Sex difference in the association between BMI and cognitive impairment in Chinese older adults

The association between body mass index (BMI) and cognitive impairment (CI) has been the subject of extensive research, yet the precise dose-response effects remain undefined.

Older adults were selected from the 2011/2012 survey at baseline and the new recruits from the 2014 and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Multiple logistic regression models were used to evaluate the association between BMI categories and CI, and Restricted Cubic Spline (RCS) was used to explore the nonlinear relationship between BMI and CI.

The study included 29,380 older adults aged from 65 to 117 years, with an average age of 82 years. Of these, 13,465 were men, and 5359 exhibited cognitive impairment. The logistic model indicated that in female participants, being underweight was positively correlated with CI (OR:1.32; 95%CI 1.20-1.46), whereas being overweight was inversely correlated with CI (OR:0.86; 95%CI 0.75-0.99), and we didn't find any association between BMI category and CI in male participants. RCS modeling revealed a U-shaped relationship between BMI and CI. When stratified by sex, men exhibited a similar trend, with the lowest risk at a BMI of 22.774 kg/ m², while women had the lowest risk of CI at a BMI of 24.817 kg/ m².

This was a cross-sectional study, it cannot provide information on causal relationships.

A U-shaped relationship was observed between BMI and CI in older adults, more pronounced in the male population, suggesting that male older adults may need to manage their BMI more rigorously.