Impact of Abdominal Obesity on Dementia, FI, and CVD in Older Chinese Adults: A Markov Scenario

07 Apr 20265 min read0 viewsJournal Feed

GIST

by Yujing Zhou, Minrui Zeng, Yuntao Chen, Piotr Bandosz, Eric Brunner, Jing Liao Background Dementia, cardiovascular disease (CVD), and functional impairment (FI) often co-occur in aging populations, with abdominal obesity as a shared modifiable risk factor. The long-term impact of abdominal obesity on these comorbidities is unclear.

We projected the 30-year burden of dementia, FI, and CVD in China under different trajectories of abdominal obesity prevalence. Methods and findings We modeled three trajectories of abdominal obesity prevalence from 2020 to 2050 using data from the China Health and Nutrition Survey (2000–2015): continuation of the observed growth prevalence trend (persistent), stabilization at 2015 levels (optimal), and a 50% reduction in the growth rate (improved).

Abdominal obesity was defined as a waist circumference of ≥90 cm for men and ≥85 cm for women.

Clinical Editorial

Abdominal Obesity Scenarios and Model Basis

The study uses three trajectories for abdominal obesity prevalence in adults aged ≥65 in China from 2020–2050: continued growth (persistent), stabilization at 2015 levels (optimal), and a 50% reduction in growth rate (improved).
Abdominal obesity is defined as waist circumference ≥90 cm in men and ≥85 cm in women.
A Markov model estimates the annual risk of dementia, cardiovascular disease (CVD), functional impairment (FI), and mortality by sex and year, projecting outcomes through 2050.
Baseline data come from the China Health and Nutrition Survey (2000–2015).

Key Burden Projections and Comparative Signals

Under the persistent scenario, dementia cases are projected to reach about 37.8 million by 2050, FI around 68.1 million, CVD about 198.3 million, and deaths near 17.6 million.
Compared with the persistent trend, scenarios with improved or optimal abdominal obesity trajectories show higher dementia and FI burdens by 2050, driven in part by reductions in CVD mortality that increase longevity and expand the population at risk.
The incremental dementia burden under optimal and improved scenarios by 2050 is roughly 1.4 million and 0.7 million cases, respectively, while FI increases are about 2.6 million and 1.3 million, in the same respective comparisons.
The shifts in dementia and FI burdens are most pronounced among those aged ≥80 years and among women.
For CVD, projected gains or reductions in case numbers are more favorable in the short term (through 2030) but remain uncertain by 2050.

Context on CVD, Mortality, and Disease Transition

Reductions in CVD mortality under the abdominal obesity reduction scenarios contribute to greater population longevity, which in turn elevates the potential years lived with dementia and FI.
The analysis emphasizes a trade-off where decreasing abdominal obesity may lower CVD incidence and deaths earlier, yet longer survival increases exposure to neurodegenerative and functional decline in later life.

Limitations and Interpretive Boundaries

The model assumes other risk factors remain constant over time.
It does not model multiple co-occurring dementia risk factors beyond abdominal obesity, limiting the capture of complex etiologies.
Uncertainty remains, particularly regarding long-term CVD trends through 2050.

Implications for Public Health Strategy

Findings suggest abdominal obesity control could shift disease burden from CVD toward dementia and FI, owing to extended longevity.
Results support integrated, life-course public health approaches that address dementia and its comorbidities alongside obesity, with attention to accelerating aging populations and sex- and age-specific patterns.