Midlife adiposity predicts cognitive decline in the prospective Multicenter AIDS Cohort Study

• Published in: Neurology Vol. 93; no. 3; pp. e261 - e271
• Main Authors: Rubin, Leah H, Gustafson, Deborah, Hawkins, Kellie L, Zhang, Long, Jacobson, Lisa P, Becker, James T, Munro, Cynthia A, Lake, Jordan E, Martin, Eileen, Levine, Andrew, Brown, Todd T, Sacktor, Ned, Erlandson, Kristine M
• Format: Journal Article
• Language: English
• Published: United States American Academy of Neurology 16-07-2019; Lippincott Williams & Wilkins
• Subjects: Adult; Aged; Aged, 80 and over; Attention; Body Mass Index; Case-Control Studies; Cognitive Dysfunction - epidemiology; HIV Infections - epidemiology; Humans; Male; Memory, Short-Term; Middle Aged; Movement; Obesity - epidemiology; Obesity, Abdominal - epidemiology; Waist Circumference
• ISSN: 0028-3878; 1526-632X
• DOI: 10.1212/WNL.0000000000007779

OBJECTIVEObesity is a common, modifiable cardiovascular and cerebrovascular risk factor. Among people with HIV, obesity may contribute to multisystem dysregulation including cognitive impairment. We examined body mass index (BMI) and central obesity (waist circumference [WC]) in association with domain-specific cognitive function and 10-year cognitive decline in men with HIV infection (MWH) vs HIV-uninfected (HIV−) men.
METHODSA total of 316 MWH and 656 HIV− Multicenter AIDS Cohort Study participants ≥40 years at baseline, with neuropsychological testing every 2 years and concurrent BMI and WC measurements, were included. MWH were included if taking ≥2 antiretroviral agents and had HIV-1 RNA <400 copies/mL at >80% of visits. Mixed-effects models included all visits from 1996 to 2015, stratified by HIV serostatus, and adjusted for sociodemographic, behavioral, and clinical characteristics. At baseline and follow-up, 8% of MWH and 15% of HIV− men and 41% of MWH and 56% of HIV− men were ≥60 years, respectively.
RESULTSCross-sectionally, higher BMI was inversely associated with motor function in MWH and HIV− men, and attention/working memory in HIV− men. WC was inversely associated with motor function in MWH and HIV− men. Longitudinal associations indicated an obese BMI was associated with a less steep decline in motor function in MWH whereas in HIV− men, obesity was associated with a greater decline in motor function, learning, and memory. WC, or central obesity, showed similar patterns of associations.
CONCLUSIONHigher adiposity is associated with lower cognition cross-sectionally and greater cognitive decline, particularly in HIV− men. Overweight and obesity may be important predictors of neurologic outcomes and avenues for prevention and intervention.