A Comprehensive Review on the Role of Obesity in Functional Cognition (Part I): Epidemiology and Alternations in Brain Structure
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Published
Sep 30, 2023
Abstract
The condition of obesity, which is defined by an excessive amount of adipose tissue, is being increasingly acknowledged as having significant consequences for the structure and functioning of the brain. Numerous studies have demonstrated that obesity is linked to significant modifications in the structure of the brain, encompassing variations in the volume of gray matter, the integrity of white matter, and modifications in particular brain regions responsible for regulating appetite and cognitive control. For example, research employing neuroimaging methodologies such as magnetic resonance imaging has consistently indicated that individuals with obesity frequently display diminished gray matter volume in areas such as the prefrontal cortex, which is known to play a critical role in processes such as decision-making and impulse control. Furthermore, there have been observations of white matter abnormalities that impact the interconnection among brain regions responsible for hunger regulation and reward processing. These abnormalities may potentially play a role in the development of overeating tendencies and compromised self-control. The aforementioned alterations in structure are not solely connected to obesity, but are also correlated with cognitive deficits, namely in domains pertaining to memory, attention, and executive functioning. Gaining a comprehensive understanding of the complex correlation between obesity and brain structure is of utmost importance, as it provides valuable insights into the neurological foundations of cognitive impairments in individuals affected by obesity. Moreover, this knowledge serves as a basis for the creation of specific interventions aimed at alleviating the cognitive repercussions associated with this widespread public health issue.
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Keywords
Obesity, Cognition, Epidemiology, Brain Structure, Outcomes
References
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9. Hruby A, Hu FB. The epidemiology of obesity: A big picture. Pharmacoeconomics 2015; 33(7):673-689. DOI: https://doi.org/10.1007/s40273-014-0243-x
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18. Poobalan AS, Aucott LS, Clarke A, Smith WC. Diet behaviour among young people in transition to adulthood (18-25 year olds): A mixed method study. Health Psychol Behav Med 2014; 2(1):909-928. DOI: https://doi.org/10.1080/21642850.2014.931232
19. Park JH, Moon JH, Kim HJ, Kong MH, Oh YH. Sedentary lifestyle: Overview of updated evidence of potential health risks. Korean J Fam Med 2020; 41(6):365-373. DOI: https://doi.org/10.4082/kjfm.20.0165
20. Samper-Ternent R, Al Snih S. Obesity in older adults: Epidemiology and implications for disability and disease. Rev Clin Gerontol 2012; 22(1):10-34. DOI: https://doi.org/10.1017/s0959259811000190
21. Batsis JA, Zagaria AB. Addressing obesity in aging patients. Med Clin North Am 2018; 102(1):65-85. DOI: https://doi.org/10.1016/j.mcna.2017.08.007
22. Anekwe CV, Jarrell AR, Townsend MJ, Gaudier GI, Hiserodt JM, Stanford FC. Socioeconomics of obesity. Curr Obes Rep 2020; 9(3):272-279. DOI: https://doi.org/10.1007/s13679-020-00398-7
23. Zajacova A, Lawrence EM. The relationship between education and health: Reducing disparities through a contextual approach. Annu Rev Public Health 2018; 39:273-289. DOI: https://doi.org/10.1146/annurev-publhealth-031816-044628
24. Kirby JB, Liang L, Chen HJ, Wang Y. Race, place, and obesity: The complex relationships among community racial/ethnic composition, individual race/ethnicity, and obesity in the United States. Am J Public Health 2012; 102(8):1572-1578. DOI: https://doi.org/10.2105/AJPH.2011.300452
25. Hilmers A, Hilmers DC, Dave J. Neighborhood disparities in access to healthy foods and their effects on environmental justice. Am J Public Health 2012; 102(9):1644-1654. DOI: https://doi.org/10.2105/AJPH.2012.300865
26. Krueger PM, Reither EN. Mind the gap: Race/ethnic and socioeconomic disparities in obesity. Curr Diab Rep 2015; 15(11):95. DOI: https://doi.org/10.1007/s11892-015-0666-6
27. Stillman CM, Weinstein AM, Marsland AL, Gianaros PJ, Erickson KI. Body-brain connections: The effects of obesity and behavioral interventions on neurocognitive aging. Front Aging Neurosci 2017; 9:115. DOI: https://doi.org/10.3389/fnagi.2017.00115
28. Li G, Hu Y, Zhang W, Wang J, Ji W, Manza P, Volkow ND, Zhang Y, Wang GJ. Brain functional and structural magnetic resonance imaging of obesity and weight loss interventions. Mol Psychiatry 2023; 28(4):1466-1479. DOI: https://doi.org/10.1038/s41380-023-02025-y
29. Drelich-Zbroja A, Matuszek M, Kaczor M, Kuczyńska M. Functional magnetic resonance imaging and obesity-novel ways to seen the unseen. J Clin Med 2022; 11(12):3561. DOI: https://doi.org/10.3390/jcm11123561
30. Sankowski R, Mader S, Valdés-Ferrer SI. Systemic inflammation and the brain: novel roles of genetic, molecular, and environmental cues as drivers of neurodegeneration. Front Cell Neurosci 2015; 9:28. DOI: https://doi.org/10.3389/fncel.2015.00028
31. Sripetchwandee J, Chattipakorn N, Chattipakorn SC. Links between obesity-induced brain insulin resistance, brain mitochondrial dysfunction, and dementia. Front Endocrinol (Lausanne) 2018; 9:496. DOI: https://doi.org/10.3389/fendo.2018.00496
32. Henning RJ. Obesity and obesity-induced inflammatory disease contribute to atherosclerosis: A review of the pathophysiology and treatment of obesity. Am J Cardiovasc Dis 2021; 11(4):504-529.
33. Dorrance AM, Matin N, Pires PW. The effects of obesity on the cerebral vasculature. Curr Vasc Pharmacol 2014; 12(3):462-472. DOI: https://doi.org/10.2174/1570161112666140423222411
34. Herzberg MP, Hodel AS, Cowell RA, Hunt RH, Gunnar MR, Thomas KM. Risk taking, decision-making, and brain volume in youth adopted internationally from institutional care. Neuropsychologia 2018; 119:262-270. DOI: https://doi.org/10.1016/j.neuropsychologia.2018.08.022
35. Ronan L, Alexander-Bloch AF, Wagstyl K, Farooqi S, Brayne C, Tyler LK; Cam-CAN; Fletcher PC. Obesity associated with increased brain age from midlife. Neurobiol Aging 2016; 47:63-70. DOI: https://doi.org/10.1016/j.neurobiolaging.2016.07.010
36. Kullmann S, Callaghan MF, Heni M, Weiskopf N, Scheffler K, Häring HU, Fritsche A, Veit R, Preissl H. Specific white matter tissue microstructure changes associated with obesity. Neuroimage 2016; 125:36-44. DOI: https://doi.org/10.1016/j.neuroimage.2015.10.006
37. Carbine KA, Duraccio KM, Hedges-Muncy A, Barnett KA, Kirwan CB, Jensen CD. White matter integrity disparities between normal-weight and overweight/obese adolescents: An automated fiber quantification tractography study. Brain Imaging Behav 2020; 14(1):308-319. DOI: https://doi.org/10.1007/s11682-019-00036-4
38. Lampe L, Zhang R, Beyer F, Huhn S, Kharabian Masouleh S, Preusser S, Bazin PL, Schroeter ML, Villringer A, Witte AV. Visceral obesity relates to deep white matter hyperintensities via inflammation. Ann Neurol 2019; 85(2):194-203. DOI: https://doi.org/10.1002/ana.25396
39. Peng X, Zhang R, Yan W, Zhou M, Lu S, Xie S. Reduced white matter integrity associated with cognitive deficits in patients with drug-naive first-episode schizophrenia revealed by diffusion tensor imaging. Am J Transl Res 2020; 12(8):4410-4421.
40. Popko K, Gorska E, Stelmaszczyk-Emmel A, Plywaczewski R, Stoklosa A, Gorecka D, Pyrzak B, Demkow U. Proinflammatory cytokines Il-6 and TNF-α and the development of inflammation in obese subjects. Eur J Med Res 2010; 15 Suppl 2(Suppl 2):120-122. DOI: https://doi.org/10.1186/2047-783x-15-s2-120
41. Kaduševičius E. Novel applications of NSAIDs: Insight and future perspectives in cardiovascular, neurodegenerative, diabetes and cancer disease therapy. Int J Mol Sci 2021; 22(12):6637. DOI: https://doi.org/10.3390/ijms22126637
42. Spinelli M, Fusco S, Grassi C. Brain insulin resistance and hippocampal plasticity: Mechanisms and biomarkers of cognitive decline. Front Neurosci 2019; 13:788. DOI: https://doi.org/10.3389/fnins.2019.00788
43. Rhea EM, Banks WA, Raber J. Insulin resistance in peripheral tissues and the brain: A tale of two sites. Biomedicines 2022; 10(7):1582. DOI: https://doi.org/10.3390/biomedicines10071582
44. Cui Y, Tang TY, Lu CQ, Ju S. Insulin resistance and cognitive impairment: Evidence from neuroimaging. J Magn Reson Imaging 2022; 56(6):1621-1649. DOI: https://doi.org/10.1002/jmri.28358
45. Benedict C, Grillo CA. Insulin resistance as a therapeutic target in the treatment of Alzheimer’s disease: A state-of-the-art review. Front Neurosci 2018; 12:215. DOI: https://doi.org/10.3389/fnins.2018.00215
46. Rhea EM, Leclerc M, Yassine HN, Capuano AW, Tong H, Petyuk VA, Macauley SL, Fioramonti X, Carmichael O, Calon F, Arvanitakis Z. State of the science on brain insulin resistance and cognitive decline due to Alzheimer’s disease. Aging Dis 2023. In press. DOI: https://doi.org/10.14336/AD.2023.0814
2. Jin X, Qiu T, Li L, Yu R, Chen X, Li C, Proud CG, Jiang T. Pathophysiology of obesity and its associated diseases. Acta Pharm Sin B 2023; 13(6):2403-2424. DOI: https://doi.org/10.1016/j.apsb.2023.01.012
3. Wang C, Chan JS, Ren L, Yan JH. Obesity reduces cognitive and motor functions across the lifespan. Neural Plast 2016; 2016:2473081. DOI: https://doi.org/10.1155/2016/2473081
4. Hu Y, Lei X, Smith JP, et al. Effects of Social Activities on Cognitive Functions: Evidence from CHARLS. In: National Research Council (US) Panel on Policy Research and Data Needs to Meet the Challenge of Aging in Asia; Smith JP, Majmundar M, editors. Aging in Asia: Findings from New and Emerging Data Initiatives. Washington (DC): National Academies Press (US); 2012. 12. Available at: https://www.ncbi.nlm.nih.gov/books/NBK109224/
5. Linday LA. Preserving cognitive function. Complement Ther Med 2022; 70:102859. DOI: https://doi.org/10.1016/j.ctim.2022.102859
6. Purnell JQ. Definitions, Classification, and Epidemiology of Obesity. 2023 May 4. In: Feingold KR, Anawalt B, Blackman MR, Boyce A, Chrousos G, Corpas E, de Herder WW, Dhatariya K, Dungan K, Hofland J, Kalra S, Kaltsas G, Kapoor N, Koch C, Kopp P, Korbonits M, Kovacs CS, Kuohung W, Laferrère B, Levy M, McGee EA, McLachlan R, New M, Purnell J, Sahay R, Shah AS, Singer F, Sperling MA, Stratakis CA, Trence DL, Wilson DP, editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000.
7. Gómez-Apo E, Mondragón-Maya A, Ferrari-Díaz M, Silva-Pereyra J. Structural brain changes associated with overweight and obesity. J Obes 2021; 2021:6613385. DOI: https://doi.org/10.1155/2021/6613385
8. Conway DS, Bermel RA, Planchon SM. The relationship between cognition, education, and employment in multiple sclerosis patients. Mult Scler J Exp Transl Clin 2022; 8(3):20552173221118309. DOI: https://doi.org/10.1177/20552173221118309
9. Hruby A, Hu FB. The epidemiology of obesity: A big picture. Pharmacoeconomics 2015; 33(7):673-689. DOI: https://doi.org/10.1007/s40273-014-0243-x
10. Lincoln KD, Abdou CM, Lloyd D. Race and socioeconomic differences in obesity and depression among Black and non-Hispanic White Americans. J Health Care Poor Underserved 2014; 25(1):257-275. DOI: https://doi.org/10.1353/hpu.2014.0038
11. World Health Organization (WHO). Obesity and overweight. Last access: September 11, 2023. Available at: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight#:~:text=Worldwide%20obesity%20has%20nearly%20tripled,%2C%20and%2013%25%20were%20obese
12. Dinsa GD, Goryakin Y, Fumagalli E, Suhrcke M. Obesity and socioeconomic status in developing countries: A systematic review. Obes Rev 2012; 13(11):1067-1079. DOI: https://doi.org/10.1111/j.1467-789X.2012.01017.x
13. Lee A, Cardel M, Donahoo WT. Social and Environmental Factors Influencing Obesity. [Updated 2019 Oct 12]. In: Feingold KR, Anawalt B, Blackman MR, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000. Available at: https://www.ncbi.nlm.nih.gov/books/NBK278977/
14. Faith MS, Kral TVE. Social Environmental and Genetic Influences on Obesity and Obesity-Promoting Behaviors: Fostering Research Integration. In: Institute of Medicine (US) Committee on Assessing Interactions Among Social, Behavioral, and Genetic Factors in Health; Hernandez LM, Blazer DG, editors. Genes, Behavior, and the Social Environment: Moving Beyond the Nature/Nurture Debate. Washington (DC): National Academies Press (US); 2006. C. Available at: https://www.ncbi.nlm.nih.gov/books/NBK19935/
15. Tiwari A, Balasundaram P. Public Health Considerations Regarding Obesity. [Updated 2023 Jun 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Available at: https://www.ncbi.nlm.nih.gov/books/NBK572122/
16. Sanyaolu A, Okorie C, Qi X, Locke J, Rehman S. Childhood and adolescent obesity in the United States: A public health concern. Glob Pediatr Health 2019; 6:2333794X19891305. DOI: https://doi.org/10.1177/2333794X19891305
17. Kansra AR, Lakkunarajah S, Jay MS. Childhood and adolescent obesity: A review. Front Pediatr 2021; 8:581461. DOI: https://doi.org/10.3389/fped.2020.581461
18. Poobalan AS, Aucott LS, Clarke A, Smith WC. Diet behaviour among young people in transition to adulthood (18-25 year olds): A mixed method study. Health Psychol Behav Med 2014; 2(1):909-928. DOI: https://doi.org/10.1080/21642850.2014.931232
19. Park JH, Moon JH, Kim HJ, Kong MH, Oh YH. Sedentary lifestyle: Overview of updated evidence of potential health risks. Korean J Fam Med 2020; 41(6):365-373. DOI: https://doi.org/10.4082/kjfm.20.0165
20. Samper-Ternent R, Al Snih S. Obesity in older adults: Epidemiology and implications for disability and disease. Rev Clin Gerontol 2012; 22(1):10-34. DOI: https://doi.org/10.1017/s0959259811000190
21. Batsis JA, Zagaria AB. Addressing obesity in aging patients. Med Clin North Am 2018; 102(1):65-85. DOI: https://doi.org/10.1016/j.mcna.2017.08.007
22. Anekwe CV, Jarrell AR, Townsend MJ, Gaudier GI, Hiserodt JM, Stanford FC. Socioeconomics of obesity. Curr Obes Rep 2020; 9(3):272-279. DOI: https://doi.org/10.1007/s13679-020-00398-7
23. Zajacova A, Lawrence EM. The relationship between education and health: Reducing disparities through a contextual approach. Annu Rev Public Health 2018; 39:273-289. DOI: https://doi.org/10.1146/annurev-publhealth-031816-044628
24. Kirby JB, Liang L, Chen HJ, Wang Y. Race, place, and obesity: The complex relationships among community racial/ethnic composition, individual race/ethnicity, and obesity in the United States. Am J Public Health 2012; 102(8):1572-1578. DOI: https://doi.org/10.2105/AJPH.2011.300452
25. Hilmers A, Hilmers DC, Dave J. Neighborhood disparities in access to healthy foods and their effects on environmental justice. Am J Public Health 2012; 102(9):1644-1654. DOI: https://doi.org/10.2105/AJPH.2012.300865
26. Krueger PM, Reither EN. Mind the gap: Race/ethnic and socioeconomic disparities in obesity. Curr Diab Rep 2015; 15(11):95. DOI: https://doi.org/10.1007/s11892-015-0666-6
27. Stillman CM, Weinstein AM, Marsland AL, Gianaros PJ, Erickson KI. Body-brain connections: The effects of obesity and behavioral interventions on neurocognitive aging. Front Aging Neurosci 2017; 9:115. DOI: https://doi.org/10.3389/fnagi.2017.00115
28. Li G, Hu Y, Zhang W, Wang J, Ji W, Manza P, Volkow ND, Zhang Y, Wang GJ. Brain functional and structural magnetic resonance imaging of obesity and weight loss interventions. Mol Psychiatry 2023; 28(4):1466-1479. DOI: https://doi.org/10.1038/s41380-023-02025-y
29. Drelich-Zbroja A, Matuszek M, Kaczor M, Kuczyńska M. Functional magnetic resonance imaging and obesity-novel ways to seen the unseen. J Clin Med 2022; 11(12):3561. DOI: https://doi.org/10.3390/jcm11123561
30. Sankowski R, Mader S, Valdés-Ferrer SI. Systemic inflammation and the brain: novel roles of genetic, molecular, and environmental cues as drivers of neurodegeneration. Front Cell Neurosci 2015; 9:28. DOI: https://doi.org/10.3389/fncel.2015.00028
31. Sripetchwandee J, Chattipakorn N, Chattipakorn SC. Links between obesity-induced brain insulin resistance, brain mitochondrial dysfunction, and dementia. Front Endocrinol (Lausanne) 2018; 9:496. DOI: https://doi.org/10.3389/fendo.2018.00496
32. Henning RJ. Obesity and obesity-induced inflammatory disease contribute to atherosclerosis: A review of the pathophysiology and treatment of obesity. Am J Cardiovasc Dis 2021; 11(4):504-529.
33. Dorrance AM, Matin N, Pires PW. The effects of obesity on the cerebral vasculature. Curr Vasc Pharmacol 2014; 12(3):462-472. DOI: https://doi.org/10.2174/1570161112666140423222411
34. Herzberg MP, Hodel AS, Cowell RA, Hunt RH, Gunnar MR, Thomas KM. Risk taking, decision-making, and brain volume in youth adopted internationally from institutional care. Neuropsychologia 2018; 119:262-270. DOI: https://doi.org/10.1016/j.neuropsychologia.2018.08.022
35. Ronan L, Alexander-Bloch AF, Wagstyl K, Farooqi S, Brayne C, Tyler LK; Cam-CAN; Fletcher PC. Obesity associated with increased brain age from midlife. Neurobiol Aging 2016; 47:63-70. DOI: https://doi.org/10.1016/j.neurobiolaging.2016.07.010
36. Kullmann S, Callaghan MF, Heni M, Weiskopf N, Scheffler K, Häring HU, Fritsche A, Veit R, Preissl H. Specific white matter tissue microstructure changes associated with obesity. Neuroimage 2016; 125:36-44. DOI: https://doi.org/10.1016/j.neuroimage.2015.10.006
37. Carbine KA, Duraccio KM, Hedges-Muncy A, Barnett KA, Kirwan CB, Jensen CD. White matter integrity disparities between normal-weight and overweight/obese adolescents: An automated fiber quantification tractography study. Brain Imaging Behav 2020; 14(1):308-319. DOI: https://doi.org/10.1007/s11682-019-00036-4
38. Lampe L, Zhang R, Beyer F, Huhn S, Kharabian Masouleh S, Preusser S, Bazin PL, Schroeter ML, Villringer A, Witte AV. Visceral obesity relates to deep white matter hyperintensities via inflammation. Ann Neurol 2019; 85(2):194-203. DOI: https://doi.org/10.1002/ana.25396
39. Peng X, Zhang R, Yan W, Zhou M, Lu S, Xie S. Reduced white matter integrity associated with cognitive deficits in patients with drug-naive first-episode schizophrenia revealed by diffusion tensor imaging. Am J Transl Res 2020; 12(8):4410-4421.
40. Popko K, Gorska E, Stelmaszczyk-Emmel A, Plywaczewski R, Stoklosa A, Gorecka D, Pyrzak B, Demkow U. Proinflammatory cytokines Il-6 and TNF-α and the development of inflammation in obese subjects. Eur J Med Res 2010; 15 Suppl 2(Suppl 2):120-122. DOI: https://doi.org/10.1186/2047-783x-15-s2-120
41. Kaduševičius E. Novel applications of NSAIDs: Insight and future perspectives in cardiovascular, neurodegenerative, diabetes and cancer disease therapy. Int J Mol Sci 2021; 22(12):6637. DOI: https://doi.org/10.3390/ijms22126637
42. Spinelli M, Fusco S, Grassi C. Brain insulin resistance and hippocampal plasticity: Mechanisms and biomarkers of cognitive decline. Front Neurosci 2019; 13:788. DOI: https://doi.org/10.3389/fnins.2019.00788
43. Rhea EM, Banks WA, Raber J. Insulin resistance in peripheral tissues and the brain: A tale of two sites. Biomedicines 2022; 10(7):1582. DOI: https://doi.org/10.3390/biomedicines10071582
44. Cui Y, Tang TY, Lu CQ, Ju S. Insulin resistance and cognitive impairment: Evidence from neuroimaging. J Magn Reson Imaging 2022; 56(6):1621-1649. DOI: https://doi.org/10.1002/jmri.28358
45. Benedict C, Grillo CA. Insulin resistance as a therapeutic target in the treatment of Alzheimer’s disease: A state-of-the-art review. Front Neurosci 2018; 12:215. DOI: https://doi.org/10.3389/fnins.2018.00215
46. Rhea EM, Leclerc M, Yassine HN, Capuano AW, Tong H, Petyuk VA, Macauley SL, Fioramonti X, Carmichael O, Calon F, Arvanitakis Z. State of the science on brain insulin resistance and cognitive decline due to Alzheimer’s disease. Aging Dis 2023. In press. DOI: https://doi.org/10.14336/AD.2023.0814
How to Cite
Callaghan, R. (2023). A Comprehensive Review on the Role of Obesity in Functional Cognition (Part I): Epidemiology and Alternations in Brain Structure. Science Insights, 43(3), 1039–1047. https://doi.org/10.15354/si.23.re692
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