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Women whose waistline expands during midlife are more likely to develop dementia, according to a new study. An excessive accumulation of fat in the abdominal area in middle-aged women is a risk factor for cognitive decline, say scientists. The study, published in the journal Menopause, shows a woman's waist size could hold clues to their risk of cognitive decline as they age. Doctors say weight gain, especially around the waist, is common during the perimenopause and post-menopause period. Such gains, along with declining oestrogen levels that are common after menopause, are linked with decreases in insulin sensitivity and increases in inflammatory processes. The new study suggests that "central adiposity" - or the excessive accumulation of fat in the abdominal region - is also a risk factor for cognitive decline. Doctors say that, compared with overall body fat, visceral adipose tissue - the intra-abdominal fat tissue stored around several organs, including the stomach, intestines, and liver - has been associated with major health risks, including diabetes, high blood pressure, cardiovascular disease, and Alzheimer's disease. The increase in inflammatory markers because of visceral adiposity and decline in oestrogen with menopause seems to be a major factor in those disease processes. That has led researchers to believe that measures of central adiposity - such as the waist-to-hip ratio - may serve as "early and easily recognisable" markers of risk for both metabolic and cognitive dysfunction because oestrogen receptors in the brain are concentrated in regions serving executive function and memory. Previous clinical trials that attempted to link hormone therapy with cognition provided mixed results, depending on the age of the participants. That led researchers in the new study to further investigate the relationship between central adiposity, cognitive function, and hormone therapy exposure in early postmenopausal women. The research involved more than 700 women aged 42 to 58 who were less than 36 months post-natural menopause. The participants were then divided into three categories - those who received oral conjugated equine oestrogen, those who received transdermal estradiol, and those who received a placebo. Central adiposity was estimated by a measure of waist-to-hip ratio. The researchers concluded that women with a higher baseline waist-to-hip-ratio had poorer performance on all cognitive outcomes, with only changes in visual attention and executive function over the four-year study time frame. Study co-author Dr Taryn James, of the University of Wisconsin-Madison, said: "Central adiposity was not found to moderate hormone therapy when compared with placebo cognitive domain-specific outcomes." Based on the results, the researchers suggest that cognitive health effects should be investigated in early postmenopausal women, even those with low cardiovascular risk statuses. Dr Monica Christmas , associate medical director for The Menopause Society, welcomed the findings. She said: “Addressing modifiable risk factors early and often is critical to maintaining optimal health and independence as women age. The metabolic and cognitive changes that commonly occur during and after the menopause transition often catch women off guard and are more difficult to address after the diagnosis has been made." Dr Christmas added: "Instituting preventive lifestyle strategies before the menopause transition will result in longitudinal health gains and reduced morbidity and mortality.”
