Association between abdominal obesity and cognitive outcomes in middle-aged adults: a systematic review
Abstract
Objective: This systematic review aimed to evaluate the association between abdominal obesity and cognitive outcomes in middle-aged adults and to summarize the underlying biological mechanisms and potential modifying factors, with intervention evidence discussed as a complementary clinical perspective.
Methods: We systematically retrieved relevant literature published from January 2000 to May 2026 across PubMed, Embase, Web of Science, Cochrane Library and CNKI databases. Eligible observational and interventional studies focusing on middle-aged adults were included. Two independent researchers strictly completed study selection, data extraction and methodological quality assessment in accordance with the PRISMA 2020 reporting guidelines.
Results: A total of 96 qualified studies were finally included for systematic analysis. Abdominal obesity assessed by waist circumference, waist-to-hip ratio and other central adiposity indicators was consistently associated with poor cognitive performance and elevated risk of cognitive decline in middle-aged populations. Multiple biological mechanisms were involved, including chronic inflammation, oxidative stress, insulin resistance, neuroendocrine dysregulation, mitochondrial dysfunction and gut-brain axis imbalance. Dietary patterns, physical activity and sleep quality effectively modify this association, while genetic susceptibility and long-term chronic stress further increase cognitive impairment vulnerability. Lifestyle interventions…
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