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Weight-adjusted-waist index, inflammation, and cognitive performance in older adults: a cross-sectional analysis from
Ingrid Revheim1, Lasse M Giil2,3,4, Ole Martin Steihaug2
1Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Introduction:
Obesity has been associated with reduced cognitive function, potentially through inflammatory and neuroinflammatory mechanisms. The weight-adjusted waist index (WWI) is a novel anthropometric measure capturing central adiposity. However, its association with cognitive performance has been scarcely studied, and it remains unclear whether inflammation influences this relationship. This study aims to examine the association between WWI and cognitive performance, and whether this association is explained by inflammatory markers.
Methods:
WWI was calculated as waist circumference divided by the square root of body weight (cm/√kg). Cognitive performance was assessed using a test battery comprising the Controlled Oral Word Association test (COWAT; verbal fluency), the Kendrick Object Learning Test (KOLT; memory), and a modified Digit Symbol Test (m-DST; processing speed). Inflammatory markers included C-reactive protein and the kynurenine-to-tryptophan ratio. Multivariable linear regression analyses were used to assess associations between WWI and cognitive test scores per standard deviation, and to evaluate potential attenuation by inflammatory markers.
Results:
A total of 2,066 community-dwelling older adults (55% women; median age 71 years [IQR 70-72]) from the Hordaland Health Study (1997-99) with complete data on WWI and cognitive tests were included in the cross-sectional analyses. Higher WWI was associated with lower cognitive performance across all tests: COWAT (ß -0.06 [95% CI -0.10, -0.02]), KOLT (ß -0.06 [95% CI -0.11, -0.02]), and m-DST (ß -0.09 [95% CI -0.12, -0.04]). Adjustment for inflammatory markers did not attenuate these associations. Body mass index, waist circumference, body fat percentage, and lean mass index were not significantly associated with cognitive performance.
Conclusion:
Higher WWI, reflecting greater central adiposity, was associated with lower performance across multiple cognitive domains. Inflammatory markers did not attenuate this relationship. Other anthropometric and body composition measures were not associated with cognitive performance. These findings suggest that central adiposity relative to body weight may be more relevant for cognitive health than overall body adiposity in older adults.