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通讯作者:

霍康,E-mail:huokang8204@xjtu.edu.cn

中图分类号:R749.1

文献标识码:A

文章编号:1007-4368(2023)09-1216-07

DOI:10.7655/NYDXBNS20230905

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目录contents

    摘要

    目的:探讨中国内脏脂肪指数(Chinese visceral adiposity index,CVAI)与认知能力障碍(cognitive impairment,CI)的相关性,并进一步分析不同年龄分层下两者的相关性,为准确评估两者关系,提供新的可干预的认知功能影响因素提供依据。方法:选取CHARLS数据库2011年和2015年的数据,包括研究对象的性别、年龄、教育程度、饮酒、吸烟史以及体重指数和生化指标。应用Logistic回归分析CVAI与CI的相关性,并根据不同年龄进行分层分析。结果:①在12102例研究对象中,认知能力障碍者为1295例(10.7%);②在≥65岁人群中,CVAI与CI具有相关性(P < 0.05),而在<65岁人群中CVAI与CI无明显相关性;③利用截断值(161.94),所有研究对象可分为高CVAI组(CVAI≥161.94)和低CVAI组(CVAI<161.94);④年龄与CI呈正相关(OR=2.24,95%CI:1.66~3.03),教育程度与CI呈负相关(OR=0.71,95%CI:0.53~0.94),在≥65岁人群中,高CVAI与CI呈正相关(OR=1.91,95%CI:1.24~2.93)。结论:CVAI、年龄、教育程度均与CI相关。在65岁及以上人群,高CVAI是CI的危险因素。

    Abstract

    Objective:The current study aims to explore the correlation between Chinese visceral adiposity index(CVAI)and cognitive impairment(CI),and further to analyze the correlation between CVAI and CI under different age levels,providing evidence for accurately evaluating the relationship between CVAI and CI,and seeking for new factors available for intervention associated with CI. Methods:The CHARLS database was used in the current study. The baseline data of 2011 and 2015 were collected,including gender,age,education level,alcohol consumption,smoking history,body mass index,and biochemical indicators. Logistic regression analysis was used to analyze the correlation of CVAI and CI,according to difterent age stratification. Results:①A total of 12102 subjects were included in the curreut study,1295(10.7%)subjects had CI. ② There was a correlation between CVAI and CI in people aged 65 and above(P < 0.05),but no significant correlation between CVAI and CI in people aged below 65(P > 0.05);③The best cut- off value of CVAI for CI was 161.94. According to the cut-off value,all subjects was divided into high CVAI group(CVAI≥161.94)and low CVAI group(CVAI<161.94). ④ Age was positively correlated with CI(OR=2.24,95% CI:1.66-3.03),education level was negatively correlated with CI(OR=0.71,95%CI:0.53-0.94),and high CVAI was correlated with CI in people aged 65 and above(OR= 1.91,95%CI:1.24-2.93). Conclusion:CVAI,age and education were correlated with CI. High CVAI is a risk factor for CI in people65 years and older.

  • 目前认知能力障碍(cognitive impairment,CI)和痴呆已经成为全球公共卫生和社会护理资源面临的重要挑战。据估计,2050 年全球痴呆人数将逾 1.52 亿。早期识别并主动管理 CI 相关的风险因素可将痴呆人口减少35%[1]。我国正在迅速步入老龄化社会,研究肥胖与认知能力之间的相关关系,识别CI的潜在危险因素,特别是那些可改变的危险因素,以制定有效的预防干预措施,有助于缓解我国未来巨大的公共卫生压力。

  • 肥胖对认知的影响说法不一,有研究认为肥胖与认知能力降低、痴呆风险增高有关[2],也有研究认为超重/肥胖老年人患CI的风险降低[3]。不同的衡量指标可能造成了这一矛盾的结果。研究证明,CI多与内脏脂肪蓄积的代谢后果有关[4],提示肥胖引起的体脂分布异常可能是影响认知能力的关键。既往研究采用的体重指数(body mass index,BMI)、腰围(waist cir⁃ cumference,WC)、腰臀比(waist⁃hip ratio,WHR)和腰高比(waist to height ratio,WHtR)等指标,易受多重因素影响,存在年龄、地区及种族差异性[5],无法区分体重增加来源于肌肉或是脂肪。计算机断层扫描和磁共振成像等影像检查作为评估测量内脏脂肪的金标准,可以定量评价内脏脂肪蓄积程度[6],但长耗时和潜在的辐射风险,制约了其在人群调查中的应用。内脏脂肪指数(visceral adiposity index,VAI) 综合 BMI、WC、甘油三酯(triglycerides,TG)和高密度脂蛋白胆固醇(high density lipoprotein cholestoral, HDL⁃C)结果,是一种新型的脂肪分布评价指标,与经影像学测量的内脏脂肪含量具有良好的一致性和相关性[7],且与胰岛素抵抗、动脉粥样硬化、高血压、糖尿病、脑卒中等多项肥胖并发症相关[8],这些因素均与 CI 相关[9]。由于 VAI 的研究限于欧美人群,而不同种族之间,体脂分布存在明显差异,所以 Xia 等[10] 在 VAI 的基础上基于中国人群数据,构建了更适宜中国人的中国内脏脂肪指数(Chinese visceral adiposity index,CVAI),该指数与内脏脂肪面积显著相关,和 VAI 相比,能够更好地揭示中国人群的内脏脂肪分布状态。徐怿琳等[11] 研究也证实,CVAI 是比 BMI、WC、WHR 更好的内脏脂肪相关性疾病的预测指标。

  • 因此,本研究试图通过一项全国性调查数据研究CVAI和CI之间的关系,并分析这一因素在不同年龄分层下的作用,为发现新的、可干预的CI危险因素提供依据。

  • 1 资料和方法

  • 1.1 资料

  • 本研究资料来自中国健康与退休纵向调查 (China Health and Retirement Longitudinal Study, CHARLS)[12],经北京大学伦理委员会审核批准(伦理编号:IRB00001052⁃11015)。采用2011年和2015年横断面资料,排除:①基线调查时年龄<45岁人群; ②有视力或听力障碍影响认知水平问卷;③精神疾病或神经疾病,可影响认知功能;④关键变量(BMI、 WC、TG、HDL⁃C)缺失。最终得到有效样本12 102例 (图1)。

  • 1.2 方法

  • 1.2.1 一般资料

  • 性别、年龄、教育程度、婚姻状况以及吸烟、饮酒史等;体格检查:身高、体重、WC和血压;实验室检查:TG和HDL⁃C等指标。

  • 图1 样本筛选流程图

  • Figure1 Flow chart of participants in the study

  • 1.2.2 诊断标准及变量定义

  • BMI=体重(kg)/身高(m)2,均符合《中国成人超重和肥胖症预防控制指南》[13]

  • CVAI=-267.93+0.68×年龄+0.03×BMI+4.00× WC+22.00×lgTG-16.32×HDL⁃C(mmol/L);CVAI =-187.32+1.71×年龄+4.23×BMI+1.12×WC+39.76× lgTG-11.66×HDL⁃C(mmol/L)[8]

  • CI测定:2011年和2015年的CHARLS研究未提供明确的认知障碍诊断,参考以往文献[14-15],采用健康状况和功能问卷部分,以心智状况和情景记忆能力这两项指标得分相加作为认知功能得分来共同衡量认知功能。该数据库中,心智状况采用年月日、星期、季节认知,对计算和画图能力进行测试,每答对1题记1分,共计0~11分,情景记忆能力采用词组回忆进行测试,每组10个词,在两次不同时间内回忆,每回忆1个词记1分,两次回忆得分的平均值为情景记忆能力最终得分,共计0~10分,认知能力得分取值介于0~21分。取认知能力得分最低的 10%人群定义为CI。

  • 吸烟:连续吸烟≥6 个月或吸烟≥1 支/d[16];饮酒:连续饮酒≥6个月或≥1次/周[17]

  • 1.3 统计学方法

  • 采用 Stata17.0 进行数据收集和统计分析。计量资料以均数±标准差(x-±s)表示,计数资料以构成比(%)表示,正态分布的计量资料组间比较采用t检验,计数资料的组间比较采用卡方检验。CVAI和认知评分之间的相关性采用Spearman相关分析,多因素分析采用Logistic回归分析。结果以比值比(odds ratio,OR)和 95%置信区间(confidence interval,CI) 表示,检验水准α=0.05。P <0.05 为差异有统计学意义。

  • 2 结果

  • 2.1 研究对象的基本特征

  • 在纳入分析的 12 102 例中,年龄 50~<65 岁 9 024 例(74.6%),年龄≥65 岁 3 078 例(25.4%),男 5 640例(46.6%),女6 462例(53.4%);年龄(59.01± 9.76)岁;在婚10 601例(87.6%);未完成小学者5 869例 (48.5%);吸烟 4 804 例(39.7%),饮酒 3 965 例 (32.8%),CI者1 295例(10.7%)。去除CVAI中分数位1%以下,99%以上的极端值,CVAI值符合正态分布(表1)。

  • 表1 正常组与CI组基线特征比较

  • Table1 Comparison of demographic charactcristics between normal group and CI group

  • 2.2 CVAI与CI的相关性分析

  • Spearman 相关分析 CVAI 与 CI 的关系,结果显示,CVAI 与 CI 存在相关性(P <0.001),但当按照 65 岁进行年龄分层后,CVAI 与 CI 的相关性仅在 ≥65岁人群中存在(P=0.014,表2)。

  • 表2 CVAI与CI的相关性

  • Table2 Correlation between CVAI and CI

  • 2.3 CVAI与CI人群分布

  • 以CI作为待诊断变量,CVAI作为诊断变量,绘制 ROC 曲线,结果显示 CVAI 与 CI 的曲线下面积 (area under curve,AUC)和 95%CI 为 0.526(0.508~0.544),灵敏度为0.34,特异度为0.70(P <0.01),提示CVAI对CI具有一定的预测价值,最佳约登指数对应的截断值为 161.94。利用截断值分为高 CVAI 组(CVAI ≥ 161.94)和低CVAI组(CVAI<161.94),CI 人群分别为439(33.9%)和856(66.1%)(表3)。

  • 表3 不同CVAI水平CI患病率比较

  • Table3 Prevalence of CI at different CVAI levels

  • χ2 =125.54,P <0.001。

  • 2.4 影响CI的单因素和多因素Logistic回归分析

  • 2.4.1 影响CI的Logistic分析

  • 以有无 CI 为因变量进行 Logistic 回归分析,单因素分析结果显示,年龄、教育程度、婚姻状况和高 CVAI 均与 CI 相关(P <0.01)。以上单因素分析有显著性差异的因素为自变量进行多因素回归分析,显示在调整性别、年龄、婚姻状况、教育程度、吸烟、饮酒等混杂因素后,年龄和高CVAI与CI呈正相关,教育程度与CI呈负相关,差异均有统计学意义(P均 <0.05,表4)。

  • 2.4.2 按年龄分层分析CVAI对CI的影响

  • ≥65岁人群中,高CVAI是CI的危险性因素,在调整性别、年龄、婚姻状况、教育程度、吸烟、饮酒后,OR=1.91,95%CI:1.24~2.93(P <0.05);50~<65 岁人群则无这种危险作用(表5)。

  • 3 讨论

  • 研究显示,中心性肥胖对CI的影响比全身性肥胖更显著[18],明确中心性肥胖与CI之间的关系成为近年来的研究热点。CVAI已经被证实在评估与内脏脂肪相关疾病方面优于BMI和WC[9],然而,在目前的文献中,没有直接证据表明 CVAI 与 CI 有关。本研究首次揭示了CVAI和CI之间的相关性,发现除了年龄、教育程度与CI存在相关性(P <0.05)外, CVAI 与 CI 也存在相关性,在进一步调整年龄后发现,这种相关性仅在≥65岁人群中存在(P <0.05),而在 45~<65 岁人群中 CVAI 与 CI 无明显相关性。这与 Tang 等[19] 研究结果类似,该研究对包括 BMI、 WC及WHR等肥胖指标与CI关系的荟萃分析显示,在≥65 岁人群中,高 WC 对 CI 存在显著相关性 (HR = 1.13,95% CI:1.08~1.19),但在 65 岁以下人群中,未观察到相关性(HR=1.04,95% CI:0.93~1.16)。新加坡的研究探讨了年龄≥60岁2型糖尿病人群内脏脂肪面积与CI的关系,结果显示超重患者的内脏脂肪面积与CI独立相关[20]。徐佩茹等[21] 研究显示,对年龄分层后,WC与CI的相关性仅在70~94岁老人中有统计学意义。也有研究有不同发现, Gardener等[22]研究显示,在≥65岁的人群中,WHR与 CI呈正相关,而在≥65岁的人群中,BMI和WHR与 CI 均没有相关性。Yoon 等[23] 研究显示,内脏脂肪 (OR=2.58,95% CI:1.00~6.62,P=0.045)与<70岁人群CI相关,但在≥70岁人群中无相关性。这些结果提示,中心性肥胖作为CI的影响因素可能有分层效应[24],可能和肥胖与CI关联的年龄依赖性有关[25]。另外,中心性肥胖的测量在老年人群中更加可靠[26],而 CVAI 能够更准确地反映老年人的体脂分布,这可能也是另一个原因。

  • 表4 Logistic分析影响CI的因素

  • Table4 Logistic regression analysis of factors associated with CI

  • 模型1:调整性别和年龄;模型2:调整性别、年龄和教育程度;模型3:调整性别、年龄、婚姻状况、教育程度、吸烟、饮酒。

  • 表5 按年龄分层的Logistic回归分析CVAI对CI的影响

  • Table5 Logistic regression of the effect of CVAI on CI by age stratification

  • 模型1:调整性别和年龄;模型2:调整性别、年龄和教育程度;模型3:调整性别、年龄、婚姻状况、教育程度、吸烟、饮酒。

  • 本研究的另一发现是,与低CVAI人群相比,高 CVAI 组 CI 的患病风险明显增加,在校正混杂因素后,这种相关性在≥65 岁人群中仍然存在(OR= 0.83,95%CI:0.72~0.97,P <0.001),支持中心性肥胖作为老年人群CI危险因素的假设。这与另一项研究结果相似,Hou等[3] 对1 100例≥60岁老年人的观察结果表明,以WHR定义的腹部肥胖与CI风险增加显著相关(OR=1.532,95%CI:1.037~2.263,P= 0.032)。智利的一项研究也显示肥胖与老年人CI的增加有关[27]。但是,也有研究认为较高的WC与认知能力下降较慢有关[28]。Lee 等[29] 的研究表明高 WC个体痴呆风险明显降低。荟萃分析显示,晚年超重和肥胖导致CI的风险分别降低21%和25%[30]。这些结果相互矛盾,可能与CI的临床前阶段较长,缺乏统一的判定标准,以及各研究何时对各种风险或保护因素与CI临床发作进行测量有关,也与较为广泛的年龄跨度对CI的影响有关,这可能也是本研究中AUC值不够理想的原因。

  • 目前肥胖对神经系统影响的机制尚未完全阐明,英国的一项研究表明,高血压、血脂异常和胰岛素抵抗等代谢综合征组分相互独立地介导肥胖与认知功能的关系[5]。胰岛素抵抗是对海马认知功能产生不良影响的关键因素[31],肥胖可通过慢性低度炎症、异位脂质沉淀和氧化应激等多种途径影响大脑中胰岛素信号传导[32]。代谢综合征的各个组分均与血管内皮损伤独立相关,从而限制脑血管血流,使CI的风险增加[33]。另一方面,肥胖引起的代谢异常可能直接或间接通过白质损伤导致灰质厚度减少以及降低脑白质完整性,进而影响认知功能[34]

  • 本研究的优势是基于一项全国性调查,是真实世界较大的样本量,并且包括了人口统计学、生活方式、血脂、BMI 以及 WC 的丰富数据,所有这些都可能参与肥胖和 CI 的关系。同时,首次探讨了 CVAI 和 CI 的关系,并进行了不同年龄的分层。本研究局限性:第一,受限于横断面研究,无法确定 CVAI与CI患病的因果关系;第二,本研究主要是根据主观评分来诊断CI,而不是根据更全面的神经心理学评估和神经影像学结果,后期如果能够对认知功能变化进行动态纵向研究,并结合其他生物标志物指标,如脑脊液β淀粉样蛋白或tau蛋白[35],可能会得到更有说服力的结果;第三,当探索CVAI不同临界值的影响时,需要更多涉及较小CVAI跨度组分析的研究来进一步明确中心性肥胖的最佳截断值。

  • 肥胖作为CI可以控制和改变的影响因素,对于有效干预或延缓 CI 进展至关重要。但是,不同时期、不同类型的肥胖及其变化趋势对认知的影响复杂,尤其体现在老年期肥胖方面。因此在制订预防策略以及临床指导建议时,应针对不同年龄、不同肥胖类型,进一步细化体重、WC、血脂等指标的管理方案和控制目标,尤其对体重在一段时间内的剧烈变化应加以关注,避免体重的过度波动对CI患病风险的不良影响[36]。希望上述结果可以为今后量身定制针对CI潜在风险因素的干预措施提供研究方向和理论依据。

  • 参考文献

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    • [2] FELLOWS R P,SCHMITTER⁃EDGECOMBE M.Indepen⁃ dent and differential effects of obesity and hypertension on cognitive and functional abilities[J].Arch Clin Neuro⁃ psychol,2018,33(1):24-35

    • [3] HOU Q T,GUAN Y,YU W H,et al.Associations between obesity and cognitive impairment in the Chinese elderly:an observational study[J].Clin Interv Aging,2019,14:367-373

    • [4] MORYS F,DADAR M,DAGHER A.Association between midlife obesity and its metabolic consequences,cerebro⁃ vascular disease,and cognitive decline[J].J Clin Endo⁃ crinol Metab,2021,106(10):4260-4274

    • [5] SOMMER I,TEUFER B,SZELAG M,et al.The perfor⁃ mance of anthropometric tools to determine obesity:a sys⁃ tematic review and meta ⁃analysis[J].Sci Rep,2020,10(1):12699

    • [6] GRAFFY P M,PICKHARDT P J.Quantification of hepatic and visceral fat by CT and MR imaging:relevance to the obesity epidemic,metabolic syndrome and NAFLD[J].Br J Radiol,2016,89(1062):20151024

    • [7] AMATO MC,GIORDANO C,GALIA M,et al.Visceral adiposity index:a reliable indicator of visceral fat func⁃ tion associated with cardiometabolic risk[J].Diabetes Care,2010,33(4):920-922

    • [8] AMATO M C,GIORDANO C.Visceral adiposity index:an indicator of adipose tissue dysfunction[J].Int J Endo⁃ crinol,2014,2014:730827

    • [9] 中华医学会老年医学分会老年神经病学组,老年人认知障碍诊治专家共识撰写组.中国老年人认知障碍诊治流程专家建议[J].中华老年医学杂志,2014,33(8):817-825

    • [10] XIA M F,CHEN Y,LIN H D,et al.A indicator of visceral adipose dysfunction to evaluate metabolic health in adult Chinese[J].Sci Rep,2016,6:38214

    • [11] 徐怿琳,魏晨敏,桑苗苗,等.中国中老年人群内脏脂肪指数与胰岛素抵抗和糖代谢的关系[J].南京医科大学学报(自然科学版),2018,38(9):1252-1258

    • [12] ZHAO Y H,HU Y S,GE T,et al.Food⁃related illnesses [EB/OL].(2014 ⁃ 04 ⁃ 29)[2021 ⁃ 08 ⁃ 03].http://charls.pku.edu.cn/Public/ashelf/public/uploads/document/2011 ⁃ charls ⁃ wave1/application/blood_user_guide_en_ 20140429.pdf

    • [13] 陈春明,孔灵芝.中国成人超重和肥胖症预防控制指南 [M].北京:人民卫生出版社,2006:2-4

    • [14] 祝慧琳,曾湘泉.社交活动与农村中老年人认知能力 ——来自 CHARLS 2011 年—2015 年的证据[J].中国劳动,2019(9):25-39

    • [15] 王炜豪,黄美佳,卢肇骏,等.认知水平对中老年人死亡风险的影响[J].现代预防医学,2021,48(16):3065-3069

    • [16] 彭魁.中国社区人群睡眠和吸烟与代谢性疾病的相关性研究[D].上海:上海交通大学,2018

    • [17] HU L H,HUANG X,YOU C J,et al.Prevalence and risk factors of prehypertension and hypertension in Southern China[J].PLoS One,2017,12(1):e0170238

    • [18] O’BRIEN J T,FIRBANK M J,RITCHIE K,et al.Associ⁃ ation between midlife dementia risk factors and longitudi⁃ nal brain atrophy:the PREVENT ⁃ dementia study[J].J Neurol Neurosurg Psychiatry,2020,91(2):158-161

    • [19] TANG X,ZHAO W,LU M,et al.Relationship between central obesity and the incidence of cognitive impairment and dementia from cohort studies involving 5 060 687 par⁃ ticipants[J].Neurosci Biobehav Rev,2021,130:301-313

    • [20] MOH M C,LOW S,NG T P,et al.Association of traditional and novel measures of central obesity with cognitive per⁃ formance in older multi⁃ethnic Asians with type 2 diabetes [J].Clin Obes,2020,10(2):e12352

    • [21] 徐佩茹,魏嵘,杨林胜,等.社区老年人BMI、腰围与轻度认知障碍的关联性研究[J].现代预防医学,2019,46(8):1434-1438

    • [22] GARDENER H,CAUNCA M,DONG C,et al.Obesity measures in relation to cognition in the Northern Manhat⁃ tan study[J].J Alzheimers Dis,2020,78(4):1653-1660

    • [23] YOON D H,CHOI S H,YU J H,et al.The relationship between visceral adiposity and cognitive performance in older adults[J].Age Ageing,2012,41(4):456-461

    • [24] PETERSEN R C.Clinical practice.Mild cognitive impair⁃ ment[J].N Engl J Med,2011,364(23):2227-2234

    • [25] 刘泽源.老年高血压患者认知功能障碍的影响因素及相关分析[D].吉林:吉林大学,2021

    • [26] HASSING L B,DAHL A K,THORVALDSSON V.Over⁃ weight in midlife and risk of dementia:a 40⁃year follow ⁃ up study[J].Int J Obes(Lond),2009,33(8):893-898

    • [27] CONCHA⁃CISTERNAS Y,LANUZA F,WADDELL H,et al.Association between adiposity levels and cognitive im⁃ pairment in the Chilean older adult population[J].J Nutr Sci,2019,8:e33

    • [28] LIANG F,FU J L,MOORE J B,et al.Body mass index,waist circumference,and cognitive decline among chinese older adults:a nationwide retrospective cohort study[J].Front Aging Neurosci,2022,14:737532

    • [29] LEE C M,WOODWARD M,BATTY G D,et al.Associa⁃ tion of anthropometry and weight change with risk of de⁃ mentia and its major subtypes:a meta⁃analysis consisting 2.8 million adults with 57 294 cases of dementia[J].Obes Rev,2020,21(4):12989

    • [30] QU Y,HU H Y,OU Y N,et al.Association of body massindex with risk of cognitive impairment and dementia:a systematic review and meta⁃analysis of prospective studies [J].Neurosci Biobehav Rev,2020,115:189-198

    • [31] GRILLO C A,PIROLI G G,LAWRENCE R C,et al.Hip⁃ pocampal insulin resistance impairs spatial learning and synaptic plasticity[J].Diabetes,2015,64(11):3927-3936

    • [32] 唐倩,黄琪,梁凤霞.肥胖引起的胰岛素抵抗对认知障碍的影响机制研究进展[J].华中科技大学学报(医学版),2022,51(5):718-724

    • [33] ARSHAD N,LIN T S,YAHAYA M F.Metabolic syn⁃ drome and its effect on the brain:possible mechanism[J].CNS Neurol Disord Drug Targets,2018,17(8):595-603

    • [34] NOTA M H C,VREEKEN D,WIESMANN M,et al.Obe⁃ sity affects brain structure and function⁃ rescue by bariatric surgery?[J].Neurosci Biobehav Rev,2020,108:646-657

    • [35] 贾建军,张岩磊,曾惟伊,等.脑脊液检测在阿尔茨海默病领域的应用现状[J].中华老年心脑血管病杂志,2019,21(11):1192-1195

    • [36] AIKEN ⁃MORGAN A T,CAPUANO A W,ARVANITA⁃ KIS Z,et al.Changes in body mass index are related to faster cognitivedecline among African American older adults[J].J Am Geriatr Soc,2020,6:2662-2667

  • 参考文献

    • [1] LIVINGSTON G,HUNTLEY J,SOMMERLAD A,et al.Dementia prevention,intervention,and care:2020 report of the Lancet Commission[J].Lancet,2020,396(10248):413-446

    • [2] FELLOWS R P,SCHMITTER⁃EDGECOMBE M.Indepen⁃ dent and differential effects of obesity and hypertension on cognitive and functional abilities[J].Arch Clin Neuro⁃ psychol,2018,33(1):24-35

    • [3] HOU Q T,GUAN Y,YU W H,et al.Associations between obesity and cognitive impairment in the Chinese elderly:an observational study[J].Clin Interv Aging,2019,14:367-373

    • [4] MORYS F,DADAR M,DAGHER A.Association between midlife obesity and its metabolic consequences,cerebro⁃ vascular disease,and cognitive decline[J].J Clin Endo⁃ crinol Metab,2021,106(10):4260-4274

    • [5] SOMMER I,TEUFER B,SZELAG M,et al.The perfor⁃ mance of anthropometric tools to determine obesity:a sys⁃ tematic review and meta ⁃analysis[J].Sci Rep,2020,10(1):12699

    • [6] GRAFFY P M,PICKHARDT P J.Quantification of hepatic and visceral fat by CT and MR imaging:relevance to the obesity epidemic,metabolic syndrome and NAFLD[J].Br J Radiol,2016,89(1062):20151024

    • [7] AMATO MC,GIORDANO C,GALIA M,et al.Visceral adiposity index:a reliable indicator of visceral fat func⁃ tion associated with cardiometabolic risk[J].Diabetes Care,2010,33(4):920-922

    • [8] AMATO M C,GIORDANO C.Visceral adiposity index:an indicator of adipose tissue dysfunction[J].Int J Endo⁃ crinol,2014,2014:730827

    • [9] 中华医学会老年医学分会老年神经病学组,老年人认知障碍诊治专家共识撰写组.中国老年人认知障碍诊治流程专家建议[J].中华老年医学杂志,2014,33(8):817-825

    • [10] XIA M F,CHEN Y,LIN H D,et al.A indicator of visceral adipose dysfunction to evaluate metabolic health in adult Chinese[J].Sci Rep,2016,6:38214

    • [11] 徐怿琳,魏晨敏,桑苗苗,等.中国中老年人群内脏脂肪指数与胰岛素抵抗和糖代谢的关系[J].南京医科大学学报(自然科学版),2018,38(9):1252-1258

    • [12] ZHAO Y H,HU Y S,GE T,et al.Food⁃related illnesses [EB/OL].(2014 ⁃ 04 ⁃ 29)[2021 ⁃ 08 ⁃ 03].http://charls.pku.edu.cn/Public/ashelf/public/uploads/document/2011 ⁃ charls ⁃ wave1/application/blood_user_guide_en_ 20140429.pdf

    • [13] 陈春明,孔灵芝.中国成人超重和肥胖症预防控制指南 [M].北京:人民卫生出版社,2006:2-4

    • [14] 祝慧琳,曾湘泉.社交活动与农村中老年人认知能力 ——来自 CHARLS 2011 年—2015 年的证据[J].中国劳动,2019(9):25-39

    • [15] 王炜豪,黄美佳,卢肇骏,等.认知水平对中老年人死亡风险的影响[J].现代预防医学,2021,48(16):3065-3069

    • [16] 彭魁.中国社区人群睡眠和吸烟与代谢性疾病的相关性研究[D].上海:上海交通大学,2018

    • [17] HU L H,HUANG X,YOU C J,et al.Prevalence and risk factors of prehypertension and hypertension in Southern China[J].PLoS One,2017,12(1):e0170238

    • [18] O’BRIEN J T,FIRBANK M J,RITCHIE K,et al.Associ⁃ ation between midlife dementia risk factors and longitudi⁃ nal brain atrophy:the PREVENT ⁃ dementia study[J].J Neurol Neurosurg Psychiatry,2020,91(2):158-161

    • [19] TANG X,ZHAO W,LU M,et al.Relationship between central obesity and the incidence of cognitive impairment and dementia from cohort studies involving 5 060 687 par⁃ ticipants[J].Neurosci Biobehav Rev,2021,130:301-313

    • [20] MOH M C,LOW S,NG T P,et al.Association of traditional and novel measures of central obesity with cognitive per⁃ formance in older multi⁃ethnic Asians with type 2 diabetes [J].Clin Obes,2020,10(2):e12352

    • [21] 徐佩茹,魏嵘,杨林胜,等.社区老年人BMI、腰围与轻度认知障碍的关联性研究[J].现代预防医学,2019,46(8):1434-1438

    • [22] GARDENER H,CAUNCA M,DONG C,et al.Obesity measures in relation to cognition in the Northern Manhat⁃ tan study[J].J Alzheimers Dis,2020,78(4):1653-1660

    • [23] YOON D H,CHOI S H,YU J H,et al.The relationship between visceral adiposity and cognitive performance in older adults[J].Age Ageing,2012,41(4):456-461

    • [24] PETERSEN R C.Clinical practice.Mild cognitive impair⁃ ment[J].N Engl J Med,2011,364(23):2227-2234

    • [25] 刘泽源.老年高血压患者认知功能障碍的影响因素及相关分析[D].吉林:吉林大学,2021

    • [26] HASSING L B,DAHL A K,THORVALDSSON V.Over⁃ weight in midlife and risk of dementia:a 40⁃year follow ⁃ up study[J].Int J Obes(Lond),2009,33(8):893-898

    • [27] CONCHA⁃CISTERNAS Y,LANUZA F,WADDELL H,et al.Association between adiposity levels and cognitive im⁃ pairment in the Chilean older adult population[J].J Nutr Sci,2019,8:e33

    • [28] LIANG F,FU J L,MOORE J B,et al.Body mass index,waist circumference,and cognitive decline among chinese older adults:a nationwide retrospective cohort study[J].Front Aging Neurosci,2022,14:737532

    • [29] LEE C M,WOODWARD M,BATTY G D,et al.Associa⁃ tion of anthropometry and weight change with risk of de⁃ mentia and its major subtypes:a meta⁃analysis consisting 2.8 million adults with 57 294 cases of dementia[J].Obes Rev,2020,21(4):12989

    • [30] QU Y,HU H Y,OU Y N,et al.Association of body massindex with risk of cognitive impairment and dementia:a systematic review and meta⁃analysis of prospective studies [J].Neurosci Biobehav Rev,2020,115:189-198

    • [31] GRILLO C A,PIROLI G G,LAWRENCE R C,et al.Hip⁃ pocampal insulin resistance impairs spatial learning and synaptic plasticity[J].Diabetes,2015,64(11):3927-3936

    • [32] 唐倩,黄琪,梁凤霞.肥胖引起的胰岛素抵抗对认知障碍的影响机制研究进展[J].华中科技大学学报(医学版),2022,51(5):718-724

    • [33] ARSHAD N,LIN T S,YAHAYA M F.Metabolic syn⁃ drome and its effect on the brain:possible mechanism[J].CNS Neurol Disord Drug Targets,2018,17(8):595-603

    • [34] NOTA M H C,VREEKEN D,WIESMANN M,et al.Obe⁃ sity affects brain structure and function⁃ rescue by bariatric surgery?[J].Neurosci Biobehav Rev,2020,108:646-657

    • [35] 贾建军,张岩磊,曾惟伊,等.脑脊液检测在阿尔茨海默病领域的应用现状[J].中华老年心脑血管病杂志,2019,21(11):1192-1195

    • [36] AIKEN ⁃MORGAN A T,CAPUANO A W,ARVANITA⁃ KIS Z,et al.Changes in body mass index are related to faster cognitivedecline among African American older adults[J].J Am Geriatr Soc,2020,6:2662-2667

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