S..LOW1, A.M.C.MOH1, S.F.WONG1, K.ANG1, W.E.TANG2, Z.LIM3, T.SUBRAMANIAM4, C.F.SUM4, S.C.LIM4
Khoo Teck Puat Hospital1, National Healthcare Group HQ2, NHG Polyclinics3, Admiralty Medical Centre4
Visceral obesity and sarcopenia separately contribute to insulin resistance which itself confers higher risk of cognitive impairment. The synergistic effect of visceral obesity and sarcopenia on cognitive impairment is not yet established. We hypothesize that visceral fat area to skeletal muscle mass(VFA-ASM) ratio, a combined anthropometric index, is associated with reduced cognitive function in type 2 diabetes(T2D).
This was a cross-sectional study of 1,326 patients from SMART2D cohort. Appendicular skeletal muscle mass(ASM) and visceral fat area(VFA) were measured by bioelectrical impedance. Cognitive function was assessed with Repeatable Battery for the Assessment of Neuropsychological Status(RBANS). Multiple linear regression was used to examine association between VFA-ASM ratio and cognitive function, adjusting for demographics, education, clinical covariates and presence of APOE ε4 allele.
The participants’ mean age was 61.5 ± 8.1 years. In unadjusted analysis, there is a decreasing trend of RBANS total score across increasing VFA-ASM ratios(ptrend<0.001). In fully adjusted analysis, only the highest quartile (Q4) VFA-ASM ratio remains negatively associated with RBANS total score with coefficient -1.99 (95%CI -3.21 to -0.77; p=0.001). Q4 VFA-ASM ratio is also associated with lower RBANS score in the domains of visuo-spatial constructional ability (coefficient -1.77; 95%CI -3.44 to -0.10; p=0.037); language (coefficient -2.47; 95%CI -4.31 to -0.63; p=0.008) and attention (coefficient -3.18; 95%CI -4.94 to -1.42; p<0.001).
Increasing VFA-ASM ratio was independently associated with reduced cognitive function globally and in multiple domains with implications for diabetes management. It is a potential intervention target for prevention of cognitive impairment in T2D in future clinical practice.