title: Cognitive Effects of Intentional Weight Loss in Elderly Obese Individuals With Mild Cognitive Impairment.
abstract: BACKGROUND
  Obesity in midlife is a risk factor for dementia, but it is unknown if caloric restriction-induced weight loss could prevent cognitive decline and therefore dementia in elderly patients with cognitive impairment.
  
  
  OBJECTIVE
  To evaluate the cognitive effect of intentional weight loss in obese elderly patients with mild cognitive impairment (MCI), considering the influence of age, apolipoprotein E (APOE) genotype, physical activity, biochemical markers, and diet.
  
  
  METHODS
  Single-center, prospective controlled trial.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  Eighty obese patients with MCI, aged 60 or older (68.1 ± 4.9 y, body mass index [BMI] 35.5 ± 4.4 kg/m(2), 83.7% women, 26.3% APOE allele ϵ4 carriers).
  
  
  METHODS
  Random allocation to conventional medical care alone (n = 40) or together with nutritional counselling (n = 40) in group meetings aiming to promote weight loss through caloric restriction for 12 months.
  
  
  METHODS
  clinical data, body composition, neuropsychological tests (main outcome), serum biomarkers, APOE genotype, physical performance, dietary recalls.
  
  
  RESULTS
  Seventy-five patients completed the follow-up. BMI, on average, decreased 1.7 ± 1.8 kg/m(2) (P = .021), and most of the cognitive tests improved, without difference between the groups. In analysis with linear generalized models, the BMI decrease was associated with improvements in verbal memory, verbal fluency, executive function, and global cognition, after adjustment for education, gender, physical activity, and baseline tests. This association was strongest in younger seniors (for memory and fluency) and in APOE allele ϵ4 carriers (for executive function). Changes in homeostasis model assessment-estimated insulin resistance, C-reactive protein, leptin and intake of energy, carbohydrates, and fats were associated with improvement in cognitive tests.
  
  
  CONCLUSIONS
  Intentional weight loss through diet was associated with cognitive improvement in patients with MCI.
authors.affiliation: Obesity and Metabolic Syndrome Group (N.C.H., E.L.M., A.H., M.E.d.M., M.C.M., C.C.), São Paulo University, School of Medicine; Psychology Division (V.T.S., M.R.P.G.), Hospital das Clínicas, São Paulo University; Institute of Psychiatry (S.S.S.), São Paulo University, School of Medicine; Nutrition Division (A.X.d.S., M.A.Z.), Clinical Hospital, São Paulo University, School of Medicine; Discipline of Geriatrics (M.M.d.B.d.F.), São Paulo University, School of Medicine; and Division of Clinical Immunology and Allergy (E.C.-N.), São Paulo University, School of Medicine, São Paulo, Brazil 01246-903.
authors.forename: Nidia Celeste
authors.initials: NC
authors.lastname: Horie
authors.affiliation: Obesity and Metabolic Syndrome Group (N.C.H., E.L.M., A.H., M.E.d.M., M.C.M., C.C.), São Paulo University, School of Medicine; Psychology Division (V.T.S., M.R.P.G.), Hospital das Clínicas, São Paulo University; Institute of Psychiatry (S.S.S.), São Paulo University, School of Medicine; Nutrition Division (A.X.d.S., M.A.Z.), Clinical Hospital, São Paulo University, School of Medicine; Discipline of Geriatrics (M.M.d.B.d.F.), São Paulo University, School of Medicine; and Division of Clinical Immunology and Allergy (E.C.-N.), São Paulo University, School of Medicine, São Paulo, Brazil 01246-903.
authors.forename: Valeria T
authors.initials: VT
authors.lastname: Serrao
authors.affiliation: Obesity and Metabolic Syndrome Group (N.C.H., E.L.M., A.H., M.E.d.M., M.C.M., C.C.), São Paulo University, School of Medicine; Psychology Division (V.T.S., M.R.P.G.), Hospital das Clínicas, São Paulo University; Institute of Psychiatry (S.S.S.), São Paulo University, School of Medicine; Nutrition Division (A.X.d.S., M.A.Z.), Clinical Hospital, São Paulo University, School of Medicine; Discipline of Geriatrics (M.M.d.B.d.F.), São Paulo University, School of Medicine; and Division of Clinical Immunology and Allergy (E.C.-N.), São Paulo University, School of Medicine, São Paulo, Brazil 01246-903.
authors.forename: Sharon Sanz
authors.initials: SS
authors.lastname: Simon
authors.affiliation: Obesity and Metabolic Syndrome Group (N.C.H., E.L.M., A.H., M.E.d.M., M.C.M., C.C.), São Paulo University, School of Medicine; Psychology Division (V.T.S., M.R.P.G.), Hospital das Clínicas, São Paulo University; Institute of Psychiatry (S.S.S.), São Paulo University, School of Medicine; Nutrition Division (A.X.d.S., M.A.Z.), Clinical Hospital, São Paulo University, School of Medicine; Discipline of Geriatrics (M.M.d.B.d.F.), São Paulo University, School of Medicine; and Division of Clinical Immunology and Allergy (E.C.-N.), São Paulo University, School of Medicine, São Paulo, Brazil 01246-903.
authors.forename: Maria Rita Polo
authors.initials: MR
authors.lastname: Gascon
authors.affiliation: Obesity and Metabolic Syndrome Group (N.C.H., E.L.M., A.H., M.E.d.M., M.C.M., C.C.), São Paulo University, School of Medicine; Psychology Division (V.T.S., M.R.P.G.), Hospital das Clínicas, São Paulo University; Institute of Psychiatry (S.S.S.), São Paulo University, School of Medicine; Nutrition Division (A.X.d.S., M.A.Z.), Clinical Hospital, São Paulo University, School of Medicine; Discipline of Geriatrics (M.M.d.B.d.F.), São Paulo University, School of Medicine; and Division of Clinical Immunology and Allergy (E.C.-N.), São Paulo University, School of Medicine, São Paulo, Brazil 01246-903.
authors.forename: Alessandra Xavier
authors.initials: AX
authors.lastname: Dos Santos
authors.affiliation: Obesity and Metabolic Syndrome Group (N.C.H., E.L.M., A.H., M.E.d.M., M.C.M., C.C.), São Paulo University, School of Medicine; Psychology Division (V.T.S., M.R.P.G.), Hospital das Clínicas, São Paulo University; Institute of Psychiatry (S.S.S.), São Paulo University, School of Medicine; Nutrition Division (A.X.d.S., M.A.Z.), Clinical Hospital, São Paulo University, School of Medicine; Discipline of Geriatrics (M.M.d.B.d.F.), São Paulo University, School of Medicine; and Division of Clinical Immunology and Allergy (E.C.-N.), São Paulo University, School of Medicine, São Paulo, Brazil 01246-903.
authors.forename: Maria Aquimara
authors.initials: MA
authors.lastname: Zambone
authors.affiliation: Obesity and Metabolic Syndrome Group (N.C.H., E.L.M., A.H., M.E.d.M., M.C.M., C.C.), São Paulo University, School of Medicine; Psychology Division (V.T.S., M.R.P.G.), Hospital das Clínicas, São Paulo University; Institute of Psychiatry (S.S.S.), São Paulo University, School of Medicine; Nutrition Division (A.X.d.S., M.A.Z.), Clinical Hospital, São Paulo University, School of Medicine; Discipline of Geriatrics (M.M.d.B.d.F.), São Paulo University, School of Medicine; and Division of Clinical Immunology and Allergy (E.C.-N.), São Paulo University, School of Medicine, São Paulo, Brazil 01246-903.
authors.forename: Marta Merenciana
authors.initials: MM
authors.lastname: Del Bigio de Freitas
authors.affiliation: Obesity and Metabolic Syndrome Group (N.C.H., E.L.M., A.H., M.E.d.M., M.C.M., C.C.), São Paulo University, School of Medicine; Psychology Division (V.T.S., M.R.P.G.), Hospital das Clínicas, São Paulo University; Institute of Psychiatry (S.S.S.), São Paulo University, School of Medicine; Nutrition Division (A.X.d.S., M.A.Z.), Clinical Hospital, São Paulo University, School of Medicine; Discipline of Geriatrics (M.M.d.B.d.F.), São Paulo University, School of Medicine; and Division of Clinical Immunology and Allergy (E.C.-N.), São Paulo University, School of Medicine, São Paulo, Brazil 01246-903.
authors.forename: Edecio
authors.initials: E
authors.lastname: Cunha-Neto
authors.affiliation: Obesity and Metabolic Syndrome Group (N.C.H., E.L.M., A.H., M.E.d.M., M.C.M., C.C.), São Paulo University, School of Medicine; Psychology Division (V.T.S., M.R.P.G.), Hospital das Clínicas, São Paulo University; Institute of Psychiatry (S.S.S.), São Paulo University, School of Medicine; Nutrition Division (A.X.d.S., M.A.Z.), Clinical Hospital, São Paulo University, School of Medicine; Discipline of Geriatrics (M.M.d.B.d.F.), São Paulo University, School of Medicine; and Division of Clinical Immunology and Allergy (E.C.-N.), São Paulo University, School of Medicine, São Paulo, Brazil 01246-903.
authors.forename: Emerson Leonildo
authors.initials: EL
authors.lastname: Marques
authors.affiliation: Obesity and Metabolic Syndrome Group (N.C.H., E.L.M., A.H., M.E.d.M., M.C.M., C.C.), São Paulo University, School of Medicine; Psychology Division (V.T.S., M.R.P.G.), Hospital das Clínicas, São Paulo University; Institute of Psychiatry (S.S.S.), São Paulo University, School of Medicine; Nutrition Division (A.X.d.S., M.A.Z.), Clinical Hospital, São Paulo University, School of Medicine; Discipline of Geriatrics (M.M.d.B.d.F.), São Paulo University, School of Medicine; and Division of Clinical Immunology and Allergy (E.C.-N.), São Paulo University, School of Medicine, São Paulo, Brazil 01246-903.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Halpern
authors.affiliation: Obesity and Metabolic Syndrome Group (N.C.H., E.L.M., A.H., M.E.d.M., M.C.M., C.C.), São Paulo University, School of Medicine; Psychology Division (V.T.S., M.R.P.G.), Hospital das Clínicas, São Paulo University; Institute of Psychiatry (S.S.S.), São Paulo University, School of Medicine; Nutrition Division (A.X.d.S., M.A.Z.), Clinical Hospital, São Paulo University, School of Medicine; Discipline of Geriatrics (M.M.d.B.d.F.), São Paulo University, School of Medicine; and Division of Clinical Immunology and Allergy (E.C.-N.), São Paulo University, School of Medicine, São Paulo, Brazil 01246-903.
authors.forename: Maria Edna
authors.initials: ME
authors.lastname: de Melo
authors.affiliation: Obesity and Metabolic Syndrome Group (N.C.H., E.L.M., A.H., M.E.d.M., M.C.M., C.C.), São Paulo University, School of Medicine; Psychology Division (V.T.S., M.R.P.G.), Hospital das Clínicas, São Paulo University; Institute of Psychiatry (S.S.S.), São Paulo University, School of Medicine; Nutrition Division (A.X.d.S., M.A.Z.), Clinical Hospital, São Paulo University, School of Medicine; Discipline of Geriatrics (M.M.d.B.d.F.), São Paulo University, School of Medicine; and Division of Clinical Immunology and Allergy (E.C.-N.), São Paulo University, School of Medicine, São Paulo, Brazil 01246-903.
authors.forename: Marcio C
authors.initials: MC
authors.lastname: Mancini
authors.affiliation: Obesity and Metabolic Syndrome Group (N.C.H., E.L.M., A.H., M.E.d.M., M.C.M., C.C.), São Paulo University, School of Medicine; Psychology Division (V.T.S., M.R.P.G.), Hospital das Clínicas, São Paulo University; Institute of Psychiatry (S.S.S.), São Paulo University, School of Medicine; Nutrition Division (A.X.d.S., M.A.Z.), Clinical Hospital, São Paulo University, School of Medicine; Discipline of Geriatrics (M.M.d.B.d.F.), São Paulo University, School of Medicine; and Division of Clinical Immunology and Allergy (E.C.-N.), São Paulo University, School of Medicine, São Paulo, Brazil 01246-903.
authors.forename: Cintia
authors.initials: C
authors.lastname: Cercato
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D003071:Cognition / Q000502:physiology*; D060825:Cognitive Dysfunction / Q000150:complications / Q000523:psychology*; D003376:Counseling; D056344:Executive Function / Q000502:physiology; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D008568:Memory / Q000502:physiology; D008875:Middle Aged; D009483:Neuropsychological Tests; D009765:Obesity / Q000150:complications / Q000523:psychology* / Q000628:therapy*; D015431:Weight Loss / Q000502:physiology*; D061217:Weight Reduction Programs