| Background and ObjectiveStudies demonstrate that obesity is a significant risk factor for Alzheimer’s disease(AD).Rate of cognitive decline in individuals with type 2 diabetes is increased by approximately 1.5 compare to those without diabetes.However,while there is evidence of diabetes-brain atrophy,the mechanisms of diabetes on cognitive impairment remains ambiguous.Recent studies show significant relationship between diabetes and obesity.Therefore,to explore the impact factors of cognitive impairment in type 2 diabetic patients with obesity and overweight is very important.It can provide evidence for prevention and early treatment of cognitive impairment.MethodsThe present study included 90 patients with type 2 diabetes(Hb A1c 7%-10%)aged 50years to 75 years.According to BMI,all participants were divided into obesity group(BMI>28 kg/m~2,n=30),overweight group(BMI 24–28 kg/m~2,n=30)and normal group(BMI 18.5–24 kg/m~2,n=30).Clinical data such as disease duration,diabetic complications and education were collected.Body mass index,waist circumference(WC),hip circumference(HC),waist-to-hip ratio(WHR),high-density lipoprotein-chesterol(HDL-C),triglyceride(TG),low-density lipoprotein-chesterol(LDL-C),total cholesterol(TC),fasting blood glucose(FBG),fasting insulin(FINS)and glycosylated hemoglobin(Hb Alc)were measured.Montreal Cognitive Assessment(MoCA)was used to assess cognitive function.Results(1)There were significant differences in waist circumference,hip circumference,waist-to-hip ratio,body mass index,total cholesterol,high-density lipoprotein-cholesterol,low-density lipoprotein-cholesterol,and triglycerides between the diabetic obese,overweight,and normal groups.However,there was no significant difference in age,education,gender,incidence of smoking and alcohol consumption,and insulin resistance index,glycosylated hemoglobin,duration of diabetes,and incidence of complications between the groups.(2)MoCA scores were significantly different among the diabetic obese(23.53±1.94),overweight(24.97±2.29)and normal(26.30±2.54)groups(P<0.05).A MoCA score≤26 was considered to have cognitive impairment,with a prevalence of cognitive impairment of 60%in the normal diabetic group,70%in the diabetic overweight group,and 93.3%in the diabetic obese group.(3)The subjects were divided into cognitive impairment group(MoCA≤26points)and cognitively normal group(MoCA>26 points)according to MoCA score,and the results showed that the levels of body mass index(26.85 4.10 kg/m2),waist circumference(85.02±9.6 cm),hip circumference(101.02±8.93 cm),and waist-to-hip ratio(0.84±0.04)in the cognitive impairment group were higher than those of BMI(23.40±3.23 kg/m2),waist circumference(76.30±9.15 cm),hip circumference(93.60±6.96 cm),and waist-to-hip ratio(0.81±0.05)in the cognitively normal group.Among the blood lipid parameters,the levels of total cholesterol(4.88±1.35 mmol/L),low-density lipoprotein-cholesterol(3.38±1.04 mmol/L),and triglyceride(2.31±1.14mmol/L)in the cognitive impairment group were higher than those in the cognitively normal group(4.88±1.35 mmol/L),low-density lipoprotein-cholesterol(3.38±1.04mmol/L),and triglyceride(2.31±1.14 mmol/L),and the mean level of high-density lipoprotein-cholesterol(1.18±0.56 mmol/L)was lower than that in the cognitively normal group(1.36±0.59),and there were statistically significant differences in body mass index,waist circumference,hip circumference,waist-to-hip ratio,and total cholesterol between the two groups(P<0.05).(4)The results of multiple linear regression analysis showed that after adjusting for the duration of diabetes,glycosylated hemoglobin,smoking,alcohol consumption,and the incidence of complications,the MoCA score was significantly correlated with waist circumference,hip circumference,body mass index,waist-to-hip ratio,and total cholesterol,that is,for every 1 cm increase in waist circumference,the MoCA score decreased by 0.101 points,for every 1 cm increase in hip circumference,the MoCA score decreased by 0.105 points,for every 1 kg/m2 increase in body mass index,the MoCA score decreased by 0.229 points,for every 0.1 increase in waist-to-hip ratio,the MoCA score decreased by 1.679 points,total cholesterol increased by 1 mmol/L,and the MoCA score decreased by 0.335 points.(5)MoCA score≤26 points was defined as having cognitive dysfunction,and the correlation between obesity and lipid related parameters and the prevalence of cognitive impairment was analyzed by binary logistic regression,and the results showed that body mass index and total cholesterol were closely related to cognitive dysfunction,and the risk of the prevalence of cognitive impairment may increase by2.844 times for every 1 kg/m2 increase in the institutional index and 0.119 times for every 1 mmol/L increase in total cholesterol.ConclusionsIn type 2 diabetes,obesity is corelated with cognitive impairment.Waist-to-hip ratio and body mass index play an important role in cognitive function evaluation.Increased BMI and TC level are risk factors for cognitive impairment in obesity patients with type 2 diabetes. |
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