Linking obesity with white matter microstructure highlights the importance of brainstem tracts and sex differences

While obesity (body mass index ≥ 30) has been consistently associated with white matter diffusion magnetic resonance imaging (MRI) phenotypes, the contributions of common obesity phenotypes on various diffusion metrics, and the moderating effects of sex and age, require further clarification. This study aims to elucidate these body-brain connections to enhance our understanding of the comorbid link between obesity and body anthropometrics and the brain using a large-scale dataset. We analysed cross-sectional data from 40 040 participants from the UK Biobank (52.2% female; ages 44-83 years) using multiple linear regression to evaluate how obesity and body anthropometrics relate to regional white matter diffusion tensor imaging metrics (fractional anisotropy, axial diffusivity, radial diffusivity, mean diffusivity). We also examined interactions with age and sex. Our analyses revealed significant associations between individual obesity phenotypes (i.e. obesity and body anthropometrics) and diffusion tensor imaging metrics of small effects, with partial correlation coefficient |r| effect sizes ranging from 0.02 to 0.20 for most regions of interest with largest effects in brainstem tracts. We observed more widespread sex-by-obesity phenotypes than age-by-obesity phenotypes interaction effects on diffusion tensor imaging metrics. Our results link obesity and body anthropometrics with white matter phenotypes and suggests that shared body fat-related pathways link physical and brain health that may vary based on sex and age. Understanding these body-brain relationships, and the role of age and sex, could enhance the development and evaluation of targeted, personalized, treatment strategies for brain disorders that co-occur with obesity, although further longitudinal and intervention studies are needed to map the causal dynamics of these associations.