OBJECTIVE To determine the prevalence of cognitive deficits and traditional diabetic complications and the association between metabolic factors and these outcomes. RESEARCH DESIGN AND METHODS We performed a cross-sectional study in severely obese individuals before bariatric surgery. Lean control subjects were recruited from a research website. Cognitive deficits were defined by the National Institutes of Health (NIH) Toolbox (<5th percentile for lean control subjects). Cardiovascular autonomic neuropathy (CAN) was defined by an expiration-to-inspiration (E-to-I) ratio of <5th percentile for lean control subjects. Retinopathy was based on retinal photographs and nephropathy on the estimated glomerular filtration rate (<60 mg/dL) and/or the albumin-to-creatinine ratio (ACR) (≥30 mg/g). NIH Toolbox, E-to-I ratio, mean deviation on frequency doubling technology testing, and ACR were used as sensitive measures of these outcomes. We used multivariable linear regression to explore associations between metabolic factors and these outcomes. RESULTS We recruited 138 severely obese individuals and 46 lean control subjects. The prevalence of cognitive deficits, CAN, retinopathy, and nephropathy were 6.5%, 4.4%, 0%, and 6.5% in lean control subjects; 22.2%, 18.2%, 0%, and 6.1% in obese participants with normoglycemia; 17.7%, 21.4%, 1.9%, and 17.9% in obese participants with prediabetes; and 25.6%, 31.9%, 6.1%, and 16.3% in obese participants with diabetes. Waist circumference was significantly associated with cognitive function (-1.48; 95% CI -2.38, -0.57) and E-to-I ratio (-0.007; 95% CI -0.012, -0.002). Prediabetes was significantly associated with retinal function (-1.78; 95% CI -3.56, -0.002). CONCLUSIONS Obesity alone is likely sufficient to cause cognitive deficits but not retinopathy or nephropathy. Central obesity is the key metabolic risk factor.

中文翻译：

---

严重肥胖者认知功能障碍和传统糖尿病并发症的患病率和决定因素。

目的确定认知缺陷和传统糖尿病并发症的患病率，以及代谢因子与这些结果之间的关联。研究设计和方法我们对减肥手术前的严重肥胖患者进行了横断面研究。瘦身控制对象是从研究网站招募的。认知缺陷是由美国国立卫生研究院（NIH）工具箱定义的（精益控制受试者的百分位数<5％）。瘦身对照受试者的呼气与吸气（E与I）之比<5个百分点定义了心血管自主神经病变（CAN）。视网膜病变基于视网膜照片，肾病基于估计的肾小球滤过率（<60 mg / dL）和/或白蛋白与肌酐比（ACR）（≥30mg / g）。NIH工具箱，E对I比，倍频技术测试的平均偏差和ACR被用作这些结果的敏感指标。我们使用多元线性回归来探讨代谢因素与这些结果之间的关联。结果我们招募了138名严重肥胖者和46名瘦身对照者。瘦弱对照组的认知缺陷，CAN，视网膜病变和肾病的患病率分别为6.5％，4.4％，0％和6.5％。患有高血糖症的肥胖参与者中，分别有22.2％，18.2％，0％和6.1％；患有糖尿病的肥胖参与者中的17.7％，21.4％，1.9％和17.9％；在肥胖的糖尿病患者中分别占25.6％，31.9％，6.1％和16.3％。腰围与认知功能（-1.48; 95％CI -2.38，-0.57）和E-I比（-0.007; 95％CI -0.012，-0.002）显着相关。糖尿病前期与视网膜功能显着相关（-1.78； 95％CI -3.56，-0.002）。结论仅肥胖症可能足以引起认知缺陷，但不足以引起视网膜病变或肾病。中枢肥胖是关键的代谢危险因素。