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The association between metabolic syndrome components and cognitive function in community-dwelling middle-aged and older adults: the first wave result of a cohort study

Journal of Health, Population and Nutrition volume 44, Article number: 94 (2025) Cite this article

Abstract

Background

The components of metabolic syndrome (MetS) have previously been demonstrated to be contributors to cognitive decline in older adults as individual factors, but not collectively as a syndrome. This study investigated whether adults ≥ 50 years old who meet the criteria for MetS were more likely to develop impaired cognition than those without MetS.

Methods

Adults aged 50 years or older without significant cognitive impairment who received outpatient care at Taipei Veterans General Hospital were recruited. Waist circumference, blood tests for Mets components, and high-sensitivity C-reactive protein (hsCRP) were measured. Demographics, health condition, cognitive function (by Montreal Cognitive Assessment Taiwanese version, MoCA-T, and AD-8), depression symptoms (by Geriatric Depression Scale-15) and functional status (by Barthel’s Index, and Lawton & Brody instrumental activities of daily living, IADL) were evaluated. Associations between MetS and cognitive function were analyzed by multivariate logistic regression.

Results

Data of 567 participants were analyzed. The prevalence of MetS of the study population was 34.2%. MetS status was not significantly correlated to cognitive decline as indicated by Montreal Cognitive Assessment Taiwan version (p = 0.13) and AD-8 (p = 0.42). Mild abdominal obesity decreased the risk of developing impaired cognition in women (adjusted OR = 0.62, 95% CI = 0.42, 0.93, p = 0.02) but not in men (adjusted OR = 0.84, 95% CI = 0.46, 1.53, p = 0.58).

Conclusions

MetS is not a significant contributory factor to cognitive decline in community-dwelling middle-aged and older adults. An optimal waist circumference in community-dwelling older women is protective against the development of mild dementia.

Introduction

Metabolic syndrome (MetS) is a constellation of metabolic disorders, including abdominal obesity, hypertension, hyperglycemia, hypertriglyceridemia, and low high-density lipoprotein cholesterol (HDL-C), which are associated with neurocognitive diseases such as stroke and neurodegeneration [1]. MetS and its components have been correlated to cognitive impairment in older adults [2, 3], as neuroendocrine crosstalk plays a major contributory role in the homeostasis of metabolism and neurological function. Neural regulation of metabolism has been well-established [4,5,6]. Both animal and human studies [7,8,9] have indicated that aberrant metabolic regulation causes downstream disruption of neurological structures and function, including cerebrovascular endothelial dysfunction in hypertension [10,11,12] and glucose-mediated neuropathy [13].

According to a systematic review, the global prevalence of cognitive impairment ranged from 5.1% to 41% among adults older than 50 years [14]. Cognitive impairment can lead to difficulties in performing daily tasks, following instructions, and producing appropriate communication [15]. Cognitive impairment is also detrimental to the ability of instrumental activities of daily living (IADL) and contributes to lower quality of life [16, 17]. Furthermore, impairment of cognitive and functional abilities in older adults poses an increased risk of falls [18]. Injuries from falls in older adults tend to be moderate to severe and are a major cause of mortality and loss of independence [19]. Consequently, cognitive impairment causes a substantial health burden and precipitate financial and emotional distress for caregivers and family members [20]. Therefore, identifying factors associated with dementia is crucial for providing insight into appropriate health management and long-term care resources for the global aging society.

Interestingly, several studies have presented evidence suggesting that the relationship between MetS and cognitive deficits may vary depending on age and sex. Although MetS has been linked to the development of cognitive impairment in middle-aged adults [21], this association is less evident in the older old (adults aged 75 years or greater) [22,23,24]. Additionally, MetS may be more likely to cause cognitive deficits in women than in men [25]. However, a limitation of many studies on the cognitive functions of patients with MetS is the assessment of cognitive ability solely with the Mini–Mental State Examination (MMSE), which may not be sensitive enough to detect mild cognitive impairment [26]. Considering the scarcity of data based on more sensitive assessments of cognitive function and the mixed results regarding age and sex as co-factors of MetS impact on cognition, further investigation of the differences in MetS effects on cognition in different age ranges between men and women is needed.

This research is a community-based cross-sectional study aimed at investigating the association between MetS and cognitive function in middle-aged and older adults. Considering the rising prevalence of MetS [27] and the global aging tendency, understanding this topic is important in facilitating long-term care planning in geriatric medicine. In this study, we use the Montreal Cognitive Assessment Taiwanese version (MoCA-T) and the Eight-item Informant Interview to Differentiate Aging and Dementia (AD-8) to evaluate cognitive function, as both are sensitive tools to identify mild cognitive impairment and dementia [28]. By presenting evidence on this pivotal issue, we aim to illuminate the healthcare challenges faced by an aging society and foster further discussion on preventive medicine directions.

Methods

Study design and participants

This cross-sectional study was the first wave of the cohort study of “The Taipei Veterans General Hospital Precision Medicine Study on Metabolic Syndrome Risk Factors” based on community-dwelling men and women who are at least 50 years old and receive outpatient care in the Taipei Veterans General Hospital (TPVGH). The protocol for this study was approved by the Institutional Review Board (IRB) of TPVGH (protocol No.: 2020–06-001A), and the research implementation adheres completely to the guidelines set forth by the Committee on Human Experimentation and the principles outlined in the Declaration of Helsinki.

Community residents visiting outpatient clinics were invited to participate in the study. After a full explanation of the study, subjects who could understand and agreed to participate signed a written informed consent. The recruitment period for the study was from 1 June 2020 to 31 May 2023. The exclusion criteria were as follows: 1) individuals with significant cognitive impairment (unable to understand the study and could not independently sign the participation consent form after an interview with and explanation of the study and informed consent by well-trained research personnel. The research personnel would also discuss the evaluation of cognitive function with the principal investigator to decide if the subject was eligible for recruitment. The subject was excluded if he/she had already been diagnosed with moderate to severe dementia.), and 2) residents of long-term care facilities or nursing homes. Figure 1 illustrates the participant selection process and subsequent data collection for this study.

Fig. 1
figure 1

Study participant selection and data collection

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Measurements and questionnaires

Participants received a comprehensive health exam, including height (cm), weight (kg), body mass index (kg/m2), waist circumference (cm), physical examination, and blood tests. Demographic information was collected for each participant, including sex, age, education level, marital status, status of cigarette smoking, alcohol consumption, income, and medical history of hypertension, type 2 DM, hypertriglyceridemia, low HDL-C, stroke, lung diseases, depression, degenerative joints diseases (DJD), malignancy, pain, and medication history. Smoking status for current smokers was further described as < 20 pack-years or ≥ 20 pack -years according to the 2025 Lung Cancer Screening guidelines recommended by the National Comprehensive Cancer Network (NCCN) for adults ≥ age 50 [29]. Heavy drinking was described as 15 or more drinks per week for men or 8 or more drinks per week for women, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA) [30].

Depression was evaluated with the Geriatric Depression Scale 15 (GDS-15) [31]. The participants’ activity of daily living (ADL) status was assessed with Barthel’s Index [32], and instrumental activity of daily living (IADL) was measured with the Lawton & Brody Instrumental Activity of Daily Living [33]. Blood tests included liver function, renal function, fasting blood glucose level, total cholesterol, high-density and low-density lipoprotein cholesterol levels, triglyceride level, uric acid level, complete blood count, and high-sensitivity C-reactive protein (hsCRP).

Definition of metabolic syndrome

Participants were screened for MetS according to the diagnostic criteria proposed by the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III [34, 35] and the World Health Organization (WHO) obesity criteria for Asian populations [36]. The criteria were as follows: waist circumference ≥ 90 cm in men and ≥ 80 cm in women; systolic blood pressure ≥ 130 mmHg or diastolic blood pressure ≥ 85 mmHg, or the patient is already under treatment for hypertension; fasting blood glucose levels ≥ 100 mg/dL, or the patient is already under treatment for elevated glucose; elevated triglyceride levels ≥ 150 mg/dL, or the patient is already under treatment for hypertriglyceridemia; HDL-C levels < 40 mg/dL in men or < 50 mg/dL in women. Participants who met three or more of the above criteria were categorized as having MetS.

Evaluation of cognitive function

Cognitive function was evaluated with the Eight-item Informant Interview to Differentiate Aging and Dementia (AD-8) [37, 38] and Montreal Cognitive Assessment (MoCA) Taiwanese Version (MoCA-T) [39, 40]. AD-8 is a widely used instrument to screen for early dementia. The AD-8 test assesses cognitive abilities including memory, orientation, judgment, and function. Scores of 2 or higher on the AD-8, indicating cognitive impairment [37], have been previously validated for the Taiwanese population [41]. The MoCA evaluates short-term memory recall, visuospatial function, executive function, sustained attention, language, and orientation. It is highly sensitive and specific for differentiating between normal cognitive aging, mild cognitive impairment, and Alzheimer’s disease [40]. According to a validation study of the MoCA-T on the Taiwanese population, a cut-off value of 23/24 was found to be optimal for differentiating mild cognitive impairment [39]. In this study, MoCA-T was utilized rather than MMSE, as a previous study demonstrated MoCA to be more sensitive and specific for screening cognitive impairment in older adults [26].

Statistical analysis

Descriptive data were presented as mean ± standard deviation (SD). Categorical variables were presented as number (%) of subjects and were analyzed using Chi-square tests. Comparisons between abnormal and normal populations in each category of MetS criteria and AD-8 and MoCA-T results were analyzed with the Chi-square test. Cognitive function was categorized by MoCA-T and AD-8 as normal (MoCA-T≥ 24, AD-8 < 2) or cognitive impairment (MoCA-T < 24, AD-8≥ 2). Multivariate logistic regression models were used to analyze the associations between MetS status and cognitive function. Possible confounders that may affect cognitive function were adjusted, including age, sex, education level, marital status, income status, history of stroke, and scores on IADL and GDS-15. The statistical analyses were conducted using IBM SPSS version 20.0 (IBM Corporation, Armonk, NY, USA). A two-tailed p value < 0.05 was considered as statistically significant.

Results

We recruited 567 patients who were older than 50 years old. The mean age of the study population is 66.3 ± 9.1 years (Table 1). Of the participants, 323 (56.97%) were older people (65 years or older). 223 (39.3%) participants were male. 415 participants (73.2%) were married. 311 participants (54.9%) had an education level of university and above. More than half of the participants did not have income (63.5%). On average, the participants had good physical function (mean score ± SD of Barthel index and IADL were 99.6 ± 3.5 and 23.5 ± 2.3, respectively) and fair cognitive level (mean score ± SD of MoCA-T and AD-8 were 25.2 ± 4.1 and 0.59 ± 1.46, respectively). Participants did not have a tendency of depression or inflammation (mean score ± SD of GDS-15 and hs-CRP were 1.7 ± 2.4 and 0.13 ± 0.17, respectively). However, about half of the participants (54.3%) reported pain.

Table 1 Basic characteristics of study population
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The prevalence of MetS of the study population was 34.2% (n = 194, Table 2). The prevalence of MetS components (abdominal obesity, hypertension or on drug treatment; hyperglycemia or on drug treatment; hypertriglyceridemia or on drug treatment; and low HDL-C or on drug treatment) in the study population was 44.8% (n = 254), 59.4% (n = 337), 37.9% (n = 215), 24.7% (n = 140), and 33.9% (n = 192), respectively. Whether cognitive function is categorized by MoCA-T or AD-8, there were no differences between cognitive function status in abdominal obesity, hypertension or on drug treatment, hyperglycemia or on drug treatment, hypertriglyceridemia or on drug treatment, low HDL-C or on drug treatment, and MetS status.

Table 2 The associations between status of metabolic syndrome and cognitive function by Chi-square tests
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Table 3 showed the association between MetS status with cognitive function. The odds of mild cognitive impairment increased with age (aOR = 1.08, 95% CI = 1.04–1.11, p < 0.001). Conversely, a higher education level, including college and graduate school, and a higher score on the IADL were found to be protective factors against mild cognitive impairment [aOR (95% CI) were 0.44 (0.36–0.55) and 0.74 (0.61–0.91), respectively, p < 0.05]. Similar to the results for mild cognitive impairment, a higher education level of college and graduate school, and a higher score on the IADL were also identified as protective factors against mild dementia [aOR with 95% CI were 0.66 (0.48–0.91) and 0.73 (0.63–0.84), respectively, p < 0.05]. Additionally, participants with a higher score on the GDS-15 were more likely to have mild dementia (aOR = 1.59, 95% CI = 1.40–1.80, p < 0.001). There were no significant associations between MetS and mild cognitive impairment or mild dementia.

Table 3 Factors associated with cognitive impairment by logistic regression
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For the associations between MetS components and cognitive function, almost all components of MetS showed no significant correlation with mild cognitive impairment or mild dementia. However, abdominal obesity exhibited a protective effect against mild dementia after adjusting age, sex, education level, marital status, income status, stroke history, and scores of IADL and GDS-15 (aOR = 0.68, 95% CI = 0.50–0.95, p = 0.02, Table 4). We further conducted a subgroup analysis stratified by sex. Table 5 demonstrates that abdominal obesity has a significant protective effect against mild dementia in women but not in men (aOR = 0.62, 95% CI = 0.42–0.93, p = 0.02 in women).

Table 4 The association between components of metabolic syndrome and cognitive function
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Table 5 The associations of abdominal obesity and cognitive impairment stratified by sex
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We additionally conducted a subgroup analysis to explore the association between waist circumference and the risk of mild dementia, stratified by sex. Both men and women were quintiled based on the sample size in each group. Figure 1 illustrates that women with a waist circumference ranging from 82 to 89 cm had a reduced risk of mild dementia compared to women with a waist circumference of less than 73 cm (aOR = 0.32, 95% CI = 0.12, 0.84, p = 0.02). No significant association was found between other quintiles of waist circumference and the risk of mild dementia (Fig. 2).

Fig. 2
figure 2

Subgroup analysis of the association between waist circumference and the risk of cognitive impairment stratified by sex, expressed as adjusted odds ratio and 95% CI. The waist circumference was divided into five groups based on the sample size in each group. Cognitive impairment was screened as AD-8 ≥ 2. The statistics were performed using logistic regression models, adjusting for age, sex, education level, marital status, income status, stroke history, and scores of instrumental activities of daily living and Geriatric Depression Scale-15. Abbreviations: WC, Waist circumference; AD-8, The Eight-Item Informant Interview to Differentiate Aging and Dementia

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Discussion

In this study, we did not observe a significant correlation between MetS status and impaired cognition as indicated by both MoCA-T and AD-8. However, we did find that an optimal waist circumference served as a protective factor against mild dementia in female community-dwelling older adults. Our study revealed gender differences in the effects of MetS components on cognition, a finding less explored in prior research.

MetS was not associated with mild cognitive impairment (MCI) (MoCA < 24) and mild dementia (AD-8 ≥ 2) in this cross-sectional study. Our study population was predominantly older people, which may explain the insignificant correlation between MetS and cognition in our study. In prior published findings, MetS increased the risk for developing MCI [42] and for the progression of MCI to dementia in middle-aged adults (55 years or older) [21] but not in the oldest old (75 years or older) [22, 24]. Another study regarding the influence of MetS in patients with Alzheimer’s disease and at least 70 years of age found that cognitive performance was worse but not statistically significant in the group with MetS [43]. Because low measurements of blood pressure, adiposity, and serum lipid levels are associated with poor physical health and cognitive performance in older people [44], MetS in older age may not exert significant detrimental effects on cognition as it does in younger ages. Therefore, older adults with MetS in our study population may be less susceptible to the effects of MetS on general health and cognitive function.

We found women with a waist circumference of 82 to 89 cm were less likely to have mild dementia. Similarly, a study investigating the correlation of BMI and waist circumference with impaired cognition in older Chinese adults found that abdominal obesity defined by waist circumference [45] was a protective factor against cognitive decline in both women and men. Past literature has shown that nutritional intake patterns are important factors to be considered. Consumption of omega-6 and omega-3 polyunsaturated fatty acids, including docosahexaenoic acid, eicosapentaenoic acid, and arachidonic acid, may contribute to central obesity but are crucial for maintaining nervous system metabolism and function [46]. Our study found that the protective effects of waist circumference on mild dementia were observed within the range of 82–89 cm, rather than with unlimited increases in waist circumference. This indicates that optimal nutrition is beneficial to cognitive function. A randomized controlled trial that evaluated nutritional habits in middle-aged and older women and assessed their cognitive function throughout the duration of the study [47] found that differences in consumption levels of different fat types, rather than of total fat, affected cognitive changes in aging. Observations from this study indicated that higher intake of saturated fatty acids correlated to poor cognitive trajectories in older age, while larger intake of mono-unsaturated fatty acids was protective against impaired cognition. Unlimited abdominal obesity poses risks for cognitive decline, while appropriate nutritional support is helpful for neuronal survival and neurotransmission, thus modulating the decline of cognitive function in aging [48].

Our observation of central adiposity acting as a protective factor against cognitive decline specifically in women aligned with evidence from a study in an Icelandic population [49]. This study found that larger amounts of subcutaneous fat in the abdomen and thigh and late-life obesity decreased the likelihood of developing dementia for women, while greater amounts of visceral fat contributed to the deterioration of cognitive function. Another possible mechanism of the inverse relationship between central obesity and development of impaired cognition in women is the production of endogenous hormones by adipose tissue [50], which is the main hormone production mechanism in postmenopause. Two endogenous hormones secreted by adipose, estrogen [51] and leptin [52], have been demonstrated to lower the risk of cognitive decline via their involvement in memory and learning pathways in the brain. Production of estrogen and leptin may be greater in older women with abdominal obesity, thus offering protection against cognitive decline that women without central obesity and men would not have. Currently, it is unclear whether ethnicity affects abdominal obesity as a protective factor against cognitive decline, and our study contributes to the evidence from Asia.

There are some limitations in this study. First, the sample population of this study is limited to adults who receive care at the outpatient clinic at TVGH, which restricts the generalizability of our findings to other community-dwelling adults. Second, dietary habits are important factors correlated with cognitive function but are unavailable in this study. Not analyzing dietary habits may lead to a misinterpretation of the protective effect of abdominal obesity on mild dementia in female participants. Finally, the cross-sectional design did not allow for the interpretation of causal inferences. Despite these limitations, the study has several strengths. First, we used MoCA-T and AD-8 to evaluate cognitive function. These tools are sensitive and well-validated in the Taiwanese population. Second, we adjusted for important confounders related to cognitive function in the analytical models. Finally, we found an optimal waist circumference is correlated to a lower risk of mild dementia in women, which is a novel finding in this field.

Conclusion

We identified an optimal waist circumference as a protective factor against mild dementia in female community-dwelling older adults. The potential roles of dietary factors and hormones in neuroprotection warrant further investigation. Our findings contribute to preventive strategies of cognitive impairment in the global aging society.

Availability of data and materials

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

AD-8:

Eight-item informant interview to differentiate aging and dementia

ADL:

Activity of daily living

BMI:

Body mass index

DJD:

Degenerative joint diseases

DM:

Diabetes mellitus

GDS-15:

Geriatric depression Scale 15

HDL-C:

High-density lipoprotein cholesterol

HFD:

High fat diet

hsCRP:

High-sensitivity C-reactive protein

IADL:

Independent activities of daily living

IQR:

Interquartile range

MCI:

Mild cognitive impairment

MetS:

Metabolic syndrome

MMSE:

Mini-mental state examination

MoCA:

Montreal cognitive assessment

MoCA-T:

Montreal cognitive assessment taiwanese version

NCCN:

National comprehensive cancer network

NIAAA:

National institute on alcohol abuse and alcoholism

SD:

Standard deviation

T1DM:

Type 1 DM

T2DM:

Type 2 DM

TVGH:

Taipei veterans general hospital

WHO:

World health organization

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Acknowledgements

The authors would like to thank the participants for their time and contribution to the study, and the Taipei Veterans General Hospital for the use of its facilities. No external organizations had roles in the study design, data collection and analysis, or manuscript preparation.

Funding

This study was funded by Taipei Veterans General Hospital, [Grant number: V109E-005–4, V110E-005–4, V111E-006–4, V112E-004–4].

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Author notes

  1. Hsin-Yeong Yen and Yi‑Hsuan Lin have equal contribution for this work.

Authors and Affiliations

  1. School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

    Hsin-Yeong Yen, Yi‑Hsuan Lin, Yen-Feng Wang, Jong-Ling Fuh, Shuu-Jiun Wang, Harn-Shen Chen, Shu-Chiung Chiang, Ming-Hwai Lin, Tzeng-Ji Chen, Shinn-Jang Hwang & Hsiao-Ting Chang

  2. Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan

    Yi‑Hsuan Lin

  3. Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan

    Yen-Feng Wang, Jong-Ling Fuh & Shuu-Jiun Wang

  4. Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Harn-Shen Chen

  5. Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Sih-Rong Li, Ming-Hwai Lin, Tzeng-Ji Chen, Shinn-Jang Hwang & Hsiao-Ting Chang

  6. Department of Family Medicine, Taipei Veterans General Hospital Hsinchu Branch, Hsinchu County, Taiwan

    Tzeng-Ji Chen

  7. Department of Post-Baccalaureate Medicine, National Chung Hsing University, Taichung, Taiwan

    Tzeng-Ji Chen

  8. Department of Family Medicine, En Chu Kong Hospital, New Taipei City, Taiwan

    Shinn-Jang Hwang

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  1. Hsin-Yeong Yen
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Contributions

HTC, SJH, SJW, and JLF contributed to conceptualization and funding acquisition for this study. SRL acquired and processed the data. YHL, HTC, SRL, and SCC carried out statistical analyses. HYY, YHL, SRL, MHL, TJC, and HTC contributed to the interpretation of the results. HYY prepared the manuscript with important feedback and suggestions from HTC, YFW, and YHL.

Corresponding author

Correspondence to Hsiao-Ting Chang.

Ethics declarations

Ethics approval and consent to participate

The protocol of this study was approved by the Research Ethics Committee of Taipei Veterans General Hospital (protocol code: 2020–06-001A).

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Not applicable.

Competing Interests

The authors declare no competing interests.

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Yen, HY., Lin, Y., Wang, YF. et al. The association between metabolic syndrome components and cognitive function in community-dwelling middle-aged and older adults: the first wave result of a cohort study. J Health Popul Nutr 44, 94 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s41043-025-00824-3

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  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s41043-025-00824-3

Keywords

Journal of Health, Population and Nutrition

ISSN: 2072-1315

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