Original Study| Volume 22, ISSUE 4, P865-872.e5, April 2021

Incident Impaired Cognitive Function in Sarcopenic Obesity: Data From the National Health and Aging Trends Survey

Published:October 21, 2020DOI:



      The prevalence of obesity with sarcopenia is increasing in adults aged ≥65 years. This geriatric syndrome places individuals at risk for synergistic complications that leads to long-term functional decline. We ascertained the relationship between sarcopenic obesity and incident long-term impaired global cognitive function in a representative US population.


      A longitudinal, secondary data set analysis using the National Health and Aging Trends Survey.


      Community-based older adults in the United States.


      Participants without baseline impaired cognitive function aged ≥65 years with grip strength and body mass index measures.


      Sarcopenia was defined using the Foundation for the National Institutes of Health Sarcopenia Project grip strength cut points (men <35.5 kg; women <20 kg), and obesity was defined using standard body mass index (BMI) categories. Impaired global cognition was identified as impairment in the Alzheimer's Disease-8 score or immediate/delayed recall, orientation, clock-draw test, date/person recall. Proportional hazard models ascertained the risk of impaired cognitive function over 8 years (referent = neither obesity or sarcopenia).


      Of the 5822 participants (55.7% women), median age category was 75 to 80, and mean grip strength and BMI were 26.4 kg and 27.5 kg/m2, respectively. Baseline prevalence of sarcopenic obesity was 12.9%, with an observed subset of 21.2% participants having impaired cognitive function at follow-up. Compared with those without sarcopenia or obesity, the risk of impaired cognitive function was no different in obesity alone [hazard ratio (HR) 0.98; 95% confidence interval (CI) 0.82–1.16]), but was significantly higher in sarcopenia (HR 1.60; 95% CI 1.42–1.80) and sarcopenic obesity (HR 1.20; 95% CI 1.03–1.40). There was no significant interaction term between sarcopenia and obesity.


      Both sarcopenia and sarcopenic obesity are associated with an increased long-term risk of impaired cognitive function in older adults.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the American Medical Directors Association
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Hales C.M.
        • Fryar C.D.
        • Carroll M.D.
        • et al.
        Trends in obesity and severe obesity prevalence in us youth and adults by sex and age, 2007–2008 to 2015–2016.
        JAMA. 2018; 319: 1723-1725
        • Sayer A.A.
        • Syddall H.
        • Martin H.
        • et al.
        The developmental origins of sarcopenia.
        J Nutr Health Aging. 2008; 12: 427-432
        • Scott D.
        • Seibel M.
        • Cumming R.
        • et al.
        Sarcopenic obesity and its temporal associations with changes in bone mineral density, incident falls, and fractures in older men: The Concord Health and Ageing in Men Project.
        J Bone Miner Res. 2017; 32: 575-583
        • Ozturk Z.A.
        • Turkbeyler I.H.
        • Abiyev A.
        • et al.
        Health-related quality of life and fall risk associated with age-related body composition changes; sarcopenia, obesity and sarcopenic obesity.
        Intern Med J. 2018; 48: 973-981
        • Tian S.
        • Xu Y.
        Association of sarcopenic obesity with the risk of all-cause mortality: A meta-analysis of prospective cohort studies.
        Geriatr Gerontol Int. 2016; 16: 155-166
        • Batsis J.A.
        • Barre L.K.
        • Mackenzie T.A.
        • et al.
        Variation in the prevalence of sarcopenia and sarcopenic obesity in older adults associated with different research definitions: Dual-energy X-ray absorptiometry data from the National Health and Nutrition Examination Survey 1999–2004.
        J Am Geriatr Soc. 2013; 61: 974-980
        • Batsis J.A.
        • Villareal D.T.
        Sarcopenic obesity in older adults: Aetiology, epidemiology and treatment strategies.
        Nat Rev Endocrinol. 2018; 14: 513-537
        • Kob R.
        • Bollheimer L.C.
        • Bertsch T.
        • et al.
        Sarcopenic obesity: Molecular clues to a better understanding of its pathogenesis?.
        Biogerontology. 2015; 16: 15-29
        • Mangialasche F.
        • Polidori M.C.
        • Monastero R.
        • et al.
        Biomarkers of oxidative and nitrosative damage in Alzheimer's disease and mild cognitive impairment.
        Ageing Res Rev. 2009; 8: 285-305
        • Weaver J.D.
        • Huang M.H.
        • Albert M.
        • et al.
        Interleukin-6 and risk of cognitive decline: MacArthur studies of successful aging.
        Neurology. 2002; 59: 371-378
        • Cheng G.
        • Huang C.
        • Deng H.
        • et al.
        Diabetes as a risk factor for dementia and mild cognitive impairment: A meta-analysis of longitudinal studies.
        Intern Med J. 2012; 42: 484-491
        • Ekblad L.L.
        • Rinne J.O.
        • Puukka P.
        • et al.
        Insulin resistance predicts cognitive decline: An 11-year follow-up of a nationally representative adult population sample.
        Diabetes Care. 2017; 40: 751-758
        • Solfrizzi V.
        • Panza F.
        • Colacicco A.M.
        • et al.
        Vascular risk factors, incidence of MCI, and rates of progression to dementia.
        Neurology. 2004; 63: 1882-1891
        • Samieri C.
        • Perier M.C.
        • Gaye B.
        • et al.
        Association of cardiovascular health level in older age with cognitive decline and incident dementia.
        JAMA. 2018; 320: 657-664
        • Wagner M.
        • Helmer C.
        • Tzourio C.
        • et al.
        Evaluation of the concurrent trajectories of cardiometabolic risk factors in the 14 years before dementia.
        JAMA Psychiatry. 2018; 75: 1033-1042
        • Deckers K.
        • Van Boxtel MPJ
        • Verhey F.R.J.
        • Kohler S.
        Obesity and cognitive decline in adults: Effect of methodological choices and confounding by age in a longitudinal study.
        J Nutr Health Aging. 2016; 21: 546-553
        • Edwards M.K.
        • Loprinzi P.D.
        Combined associations of sedentary behavior and cardiorespiratory fitness on cognitive function among older adults.
        Int J Cardiol. 2017; 229: 71-74
        • Studenski S.A.
        • Peters K.W.
        • Alley D.E.
        • et al.
        The FNIH sarcopenia project: Rationale, study description, conference recommendations, and final estimates.
        J Gerontol A Biol Sci Med Sci. 2014; 69: 547-558
        • Zammit A.R.
        • Robitaille A.
        • Piccinin A.M.
        • et al.
        Associations between aging-related changes in grip strength and cognitive function in older adults: A systematic review.
        J Gerontol A Biol Sci Med Sci. 2018; 74: 519-527
        • Levine M.E.
        • Crimmins E.M.
        The impact of insulin resistance and inflammation on the association between sarcopenic obesity and physical functioning.
        Obesity (Silver Spring). 2012; 20: 2101-2106
        • Tolea M.I.
        • Chrisphonte S.
        • Galvin J.E.
        Sarcopenic obesity and cognitive performance.
        Clin Interv Aging. 2018; 13: 1111-1119
        • Galvin J.E.
        • Roe C.M.
        • Powlishta K.K.
        • et al.
        The AD8: A brief informant interview to detect dementia.
        Neurology. 2005; 65: 559-564
        • Galvin J.E.
        • Roe C.M.
        • Xiong C.
        • et al.
        Validity and reliability of the AD8 informant interview in dementia.
        Neurology. 2006; 67: 1942-1948
        • Agrell B.
        • Dehlin O.
        The clock-drawing test. 1998.
        Age Ageing. 2012; 41: iii41-iii45
        • Jensen M.D.
        • Ryan D.H.
        • Apovian C.M.
        • et al.
        2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults.
        Circulation. 2014; 129: S102-S138
        • Alberti K.G.
        • Eckel R.H.
        • Grundy S.M.
        • et al.
        Harmonizing the metabolic syndrome: A joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity.
        Circulation. 2009; 120: 1640-1645
        • Bhasin S.
        • Travison T.G.
        • Manini T.M.
        • et al.
        Sarcopenia definition: The position statements of the Sarcopenia Definition and Outcomes Consortium.
        J Am Geriatr Soc. 2020; 68: 1410-1418
        • Haapanen N.
        • Miilunpalo S.
        • Pasanen M.
        • et al.
        Agreement between questionnaire data and medical records of chronic diseases in middle-aged and elderly Finnish men and women.
        Am J Epidemiol. 1997; 145: 762-769
        • Zhu K.
        • McKnight B.
        • Stergachis A.
        • et al.
        Comparison of self-report data and medical records data: Results from a case-control study on prostate cancer.
        Int J Epidemiol. 1999; 28: 409-417
        • Pope G.C.
        • Ellis R.P.
        • Ash A.S.
        • et al.
        Principal inpatient diagnostic cost group model for Medicare risk adjustment.
        Health Care Financ Rev. 2000; 21: 93-118
      1. Chronic Conditions Data Warehouse.
        (Available at:)
        Date: 2020
        Date accessed: August 23, 2020
        • Kasper J.A.
        • Freedman V.A.
        • Spillman B.
        Classification of persons by dementia status in the National Health and Aging Trends Study.
        (Technical Paper #5) Johns Hopkins University School of Public Health, Baltimore, MD2013
        • Kasper J.A.
        • Freedman V.A.
        • Spillman B.
        • et al.
        Addendum to classification of persons by dementia status in the National Health and Aging Trends Study for Follow-up Rounds.
        Johns Hopkins University School of Public Health, Baltimore, MD2015
        • Abellan van Kan G.
        • Cesari M.
        • Gillette-Guyonnet S.
        • et al.
        Sarcopenia and cognitive impairment in elderly women: Results from the EPIDOS cohort.
        Age Ageing. 2013; 42: 196-202
        • Chang K.V.
        • Hsu T.H.
        • Wu W.T.
        • et al.
        Association between sarcopenia and cognitive impairment: A systematic review and meta-analysis.
        J Am Med Dir Assoc. 2016; 17 (1164.e7–1164.e15)
        • Levine M.E.
        • Crimmins E.M.
        Sarcopenic obesity and cognitive functioning: The mediating roles of insulin resistance and inflammation?.
        Curr Gerontol Geriatr Res. 2012; 2012: 826398
        • Low S.
        • Goh K.S.
        • Ng T.P.
        • et al.
        The prevalence of sarcopenic obesity and its association with cognitive performance in type 2 diabetes in Singapore.
        Clin Nutr. 2020; 39: 2274-2281
        • Goncalves Damascena K.
        • Batisti Ferreira C.
        • Dos Santos Teixeira P.
        • et al.
        Functional capacity and obesity reflect the cognitive performance of older adults living in long-term care facilities.
        Psychogeriatrics. 2017; 17: 439-445
        • Kera T.
        • Kawai H.
        • Hirano H.
        • et al.
        Differences in body composition and physical function related to pure sarcopenia and sarcopenic obesity: A study of community-dwelling older adults in Japan.
        Geriatr Gerontol Int. 2017; 17: 2602-2609
        • Wang H.
        • Hai S.
        • Liu Y.X.
        • et al.
        Associations between sarcopenic obesity and cognitive impairment in elderly Chinese community-dwelling individuals.
        J Nutr Health Aging. 2019; 23: 14-20
        • Jeong S.M.
        • Choi S.
        • Kim K.
        • et al.
        Association among handgrip strength, body mass index and decline in cognitive function among the elderly women.
        BMC Geriatr. 2018; 18: 225
        • Choudhary A.K.
        • Jiwane R.
        • Alam T.
        • et al.
        Grip strength and impact on cognitive function in healthy kitchen workers.
        Achievements in the Life Sciences. 2016; 10: 168-174
        • Cawthon P.M.
        • Travison T.G.
        • Manini T.M.
        • et al.
        Establishing the link between lean mass and grip strength cut-points with mobility disability and other health outcomes: Proceedings of the Sarcopenia Definition and Outcomes Consortium Conference.
        J Gerontol A Biol Sci Med Sci. 2020; 75: 1317-1323
        • Clark B.C.
        • Manini T.M.
        What is dynapenia?.
        Nutrition. 2012; 28: 495-503
        • Cruz-Jentoft A.J.
        • Bahat G.
        • Bauer J.
        • et al.
        Sarcopenia: Revised European consensus on definition and diagnosis.
        Age Ageing. 2019; 48: 16-31
        • Woo J.
        • Leung J.
        Sarcopenic obesity revisited: Insights from the Mr and Ms Os cohort.
        J Am Med Dir Assoc. 2018; 19: 679-684.e2
        • Yoshimura Y.
        • Wakabayashi H.
        • Nagano F.
        • et al.
        Sarcopenic obesity is associated with activities of daily living and home discharge in post-acute rehabilitation.
        J Am Med Dir Assoc. 2020; 21: 1475-1480
        • Batsis J.A.
        • Mackenzie T.A.
        • Bartels S.J.
        • et al.
        Diagnostic accuracy of body mass index to identify obesity in older adults: NHANES 1999–2004.
        Int J Obes (Lond). 2016; 40: 761-767
        • Kemmler W.
        • Teschler M.
        • Weissenfels A.
        • et al.
        Prevalence of sarcopenia and sarcopenic obesity in older German men using recognized definitions: High accordance but low overlap!.
        Osteoporos Int. 2017; 28: 1881-1891
        • Chiles Shaffer N.
        • Ferrucci L.
        • Shardell M.
        • et al.
        Agreement and predictive validity using less-conservative foundation for the National Institutes of Health Sarcopenia Project weakness cutpoints.
        J Am Geriatr Soc. 2017; 65: 574-579
        • Locquet M.
        • Beaudart C.
        • Reginster J.Y.
        • et al.
        Comparison of the performance of five screening methods for sarcopenia.
        Clin Epidemiol. 2018; 10: 71-82
        • Stephan Y.
        • Sutin A.R.
        • Terracciano A.
        “Feeling younger, walking faster”: Subjective age and walking speed in older adults.
        Age (Dordr). 2015; 37: 86