Associations of fat mass and muscle function but not lean mass with cognitive impairment: The Yishun Study

Tou, Nien Xiang; Wee, Shiou Liang; Pang, Benedict Wei Jun; Lau, Lay Khoon; Jabbar, Khalid Abdul; Seah, Wei Ting; Chen, Kexun Kenneth; Ng, Tze Pin · 2021 · OpenAlex-citations

DOI: 10.1371/journal.pone.0256702

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Summary

This study investigates the association between sarcopenic obesity (SO)—the coexistence of sarcopenia and obesity—and cognitive impairment, addressing sparse and inconclusive evidence regarding how body composition affects cognitive health. While sarcopenia and obesity are individually linked to cognitive decline, the specific impact of their combination, particularly using precise body composition metrics rather than body mass index, remains unclear. The research aimed to determine if SO, as well as its individual components (lean mass, muscle strength, physical performance, and fat mass), are associated with global and domain-specific cognitive impairment in a general adult population. The study utilized data from the Yishun Study, a cross-sectional analysis of 535 community-dwelling adults aged 21 to 90 years in Singapore. Researchers assessed body composition using dual X-ray absorptiometry to calculate fat mass index (FMI) and appendicular lean mass index (ALMI). Muscle strength was measured via handgrip strength (HGS), and physical function via gait speed (GS). Cognitive function was evaluated using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), covering five domains: immediate memory, visuospatial/constructional abilities, language, attention, and delayed memory. Sarcopenia was defined according to the 2019 Asian Working Group for Sarcopenia criteria, while obesity was defined by the upper two quintiles of FMI. Multivariate logistic regressions were performed to examine associations, adjusting for age, gender, physical activity, medical history, and education. The results indicated that sarcopenia alone or in combination with obesity (SO) was not significantly associated with cognitive impairment after controlling for confounding variables. However, obesity on its own was significantly associated with greater odds of impaired attention (OR: 2.05, 95% CI 1.12–3.82). When analyzing individual components, low appendicular lean mass was not associated with cognitive impairment. In contrast, low handgrip strength was significantly associated with impaired immediate memory (OR: 1.91, 95% CI 1.04–3.49), and slow gait speed was associated with impaired immediate memory (OR: 2.17, 95% CI 1.26–3.72). High fat mass index was significantly associated with impaired attention (OR: 2.06, 95% CI 1.22–3.51). Furthermore, the co-occurrence of high FMI with either low HGS or slow GS exacerbated the odds of global and domain-specific cognitive impairment, particularly in attention and visuospatial domains. The study concludes that lean mass is not relevant to cognitive impairment, whereas muscle strength, physical performance, and adiposity are significant factors. These findings suggest that definitions of sarcopenia and sarcopenic obesity should prioritize muscle function and fat mass over lean mass when assessing cognitive risks. The results highlight the importance of distinguishing between muscle mass and function, as well as using precise adiposity measures, to better understand the physiological mechanisms linking body composition to cognitive decline.

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• cognitive impairment