Scott T Chiesa PhD , Tom Norris PhD , Victoria Garfield PhD , Prof Marcus Richards PhD , Prof Alun D Hughes PhD
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This study therefore aimed to test potential bidirectional direct and indirect pathways linking cumulative exposure to excess bodyweight and cognitive function in the early decades of life.</p></div><div><h3>Methods</h3><p>In this longitudinal analysis, harmonised measures of BMI and cognitive function were available in 19 742 participants aged 47–53 years recruited to the 1946 National Survey of Health and Development (n=2131), the 1958 National Child Development Study (n=9385), and the 1970 British Cohort Study (n=8226). Individual BMI trajectories spanning three decades from age 10–40 years were created for each participant and excess bodyweight duration, BMI change between ages, and cumulative excess bodyweight exposure were calculated. Harmonised measures of verbal and non-verbal ability, mathematical ability, and reading ability were used to create a latent factor for childhood cognitive function, and immediate and delayed recall, animal naming, and letter-search speed tests were used for midlife cognitive function. Multivariable linear regression and structural equation models (SEM) were used to test for potential bidirectional relationships between cognition and excess bodyweight in both individual cohorts and pooled datasets while accounting for other potential early-life confounders.</p></div><div><h3>Findings</h3><p>Increases in BMI during adolescence and greater cumulative exposure to excess bodyweight across early life were associated with lower midlife cognitive function in all cohorts (eg, pooled difference in cognitive function per 10 years excess bodyweight duration –0·10; 95% CI –0·12 to –0·08; p<0·001). Further adjustment for childhood cognitive function attenuated many of these associations towards the null (eg, pooled difference in cognitive function per 10 years excess bodyweight duration –0·04; 95% CI –0·06 to –0·02; p=0·001), however, with any remaining associations then fully attenuating once further adjusted for other early-life factors (eg, pooled difference in cognitive function per 10 years excess bodyweight duration 0, –0·03 to 0·01; p=0·38). In the reverse direction, low childhood cognition was associated with greater cumulative exposure to excess bodyweight over the next four decades, although much of this relationship was found to probably be explained via other potentially modifiable upstream early-life factors such as childhood disadvantage. SEM in all cohorts suggested the presence of modest direct and indirect pathways connecting earlier cognitive function to later excess bodyweight, but scarce evidence for an effect of early-life excess bodyweight on cognitive function by midlife.</p></div><div><h3>Interpretation</h3><p>The association between cumulative exposure to excess bodyweight in early life and lower cognitive function in midlife is probably confounded by a persistently lower cognitive function from childhood. Initiatives to improve early-life factors such as childhood disadvantage and education, however, might exert dual but independent benefits on both of these factors before old age.</p></div><div><h3>Funding</h3><p>Alzheimer's Research UK, Diabetes Research and Wellness Foundation, Diabetes UK, British Heart Foundation, and Medical Research Council.</p></div>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":null,"pages":null},"PeriodicalIF":13.4000,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666756824000059/pdfft?md5=58dedd6dbb989655c2147d4b4a88df1b&pid=1-s2.0-S2666756824000059-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Early-life cumulative exposure to excess bodyweight and midlife cognitive function: longitudinal analysis in three British birth cohorts\",\"authors\":\"Scott T Chiesa PhD , Tom Norris PhD , Victoria Garfield PhD , Prof Marcus Richards PhD , Prof Alun D Hughes PhD\",\"doi\":\"10.1016/S2666-7568(24)00005-9\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Excess bodyweight (BMI >25 kg/m<sup>2</sup>) in midlife (age 40–65 years) has been linked to future cognitive decline and an increased risk of dementia. Whether chronic exposure to excess bodyweight in the early decades of life (<40 years) is associated with compromised cognitive function by midlife, however, remains unclear. This study therefore aimed to test potential bidirectional direct and indirect pathways linking cumulative exposure to excess bodyweight and cognitive function in the early decades of life.</p></div><div><h3>Methods</h3><p>In this longitudinal analysis, harmonised measures of BMI and cognitive function were available in 19 742 participants aged 47–53 years recruited to the 1946 National Survey of Health and Development (n=2131), the 1958 National Child Development Study (n=9385), and the 1970 British Cohort Study (n=8226). Individual BMI trajectories spanning three decades from age 10–40 years were created for each participant and excess bodyweight duration, BMI change between ages, and cumulative excess bodyweight exposure were calculated. Harmonised measures of verbal and non-verbal ability, mathematical ability, and reading ability were used to create a latent factor for childhood cognitive function, and immediate and delayed recall, animal naming, and letter-search speed tests were used for midlife cognitive function. Multivariable linear regression and structural equation models (SEM) were used to test for potential bidirectional relationships between cognition and excess bodyweight in both individual cohorts and pooled datasets while accounting for other potential early-life confounders.</p></div><div><h3>Findings</h3><p>Increases in BMI during adolescence and greater cumulative exposure to excess bodyweight across early life were associated with lower midlife cognitive function in all cohorts (eg, pooled difference in cognitive function per 10 years excess bodyweight duration –0·10; 95% CI –0·12 to –0·08; p<0·001). 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引用次数: 0
摘要
背景中年时期(40-65 岁)体重超标(BMI 25 kg/m2)与未来认知能力下降和痴呆症风险增加有关。然而,生命最初几十年(40 岁)长期暴露于超重是否与中年认知功能受损有关,目前仍不清楚。在这项纵向分析中,1946 年全国健康与发展调查(National Survey of Health and Development)(人数=2131)、1958 年全国儿童发展研究(National Child Development Study)(人数=9385)和 1970 年英国队列研究(British Cohort Study)(人数=8226)招募的 19 742 名年龄在 47-53 岁之间的参与者的体重指数(BMI)和认知功能均采用了统一的测量方法。研究人员为每位参与者创建了从 10 岁到 40 岁这三十年间的个人体重指数轨迹,并计算了超重持续时间、各年龄段之间的体重指数变化以及累计超重暴露量。采用语言和非语言能力、数学能力和阅读能力的统一测量方法来创建儿童期认知功能的潜在因子,采用即时和延迟回忆、动物命名和字母搜索速度测试来创建中年期认知功能的潜在因子。多变量线性回归和结构方程模型(SEM)用于检验个体队列和集合数据集中认知与超重之间的潜在双向关系,同时考虑其他潜在的早期生活混杂因素。研究结果在所有队列中,青春期体重指数的增加和整个生命早期体重超标的累积暴露与中年认知功能降低有关(例如,每10年体重超标持续时间的认知功能汇总差异为-0-10;95% CI为-0-12至-0-08;p<0-001)。对童年认知功能的进一步调整使其中许多关联趋于无效(例如,每10年超重持续时间的认知功能汇总差异为-0-04;95% CI为-0-06至-0-02;p=0-001),然而,一旦对其他早期生活因素进行进一步调整,任何剩余的关联都会完全减弱(例如,每10年超重持续时间的认知功能汇总差异为0,-0-03至0-01;p=0-38)。从反向来看,低童年认知能力与接下来四十年中更大的超重累积暴露相关,尽管这种关系的大部分可能是通过其他潜在的可改变的早期生活上游因素(如童年不利条件)来解释的。所有队列中的 SEM 都表明,早期认知功能与后来超重之间存在着适度的直接和间接联系,但早期超重对中年认知功能影响的证据却很少。然而,改善儿童期不利条件和教育等早期生活因素的措施可能会在老年期之前对这两个因素产生双重但独立的益处。
Early-life cumulative exposure to excess bodyweight and midlife cognitive function: longitudinal analysis in three British birth cohorts
Background
Excess bodyweight (BMI >25 kg/m2) in midlife (age 40–65 years) has been linked to future cognitive decline and an increased risk of dementia. Whether chronic exposure to excess bodyweight in the early decades of life (<40 years) is associated with compromised cognitive function by midlife, however, remains unclear. This study therefore aimed to test potential bidirectional direct and indirect pathways linking cumulative exposure to excess bodyweight and cognitive function in the early decades of life.
Methods
In this longitudinal analysis, harmonised measures of BMI and cognitive function were available in 19 742 participants aged 47–53 years recruited to the 1946 National Survey of Health and Development (n=2131), the 1958 National Child Development Study (n=9385), and the 1970 British Cohort Study (n=8226). Individual BMI trajectories spanning three decades from age 10–40 years were created for each participant and excess bodyweight duration, BMI change between ages, and cumulative excess bodyweight exposure were calculated. Harmonised measures of verbal and non-verbal ability, mathematical ability, and reading ability were used to create a latent factor for childhood cognitive function, and immediate and delayed recall, animal naming, and letter-search speed tests were used for midlife cognitive function. Multivariable linear regression and structural equation models (SEM) were used to test for potential bidirectional relationships between cognition and excess bodyweight in both individual cohorts and pooled datasets while accounting for other potential early-life confounders.
Findings
Increases in BMI during adolescence and greater cumulative exposure to excess bodyweight across early life were associated with lower midlife cognitive function in all cohorts (eg, pooled difference in cognitive function per 10 years excess bodyweight duration –0·10; 95% CI –0·12 to –0·08; p<0·001). Further adjustment for childhood cognitive function attenuated many of these associations towards the null (eg, pooled difference in cognitive function per 10 years excess bodyweight duration –0·04; 95% CI –0·06 to –0·02; p=0·001), however, with any remaining associations then fully attenuating once further adjusted for other early-life factors (eg, pooled difference in cognitive function per 10 years excess bodyweight duration 0, –0·03 to 0·01; p=0·38). In the reverse direction, low childhood cognition was associated with greater cumulative exposure to excess bodyweight over the next four decades, although much of this relationship was found to probably be explained via other potentially modifiable upstream early-life factors such as childhood disadvantage. SEM in all cohorts suggested the presence of modest direct and indirect pathways connecting earlier cognitive function to later excess bodyweight, but scarce evidence for an effect of early-life excess bodyweight on cognitive function by midlife.
Interpretation
The association between cumulative exposure to excess bodyweight in early life and lower cognitive function in midlife is probably confounded by a persistently lower cognitive function from childhood. Initiatives to improve early-life factors such as childhood disadvantage and education, however, might exert dual but independent benefits on both of these factors before old age.
Funding
Alzheimer's Research UK, Diabetes Research and Wellness Foundation, Diabetes UK, British Heart Foundation, and Medical Research Council.
期刊介绍:
The Lancet Healthy Longevity, a gold open-access journal, focuses on clinically-relevant longevity and healthy aging research. It covers early-stage clinical research on aging mechanisms, epidemiological studies, and societal research on changing populations. The journal includes clinical trials across disciplines, particularly in gerontology and age-specific clinical guidelines. In line with the Lancet family tradition, it advocates for the rights of all to healthy lives, emphasizing original research likely to impact clinical practice or thinking. Clinical and policy reviews also contribute to shaping the discourse in this rapidly growing discipline.