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Sci Rep. 2018 Oct 31;8(1):16128. doi: 10.1038/s41598-018-33843-8.

Type 2 diabetes and cognitive impairment in an older population with overweight or obesity and metabolic syndrome: baseline cross-sectional analysis of the PREDIMED-plus study.

Author information

1
Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.
2
CIBER de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain.
3
University of Navarra, Department of Preventive Medicine and Public Health, Medical School, and Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.
4
Department of Preventive Medicine, University of Valencia, Valencia, Spain.
5
Rovira i Virgili University, Department of Biochemistry and Biotechnology, Human Nutrition Unit, IISPV, Hospital Universitari Sant Joan de Reus, Reus, Spain.
6
Instituto Hospital del Mar de Investigaciones Médicas, Barcelona, Spain.
7
University of Miguel Hernández, ISABIAL-FISABIO, Alicante, Spain.
8
CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.
9
Instituto de Investigación Sanitaria Illes Balears (IdISBa), University Hospital of Son Espases, Palma de Mallorca, Spain.
10
Department of Nutrition, Food Sciences, and Physiology, Center for Nutrition Research, University of Navarra, Pamplona, IMDEAfood, Madrid, Spain.
11
Department of nursing, school of health sciences. University of Malaga-IBIMA, Malaga, Spain.
12
Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain.
13
Department of Internal Medicine, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Barcelona, Spain.
14
Departament of Preventive Medicine and Public Health, University of Granada, Granada, Spain.
15
Department of Cardiology, University Hospital Araba, Vitoria, Spain.
16
Research Group on Community Nutrition and Oxidative Stress, University of the Balearic Islands, Palma de Mallorca, Spain.
17
Department of Endocrinology and Nutrition, Virgen de la Victoria Hospital (IBIMA), Malaga University, Malaga, Spain.
18
Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
19
Biomedicine Institute (IBIOMED), University of León, León, Spain.
20
Department of Family Medicine, Research Unit, Distrito Sanitario Atención Primaria Sevilla, Sevilla, Spain.
21
Department of Endocrinology and Nutrition, University Hospital Fundación Jiménez Díaz, Madrid, Spain.
22
Lipid Unit, Department of Internal Medicine, Bellvitge Biomedical Research Institute (IDIBELL)-Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
23
Department of Endocrinology and Nutrition, Hospital Clínic, Barcelona, Spain.
24
CIBER de Diabetes y Enfermedades Metabólicas asociadas (CIBERDEM), Barcelona, Spain.
25
Nutritional Genomics and Epigenomics Group, IMDEA Food, CEI UAM + CSIC, 28049, Madrid, Spain.
26
Center for Advanced Studies in Olive Grove and Olive Oils, University of Jaén, Jaén, Spain.
27
Endocrinology and Nutrition Department, Hospital Clínico San Carlos-IdISSC, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
28
Lipid Clinic, Endocrinology and Nutrition Service, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain.
29
Departament de Psicobiologia i Metodologia, Universitat Autònoma de Barcelona, Barcelona, Spain.
30
Primary Health Care Division, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain.
31
Universitat de les Illes Balear, Palma de Mallorca, Spain.
32
Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain.
33
Harvard TH Chan School of Public Health, Dpt. Nutrition, Harvard, University, Boston, USA.
34
CIBER de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain. RTorre@imim.es.
35
Instituto Hospital del Mar de Investigaciones Médicas, Barcelona, Spain. RTorre@imim.es.
36
Department of Experimental and Health Sciences, University Pompeu Fabra, Barcelona, Spain. RTorre@imim.es.
37
Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain. ffernandez@bellvitgehospital.cat.
38
CIBER de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain. ffernandez@bellvitgehospital.cat.
39
Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain. ffernandez@bellvitgehospital.cat.

Abstract

This study cross-sectionally examines in the elderly population: (a) the association of type 2 diabetes with executive function (EF); (b) the effect of BMI on both type 2 diabetes and EF; (c) the association between glycaemia control and EF in type 2 diabetes. 6823 older individuals with overweight/obesity and metabolic syndrome participating in the PREDIMED-PLUS study, were assessed with a battery of cognitive tests and a medical interview. ANOVA showed a significantly worse performance on EF in type 2 diabetes vs. non-diabetic individuals. Two complementary models were displayed: (1) in the whole sample, the presence of type 2 diabetes, depressive symptoms and BMI had a direct negative effect on EF, while apnoea had an indirect negative effect; (2) in the diabetes subsample, higher illness duration was associated with worse performance in EF. Participants with type 2 diabetes and HbA1c<53 mmol/mol displayed better cognitive performance when compared to those with HbA1c≥53 mmol/mol. Our results provide a controlled comprehensive model that integrates relevant neuropsychological and physical variables in type 2 diabetes. The model suggests that, to improve treatment adherence and quality of life once diabetes has been diagnosed, cognitive decline prevention strategies need to be implemented while monitoring depressive symptoms, BMI and glycaemia control.

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