Short‐term associations between metabolic heterogeneity of obesity and cognitive frailty transitions: An ongoing Chinese elderly cohort study

Abstract Aims To clarify the association between metabolic heterogeneity of obesity and cognitive frailty (CF) progression and assess the reversibility of CF through early identification of reversible cognitive frailty (RCF). Materials and Methods This ongoing community‐based cohort (Tianjin, China; 2023–2024) included 3048 older adults (mean age 68.0 years, 56.9% female) with annual cognitive assessments. Multistate Markov models quantified transition probabilities and hazard ratios between non‐CF (NCF), RCF and CF across four metabolic phenotypes of obesity: metabolically healthy normal weight (MHNW), metabolically unhealthy normal weight (MUNW), metabolically healthy overweight/obesity (MHOO), and metabolically unhealthy overweight/obesity (MUOO). Results Over 12 months of follow‐up, RCF showed bidirectional transitions with 0.535 reversion to NCF and 0.066 progression to CF. The transition probabilities of NCF progressing to RCF and CF were 0.232 and 0.055, respectively. MUOO demonstrated the highest probability of direct progression from NCF to CF (0.079). MHOO showed elevated short‐term transition risk, with the higher probability from NCF to RCF (0.209) and RCF to CF (0.086) than MHNW. Compared with MHNW, MHOO increased the risk of transitioning from NCF to RCF (HR, 1.65, 95% CI, 1.00–2.73), while MUOO significantly amplified the risk from NCF to CF (HR, 3.15, 95% CI, 1.46–6.80). Conclusions These preliminary findings emphasize the bidirectional nature of RCF transitions in Chinese older adults, highlighting its importance as an intervention window. Metabolic status demonstrates a strong association with obesity‐related CF progression. MUOO correlates with irreversible decline, whereas MHOO is linked to accelerated early stage transitions. Tailored interventions targeting metabolic health in obese older adults may mitigate cognitive frailty risks and optimize outcomes.