Abstract
Overweight and obesity constitute the fifth leading cause of preventable deaths worldwide. One pathway through which excess weight contributes to poor health outcomes is via inflammatory activity and changes in cognitive processes. Prior theory has proposed a vicious cycle whereby obesity potentiates inflammatory activity, which alters cognitive processes such as working memory, which in turn leads to a reduced ability to self-regulate and therefore manage weight. However, to date no longitudinal studies have examined this potential dynamic. In the current study, we addressed this gap by assessing the relations among fat mass, C-reactive protein (CRP), and working memory across time in a large sample of 8536 children followed through adolescence in the Avon Longitudinal Study of Parents and Children in the United Kingdom. Adiposity was quantified via dual emission x-ray absorptiometry (DEXA) at ages 9 and 15.5 years old, and inflammatory activity was indexed via circulating serum C-reactive protein (CRP) levels assessed with a high-sensitivity assay at those same ages. Working memory was assessed between these two time points, at age 10, permitting examination of the temporal relations between working memory, adiposity, and inflammatory activity. As hypothesized, we found that fat mass predicted later poor working memory, and this association was statistically mediated by CRP. Further, we found that poor working memory predicted greater subsequent fat mass and CRP, and the link between working memory and subsequent CRP was partially mediated by fat mass. These results thus could be taken to suggest the existence of a vicious cycle of mutually amplifying adiposity, inflammatory activity, and poor working memory over time.
Highlights
The growing prevalence of overweight and obesity has been called a global public health crisis (Karnik and Kanekar, 2012; Lobstein et al, 2004)
Many cognitive processes are related to both adiposity and inflammatory activity—for example, long-term memory (Harrison et al, 2014; Loprinzi and Frith, 2018; Marsland et al, 2008) or cognitive inhibition (Shields et al, 2020; Yang et al, 2018, 2019a)—we chose to focus on working memory rather than other cognitive processes because we recently found cross-sectional evidence for a statistical mediation of an association between body mass index and working memory by C-reactive protein (CRP; Yang et al, 2020)
Greater adiposity at age 9 was a significant predictor of worse working memory at age 10, r(6163) 1⁄4 À0.038, p 1⁄4 .003, and worse working memory at age 10 was a significant predictor of greater adiposity at age 15.5, r(4445) 1⁄4 À0.056, p < .001—suggestive of a small but significant bidirectional relationship between these variables that unfolds over time
Summary
The growing prevalence of overweight and obesity has been called a global public health crisis (Karnik and Kanekar, 2012; Lobstein et al, 2004). Overweight and obesity constitute the fifth leading cause of preventable deaths worldwide, responsible for 4.72 million deaths in 2017 (GBD 2017 Risk Factor Collaborators, 2018). These statistics have prompted a wealth of research aimed at understanding the health consequences and factors that contribute to the development or maintenance of adiposity (e.g., Cazettes et al, 2011; Shields et al, 2017; Slavich, 2015; Verbeken et al, 2013a; Yokum and Stice, 2013). To date no study has examined longitudinal relations between working memory, inflammatory activity, and adiposity, to provide support for the existence of a potential vicious cycle
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