Association of body composition trajectories with changes in cognitive performance in the Look AHEAD study

Abstract Objective The objective of this study was to investigate the longitudinal association of total body fat and appendicular lean mass (ALM), as well as sarcopenia, with cognitive decline after weight loss intervention. Methods Among 972 Look AHEAD‐MIND participants with type 2 diabetes and overweight or obesity, we investigated the longitudinal association of dual‐energy x‐ray absorptiometry body composition trajectories with cognitive change. We identified three latent trajectories each for total body fat and ALM. Mixed linear regression models were adjusted for the following: repeated measures; order of cognitive test; years from randomization; randomization arm; age; sex; race and ethnicity; and education. We also investigated differences in cognitive score by sarcopenia and BMI categories. Results A gradual decrease in total body fat and no decrease in ALM were significantly independently associated with higher cognitive scores compared with other trajectories. Differences in cognitive score were large for sarcopenia, but not for obesity. Full adjustment for demographic and socioeconomic factors substantially attenuated the estimates. Conclusions Weight loss approaches that preserve ALM and function may lead to reduced cognitive decline compared with weight loss alone. The improved ability to target interventions toward those who are more resilient to aging‐related body composition changes may prevent unintended consequences of weight loss.