Relationships Between Body Composition and Cognitive Impairment in Hospitalised Middle-Aged Type 2 Diabetic Patients

Figures & data

Table 1 General Clinical Data of Subjects According to Gender and Cognition

Variables	Male (n = 279)			Female (n = 225)
	NCF (n = 166)	CI (n = 113)	P value	NCF (n = 140)	CI (n = 85)	P value
Age (years)	57 [54, 61]	58 [55, 61]	0.038*	58 [54, 62]	60 [56, 62]	0.043*
Education (years)	12 [9, 12]	9 [9, 12]	<0.001*	12 [9, 12]	9 [9, 12]	<0.001*
Married	163 (98.2%)	101 (89.4%)	0.001*	134 (95.7%)	74 (87.1%)	0.017*
Current smoking	86 (51.8%)	56 (49.6%)	0.712	13 (9.3%)	11 (12.9%)	0.389
Current drinking	89 (53.6%)	61 (54.0%)	0.952	7 (5.0%)	4 (4.7%)	0.921
Sedentary lifestyle	52 (31.5%)	29 (25.7%)	0.292	37 (26.4%)	21 (24.7%)	0.775
Dietary control of diabetes	116 (70.3%)	67 (59.3%)	0.057	101 (72.1%)	47 (55.3%)	0.010*
Duration of diabetes (years)	4 [1, 10]	5 [0, 11]	0.726	5 [1, 10]	5 [1, 10]	0.916
Hypoglycemic episode in 3 months	28 (17.0%)	28 (24.8%)	0.111	34 (24.8%)	22 (26.5%)	0.780
Diabetic microangiopathy	78 (47.3%)	56 (50.0%)	0.656	59 (42.1%)	32 (37.6%)	0.505
DPN	121 (73.3%)	85 (75.9%)	0.632	102 (72.9%)	65 (76.5%)	0.548
CAS	77 (46.7%)	67 (59.8%)	0.032*	63 (45.0%)	47 (55.3%)	0.134
LEASD	77 (46.7%)	65 (58.0%)	0.063	58 (41.4%)	41 (48.2%)	0.319
CHD	43 (26.1%)	29 (25.9%)	0.975	41 (29.3%)	24 (28.2%)	0.866
CVD	22 (13.3%)	28 (25.0%)	0.013*	16 (11.4%)	27 (31.8%)	<0.001*
Hypertension	94 (57.0%)	68 (60.7%)	0.535	88 (62.9%)	55 (64.7%)	0.780
WBC (10^9/L)	6.16 [5.27, 7.38]	5.95 [5.04, 7.10]	0.292	5.83 [4.97, 6.86]	6.22 [5.10, 7.45]	0.081
Hb (g/L)	146.7 ± 12.4	142.2 ± 13.0	0.004*	128.5 ± 11.3	128.7 ± 10.8	0.928
HbA1c (%)	8.65 [7.50, 10.70]	8.60 [7.20, 10.58]	0.436	8.60 [7.45, 10.30]	8.50 [7.60, 10.20]	0.854
FPG (mmol/L)	8.88 [6.79, 10.65]	8.85 [7.10, 11.05]	0.593	8.37 [6.61, 10.10]	8.96 [7.10, 11.09]	0.212
FINS (mU/L)	9.96 [6.39, 14.88]	10.74 [7.34, 14.91]	0.506	12.86 [7.60, 20.69]	13.11 [8.76, 17.99]	0.797
HOMA-IR	3.74 [2.56, 5.36]	3.68 [2.49, 6.55]	0.633	4.67 [2.96, 8.15]	5.40 [3.05, 7.90]	0.413
TC (mmol/L)	4.87 ± 1.12	4.83 ± 1.15	0.753	5.10 ± 1.01	5.25 ± 1.22	0.333
TG (mmol/L)	1.62 [1.14, 2.61]	1.74 [1.17, 3.05]	0.870	1.82 [1.14, 2.47]	1.57 [1.23, 2.27]	0.403
HDL-C (mmol/L)	1.14 [1.00, 1.34]	1.13 [0.96, 1.30]	0.456	1.23 [1.10, 1.39]	1.21 [1.08, 1.41]	0.975
LDL-C (mmol/L)	2.88 ± 0.79	2.78 ± 0.73	0.298	3.05 ± 0.79	3.13 ± 0.90	0.470
THR	1.58 [0.99, 2.43]	1.53 [1.03, 2.81]	0.829	1.55 [0.85, 2.19]	1.29 [0.96, 2.02]	0.318
Alb (g/L)	41.1 ± 3.2	40.8 ± 3.4	0.354	40.1 ± 3.6	40.3 ± 3.5	0.647
ALT (U/L)	21.5 [15.4, 34.0]	19.7 [14.9, 32.0]	0.333	19.7 [14.9, 33.3]	20.6 [14.2, 38.6]	0.902
Cr (umol/L)	65.0 [58.0, 73.3]	65.1 [57.0, 75.0]	0.899	49.2 ± 10.9	52.0 ± 9.3	0.056
ACR (mg/g)	10.88 [5.90, 29.73]	12.74 [6.02, 43.72]	0.524	12.04 [6.02, 29.96]	16.19 [7.52, 34.56]	0.121
UA (umol/L)	304.0 [246.2, 334.5]	305.8 [256.5, 368.0]	0.064	282.5 [231.8, 329.5]	269.9 [214.4, 307.0]	0.081
HCY (μmol/L)	11.50 [9.73, 13.44]	11.63 [9.40, 14.14]	0.566	8.95 [7.72, 10.52]	9.74 [7.95, 1.02]	0.114
MoCA	28 [27, 29]	24 [23, 25]	<0.001*	27 [26, 28]	24 [22, 25]	<0.001*

Notes: The measurement data are shown as mean ± standard deviation (SD) or median and interquartile range [P25, P75], depending on the normality of data distribution. Categorical data are presented as the number of cases (percentage) [n (%)]. *P < 0.05 was regarded as a significant difference.

Abbreviations: NCF, normal cognitive function; CI, cognitive impairment; BMI, body mass index; WC, waist circumference; AO, abdominal obesity; DPN, diabetic peripheral neuropathy; CAS, carotid atherosclerosis; LEASD, low extremity atherosclerosis disease; CHD, coronary heart disease; CVD, cerebrovascular disease (including hemorrhagic and ischemic stroke); WBC, white blood cell count; Hb, hemoglobin; HbA1c, hemoglobin A1c; FPG, fasting plasma glucose; FINS, fasting plasma insulin; HOMA-IR, homeostatic model assessment for insulin resistance; TC, total cholesterol; TG, triglyceride; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; THR, triglyceride/high density lipoprotein cholesterol ratio; Alb, albumin; ALT, alanine transaminase; Cr, creatinine; ACR, urinary albumin-to-creatinine ratio; UA, uric acid; HCY, homocysteine; MoCA, Montreal Cognitive Assessment.

Table 2 Body Composition Parameters of Subjects According to Gender and Cognition

Parameters	Male (n = 279)			Female (n = 225)
	NCF (n = 166)	CI (n = 113)	P value	NCF (n = 140)	CI (n = 85)	P value
BMI (kg/m^2)	26.6 ± 3.5	25.4 ± 2.9	0.004*	26.4 ± 4.0	26.5 ± 3.4	0.857
BFM (kg)	20.6 [16.3, 25.4]	19.1 [15.6, 24.1]	0.080	24.0 [18.7, 28.2]	24.9 [20.7, 29.4]	0.256
PBF (%)	27.0 ± 6.5	25.9 ± 5.9	0.136	35.6 ± 6.0	36.8 ± 6.0	0.144
FMI (kg/m^2)	7.03 [5.43, 8.66]	6.22 [5.27, 8.27]	0.063	9.38 [7.44, 11.10]	9.69 [8.28, 11.31]	0.266
VFA (cm^2)	94.2 [73.4, 114.9]	92.1 [78.6, 115.7]	0.975	100.1 [83.0, 119.5]	111.1 [96.6, 129.1]	0.006*
VO	67 (40.4%)	41 (36.3%)	0.492	71 (50.7%)	61 (71.8%)	0.002*
WC (cm)	95.4 ± 11.8	94.9 ± 9.5	0.726	91.7 ± 11.5	94.7 ± 10.3	0.051
AO	109 (65.7%)	78 (69.0%)	0.557	93 (66.4%)	71 (83.5%)	0.005*
WHR	0.95 [0.91, 1.00]	0.95 [0.92, 1.00]	0.606	0.95 [0.91, 1.00]	0.97 [0.93, 1.01]	0.081
ASM (kg)	24.2 ± 2.9	23.7 ± 2.8	0.147	17.5 ± 2.5	17.4 ± 2.5	0.702
SMI (kg/m^2)	8.16 ± 0.73	7.97 ± 0.64	0.021*	6.78 ± 0.72	6.74 ± 0.68	0.662
SM (kg)	31.9 ± 3.6	31.1 ± 3.6	0.101	23.6 ± 3.0	23.3 ± 3.1	0.388
LM (kg)	54.2 ± 5.7	53.1 ± 5.7	0.101	40.4 [38.0, 42.9]	40.4 [37.3, 44.5]	0.710
LMI (kg/m^2)	18.3 ± 1.5	17.8 ± 1.4	0.012*	15.9±1.4	15.8±1.3	0.598
FFM (kg)	57.4 ± 6.1	56.2 ± 6.0	0.102	43.8 ± 5.2	43.2 ± 5.1	0.412
BFM/FFM	0.36 [0.29, 0.44]	0.33 [0.29, 0.42]	0.142	0.56 ± 0.14	0.59 ± 0.14	0.150
BMD (g/m^2)	0.33 ± 0.04	0.33 ± 0.03	0.509	0.30 ± 0.04	0.29 ± 0.04	0.928
ECW (kg)	16.3 ± 1.8	16.1 ± 1.8	0.282	12.5 ± 1.5	12.4 ± 1.5	0.749
TBW (kg)	42.2 ± 4.5	41.6 ± 4.6	0.253	32.1 ± 3.8	31.9 ± 3.8	0.633
ETR	0.39 [0.38, 0.39]	0.39 [0.38, 0.39]	0.443	0.39 ± 0.01	0.39 ± 0.01	0.300

Notes: The measurement data are shown as mean ± standard deviation (SD) or median and interquartile range [P25, P75], depending on the normality of data distribution. Categorical data are presented as the number of cases (percentage) [n (%)]. *P < 0.05 was regarded as a significant difference.

Abbreviations: NCF, normal cognitive function; CI, cognitive impairment; BMI, body mass index; BFM, body fat mass; PBF, percentage of body fat; FMI, fat mass index; VFA, visceral fat area; VO, visceral obesity (defined as VFA ≥ 100 cm²); WC, waist circumference; AO, abdominal obesity (defined as WC ≥ 90 cm in male; and WC ≥ 85 cm in female); WHR, waist-to-hip ratio; ASM, appendicular skeletal muscle; SMI, appendicular skeletal muscle index (ASM/height²); SM, skeletal muscle; LM, lean mass; LMI, lean mass index (LM/height²); FFM, fat free mass; BMD, mean bone mineral density; ECW, extracellular water; TBW, total body water; ETR, extracellular water-to-total body water ratio.

Table 3 Linear Regression Analysis of Body Composition and Cognitive Scores in Different Genders

	MoCA
	β	95% CI	P value
Male (n = 279)
BMI (kg/m^2)^1	0.172	0.085, 0.260	< 0.001*
BMI (kg/m^2)^2	0.143	0.060, 0.227	0.001*
BMI (kg/m^2)^3	0.138	0.054, 0.223	0.001*
SMI (kg/m^2)^1	0.684	0.267, 1.101	0.001*
SMI (kg/m^2)^2	0.594	0.201, 0.988	0.003*
SMI (kg/m^2)^3	0.580	0.186, 0.974	0.004*
LMI (kg/m^2)^1	0.335	0.136, 0.534	0.001*
LMI (kg/m^2)^2	0.291	0.103, 0.479	0.003*
LMI (kg/m^2)^3	0.283	0.094, 0.472	0.003*
Female (n = 225)
VFA (cm^2)^1	−0.010 (−0.021, 0.001)		0.071
VFA (cm^2)^2	−0.006 (−0.016, 0.005)		0.283
VFA (cm^2)^3	−0.005 (−0.016, 0.005)		0.308

Notes: LMI, BMI and SMI were significant predictors for the MoCA scores in male patients. BMI¹ / SMI¹ / LMI¹ / VFA¹: unadjusted. BMI² / SMI² / LMI^2: adjusted for age, education, and married. BMI³ / SMI³ / LMI^3: BMI² / SMI² / LMI² + carotid atherosclerosis, cerebrovascular disease, and hemoglobin. VFA²: adjusted for age, education, married, and dietary control of diabetes. VFA³: VFA² + cerebrovascular disease. *P < 0.05 was regarded as a significant difference.

Abbreviations: MoCA, Montreal Cognitive Assessment; β, coefficient; CI, confidence interval; BMI, body mass index; SMI, appendicular skeletal muscle index (appendicular skeletal muscle/height²); LMI, lean mass index (lean mass/height²); VFA, visceral fat area.

Figure 1 Odds ratios of body composition for cognitive impairment. BMI and LMI were independent protective factors for cognitive impairment in men (A), while VO and AO were independent risk factors for cognitive impairment in women (B). BMI¹ / SMI¹ / LMI¹ / VFA¹ / VO¹ / AO¹: unadjusted. BMI² / SMI² / LMI^2: adjusted for age, education, and married. BMI³ / SMI³ / LMI^3: BMI² / SMI² / LMI² + carotid atherosclerosis, cerebrovascular disease, and hemoglobin. VFA² / VO² / AO²: adjusted for age, education, married, and dietary control of diabetes. VFA³ / VO³ / AO³: VFA² / VO² / AO² + cerebrovascular disease. *, **Represented P < 0.05, 0.01 respectively, and were regarded as significant differences.

Abbreviations: OR, odds ratio; CI, confidence interval; BMI, body mass index; SMI, appendicular skeletal muscle index (appendicular skeletal muscle/height²); LMI, lean mass index (lean mass/height²); VFA, visceral fat area; VO, visceral obesity (defined as VFA ≥ 100 cm²); AO, abdominal obesity (defined as WC ≥ 90 cm in male; and WC ≥ 85 cm in female).

Figure 2 The interactions of gender and body compositions on cognitive function. There were interactions between gender and BMI (A), SMI (B), LMI (C), abdominal obesity (D) and visceral obesity (E) on the MoCA score.

Abbreviations: MoCA, Montreal Cognitive Assessment; BMI, body mass index; SMI, appendicular skeletal muscle index (appendicular skeletal muscle/height²); LMI, lean mass index (lean mass/height²), abdominal obesity: defined as WC ≥ 90 cm in male, and WC ≥ 85 cm in female, visceral obesity: defined as VFA ≥ 100 cm².