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ORIGINAL ARTICLE

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

Morgana Mongraw-Chaffin

Corresponding Author

Morgana Mongraw-Chaffin

Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA

Correspondence

Morgana Mongraw-Chaffin, Population Health Reseach, MedStar Health Research Institute, 10980 Granchester Way, 7th Floor, Columbia, MD 21044-1065, USA.

Email: [email protected]

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Joni K. Evans

Joni K. Evans

Department of Biostatistics and Data Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA

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Heather M. Shappell

Heather M. Shappell

Department of Biostatistics and Data Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA

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Mark A. Espeland

Mark A. Espeland

Department of Biostatistics and Data Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA

Department of Geriatrics and Gerontology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA

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Kathleen M. Hayden

Kathleen M. Hayden

Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA

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First published: 20 July 2025

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.

CONFLICT OF INTEREST STATEMENT

The authors declared no conflicts of interest.

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