Association between sarcopenic obesity and mild cognitive impairment in patients with type 2 diabetes mellitus

Type 2 diabetes mellitus (T2DM) is a major risk factor for cognitive decline. Sarcopenic obesity (SO), a metabolically detrimental trait, is common in people with T2DM. However, its association with mild cognitive impairment (MCI) remains poorly characterized.

This study included 509 hospitalized patients aged ≥50 years with T2DM. Participants were classified into four groups: the normal group (N), the obesity-only group (O), the sarcopenia-only group (S), and the sarcopenic obesity group (SO). The Montreal Cognitive Assessment (MoCA) was used to evaluate MCI. Spearman's correlation analysis and binary logistic regression were performed to examine the relationship between body composition and MCI. A sensitivity analysis was conducted to verify the robustness of the results.

The prevalence of MCI varied substantially among the groups, with the SO group having the highest at 76.0%, followed by the S group at 70.5%. The prevalence in both groups was markedly higher than that in the N group (45.3%) and the O group (53.3%). Correlation analysis revealed that the MoCA score was significantly positively correlated with the appendicular skeletal muscle mass index (ASMI) and inversely correlated with body fat percentage (BFP) (all p < 0.001). In a multivariable-adjusted binary logistic regression model, when the N group was used as a reference, being in the SO group (OR = 3.056) or S group (OR = 2.397) was identified as an independent risk factor for MCI, with the SO group demonstrating a more significant increase in risk. Further validated by modified Poisson regression, the risk of MCI was significantly elevated in the SO group (PR = 1.499) and the S group (PR = 1.401), whereas no statistically significant difference was observed in the O group. Subgroup analysis revealed that these relationships were more significant in patients aged 65 years and older and in female patients.

Among middle-aged and older patients with T2DM, compared with sarcopenia or obesity alone, SO is a significant independent risk factor for MCI. Routine assessment of body composition is recommended in clinical practice to identify individuals at high risk of early cognitive decline.