Association Between Components of Metabolic Syndrome and Cognitive Impairment among Middle-Aged and Elderly in Indonesia: A Nationwide Survey
Article History
Submited : December 24, 2021
Published : January 19, 2022
Cognitive impairment is common among population worldwide which become an increasingly important health issue related with aging. Indonesia is one of low-middle income countries with reach the era of aging, as the population aged 60 years and over is 10.0% in 2020.The purpose of this study was to investigate associations between components of metabolic syndrome (MetS) and cognitive impairment among middle-aged and elderly Indonesians. Cognitively impaired was measured with the questionnaire derived from the instrument of telephone interview for cognitive status (TICS). Analysis of covariance was used to examine the differences and multivariate with logistic regression analysis of the odds of cognitive impairment. Setting on this study was using The Indonesia Family Life Survey (IFLS)-5 conducted in 2014-2015 with 1532 participants were placed into middle-aged and elderly. This study found that central obesity and dyslipidemia were less likely to have cognitive impairment among middle-aged and elderly. (OR adjusted for age and sex 0.67; 95% CI 0.37~1.20; p=0.175). In conclucion, central obesity and dyslipidemia were less likely to have cognitive impairment among middle-aged and elderly in Indonesia. Our findings suggest that middle-aged people should manage their waist circumference in order to prevent cognitive impairment as they age.
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31. Borshchev, Y.Y.; Uspensky, Y.P.; Galagudza, M.M. Pathogenetic pathways of cognitive dysfunction and dementia in metabolic syndrome. Life sciences 2019, 237, 116932.
32. Vidyanti, A.N.; Hardhantyo, M.; Wiratama, B.S.; Prodjohardjono, A.; Hu, C.-J. Obesity Is Less Frequently Associated with Cognitive Impairment in Elderly Individuals: A Cross-Sectional Study in Yogyakarta, Indonesia. Nutrients 2020, 12, 367.
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35. Grundman, M.; Corey-Bloom, J.; Jernigan, T.; Archibald, S.; Thal, L. Low body weight in Alzheimer's disease is associated with mesial temporal cortex atrophy. Neurology 1996, 46, 1585-1591.
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40. Chang, Y.-C.; Hua, S.-C.; Chang, C.-H.; Kao, W.-Y.; Lee, H.-L.; Chuang, L.-M.; Huang, Y.-T.; Lai, M.-S. High TSH level within normal range is associated with obesity, dyslipidemia, hypertension, inflammation, hypercoagulability, and the metabolic syndrome: a novel cardiometabolic marker. Journal of clinical medicine 2019, 8, 817.
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42. Mehra, A.; Suri, V.; Kumari, S.; Avasthi, A.; Grover, S. Association of Mild Cognitive impairment and Metabolic Syndrome in patients with Hypertension. Asian Journal of Psychiatry 2020, 102185.
43. Cheong, K.C.; Ghazali, S.M.; Hock, L.K.; Subenthiran, S.; Huey, T.C.; Kuay, L.K.; Mustapha, F.I.; Yusoff, A.F.; Mustafa, A.N. The discriminative ability of waist circumference, body mass index and waist-to-hip ratio in identifying metabolic syndrome: Variations by age, sex and race. Diabetes & Metabolic Syndrome: Clinical Research & Reviews 2015, 9, 74-78, doi:https://doi.org/10.1016/j.dsx.2015.02.006.
44. Atti, A.R.; Valente, S.; Iodice, A.; Caramella, I.; Ferrari, B.; Albert, U.; Mandelli, L.; De Ronchi, D.J.T.A.J.o.G.P. Metabolic syndrome, mild cognitive impairment, and dementia: A meta-analysis of longitudinal studies. 2019, 27, 625-637.
2. Fox, A.; Feng, W.; Asal, V. What is driving global obesity trends? Globalization or “modernization”? Globalization and Health 2019, 15, 32, doi:10.1186/s12992-019-0457-y.
3. Agency, C.I. The world factbook: Indonesia. 2017.
4. UNFPA, B.B. Indonesia Population Projection 2010-2035. 2013.
5. Oddo, V.M.; Maehara, M.; Rah, J.H. Overweight in Indonesia: an observational study of trends and risk factors among adults and children. BMJ open 2019, 9, e031198.
6. Rachmi, C.; Li, M.; Baur, L.A. Overweight and obesity in Indonesia: prevalence and risk factors—a literature review. Public Health 2017, 147, 20-29.
7. Unit, E.I. Tackling obesity in ASEAN: Prevalence, impact, and guidance on interventions. Asia Roundtable Food Innov Improv Nutr [Internet] 2017.
8. Schröders, J.; Wall, S.; Hakimi, M.; Dewi, F.S.T.; Weinehall, L.; Nichter, M.; Nilsson, M.; Kusnanto, H.; Rahajeng, E.; Ng, N. How is Indonesia coping with its epidemic of chronic noncommunicable diseases? A systematic review with meta-analysis. PloS one 2017, 12, e0179186.
9. Maharani, A.; Tampubolon, G. National economic development status may affect the association between central adiposity and cognition in older adults. PloS one 2016, 11, e0148406.
10. Perona, J.S.; Schmidt Rio‐Valle, J.; Ramírez‐Vélez, R.; Correa‐Rodríguez, M.; Fernández‐Aparicio, Á.; González‐Jiménez, E. Waist circumference and abdominal volume index are the strongest anthropometric discriminators of metabolic syndrome in Spanish adolescents. European journal of clinical investigation 2019, 49, e13060.
11. United Nations, D.o.E.a.S.A., Population Division. World Population Ageing - Highlights (ST/ESA/SER.A/368). 2015.
12. Statistik, B.P.J.D.d.h.s.b.g.i.i.p.d.p. Survei Penduduk Antar Sensus (SUPAS). 2016.
13. Kemenkes, R.J.O.h.w.d.g.i.r.d.i.-t.m.r.H.R. Hasil utama RISKESDAS 2018. 2018, 202018.
14. J. Strauss, F.W., and B. Sikoki. The Fifh Wave of the Indonesia Family Life Survey (IFLS5): Overview and Field Report. 2016, 1.
15. Alberti, K.G.; Eckel, R.H.; Grundy, S.M.; Zimmet, P.Z.; Cleeman, J.I.; Donato, K.A.; Fruchart, J.C.; James, W.P.; Loria, C.M.; Smith, S.C., Jr. 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, doi:10.1161/circulationaha.109.192644.
16. Brandt, J.; Spencer, M.; Folstein, M. The Telephone Interview for Cognitive Status. Cognitive and Behavioral Neurology 1988, 1.
17. Fong, T.G.; Fearing, M.A.; Jones, R.N.; Shi, P.; Marcantonio, E.R.; Rudolph, J.L.; Yang, F.M.; Kiely, D.K.; Inouye, S.K. Telephone interview for cognitive status: Creating a crosswalk with the Mini-Mental State Examination. Alzheimers Dement 2009, 5, 492-497, doi:10.1016/j.jalz.2009.02.007.
18. Indonesia, D.J.D.K.R. Masyarakat DG Petunjuk Teknis Pemantauan Status Gizi Orang Dewasa Dengan Indeks Massa Tubuh. 27.
19. González, P.; Nuñez, A.; Merz, E.; Brintz, C.; Weitzman, O.; Navas, E.L.; Camacho, A.; Buelna, C.; Penedo, F.J.; Wassertheil-Smoller, S., et al. Measurement properties of the Center for Epidemiologic Studies Depression Scale (CES-D 10): Findings from HCHS/SOL. Psychological assessment 2017, 29, 372-381, doi:10.1037/pas0000330.
20. Kilburn, K.; Prencipe, L.; Hjelm, L.; Peterman, A.; Handa, S.; Palermo, T. Examination of performance of the Center for Epidemiologic Studies Depression Scale Short Form 10 among African youth in poor, rural households. BMC psychiatry 2018, 18, 201.
21. Pengpid, S.; Peltzer, K.; Susilowati, I.H. Cognitive Functioning and Associated Factors in Older Adults: Results from the Indonesian Family Life Survey-5 (IFLS-5) in 2014-2015. Curr Gerontol Geriatr Res 2019, 2019, 4527647-4527647, doi:10.1155/2019/4527647.
22. Liu, X.; Zhang, D.; Liu, Y.; Sun, X.; Han, C.; Wang, B.; Ren, Y.; Zhou, J.; Zhao, Y.; Shi, Y., et al. Dose-Response Association Between Physical Activity and Incident Hypertension: A Systematic Review and Meta-Analysis of Cohort Studies. Hypertension 2017, 69, 813-820, doi:10.1161/hypertensionaha.116.08994.
23. Isaura, E.R.; Chen, Y.-C.; Yang, S.-H. The Association of Food Consumption Scores, Body Shape Index, and Hypertension in a Seven-Year Follow-Up among Indonesian Adults: A Longitudinal Study. International Journal of Environmental Research and Public Health 2018, 15, 175.
24. Feinkohl, I.; Janke, J.; Hadzidiakos, D.; Slooter, A.; Winterer, G.; Spies, C.; Pischon, T. Associations of the metabolic syndrome and its components with cognitive impairment in older adults. BMC geriatrics 2019, 19, 77.
25. Lin, E.; Yang, A.C.; Tsai, S.-J. Association between metabolic syndrome and cognitive function in old adults in a Taiwanese population. 2017, 31, 232-240+ iv.
26. Liu, Z.; Yang, H.; Chen, S.; Cai, J.; Huang, Z. The association between body mass index, waist circumference, waist–hip ratio and cognitive disorder in older adults. Journal of Public Health 2018, 41, 305-312, doi:10.1093/pubmed/fdy121 %J Journal of Public Health.
27. Lee, Y.; An, J. Sex Differences in Risk Factors for Metabolic Syndrome in the Korean Population. International Journal of Environmental Research and Public Health 2020, 17, 9513.
28. Bonomini, F.; Rodella, L.F.; Rezzani, R. Metabolic syndrome, aging and involvement of oxidative stress. Aging and disease 2015, 6, 109.
29. Kazlauskaite, R.; Janssen, I.; Wilson, R.S.; Appelhans, B.M.; Evans, D.A.; Arvanitakis, Z.; El Khoudary, S.R.; Kravitz, H.M. Is midlife metabolic syndrome associated with cognitive function change? The Study of Women’s Health Across the Nation. The Journal of Clinical Endocrinology & Metabolism 2020, 105, e1093-e1105.
30. Yi, Y.; An, J. Sex Differences in Risk Factors for Metabolic Syndrome in the Korean Population. International Journal of Environmental Research and Public Health 2020, 17, 9513.
31. Borshchev, Y.Y.; Uspensky, Y.P.; Galagudza, M.M. Pathogenetic pathways of cognitive dysfunction and dementia in metabolic syndrome. Life sciences 2019, 237, 116932.
32. Vidyanti, A.N.; Hardhantyo, M.; Wiratama, B.S.; Prodjohardjono, A.; Hu, C.-J. Obesity Is Less Frequently Associated with Cognitive Impairment in Elderly Individuals: A Cross-Sectional Study in Yogyakarta, Indonesia. Nutrients 2020, 12, 367.
33. Strandberg, T.E.; Stenholm, S.; Strandberg, A.Y.; Salomaa, V.V.; Pitkälä, K.H.; Tilvis, R.S. The “obesity paradox,” frailty, disability, and mortality in older men: a prospective, longitudinal cohort study. American journal of epidemiology 2013, 178, 1452-1460.
34. Wang, X.; Luan, D.; Xin, S.; Liu, Y.; Gao, Q. Association Between Individual Components of Metabolic Syndrome and Cognitive Function in Northeast Rural China. American Journal of Alzheimer's Disease & Other Dementiasr 2019, 34, 507-512, doi:10.1177/1533317519865428.
35. Grundman, M.; Corey-Bloom, J.; Jernigan, T.; Archibald, S.; Thal, L. Low body weight in Alzheimer's disease is associated with mesial temporal cortex atrophy. Neurology 1996, 46, 1585-1591.
36. Forny-Germano, L.; De Felice, F.G.; Vieira, M.N.d.N.J.F.i.n. The role of leptin and adiponectin in obesity-associated cognitive decline and Alzheimer’s disease. 2019, 12, 1027.
37. Feinkohl, I.; Janke, J.; Slooter, A.J.; Winterer, G.; Spies, C.; Pischon, T.J.P. Plasma leptin, but not adiponectin, is associated with cognitive impairment in older adults. 2020, 120, 104783.
38. Mejido, D.C.; Andrade, J.; Vieira, M.N.; Ferreira, S.T.; De Felice, F.G.J.N. Insulin and leptin as potential cognitive enhancers in metabolic disorders and Alzheimer's disease. 2020, 108115.
39. Hou, Q.; Guan, Y.; Yu, W.; Liu, X.; Wu, L.; Xiao, M.; Lü, Y. Associations between obesity and cognitive impairment in the Chinese elderly: an observational study. Clin Interv Aging 2019, 14, 367-373, doi:10.2147/CIA.S192050.
40. Chang, Y.-C.; Hua, S.-C.; Chang, C.-H.; Kao, W.-Y.; Lee, H.-L.; Chuang, L.-M.; Huang, Y.-T.; Lai, M.-S. High TSH level within normal range is associated with obesity, dyslipidemia, hypertension, inflammation, hypercoagulability, and the metabolic syndrome: a novel cardiometabolic marker. Journal of clinical medicine 2019, 8, 817.
41. Tamura, Y.; Omura, T.; Toyoshima, K.; Araki, A.J.N. Nutrition Management in Older Adults with Diabetes: A Review on the Importance of Shifting Prevention Strategies from Metabolic Syndrome to Frailty. 2020, 12, 3367.
42. Mehra, A.; Suri, V.; Kumari, S.; Avasthi, A.; Grover, S. Association of Mild Cognitive impairment and Metabolic Syndrome in patients with Hypertension. Asian Journal of Psychiatry 2020, 102185.
43. Cheong, K.C.; Ghazali, S.M.; Hock, L.K.; Subenthiran, S.; Huey, T.C.; Kuay, L.K.; Mustapha, F.I.; Yusoff, A.F.; Mustafa, A.N. The discriminative ability of waist circumference, body mass index and waist-to-hip ratio in identifying metabolic syndrome: Variations by age, sex and race. Diabetes & Metabolic Syndrome: Clinical Research & Reviews 2015, 9, 74-78, doi:https://doi.org/10.1016/j.dsx.2015.02.006.
44. Atti, A.R.; Valente, S.; Iodice, A.; Caramella, I.; Ferrari, B.; Albert, U.; Mandelli, L.; De Ronchi, D.J.T.A.J.o.G.P. Metabolic syndrome, mild cognitive impairment, and dementia: A meta-analysis of longitudinal studies. 2019, 27, 625-637.
Ardiansyah, S., Wiratama, B. S., & Lin, S.-H. (2022). Association Between Components of Metabolic Syndrome and Cognitive Impairment among Middle-Aged and Elderly in Indonesia: A Nationwide Survey. Journal of Global Nutrition, 1(2), 56-65. https://doi.org/10.53823/jgn.v1i2.19
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