ORIGINAL RESEARCH article
Front. Aging Neurosci.
Sec. Neurocognitive Aging and Behavior
Volume 17 - 2025 | doi: 10.3389/fnagi.2025.1543501
Obesity Paradox in Cognitive Function: A Longitudinal Study of BMI and Cognitive Impairment in Elderly Chinese Population
Provisionally accepted
Jing Chen1*
Jun Zhang2Hao Wang1Hong liang Zhu2Jia lin Fu2Chuan wei Li2Qing rong Zhang2Xing zhi Xia3He Ma2
Jun jun Liu4*
Xiang dong Du1*- 1Soochow University Medical College, Suzhou, China
- 2Suzhou Guangji Hospital, Suzhou, Jiangsu Province, China
- 3Xuzhou Medical University, Xuzhou, Jiangsu Province, China
- 4Nanjing Meishan Hospital, Nanjing, China
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Objective: This study endeavored to investigate the correlation between body mass index (BMI) and cognitive impairment in the demographic of Chinese individuals who are 60 years of age and above. Methods: We selected data from China Health and Retirement Longitudinal Study (CHARLS) 2015-2018 and 2,942 subjects aged ≥60 years were included. The Mini-Mental State Examination (MMSE) was used to assess cognitive impairment. BMI was examined in two forms: as a continuous variable and was stratified into tertiles. Analysis was conducted using both univariate and multivariate logistic regression. Non-linear relationships were analyzed using curve fitting and segmented logistic regression. Results: During the study, 600 out of 2,942 subjects (20.4%) experienced cognitive impairment. In fully adjusted models, each unit increase in BMI was related to a 4% decrease in the odds of cognitive impairment (OR: 0.96, 95% CI: 0.93-0.99, P = 0.008). There was a noticeable protective effect from the highest BMI tertile in comparison to the lowest tertile (OR: 0.64, 95% CI: 0.50-0.83, P < 0.001). Non-linear analysis revealed an inflection point at BMI of 26.60 kg/m², with a significant inverse relationship below this point (OR: 0.96, 95% CI: 0.93-0.99, P = 0.008) and no substantial association above it. Conclusions: This study provides evidence supporting the "obesity paradox" in the cognitive function of elderly Chinese population. Higher BMI is linked to lower cognitive impairment risk, especially among overweight persons.These findings indicate a complex and non-linear link between BMI and cognitive health among elderly adults, emphasizing the importance of tailored strategies for weight management in this population.
Keywords: Body Mass Index, cognitive impairment, Obesity paradox, elderly population, Non-linear association
Received: 16 Dec 2024; Accepted: 22 Apr 2025.
Copyright: © 2025 Chen, Zhang, Wang, Zhu, Fu, Li, Zhang, Xia, Ma, Liu and Du. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Jing Chen, Soochow University Medical College, Suzhou, China
Jun jun Liu, Nanjing Meishan Hospital, Nanjing, China
Xiang dong Du, Soochow University Medical College, Suzhou, China
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