Potential mediating effect of inflammation on the sex differences in cognition function in middle-aged and elderly individuals undergoing health checkups
10.3760/cma.j.cn115624-20241016-00823
- VernacularTitle:炎症在中老年体检人群认知功能性别差异中的潜在中介效应
- Author:
Jiwei JIANG
1
;
Yang LIU
1
;
Ying ZHANG
1
;
Juan LI
1
;
Yin HONG
1
;
Huaguang ZHENG
1
Author Information
1. 首都医科大学附属北京天坛医院健康管理中心，脑健康中心，北京 100070
- Publication Type:Journal Article
- Keywords:
Middle-aged and elderly adults;
Sex;
Cognition;
Inflammation;
Brain health;
Risk factors
- From:
Chinese Journal of Health Management
2025;19(8):597-604
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the mediating effect of the inflammation on the sex differences in cognitive function among middle-aged and elderly individuals receiving health checkups.Methods:This cross-sectional study consecutively collected data from 757 middle-aged and elderly individuals receiving health checkups at Beijing Tiantan Hospital, Capital Medical University between January 1, 2023 and December 31, 2023. The gender, age, body mass index (BMI), waist to hip ratio (WHR), educational years, medical history and personal history were collected. The Montreal Cognitive Assessment (MoCA) were performed to assess the cognitive function. Inflammation indicators included the single blood inflammatory markers [white blood cell (WBC), high sensitivity C-reactive protein (hs-CRP), interleukin (IL)-6, and erythrocyte sedimentation rate (ESR)], inflammatory markers derived from blood cell counts, including neutrophil-lymphocyte ratio (NLR), derived neutrophil-lymphocyte ratio (dNLR), monocyte-to-lymphocyte ratio (MLR), neutrophil-monocyte to lymphocyte ratio (NMLR), systemic inflammatory response index (SIRI), systemic immune-inflammation index (SII), and aggregate index of systemic inflammation (AISI); and inflammatory markers derived from blood cell counts and high-density lipoprotein cholesterol (HDL-C), including neutrophil to HDL-C ratio (NHR), monocyte to HDL-C ratio (MHR), lymphocyte to HDL-C ratio (LHR), and platelet to HDL-C ratio (PHR) were all recorded. The simple mediation effect model in the SPSS 29.0 PROCESS macro was used to analyze the mediation effects of the inflammation indicators on the gender differences in cognitive function among middle-aged and elderly individuals receiving health checkups.Results:Among the 757 health checkup population in the final analysis, 466 were male (61.56%), and 291 were female (38.44%), with a mean age of (54.24±8.42) years. The male had higher BMI, WHR, educational years, frequency of hypertension and diabetes mellitus, MoCA scores, and inflammation indicators, including hs-CRP, WBC, NLR, MLR, NMLR, SIRI, AISI, NHR, MHR, LHR and PHR than those in the female [(26.41±3.20) vs (24.32±3.06) kg/m 2, (0.93±0.05) vs (0.83±0.06), 12 (9, 16) vs 11 (8, 15) years, 37.77% vs 21.31%, 16.52% vs 8.93%, 26 (24, 28) vs 26 (22, 28) points, 0.81 (0.38, 1.61) vs 0.63 (0.27, 1.63) mg/L, 5.75 (4.96, 6.78) vs 5.08 (4.27, 6.05)×10 9/L, 2.06 (1.67, 2.64) vs 1.87 (1.50, 2.37), 0.21 (0.17, 0.25) vs 0.17 (0.13, 0.21), 2.26 (1.84, 2.88) vs 2.02 (1.68, 2.55), 0.71 (0.51, 1.01) vs 0.49 (0.35, 0.67), 153.43 (108.91, 220.63) vs 113.34 (78.06, 164.27), 0.16 (0.12, 0.20) vs 0.11 (0.08, 0.14), 0.02 (0.01, 0.02) vs 0.01 (0.01, 0.01), 0.08 (0.06, 0.01) vs 0.06 (0.04, 0.07), 9.33 (7.82, 11.33) vs 8.36 (6.37, 10.21)] (all P<0.05). ESR and dNLR levels in the male were both lower than those in the female [6 (2, 11) vs 11 (6, 18) mm/h, 0.87 (0.85, 0.89) vs 0.89 (0.87, 0.91)] (both P<0.05). The MoCA score was negatively correlated with age, WHR, hs-CRP, IL-6, NLR, dNLR, NMLR, SIRI, NHR ( r=-0.355, -0.103, -0.115, -0.085, -0.094, -0.078, -0.093, -0.074, -0.108), and positively correlated with educational years ( r=0.512) (all P<0.05). After adjustment for confounding factors, including age, BMI, WHR, educational years, hypertension, and diabetes mellitus, dNLR and NHR mediated 13.11% and 12.80% association between gender and MoCA scores, respectively; after adjustment for above-mentioned confounders adding hs-CRP and IL-6, dNLR mediated 13.07% association between gender and MoCA score (all P<0.05), whereas no significant mediating effect was found of NHR on this association. Conclusions:Inflammation performed potential mediating effect on the association between sex difference and cognitive function among middle-to-old aged health checkup population, and the sex difference in cognitive function was partly mediated by the dNLR and NHR.
