The association between regional adiposity, cognitive function, and dementia-related brain changes: a systematic review

Ethel Boccara, Sapir Golan, Michal Schnaider Beeri

Research output: Contribution to journalReview articlepeer-review

10 Scopus citations


Background: Adiposity has been previously associated with cognitive impairment and Alzheimer’s disease and related disorders (ADRD). Body mass index (BMI) is the most common measure of global adiposity, but inconsistent results were found since it is a global measurement. BMI does not represent regional fat distribution which differs between sexes, race, and age. Regional fat distribution may contribute differently to cognitive decline and Alzheimer’s disease (AD)-related brain changes. Fat-specific targeted therapies could lead to personalized improvement of cognition. The goal of this systematic review is to explore whether regional fat depots, rather than central obesity, should be used to understand the mechanism underlying the association between adiposity and brain. Methods: This systematic review included 33 studies in the English language, conducted in humans aged 18 years and over with assessment of regional adiposity, cognitive function, dementia, and brain measures. We included only studies that have assessed regional adiposity using imaging technics and excluded studies that were review articles, abstract only or letters to editor. Studies on children and adolescents, animal studies, and studies of patients with gastrointestinal diseases were excluded. PubMed, PsychInfo and web of science were used as electronic databases for literature search until November 2022. Results: Based on the currently available literature, the findings suggest that different regional fat depots are likely associated with increased risk of cognitive impairment, brain changes and dementia, especially AD. However, different regional fat depots can have different cognitive outcomes and affect the brain differently. Visceral adipose tissue (VAT) was the most studied regional fat, along with liver fat through non-alcoholic fatty liver disease (NAFLD). Pancreatic fat was the least studied regional fat. Conclusion: Regional adiposity, which is modifiable, may explain discrepancies in associations of global adiposity, brain, and cognition. Specific regional fat depots lead to abnormal secretion of adipose factors which in turn may penetrate the blood brain barrier leading to brain damage and to cognitive decline.

Original languageEnglish
Article number1160426
JournalFrontiers in Medicine
StatePublished - 2023

Bibliographical note

Publisher Copyright:
Copyright © 2023 Boccara, Golan and Beeri.


The authors thank Marina Nissim (Milan Italy Funding). The authors are also grateful for the generosity of the LeRoy Schecter Foundation. Thanks to Marina Nissim for her generosity. This work was funded by National Institutes of Health grants R01-AG-034087, AG-053446, and AG-051545 (to MB).

FundersFunder number
Marina Nissim
National Institutes of HealthAG-051545, AG-053446, R01-AG-034087
LeRoy Schecter Foundation


    • Alzheimer’s disease
    • brain
    • cognition
    • dementia
    • fat distribution
    • liver
    • regional adiposity
    • visceral


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