Is Cognition Affected by Obesity/Metabolic Disease?

A recent provocative study : “Childhood Metabolic Biomarkers Are Associated with Performance on Cognitive Tasks in Young Children” ALB Shapiro et al. J Pediatr 2019; 211: 92-7

Methods: Data were obtained from children (n=137, 4.6 years old on average) participating in the Healthy Start study, a pre-birth cohort in Colorado. This included metabolic markers (HOMA-IR, glucose, insulin) and cognitive performance markers (Flanker task, Dimensional Change Card Sort test (which assesses cognitive flexibility), and Picture Vocabulary test).

Key findings:

  • HOMA-IR, glucose, and insulin were all inversely significantly-associated with cognitive flexibility testing. Thus, the authors found that “greater blood biomarkers of poor metabolic health are related to lower cognitive flexibility and inhibitory control in healthy, young children.”

Discussion:

  • The authors note that their findings “contribute to the large body of literature in children with overt type 1 and type 2 diabetes that demonstrates consistent and negative effects of poor metabolic health on cognition.”
  • The metabolic effects on cognition may be more critical in childhood due to brain maturation as well as potential for longer exposure periods.  However, studies from adults indicate that “adults without overt diabetes, the cumulative burden of metabolic conditions (eg. obesity, hyperglycemia) was significantly associated with lower cognitive scores.”

My take: While the effects of metabolic disease on cardiovascular disease is well-recognized, this study adds to the body of knowledge that indicates the potential harm of metabolic disease on the brain as well.

Near Chattahoochee River

Nutrition Week (Day 5) What a Gastrostomy Tube Means for Cognition

Looking at a retrospective cohort of 194 neonates, a recent study (SR Jadcherla et al. J Pediatr 2017; 181: 125-30) showed that infants discharged with a gastrostomy tube (Gtube) had associated lower cognitive outcomes.

The authors examined discharge milestones along with Bayley Scales of Infant Development (3rd edition) at 18-24 months of age.

Key findings:

  • 60% of infants (n=117) were discharged on oral feedings and 96% remained oral-fed at 1 year.
  • 40% (n=77) were discharged on gastrostomy feedings.31 (40%) remained fully Gtube dependent, 17 (22%) were orally-fed, and 29 (38%) were on oral/gtube combination.
  • Gtube feedings at discharge were a marker for lower cognition (P<0.01), communication (P=0.03) and motor (P<0.01) composite scores at 18-24 months of age.
  • Other factors associated with neurodevelopmental delay included intraventricular hemorrhage, younger gestational age, and bronchopulmonary dysplasia.

My take: This study provides evidence for an expected finding –infants who need gtubes have poorer neurodevelopmental outcomes than infants who do not need gtubes.

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Thanks to an Olive Oyl fan for this picture

Thanks to an Olive Oyl fan for this picture