Nidia Celeste Horie, Valeria T Serrao, Sharon Sanz Simon, Maria Rita Polo Gascon, Alessandra Xavier Dos Santos, Maria Aquimara Zambone, Marta Merenciana Del Bigio de Freitas, Edecio Cunha-Neto, Emerson Leonildo Marques, Alfredo Halpern, Maria Edna de Melo, Marcio C Mancini, Cintia Cercato
Journal: The Journal of clinical endocrinology and metabolism 2016;101(3):1104-12
PMID: 26713821
Several studies have elucidated that midlife obesity increases the risk of dementia later in life. While the neuroprotective effects of caloric restriction have been widely demonstrated, they have not yet been investigated in patients with mild cognitive impairment (MCI). The aim of this trial was to evaluate the effect of intentional weight loss in elderly adults with mild cognitive impairment (MCI). Eighty participants aged over 60 were randomly allocated to receive either nutritional counselling or medical care alone for 12 months. The findings of this study indicated that intentional weight loss through diet was associated with cognitive improvement in patients with MCI, and this association was strongest in younger adults and APOE4 carriers. As this was the first clinical trial exploring these effects in patients with MCI further research is warranted.
CONTEXT
Obesity in midlife is a risk factor for dementia, but it is unknown if caloric restriction-induced weight loss could prevent cognitive decline and therefore dementia in elderly patients with cognitive impairment.
OBJECTIVE
To evaluate the cognitive effect of intentional weight loss in obese elderly patients with mild cognitive impairment (MCI), considering the influence of age, apolipoprotein E (APOE) genotype, physical activity, biochemical markers, and diet.
DESIGN
Single-center, prospective controlled trial.
SETTING
Academic medical center.
PARTICIPANTS
Eighty obese patients with MCI, aged 60 or older (68.1 ± 4.9 y, body mass index [BMI] 35.5 ± 4.4 kg/m(2), 83.7% women, 26.3% APOE allele ϵ4 carriers).
INTERVENTION
Random allocation to conventional medical care alone (n = 40) or together with nutritional counselling (n = 40) in group meetings aiming to promote weight loss through caloric restriction for 12 months.
OUTCOME MEASUREMENTS
clinical data, body composition, neuropsychological tests (main outcome), serum biomarkers, APOE genotype, physical performance, dietary recalls.
RESULTS
Seventy-five patients completed the follow-up. BMI, on average, decreased 1.7 ± 1.8 kg/m(2) (P = .021), and most of the cognitive tests improved, without difference between the groups. In analysis with linear generalized models, the BMI decrease was associated with improvements in verbal memory, verbal fluency, executive function, and global cognition, after adjustment for education, gender, physical activity, and baseline tests. This association was strongest in younger seniors (for memory and fluency) and in APOE allele ϵ4 carriers (for executive function). Changes in homeostasis model assessment-estimated insulin resistance, C-reactive protein, leptin and intake of energy, carbohydrates, and fats were associated with improvement in cognitive tests.
CONCLUSIONS
Intentional weight loss through diet was associated with cognitive improvement in patients with MCI.
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