Background: Fluid imbalance is associated with various clinical conditions, but the association between elevated extracellular-water to total-body-water (ECW/TBW) ratio, an indicator of fluid balance, and cognitive impairment is unknown. We aimed to investigate relationship between ECW/TBW ratio and cognitive function in type 2 diabetes mellitus.
Methods: This study was a cross-sectional design, comparing 1233 patients aged 61.4 ± 8.0 years from the Singapore Study of Macro-angiopathy and Micro-vascular Reactivity in Type 2 Diabetes (SMART2D) cohort. ECW/TBW was measured using bioelectrical impedance method. Cognitive function was assessed with Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Multiple linear regression was used to examine association between ECW/TBW and RBANS scores, adjusting for demographics, education, clinical covariates, and apolipoprotein E allele.
Results: In unadjusted analyses, there was an inverse dose-dependent association between ECW/TBW and RBANS total score. The associations persisted in fully adjusted model with β = -1.18 (95% confidence interval [CI] -2.19 to -0.17; P = 0.022) for slight edema and -2.33 (-3.99 to -0.67; P = 0.006) for edema. Slight edema and edema were significantly associated with reduced cognitive function in delayed memory and attention. There was significant association between edema but not slight edema, with reduced cognitive function in language. Pulse pressure accounted for 16.8% of association between ECW/TBW and RBANS total score.
Conclusions: Our novel finding of an independent association between higher ECW/TBW and poorer cognitive function highlights the potential importance of maintaining body fluid balance in the management of cognitive impairment.
背景: 体液失衡与多种临床症状有关, 但作为体液平衡指标的细胞外液/全身水比值(ECW/TBW)升高与认知功能损害之间的关系尚不清楚。本研究旨在探讨2型糖尿病患者ECW/TBW比值与认知功能的关系。 方法: 本研究采用横断面设计, 比较了新加坡2型糖尿病大血管病变和微血管反应性研究(SMART2D)队列的1233例患者, 年龄在61.4±8.0岁。采用生物电阻抗法测量ECW/TBW。认知功能采用可重复使用的神经心理状态评定量表(RBANS)进行评定。在校正了人口统计学、教育程度、临床协变量和载脂蛋白E等位基因后, 采用多元线性回归来检验ECW/TBW和RBANS评分之间的相关性。 结果: 在非校正分析中, ECW/TBW与RBANS总分呈剂量负相关。这种关联持续存在于完全校正轻度水肿β=− 1.18(95% 置信区间 [CI] −2.19 to −0.17; P = 0.022)和水肿β= −2.33 (−3.99 to −0.67; P = 0.006) 的模型中。轻度水肿和水肿与延迟记忆和注意力的认知功能降低显著相关。语言认知功能下降与水肿之间有显著的相关性。脉搏压可解释ECW/TBW与RBANS总分相关性的16.8%。 结论: 我们首次发现较高的ECW/TBW和较差的认知功能之间存在独立的关联, 这突出了在认知障碍的管理中保持体液平衡的潜在重要性。.
Keywords: body composition; diabetes complications; diabetes mellitus; 糖尿病; 糖尿病并发症; 身体成分.
© 2020 Ruijin Hospital, Shanghai JiaoTong University School of Medicine and John Wiley & Sons Australia, Ltd.