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Abstract
Objective Obesity is a common, modifiable cardiovascular and cerebrovascular risk factor. Among people with HIV, obesity may contribute to multisystem dysregulation including cognitive impairment. We examined body mass index (BMI) and central obesity (waist circumference [WC]) in association with domain-specific cognitive function and 10-year cognitive decline in men with HIV infection (MWH) vs HIV-uninfected (HIV−) men.
Methods A total of 316 MWH and 656 HIV− Multicenter AIDS Cohort Study participants ≥40 years at baseline, with neuropsychological testing every 2 years and concurrent BMI and WC measurements, were included. MWH were included if taking ≥2 antiretroviral agents and had HIV-1 RNA <400 copies/mL at >80% of visits. Mixed-effects models included all visits from 1996 to 2015, stratified by HIV serostatus, and adjusted for sociodemographic, behavioral, and clinical characteristics. At baseline and follow-up, 8% of MWH and 15% of HIV− men and 41% of MWH and 56% of HIV− men were ≥60 years, respectively.
Results Cross-sectionally, higher BMI was inversely associated with motor function in MWH and HIV− men, and attention/working memory in HIV− men. WC was inversely associated with motor function in MWH and HIV− men. Longitudinal associations indicated an obese BMI was associated with a less steep decline in motor function in MWH whereas in HIV− men, obesity was associated with a greater decline in motor function, learning, and memory. WC, or central obesity, showed similar patterns of associations.
Conclusion Higher adiposity is associated with lower cognition cross-sectionally and greater cognitive decline, particularly in HIV− men. Overweight and obesity may be important predictors of neurologic outcomes and avenues for prevention and intervention.
Glossary
- AD=
- Alzheimer disease;
- ARV=
- antiretroviral;
- BMI=
- body mass index;
- CalCAP=
- California Computerized Assessment Package;
- GPEG=
- Grooved Pegboard;
- HIV−=
- HIV-uninfected;
- MACS=
- Multicenter AIDS Cohort Study;
- MCI=
- mild cognitive impairment;
- MWH=
- men with HIV;
- PWH=
- people with HIV;
- RAVLT=
- Rey Auditory Verbal Learning Test;
- SDMT=
- Symbol Digit Modalities Test;
- TMT=
- Trail-Making Test;
- WC=
- waist circumference
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Editorial, page 95
- Received December 3, 2018.
- Accepted in final form March 11, 2019.
- © 2019 American Academy of Neurology
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