Association of adiposity evaluated by anthropometric and bioelectrical impedance analysis measures with cognitive performance in the ELSA-Brasil study.

Background: While midlife obesity is linked to cognitive decline, this association is inconsistent in older adults, possibly due to the limitations of body mass index (BMI) in accurately assessing adiposity at older ages. Most studies focused on White or Asian populations, did not include other adiposity measures besides BMI, adjusted the analyses for mediators, and did not investigate potential subgroup-specific associations. We compared the associations of adiposity measured by anthropometrical and bioelectrical impedance analysis (BIA) with cognitive performance in a diverse population, examining modifications by age, sex, and race, and investigating the mediating effects of obesity-related comorbidities.

Methods: Cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort (n = 12,636). Adiposity was evaluated using BMI, waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), and body fat percentage (BFP). A composite global cognition score was derived from immediate, delayed recall, and word recognition word list, phonemic and semantic verbal fluency, and trail-making tests. Adjusted linear regression models were used to investigate associations. We included an interaction term in the regression models to verify if age, sex, and race were modifiers of these associations and used causal mediation methods to assess the mediating role of obesity-related comorbidities.

Results: Among 10,725 participants [mean age (SD): 58.9 (8.6) years; 55.8% women, 54.4% White], larger WHR and WHtR were associated with worse global cognitive performance. These associations were not modified by age, sex, or race. An association of BFP with cognition was observed only in younger adults. Mediation analysis identified only indirect effects of these adiposity measures on cognitive performance and no direct effects.

Conclusion: WHR and WHtR were more consistently associated with cognitive performance than BMI. BIA measures of adiposity were associated with cognition only in younger adults. Obesity-related comorbidities fully mediated the associations of adiposity with cognition.