城市社区老年居民内脏脂肪指数与认知功能下降的关联性研究

Association between the visceral adiposity index and cognitive decline in community-dwelling elderly residents

目的探究老年人内脏脂肪指数(VAI)与认知功能下降的关联性。方法横断面研究,2020年10月至2023年3月在合肥市社区选取老年居民483例,并根据VAI水平将其分为4组,即Q1(VAI≤1.14),Q2(1.15<VAI≤1.85),Q3(1.86<VAI≤2.81)和Q4(VAI>2.82)。使用简易精神状态量表(MMSE)、蒙特利尔认知评估量表(MoCA)评定研究对象整体认知功能,数字顺、倒背广度任务评定其注意力及工作记忆。使用Logistic回归分析不同VAI水平与胰岛素抵抗指数的关系。并使用偏相关分析VAI与各认知领域功能的相关性。结果随着VAI水平的升高,体质指数、空腹血糖、空腹胰岛素、糖化血红蛋白、超敏C反应蛋白、稳态模型胰岛素抵抗指数和稳态模型β细胞分泌功能指数均升高(均P<0.01),校正了性别等混杂因素后,VAI与胰岛素敏感性呈显著相关,Q4发生胰岛素抵抗的风险为Q1的7.40倍(OR=7.40,95%CI:4.30~12.74,P<0.05)。此外,VAI与数字顺、倒背广度测试结果相关系数分别为-0.116和-0.105(均P<0.05),与MMSE、MoCA测试结果无关。结论VAI与胰岛素抵抗密切相关,VAI的升高与老年人工作记忆及注意力功能降低相关。VAI与老年内脏型肥胖患者早期认知功能下降相关。

Objective To investigate the relationship between the visceral adiposity index(VAI)and cognitive decline.Methods A cross-sectional study was conducted.Between October 2020 and March 2023,483 elderly residents living in communities in Hefei were recruited and divided into four groups based on VAI scores,Q1(VAI≤1.14),Q2(VAI>1.15 and≤1.85),Q3(VAI>1.86 and≤2.81)and Q4(VAI>2.82).General cognitive function was assessed by(MMSE)and(MoCA).Attention and working memory were tested by forward and backward digit span tasks.Logistic regression was utilized to analyze the relationship between different VAI scores and insulin resistance.The correlation between different VAI scores and cognitive function domains was analyzed by partial correlation.Results The values of BMI,fasting plasma glucose,fasting insulin,HbA1c,high-sensitivity C-reactive protein,HOMA-IR and HOMA-βincreased with increasing VAI scores(all P<0.01).VAI was significantly correlated with insulin sensitivity after adjusting for confounding factors including sex.The risk of insulin resistance in Q4 was 7.40 times that in Q1(OR=7.40,95%CI:4.30-12.74,P<0.05).In addition,the correlation coefficients between VAI and forward digital span and between VAI and backward digital span were-0.116 and-0.105,respectively(both P<0.05),but there was no correlation between VAI and MMSE or MoCA.Conclusions VAI is closely related to insulin resistance and also associated with early cognitive decline in elderly people with visceral obesity.