Association between Body Mass Index and Cognitive Impairment in the Elderly in Guandu District of Kunming City
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摘要:
目的 探讨云南省官渡区社区老年人体重指数与认知功能障碍之间关联。 方法 数据来自云南省官渡区2021至2023年社区老年人体检，通过简易精神状态检查（MMSE表）和体格检查的横断面数据（≥ 65，n = 17352 ）收集分析。结果 在 17352 名参与者中，该地区老年人受教育程度低，认知障碍的发生率22.31%，女性高于男性，教育程度越高发生率越低，基线时体重过轻、正常、超重和肥胖的比例分别为2.5%、41.9%、40.7%和14.9%，与正常基线 BMI 组相比，排外年龄、性别、教育程度、吸烟、糖尿病、高血压及中风等因素的影响，BMI 25～27.9 kg/m2认知障碍风险最低MMSE值最高、和BMI正常的人群相比风险下降11%、而BMI < 18.5 kg/m2和BMI ≥ 28 kg/m2的参与者认知障碍风险增加50%及60%，老年女性BMI > 25 kg/m2认知功能障碍的发病率高于同体重男性12%、BMI ≥ 28 kg/m2人群高于同体重男性42%。结论 昆明市官渡区接受调查的老年人认知功能障碍发病率高，体重过轻和肥胖人群认知功能障碍的风险高，保持适当的体重特别是BMI在25～27 kg/m2是官渡地区老年人认知功能障碍的保护因素，特别是女性。 Abstract:Objective To explore the association between body mass index （BMI） and cognitive impairment in the elderly in Guandu district of Yunnan province. Methods The data were collected from the community health check-ups for elderly individuals in Guandu District, Yunnan Province, from 2021 to 2023. It includes cross-sectional data from the Mini-Mental State Examination （MMSE） and physical examinations for those over 65 years （n = 17, 352）. Results Among 17, 352 participants, elderly individuals in this region had a low level of education, with a prevalence of cognitive impairment at 22.31%. Women had higher rates than men, and the higher the education level, the lower the prevalence. At baseline, the proportions of underweight, normal weight, overweight, and obese individuals were 2.5%, 41.9%, 40.7%, and 14.9% respectively. When controlling for factors like age, gender, education level, smoking, diabetes, hypertension, and stroke, those with a BMI of 25-27.9 kg/m2 had the lowest risk of cognitive impairment and the highest MMSE value. Compared to those with a normal BMI, their risk decreased by 11%. In contrast, participants with a BMI less than 18.5 kg/m2 or greater than or equal to 28 kg/m2 had a 50% and 60% increase in the risk of cognitive impairment, respectively. Elderly women with a BMI greater than 25 kg/m2 had a 12% higher incidence of cognitive dysfunction compared to similarly weighted men, and those with a BMI greater than or equal to 28 kg/m2 had a 42% higher rate compared to men of the same weight. Conclusion This study suggests that the prevalence of cognitive impairment among the elderly surveyed in Guandu District, Kunming, is not low. Those who are underweight or obese have a higher risk of cognitive impairment. Maintaining an appropriate weight, especially a BMI between 25 and 27, is a protective factor against cognitive impairment for the elderly in this region, particularly for women. -
Key words:
- Elderly people /
- Body mass index /
- Cognitive impairment
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表 1 体检人群一般情况（n）
Table 1. General Information
指标 n 比率（%） MMSE值 F/t P 性别 男 7318 42.20 24.42 ± 4.23 16.234 <0.001* 女 10034 57.80 23.30 ± 4.71 学历 文盲 3055 18.03 20.33 ± 5.05 1229.522 <0.001* 小学 6773 37.85 23.31 ± 4.25 中学 5415 36.83 25.40 ± 3.68 大学 2109 7.44 26.05 ± 3.26 *P < 0.05。 
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表 2 多变量调整模型
Table 2. Multivariate Adjustment Model
变量 认知障碍 Odds Ratio 95%CI P Model BMI 体重过轻 1.50 1.34～1.67 < 0.001* 正常 1 （Ref） 超重 0.89 0.77～1.09 < 0.001* 肥胖 1.60 1.43～1.78 < 0.001* *P < 0.05。
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表 3 8组人群及相应的MMSE值（$\bar x \pm s $）
Table 3. 8 groups of population and their corresponding MMSE values （$\bar x \pm s $）
指标 分组 n MMSE F/t P BMI分组 <18.5 1 637 23.30 ± 4.74 6.712 <0.001* 18.5-21 2 1616 23.69 ± 4.76 21-24 3 3438 23.66 ± 4.69 23-25 4 4169 23.95 ± 4.44abc 25-27 5 3699 23.98 ± 4.37abc 27-29 6 2102 23.85 ± 4.49a 29-31 7 1008 23.33 ± 4.67cdef ≥31 8 683 23.14 ± 4.54bcdef 注：a ：P < 0.05，与组1比较差异有统计学意义；b：P < 0.05，与组2比较差异有统计学意义；c：P < 0.053与组3比较差异有统计学意义；d： P < 0.05，与组4比较差异有统计学意义；e：P < 0.05，与组5比较差异有统计学意义；f：P < 0.05，与组6比较差异有统计学意义。
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表 4 组之间两两比较（1）
Table 4. Pairwise comparison between groups （1）
BMI分组 平均差 标准误 P 95%CI 下限值 上限 1 2 −0.384 0.213 0.071 −0.8 0.033 3 −0.356 0.196 0.07 −0.74 0.028 4 − 0.6492 *0.193 0.001 −10.028 −0.27 5 − 0.6783 *0.195 0.001 −10.06 −0.296 6 − 0.5497 *0.205 0.007 −0.952 −0.147 7 −0.033 0.23 0.886 −0.484 0.418 8 0.161 0.25 0.52 −0.33 0.651 2 1 0.384 0.213 0.071 −0.033 0.8 3 0.028 0.137 0.838 −0.241 0.297 4 − 0.2656 *0.133 0.046 −0.527 −0.005 5 − 0.2947 *0.135 0.03 −0.56 −0.029 6 −0.166 0.15 0.269 −0.461 0.129 7 0.351 0.182 0.054 −0.007 0.708 8 0.5445 *0.207 0.009 0.138 0.951 3 1 0.356 0.196 0.07 −0.028 0.74 2 −0.028 0.137 0.838 −0.297 0.241 4 − 0.2935 *0.105 0.005 −0.499 −0.088 5 − 0.3227 *0.108 0.003 −0.534 −0.112 6 −0.194 0.126 0.123 −0.441 0.053 7 0.3227 *0.163 0.047 0.004 0.642 8 0.5165 *0.19 0.007 0.143 0.89
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表 4 组之间两两比较（2）
Table 4. Pairwise comparison between groups （2）
BMI分组 平均差 标准误 P 95%CI 下限值 上限 4 1 0.6492 *0.193 0.001* 0.27 10.028 2 0.2656 *0.133 0.046 0.005 0.527 3 0.2935 *0.105 0.005* 0.088 0.499 5 −0.029 0.103 0.776 −0.23 0.172 6 0.099 0.122 0.413 −0.139 0.338 7 0.6163 *0.159 0 0.304 0.929 8 0.8100 *0.188 0 0.442 10.178 5 1 0.6783 *0.195 0.001* 0.296 10.06 2 0.2947 *0.135 0.03* 0.029 0.56 3 0.3227 *0.108 0.003 0.112 0.534 4 0.029 0.103 0.776 −0.172 0.23 6 0.129 0.124 0.3 −0.115 0.372 7 0.6454 *0.161 0 0.329 0.962 8 0.8392 *0.189 0 0.468 10.21 6 1 0.5497 *0.205 0.007* 0.147 0.952 2 0.166 0.15 0.269 −0.129 0.461 3 0.194 0.126 0.123 −0.053 0.441 4 −0.099 0.122 0.413 −0.338 0.139 5 −0.129 0.124 0.3 −0.372 0.115 7 0.5168 *0.174 0.003* 0.176 0.858 8 0.7105 *0.2 0 0.318 10.103 7 1 0.033 0.23 0.886 −0.418 0.484 2 −0.351 0.182 0.054 −0.708 0.007 3 − 0.3227 *0.163 0.047* −0.642 −0.004 4 − 0.6163 *0.159 0 −0.929 −0.304 5 − 0.6454 *0.161 0 −0.962 −0.329 6 − 0.5168 *0.174 0.003* −0.858 −0.176 8 0.194 0.225 0.389 −0.248 0.635 8 1 −0.161 0.25 0.52 −0.651 0.33 2 − 0.5445 *0.207 0.009* −0.951 −0.138 3 − 0.5165 *0.19 0.007* −0.89 −0.143 4 − 0.8100 *0.188 0 −10.178 −0.442 5 − 0.8392 *0.189 0 −10.21 −0.468 6 − 0.7105 *0.2 0 −10.103 −0.318 7 −0.194 0.225 0.389 −0.635 0.248 *P < 0.05。
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表 5 不同BMI分性别比较
Table 5. Comparison of different BMI by gender
组别 变量 Odds Ratio 认知障碍（95%CI） P 体重正常组 性别 女 1.06 0.94～1.18 0.301 男 1 （Ref） 体重过轻组 性别 女 0.82 0.53～1.25 0.362 男 1 （Ref） 体重超重组 性别 女 1.22 1.09～1.38 0.001* 男 1 （Ref） 体重肥胖组 性别 女 1.42 1.17～1.74 < 0.001* 男 1 （Ref） *P < 0.05。
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