusted models included demographics and cardiovascular disease risk factors. Median follow-up was 10.6 years among participants with available VAT (n=2844), SAT (n=2843), and PAT (n=1386). Fully adjusted hazard ratios (95% CIs) of distinct computed tomography-derived adiposity measures (PAT per 10 cm³, VAT or SAT per 100 cm³) were as follows: for incident HF, PAT 1.08 (95% CI, 1.02-1.14) and VAT 1.04 (95% CI, 1.01-1.08); for HF with preserved ejection fraction, PAT 1.13 (95% CI, 1.04-1.21) and VAT 1.07 (95% CI, 1.01-1.13); for mortality, PAT 1.07 (95% CI, 1.03-1.12) and VAT 1.01 (95% CI, 0.98-1.04). SAT was not associated with either outcome. Conclusions High PAT and VAT, but not SAT, were associated with incident HF and HF with preserved ejection fraction, and only PAT was associated with mortality in the fully adjusted models in a longitudinal community cohort of Black participants. Future studies may help understand whether changes in regional adiposity improves HF, particularly HF with preserved ejection fraction, risk predictions. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00005485.

Thigh and abdominal adipose tissue depot associations with testosterone levels in postmenopausal females

OBJECTIVE

Research findings on the relationship between serum androgens and adipose tissue in older females are inconsistent. We aimed to clarify the relationship using state-of-the-art techniques to evaluate associations between body fat distribution and plasma testosterone (T) levels in older postmenopausal women.

DESIGN

Observational, cross-sectional study of healthy, community dwelling postmenopausal women.

PATIENTS AND MEASUREMENTS

Postmenopausal women (60-80 years old) were included in this study. Overall body composition was evaluated by dual-energy X-ray absorptiometry. Abdominal and thigh fat depots were measured by magnetic resonance imaging. Circulating T concentrations were analysed by liquid chromatography-tandem mass spectrometry.

RESULTS

Thirty-five women (66.6 ± 0.8 years) participated in this study. T levels were positively associated with clinical proxy measures of adiposity including weight (ρ = 0.39), BMI (ρ = 0.43) and waist circumference (ρ = 0.39) (all P < 0.05). Fat mass and % body fat were correlated with T levels (ρ = 0.42 and 0.38 respectively, both P < 0.05). T correlated with overall and superficial abdominal fat (ρ = 0.34 and 0.37 respectively, both P < 0.05) but not with visceral adipose tissue. T increased with greater thigh fat (ρ = 0.49, P < 0.05) in both superficial and deep depots (ρ = 0.50 and 0.35 respectively, both P < 0.05).

CONCLUSION

Our results suggest that postmenopausal women with higher circulating T levels have both higher regional and overall body adiposity. These findings underscore the sexual dimorphism in the relationship between serum androgen levels and adiposity.

Beyond scoring systems: usefulness of morphometry considering demographic variables, to evaluate neck and overall obesity in Andalusian horses

Morphometry has proven to be a useful tool, both for the clinician and horse owners, for evaluating the body condition in equids due to its objectivity, easiness and capacity for detection of important metabolic disturbances. However, limited information is available on the use of morphometric ratios to characterize regional and overall adiposity and much less about their application in different genders, ages and horses with different levels of obesity. The objectives were to evaluate body and neck absolute measurements and ratios; factors affecting them such as the influence of gender, age, appearance of the neck crest and overall body condition and; relationships among these measurements. A total of 154 Andalusian horses classified according to their gender, age, body score status and cresty neck condition were evaluated in this cross-sectional study. Two evaluators assigned a body condition score (BCS, 1 to 9) and a cresty neck score (CNS, 0 to 5) to each horse. Horses were divided into males and females; young (2 to 5 years) and adults (6 to 15 years); obese (BCS⩾7) and non-obese (BCS<7); cresty neck (CNS⩾3) and non-cresty neck horses (CNS<3). Morphometric measurements (cm) included were: height at the withers (HW); body length (BL), girth (GC) and waist (WC) circumferences; neck length (NL); three neck circumferences (NCs), over the first (NC25%), the second (NC50%) and the third part (NC75%) of the NL and neck crest height (NCH). These measurements were also used to calculate the following ratios: GC : HW, WC : HW, GC : BL, WC : BL, NC25% : HW, NC50% : HW, NC75% : HW, NC25% : BL, NC50% : BL, NC75% : BL, NC25% : NL, NC50% : NL, NC75% : NL, NC25% : NCH, NC50% : NCH and NC75% : NCH. The results showed that most of the absolute measurements and ratios were greater than those described in other light breeds. In addition, most neck ratios were higher (P<0.050) in males than in females, however, all body ratios were greater (P<0.001) in females. Among the absolute measurements, WC in obese horses and NC25% and NC75% in cresty neck horses highlighted as higher. Either GC : HW or WC : HW and NC75% : BL were alternative surrogates for the appraisal of overall and regional adiposity in Andalusians. Several interactions were observed between the gender and adiposity scoring systems affecting the morphometric evaluation. This study establishes absolute morphometric measurements and ratios in Andalusian horses. It also highlights the variability of morphometric values and how the outcome of these can be influenced by demographic variables and the breed analyzed. Further studies are necessary to set morphometric reference values in other breeds.

Longitudinal Body Composition Changes in NCAA Division I College Football Players

Trexler, ET, Smith-Ryan, AE, Mann, JB, Ivey, PA, Hirsch, KR, and Mock, MG. Longitudinal body composition changes in NCAA Division I college football players. J Strength Cond Res 31(1): 1-8, 2017-Many athletes seek to optimize body composition to fit the physical demands of their sport. American football requires a unique combination of size, speed, and power. The purpose of the current study was to evaluate longitudinal changes in body composition in Division I collegiate football players. For 57 players (mean ± SD, age = 19.5 ± 0.9 years, height = 186.9 ± 5.7 cm, weight = 107.7 ± 19.1 kg), body composition was assessed via dual-energy x-ray absorptiometry in the off-season (March-Pre), end of off-season (May), mid-July (Pre-Season), and the following March (March-Post). Outcome variables included weight, body fat percentage (BF%), fat mass, lean mass (LM), android and gynoid (GYN) fat, bone mineral content (BMC), and bone mineral density (BMD). For a subset of athletes (n = 13 out of 57), changes over a 4-year playing career were evaluated with measurements taken every March. Throughout a single year, favorable changes were observed for BF% (Δ = -1.3 ± 2.5%), LM (Δ = 2.8 ± 2.8 kg), GYN (Δ = -1.5 ± 3.0%), BMC (Δ = 0.06 ± 0.14 kg), and BMD (Δ = 0.015 ± 0.027 g·cm, all p ≤ 0.05). Across 4 years, weight increased significantly (Δ = 6.6 ± 4.1 kg) and favorable changes were observed for LM (Δ = 4.3 ± 3.0 kg), BMC (Δ = 0.18 ± 0.17 kg), and BMD (Δ = 0.033 ± 0.039 g·cm, all p ≤ 0.05). Similar patterns in body composition changes were observed for linemen and non-linemen. Results indicate that well-trained collegiate football players at high levels of competition can achieve favorable changes in body composition, even late in the career, which may confer benefits for performance and injury prevention.

Relative fat distribution in relation to menarcheal status among Bengalee Hindu girls of West Bengal, India

Background:

Menarche seems be related to the relative distribution rather than the total amount of body fat. Previous studies showed that the ratio between lower-body vs. upper-body fat was associated with the timing of menarche.

Aim:

To compare the relative distribution of subcutaneous fat among Bengali Hindu pre- and post-menarcheal girls.

Materials and Methods:

The participants were 234 Bengali Hindu girls aged 11-14 years: 111 pre-menarcheal and 123 post-menarcheal girls, randomly selected from a secondary school from a suburb of Kolkata, West Bengal, India. Triceps, abdominal, sub-scapular, and calf skinfolds were measured. For each skinfold site, ratio was calculated as follows: Log (one skinfold/sum of skinfolds). Principal components (PC) analysis was performed to derive components which express the maximum contrast among the log of ratios. T-test was employed to assess differences between individual scores of components between pre- and post-menarcheal girls.

Results:

The three identified PC suggested extremities-trunk, lower trunk-upper trunk, and an upper extremity-lower extremity contrasts, respectively. Scores for second and third components showed significant differences between pre- and post-menarcheal groups of girls.

Conclusion:

The attainment of menarche by Bengali girls aged 11-14 years was associated with characteristically more relative subcutaneous fat distribution in the upper trunk and in the lower limbs, in contrast to lower trunk and upper limbs, respectively.

Estradiol effects on subcutaneous adipose tissue lipolysis in premenopausal women are adipose tissue depot specific and treatment dependent

Estrogen has direct effects within adipose tissue and has been implicated in regional adiposity; however, the influence of estrogen on in vivo lipolysis is unclear. The purpose of this study was to investigate the effect of local 17β-estradiol (E(2)) on subcutaneous adipose tissue (SAT) lipolysis in premenopausal women. In vivo lipolysis (dialysate glycerol) was measured in 17 women (age 27.4 ± 2.0 yr, BMI 29.7 ± 0.5 kg/m(2)) via microdialysis of abdominal (AB) and gluteal (GL) SAT. Glycerol was measured at baseline and during acute interventions to increase lipolysis including local perfusion of isoproterenol (ISO, β-adrenergic agonist, 1.0 μmol/l), phentolamine (PHEN, α-adrenergic antagonist, 0.1 mmol/l), and submaximal exercise (60% Vo(2peak), 30 min); all with and without coperfusion of E(2) (500 nmol/l). E(2) coperfusion blunted the lipolytic response to ISO in AB (E(2) 196 ± 31%, control 258 ± 26%, P = 0.003) but not in GL (E(2) 113 ± 14%, control 111 ± 12%, P = 0.43) adipose tissue. At rest, perfusion of PHEN with ISO did not change dialysate glycerol. Submaximal exercise during ISO + PHEN increased dialysate glycerol in the AB (56 ± 9%) and GL (62 ± 12%) regions. Probes perfused with E(2) during exercise and ISO + PHEN had an increased lipolytic response in AB (90 ± 9%, P = 0.007) but a lower response in GL (35 ± 7%, P = 0.05) SAT compared with no-E(2) conditions. E(2) effects on lipolysis are region specific and may work through both adrenergic and adrenergic-independent mechanisms to potentiate and/or blunt SAT lipolysis in premenopausal women.

Longitudinal relationships between whole body and central adiposity on weight-bearing bone geometry, density, and bone strength: a pQCT study in young girls

Longitudinal relationships between adiposity (total body and central) and bone development were assessed in young girls. Total body and android fat masses were positively associated with bone strength and density parameters of the femur and tibia. These results suggest adiposity may have site-specific stimulating effects on the developing bone.

INTRODUCTION

Childhood obesity may impair bone development, but the relationships between adiposity and bone remain unclear. Failure to account for fat pattern may explain the conflicting results.

PURPOSE

Longitudinal associations of total body fat mass (TBFM) and android fat mass (AFM) with 2-year changes in weight-bearing bone parameters were examined in 260 girls aged 8-13 years at baseline. Peripheral quantitative computed tomography was used to measure bone strength index (BSI, square milligrams per quartic millimeter), strength-strain index (SSI, cubic millimeters), and volumetric bone mineral density (vBMD, milligrams per cubic centimeter) at distal metaphyseal and diaphyseal regions of the femur and tibia. TBFM and AFM were assessed by dual-energy x-ray absorptiometry.

RESULTS

Baseline TBFM and AFM were positively associated with the change in femur BSI (r = 0.20, r = 0.17, respectively) and femur trabecular vBMD (r = 0.19, r = 0.19, respectively). Similarly, positive associations were found between TBFM and change in tibia BSI and SSI (r = 0.16, r = 0.15, respectively), and femur total and trabecular vBMD (r = 0.12, r = 0.14, respectively). Analysis of covariance showed that girls in the middle thirds of AFM had significantly lower femur trabecular vBMD and significantly higher tibia cortical vBMD than girls in the highest thirds of AFM. All results were significant at p < 0.05.

CONCLUSIONS

Whereas baseline levels of TBFM and AFM are positive predictors of bone strength and density at the femur and tibia, higher levels of AFM above a certain level may impair cortical vBMD growth at weight-bearing sites. Future studies in obese children will be needed to test this possibility.

Oral dehydroepiandrosterone replacement in older adults: effects on central adiposity, glucose metabolism and blood lipids

OBJECTIVE

To determine the effects of dehydroepiandrosterone (DHEA) therapy on changes in central adiposity, insulin action and blood lipids. Many of the actions of DHEA in humans are thought to be mediated through its conversion to sex hormones, which are modulators of adiposity, muscularity and insulin sensitivity. The effects of DHEA replacement on regional tissue composition, glucose metabolism and blood lipid profile in older adults have been inconsistent.

DESIGN

A randomized, double-blinded, placebo-controlled trial. The intervention was oral DHEA 50 mg/day or placebo for 12 months.

PARTICIPANTS

Fifty-eighty women and 61 men, aged 60-88 years, with low serum DHEA sulphate (DHEAS) levels at study entry.

MEASUREMENTS

Computed tomography measures of abdominal fat areas, thigh muscle and fat areas, DXA-derived trunk fat mass, serum glucose and insulin responses to an oral glucose challenge, and fasted serum total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides were assessed before and after the intervention.

RESULTS

There were no significant (P > 0·05) differences between the DHEA and placebo groups in the changes in regional tissue composition or glucose metabolism. HDL-cholesterol (P = 0·01) and fasted triglycerides (P = 0·02) decreased in women and men taking DHEA.

CONCLUSION

Restoring serum DHEAS levels in older adults to young adult levels for 1 year does not appear to reduce central adiposity or improve insulin action. The benefit of DHEA on decreasing serum triglycerides must be weighed against the HDL-lowering effect.

The effects of changing exercise levels on weight and age-related weight gain

OBJECTIVE

To determine prospectively whether physical activity can prevent age-related weight gain and whether changing levels of activity affect body weight.

DESIGN/SUBJECTS

The study consisted of 8,080 male and 4,871 female runners who completed two questionnaires an average (+/-standard deviation (s.d.)) of 3.20+/-2.30 and 2.59+/-2.17 years apart, respectively, as part of the National Runners' Health Study.

RESULTS

Changes in running distance were inversely related to changes in men's and women's body mass indices (BMIs) (slope+/-standard error (s.e.): -0.015+/-0.001 and -0.009+/-0.001 kg/m(2) per Deltakm/week, respectively), waist circumferences (-0.030+/-0.002 and -0.022+/-0.005 cm per Deltakm/week, respectively) and percent changes in body weight (-0.062+/-0.003 and -0.041+/-0.003% per Deltakm/week, respectively, all P<0.0001). The regression slopes were significantly steeper (more negative) in men than women for DeltaBMI and Delta%body weight (P<0.0001). A longer history of running diminished the impact of changing running distance on men's weights. When adjusted for Deltakm/week, years of aging in men and years of aging in women were associated with increases of 0.066+/-0.005 and 0.056+/-0.006 kg/m(2) in BMI, respectively, increases of 0.294+/-0.019 and 0.279+/-0.028% in Delta%body weight, respectively, and increases of 0.203+/-0.016 and 0.271+/-0.033 cm in waist circumference, respectively (all P<0.0001). These regression slopes suggest that vigorous exercise may need to increase 4.4 km/week annually in men and 6.2 km/week annually in women to compensate for the expected gain in weight associated with aging (2.7 and 3.9 km/week annually when correct for the attenuation due to measurement error).

CONCLUSIONS

Age-related weight gain occurs even among the most active individuals when exercise is constant. Theoretically, vigorous exercise must increase significantly with age to compensate for the expected gain in weight associated with aging.