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Background <p>While metabolic syndrome (MetS) is a well-established driver of cognitive decline, conventional dichotomous diagnostic criteria fail to capture the cumulative and synergistic allostatic load of metabolic dysfunction. We investigated the longitudinal association between an age- and sex-standardized continuous MetS severity score and risk of incident dementia in a nationally Chinese cohort.</p> Methods <p>This prospective analysis utilized data from the China Health and Retirement Longitudinal Study. A continuous MetS score was calculated at baseline integrating waist circumference, triglycerides, high-density lipoprotein cholesterol, mean arterial pressure, and fasting blood glucose via validated linear models, and then quartiled (lowest quartile as reference). Incident dementia was ascertained during the Wave 4 follow-up using a rigorous, multidimensional diagnostic protocol. The dose–response relationship was evaluated using restricted cubic splines (RCS) and logistic regression.</p> Results <p>Among 4,920 dementia-free participants at baseline, 667 (13.56%) developed dementia over the follow-up. RCS modeling revealed a significant, linear dose–response association between increasing MetS scores and dementia risk. Each 1-SD increment in the MetS score was independently associated with a 12% higher risk of dementia (OR = 1.12, 95% CI: 1.01–1.24). Participants in the highest quartile group faced a 48% increased risk compared to those in the lowest quartile (OR = 1.48, 95% CI: 1.07–2.04). This risk amplification was uniquely pronounced among non-obese individuals (BMI &lt; 24 kg/m<sup>2</sup>; P-interaction = 0.378).</p> Conclusions <p>An elevated continuous MetS score is a robust, independent predictor of incident dementia in middle-aged and older adults. Transitioning from binary criteria to a continuous MetS metric provides a nuanced, dose-dependent assessment of dementia risk.</p>

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Association between continuous metabolic syndrome score and incident dementia: a longitudinal study of middle-aged and older Chinese adults

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月3日

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  • Ling Lin,
  • Hua Liu,
  • Dan Long,
  • Chaofeng Fan

摘要

Background

While metabolic syndrome (MetS) is a well-established driver of cognitive decline, conventional dichotomous diagnostic criteria fail to capture the cumulative and synergistic allostatic load of metabolic dysfunction. We investigated the longitudinal association between an age- and sex-standardized continuous MetS severity score and risk of incident dementia in a nationally Chinese cohort.

Methods

This prospective analysis utilized data from the China Health and Retirement Longitudinal Study. A continuous MetS score was calculated at baseline integrating waist circumference, triglycerides, high-density lipoprotein cholesterol, mean arterial pressure, and fasting blood glucose via validated linear models, and then quartiled (lowest quartile as reference). Incident dementia was ascertained during the Wave 4 follow-up using a rigorous, multidimensional diagnostic protocol. The dose–response relationship was evaluated using restricted cubic splines (RCS) and logistic regression.

Results

Among 4,920 dementia-free participants at baseline, 667 (13.56%) developed dementia over the follow-up. RCS modeling revealed a significant, linear dose–response association between increasing MetS scores and dementia risk. Each 1-SD increment in the MetS score was independently associated with a 12% higher risk of dementia (OR = 1.12, 95% CI: 1.01–1.24). Participants in the highest quartile group faced a 48% increased risk compared to those in the lowest quartile (OR = 1.48, 95% CI: 1.07–2.04). This risk amplification was uniquely pronounced among non-obese individuals (BMI < 24 kg/m2; P-interaction = 0.378).

Conclusions

An elevated continuous MetS score is a robust, independent predictor of incident dementia in middle-aged and older adults. Transitioning from binary criteria to a continuous MetS metric provides a nuanced, dose-dependent assessment of dementia risk.