Association of BMI and Cognitive Performance in the Diabetes Prevention Program Outcomes Study

Objective: This study aimed to examine the association of BMI with cognitive performance in individuals with diabetes or prediabetes. Methods: Among Diabetes Prevention Program Outcomes Study (DPPOS) participants, BMI was categorized as normal (< 25 kg/m²), overweight (25 to < 30 kg/m²), or obesity (≥ 30 kg/m²). Cognitive tests included the Brief Spanish English Verbal Learning Test (B-SEVLT) and the Digit Symbol Substitution test (DSST). The relationship between BMI at DPPOS Year 8 (Y8) visit and cognitive test scores at Y8, Y10, and Y15 visits was ascertained via linear mixed models accounting for repeated measures. Analogous models related BMI to Modified Mini-Mental State exam (3MS) score at Y15. Results: A total of 2285 participants (mean ± SD age 51.1 ± 10.0 years; 67.7% female; 31% with overweight; and 60% with obesity at DPPOS Y8) completed cognitive assessments. Those with overweight or obesity at Y8 had a slower decline in B-SEVLT immediate and delayed recall, compared with those with normal BMI; 3MS performance was higher among individuals with overweight or obesity compared to those with normal BMI at Y15. Conclusions: Among individuals with prediabetes or diabetes in DPPOS, overweight or obesity was associated with slower decline in verbal learning and memory compared with those with normal BMI.