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已发表论文
中国中老年人肥胖相关代谢表型、代谢状态转变与认知功能的关联研究
Authors Ma Q, Jiao Y, Mu S, Zhou T, Shang L, Kang B
Received 18 June 2025
Accepted for publication 1 November 2025
Published 8 November 2025 Volume 2025:18 Pages 7383—7399
DOI https://doi.org/10.2147/JMDH.S548051
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Dr David C. Mohr
Qing Ma,1 Yuxin Jiao,2 Shengzhi Mu,3 Ting Zhou,1 Liang Shang,1 Bei Kang2
1Department of Geriatrics, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, 710068, People’s Republic of China; 2Department of Neurology II, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, 710068, People’s Republic of China; 3Department of Burns and Plastic Surgery, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, 710068, People’s Republic of China
Correspondence: Bei Kang, Department of Neurology II, Shaanxi Provincial People’s Hospital, No. 256 Youyi West Road, Xi’an, Shaanxi, 710068, People’s Republic of China, Tel +8613759953766, Email beikangkb@126.com
Objective: This study aimed to examine the association between different obesity-related metabolic phenotypes, transitions in metabolic status over time, and cognitive function improvement among middle-aged and older adults in China.
Methods: Data were derived from the China Health and Retirement Longitudinal Study, a nationally representative longitudinal cohort involving urban and rural residents aged 45 years and older. Baseline data were collected in 2011, with follow-up assessments extending to 2020. Participants were classified into four body mass index (BMI)-metabolic phenotypes: Metabolically Healthy Normal Weight (MHNW), Metabolically Unhealthy Normal Weight (MUNW), Metabolically Healthy Overweight/Obesity (MHOO), and Metabolically Unhealthy Overweight/Obesity (MUOO). Cognitive function was evaluated through assessments of episodic memory, mental status, and overall cognitive performance. Statistical analyses were performed using R Studio 4.3.1. Cox regression analysis models were employed to estimate associations between metabolic phenotypes, their longitudinal transitions, and changes in cognitive function.
Results: In both the 2011 and 2015 surveys, MHOO demonstrated significantly higher scores in episodic memory, mental status, and overall cognitive function compared to other groups, while MUNW demonstrated significantly lower scores across all domains. In addition, cognitive outcomes varied by BMI-metabolic phenotypes: MHOO was positively associated with cognitive improvement, MUNW was usually associated with poorer cognitive outcomes, and MUOO had no significant association with cognitive changes. Moreover, individuals with stable MUNW status exhibited a lower likelihood of cognitive improvement relative to those with stable MHNW status. In contrast, individuals with stable MHOO status demonstrated a significantly greater likelihood of cognitive improvement. Furthermore, transitioning from MHNW to MUNW was associated with decreased likelihood of favorable cognitive outcomes.
Conclusion: Regardless of weight classification, metabolic health was associated with superior baseline cognitive function and a slower rate of cognitive decline. These findings underscore the significance of metabolic health in predicting cognitive aging trajectories among middle-aged and older individuals.
Keywords: body mass index-metabolic phenotype, CHARLS database, cognitive function, heterogeneity of obesity metabolism, R studio
1Department of Geriatrics, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, 710068, People’s Republic of China; 2Department of Neurology II, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, 710068, People’s Republic of China; 3Department of Burns and Plastic Surgery, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, 710068, People’s Republic of China
Correspondence: Bei Kang, Department of Neurology II, Shaanxi Provincial People’s Hospital, No. 256 Youyi West Road, Xi’an, Shaanxi, 710068, People’s Republic of China, Tel +8613759953766, Email beikangkb@126.com
Objective: This study aimed to examine the association between different obesity-related metabolic phenotypes, transitions in metabolic status over time, and cognitive function improvement among middle-aged and older adults in China.
Methods: Data were derived from the China Health and Retirement Longitudinal Study, a nationally representative longitudinal cohort involving urban and rural residents aged 45 years and older. Baseline data were collected in 2011, with follow-up assessments extending to 2020. Participants were classified into four body mass index (BMI)-metabolic phenotypes: Metabolically Healthy Normal Weight (MHNW), Metabolically Unhealthy Normal Weight (MUNW), Metabolically Healthy Overweight/Obesity (MHOO), and Metabolically Unhealthy Overweight/Obesity (MUOO). Cognitive function was evaluated through assessments of episodic memory, mental status, and overall cognitive performance. Statistical analyses were performed using R Studio 4.3.1. Cox regression analysis models were employed to estimate associations between metabolic phenotypes, their longitudinal transitions, and changes in cognitive function.
Results: In both the 2011 and 2015 surveys, MHOO demonstrated significantly higher scores in episodic memory, mental status, and overall cognitive function compared to other groups, while MUNW demonstrated significantly lower scores across all domains. In addition, cognitive outcomes varied by BMI-metabolic phenotypes: MHOO was positively associated with cognitive improvement, MUNW was usually associated with poorer cognitive outcomes, and MUOO had no significant association with cognitive changes. Moreover, individuals with stable MUNW status exhibited a lower likelihood of cognitive improvement relative to those with stable MHNW status. In contrast, individuals with stable MHOO status demonstrated a significantly greater likelihood of cognitive improvement. Furthermore, transitioning from MHNW to MUNW was associated with decreased likelihood of favorable cognitive outcomes.
Conclusion: Regardless of weight classification, metabolic health was associated with superior baseline cognitive function and a slower rate of cognitive decline. These findings underscore the significance of metabolic health in predicting cognitive aging trajectories among middle-aged and older individuals.
Keywords: body mass index-metabolic phenotype, CHARLS database, cognitive function, heterogeneity of obesity metabolism, R studio