Associations of Visceral Obesity Indices and Risk of Mild Cognitive Impairment in Patients With Diabetes: A Retrospective Cohort Study.

Abstract

This study aimed to investigate the associations between visceral obesity indices and the risk of mild cognitive impairment (MCI) in patients with diabetes and to identify the most valuable visceral obesity index to develop a risk assessment nomogram. We explored the relationship between visceral obesity indices and MCI risk in patients with diabetes and developed a nomogram utilising a cohort of 1080 patients from Nanjing Drum Tower Hospital. MCI was diagnosed according to the criteria recommended by the National Institute on Aging-Alzheimer's Association Workgroup. Logistic regression models were used to identify factors independently associated with MCI in the cohort. Furthermore, the nomogram was externally validated by a multicenter retrospective cohort (Cohort 2) and a prospective cohort with a follow-up period of up to 10 years (Cohort 3). We identified a positive but non-linear dose-response relationship between visceral obesity indices and the risk of MCI in patients with diabetes. Compared with a body shape index (ABSI), visceral adiposity index (VAI), lipid accumulation product (LAP) and Chinese visceral adiposity index (CVAI), body roundness index (BRI) exhibited superior discriminative ability (AUC: 0.734, 95% CI: 0.703-0.764). The nomogram constructed from BRI, age, education and haemoglobin A1c (HbA1c) achieved an optimal AUC of 0.804 (95% CI: 0.777-0.830) in the internal validation cohort. The model exhibited consistent performance across external validations, yielding a discriminative AUC of 0.756 (95% CI: 0.722-0.790) in Cohort 2 and a 10-year predictive AUC of 0.762 (95% CI: 0.727-0.797) in Cohort 3. Higher visceral obesity indices were associated with an increased risk of MCI in patients with diabetes. Assessment of visceral obesity may help identify patients with diabetes who are at a high risk of MCI.