Cognitive Performance at Late Adolescence and the Risk for Impaired Fasting Glucose Among Young Adults

Abstract

Context:Although dysglycemia is a risk factor for cognitive decline, it is unknown whether cognitive performance among young and apparently healthy adults affect the risk for impaired fasting glucose (IFG).Objective: This study aimed to characterize the relationship between cognitive function and the risk for IFG among young adults. Design and Setting:This was a retrospective cohort study utilizing data collected at pre-military recruitment assessments with information collected at the screening center of Israeli Army Medical Corps.Participants: Normoglycemic adults (n ϭ 17 348) (free of IFG and diabetes; mean age 31.0 Ϯ 5.6 y; 87% men) of the Metabolic Lifestyle and Nutrition Assessment in Young Adults (MELANY) cohort with data regarding their General Intelligence Score (GIS), a comprehensive measure of cognitive function, at age 17 y.Interventions: Fasting plasma glucose was assessed every 3-5 y at scheduled visits. Cox proportional hazards models were applied. Main Outcomes Measures:The main outcome of the study was incident IFG (Ն100 mg/dL and Ͻ126 mg/dL) at scheduled visits.Results: During a median followup of 6.6 y, 1478 cases of IFG were recorded (1402 men). After adjustment for age and sex, participants in the lowest GIS category had a 1.9-fold greater risk for incident IFG compared with those in the highest GIS category. In multivariable analysis adjusted for age, sex, body mass index, fasting plasma glucose, family history of diabetes, country of origin, socioeconomic status, education, physical activity, smoking status, alcohol consumption, breakfast consumption, triglyceride level, white blood cell count, the risk for IFG was nearly doubled in the lowest GIS category compared with the highest GIS category (hazard ratio, 1.8; 95% confidence interval, 1.4 -2.3; P Ͻ .001). These results persisted when GIS was treated as a continuous variable and when the model was adjusted also for body mass index at the end of followup. Conclusions:This study demonstrates that lower cognitive function at late adolescence is independently associated with an elevated risk IFG in both men and women. (J Clin Endocrinol Metab

The chicken or the egg? Does glycaemic control predict cognitive function or the other way around?

“…This is consistent with previous studies by the same research group, where cognitive function at age 11 has been shown to be associated with type 2 diabetes status and HbA 1c levels at the age of 70 [29,30]. In line with this, lower cognitive function at late adolescence (age 17 years) has been associated with elevated risk for impaired fasting glucose and future type 2 diabetes [31,32]. Furthermore, Altschul et al [7] showed that poorer cognitive function at the age of 70 is associated with increasing HbA 1c levels over the following decade.…”

“…In addition, the findings by Altschul et al [7], along with others [29][30][31][32], support the concept that early-life cognitive function is associated with the risk for developing type 2 diabetes (or related characteristics, such as poor glycaemic control) in late life. This underlies the hypothesis that early adolescents with lower cognitive function may be at risk for developing type 2 diabetes later in life, and that there may be value in targeting preventive intervention strategies at this age group.…”

A socioeconomic and behavioral survey of patients with difficult-to-control type 2 diabetes mellitus reveals an association between diabetic retinopathy and educational attainment

“…It has been reported that lower cognitive function during late adolescence is independently associated with an elevated risk for impaired fasting glucose and diabetes 26,27. We demonstrated in our previous report that patients with T2DM tended to have a preference for risk-seeking compared to those with T1DM.…”

Brain function and structure and risk for incident diabetes: The Atherosclerosis Risk in Communities Study

“…[13–15] Investigators from the Metabolic, Lifestyle and Nutrition Assessment in Young Adults (MELANY) study observed that, among young Israeli adults, those with the lowest level of cognitive function had two-fold increased risk for developing diabetes or impaired fasting glucose, compared to individuals with the highest level of cognitive function after adjustment for diabetes risk factors. [14, 15] Data from Elderly Nutrition and Health Survey in Taiwan (NAHSIT Elderly) showed older women with cognitive impairment had a significant 2.4-fold greater risk for developing diabetes compared to those without cognitive impairment, while in elderly men this association was more modest and not statistically significant. [13] Several factors may have contributed to our finding that cognitive function was not associated with incident diabetes in the same magnitude as previously reported.…”

“…[13–15] However, determination of baseline brain health in these studies is limited to cognitive assessment only. Wechsler noted that factors not indicative of cognitive function per se, such as experience and familiarity with testing and socioeconomic structures, may influence performance on cognitive assessments.…”