There is a synergistic effect between sarcopenia and obesity, and they are important factors affecting cognitive function. It's essential to explore the complex relationship among the three.
Objective
To explore the mediating effect of waist circumference in the relationship between sarcopenia and cognitive function.
Methods
A total of 5577 participants aged 60 years and older from CHARLS (China Health and Retirement Longitudinal Study) were included. Cognitive function was assessed via episodic memory and mental integrity. Sarcopenia status was diagnosed according to the criteria of the AWGS 2019. General linear regression models were applied to investigate the association between WC, sarcopenia, their combined effects and cognitive function. Mediation analysis was used to access the mediating effect of WC in the relationship between sarcopenia and cognitive function. The nonlinear association between WC and cognitive function was explored by using the restricted cubic spline model.
Results
Among 5577 participants, the average cognitive score was 12.41. After controlling for confounding factors, participants with central obesity and severe sarcopenia had the worst cognitive scores (β = −3.22, 95%CI = −4.81, −1.61). WC mediated 16.95% of the association between sarcopenia and cognitive scores, and 9.26% of the association between severe sarcopenia and cognitive scores. The strongest positive association was found between WC and cognitive scores when WC was 96.74 cm in men.
Conclusions
Central obesity was associated with better cognitive function. However, central obesity accompanied by sarcopenia or severe sarcopenia was associated with lower cognitive function. There were significant differences in the mediating effect of WC between different sarcopenia status and cognitive function.
XiongSLiuSQiaoY, et al.Estimation of losses of quality-adjusted life expectancy attributed to the combination of cognitive impairment and multimorbidity among Chinese adults aged 45 years and older. BMC Public Health2021; 21: 24.
2.
XueJLiJLiangJ, et al.The prevalence of mild cognitive impairment in China: a systematic review. Aging Dis2018; 9: 706–715.
KitamuraASeinoSAbeT, et al.Sarcopenia: prevalence, associated factors, and the risk of mortality and disability in Japanese older adults. J Cachexia Sarcopenia Muscle2021; 12: 30–38.
7.
ChenLWooJAssantachaiP, et al.Asian working group for sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment. J Am Med Dir Assoc2020; 21: 300–307.
8.
ZhangXHuangPDouQ, et al.Falls among older adults with sarcopenia dwelling in nursing home or community: a meta-analysis. Clin Nutr2020; 39: 33–39.
9.
Cruz-JentoftAJBahatGBauerJ, et al.Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing2019; 48: 601.
10.
CawthonPMLuiLTaylorBC, et al.Clinical definitions of sarcopenia and risk of hospitalization in community-dwelling older men: the osteoporotic fractures in men study. J Gerontol A Biol Sci Med Sci2017; 72: 1383–1389.
11.
GlobalBMCDi AngelantonioEBhupathirajuS, et al.Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents. Lancet2016; 388: 776–786.
12.
LuYHajifathalianKEzzatiM, et al.Metabolic mediators of the effects of body-mass index, overweight, and obesity on coronary heart disease and stroke: a pooled analysis of 97 prospective cohorts with 1·8 million participants. Lancet2014; 383: 970–983.
13.
PedditziEPetersRBeckettN. The risk of overweight/obesity in mid-life and late life for the development of dementia: a systematic review and meta-analysis of longitudinal studies. Age Ageing2016; 45: 14–21.
14.
PhiromKNantakoolSChuatrakoonB, et al.Role of obesity-related anthropometric indicators on cognitive function in obese older adults: a systematic review and meta-analysis. Public Health2025; 241: 60–68.
15.
DyeLBoyleNBChampC, et al.The relationship between obesity and cognitive health and decline. Proc Nutr Soc2017; 76: 443–454.
16.
XuXXuYShiR. Association between obesity, physical activity, and cognitive decline in Chinese middle and old-aged adults: a mediation analysis. BMC Geriatr2024; 24: 54.
17.
LiangFFuJMooreJB, et al.Body mass index, waist circumference, and cognitive decline among Chinese older adults: a nationwide retrospective cohort study. Front Aging Neurosci2022; 14: 737532.
18.
LiCYuKShyh-ChangN, et al.Pathogenesis of sarcopenia and the relationship with fat mass: descriptive review. J Cachexia Sarcopenia Muscle2022; 13: 781–794.
19.
MoSWangYPengM, et al.Sex disparity in cognitive aging related to later-life exposure to ambient air pollution. Sci Total Environ2023; 886: 163980.
20.
HanCJoSASeoJA, et al.Adiposity parameters and cognitive function in the elderly: application of “jolly fat” hypothesis to cognition. Arch Gerontol Geriatr2009; 49: e133–e138.
21.
RenZLiYLiX, et al.Associations of body mass index, waist circumference and waist-to-height ratio with cognitive impairment among Chinese older adults: based on the CLHLS. J Affect Disord2021; 295: 463–470.
22.
DuHYuMXueH, et al.Association between sarcopenia and cognitive function in older Chinese adults: evidence from the China Health and Retirement Longitudinal Study. Front Public Health2022; 10: 1078304.
23.
WenXWangMJiangC, et al.Anthropometric equation for estimation of appendicular skeletal muscle mass in Chinese adults. Asia Pac J Clin Nutr2011; 20: 551–556.
24.
ZhangJJiaXLiY, et al.The longitudinal bidirectional association between sarcopenia and cognitive function in community-dwelling older adults: findings from the China Health and Retirement Longitudinal Study. J Glob Health2023; 13: 4182.
25.
BolinJH. Hayes, andrew f. (2013). Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. New York, NY: the Guilford Press. J Educ Meas2014; 51: 335–337.
26.
LiTLiCLiuC, et al.Obesity marker trajectories and cognitive impairment in older adults: a 10-year follow-up in Taichung Community Health Study for elders. BMC Psychiatry2022; 22: 748.
27.
CoinAVeroneseNDe RuiM, et al.Nutritional predictors of cognitive impairment severity in demented elderly patients: the key role of BMI. J Nutr Health Aging2012; 16: 553–556.
28.
KerwinDRZhangYKotchenJM, et al.The cross-sectional relationship between body mass index, waist-hip ratio, and cognitive performance in postmenopausal women enrolled in the women's health initiative. J Am Geriatr Soc2010; 58: 1427–1432.
29.
MacotelaYEmanuelliBMoriMA, et al.Intrinsic differences in adipocyte precursor cells from different white fat depots. Diabetes2012; 61: 1691–1699.
30.
XieJVan HoeckeLVandenbrouckeRE. The impact of systemic inflammation on Alzheimer's disease pathology. Front Immunol2021; 12: 796867.
31.
HarveyJSolovyovaNIrvingA. Leptin and its role in hippocampal synaptic plasticity. Prog Lipid Res2006; 45: 369–378.
32.
BakoyiannisIDucourneauEGN'DiayeM, et al.Obesogenic diet induces circuit-specific memory deficits in mice. Elife2024; 13: e80388.
33.
AbbottKNArnottCKWestbrookRF, et al.The effect of high fat, high sugar, and combined high fat-high sugar diets on spatial learning and memory in rodents: a meta-analysis. Neurosci Biobehav Rev2019; 107: 399–421.
34.
EnginA. The mechanism of leptin resistance in obesity and therapeutic perspective. Adv Exp Med Biol2024; 1460: 463–487.
35.
LumengCNSaltielAR. Inflammatory links between obesity and metabolic disease. J Clin Invest2011; 121: 2111–2117.
36.
Valladolid-AcebesI. Hippocampal leptin resistance and cognitive decline: mechanisms, therapeutic strategies and clinical implications. Biomedicines2024; 12: 2422.
37.
FriedmanJM. Leptin and the endocrine control of energy balance. Nat Metab2019; 1: 754–764.
38.
BooranasuksakulUGuanZMacdonaldIA, et al.Sarcopenic obesity and brain health: a critical appraisal of the current evidence. Nutr Bull2025; 50: 30–43.
39.
MorleyJE. Sarcopenia in the elderly. Fam Pract2012; 29: i44–i48.
40.
MorleyJE. Sarcopenia: diagnosis and treatment. J Nutr Health Aging2008; 12: 452–456.
41.
JungCMokJ. Recent updates on associations among various obesity metrics and cognitive impairment: from body mass index to sarcopenic obesity. J Obes Metab Syndr2022; 31: 287–295.
42.
DalleSRossmeislovaLKoppoK. The role of inflammation in age-related sarcopenia. Front Physiol2017; 8: 1045.
43.
LiCYuKShyh-ChangN, et al.Circulating factors associated with sarcopenia during ageing and after intensive lifestyle intervention. J Cachexia Sarcopenia Muscle2019; 10: 586–600.
44.
SrikanthanPHevenerALKarlamanglaAS. Sarcopenia exacerbates obesity-associated insulin resistance and dysglycemia: findings from the national health and nutrition examination survey III. PLoS One2010; 5: e10805.
45.
Dos SantosEPGadelhaABSafonsMP, et al.Sarcopenia and sarcopenic obesity classifications and cardiometabolic risks in older women. Arch Gerontol Geriatr2014; 59:56–61.
46.
MessierVKarelisADLavoieM, et al.Metabolic profile and quality of life in class i sarcopenic overweight and obese postmenopausal women: a MONET study. Appl Physiol Nutr Metab2009; 34: 18–24.
47.
EinstadMSSaltvedtILydersenS, et al.Associations between post-stroke motor and cognitive function: a cross-sectional study. BMC Geriatr2021; 21: 103.
48.
GuoDZhangXZhanC, et al.Sex differences in the association between obesity and cognitive impairment in a low-income elderly population in rural China: a population-based cross-sectional study. Front Neurol2021; 12: 669174.
