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      An association study between epicardial fat thickness and cognitive impairment in the elderly

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          Abstract

          The amount of fat surrounding the heart, called epicardial adipose tissue (EAT), is a marker of cardiometabolic risk and correlates with the quantity of visceral adipose tissue (VAT). The amount of VAT is associated with an increased risk of cardiovascular and cerebrovascular disease and with cognitive impairment. We aimed to evaluate the association between EAT thickness as a measure of VAT and cognitive function. In 71 elderly subjects (mean age 72.7 ± 7.1 yr) we measured EAT thickness through transthoracic echocardiography, assessed the metabolic profile through evaluation of biochemical parameters, and estimated the cognitive function via the Mini Mental State Examination (MMSE). We found that greater EAT thickness was associated with lower cognitive performance evaluated by MMSE ( P < 0.01) independently of the presence or absence of metabolic syndrome or obesity. Lower MMSE results were also associated with the presence of metabolic syndrome ( P < 0.01), elevated HOMA index ( P < 0.01), and high BMI values ( P < 0.01). The results of mediation analysis confirmed that the total effect of metabolic syndrome, HOMA, and BMI on MMSE is mainly explained by an indirect effect through EAT thickness. In conclusion, increased EAT thickness assessed by transthoracic echocardiography is associated with deficient results of psychometric tests assessing cognitive performance and may consistently foresee impairment of cognition in the elderly.

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              A general approach to causal mediation analysis.

              Traditionally in the social sciences, causal mediation analysis has been formulated, understood, and implemented within the framework of linear structural equation models. We argue and demonstrate that this is problematic for 3 reasons: the lack of a general definition of causal mediation effects independent of a particular statistical model, the inability to specify the key identification assumption, and the difficulty of extending the framework to nonlinear models. In this article, we propose an alternative approach that overcomes these limitations. Our approach is general because it offers the definition, identification, estimation, and sensitivity analysis of causal mediation effects without reference to any specific statistical model. Further, our approach explicitly links these 4 elements closely together within a single framework. As a result, the proposed framework can accommodate linear and nonlinear relationships, parametric and nonparametric models, continuous and discrete mediators, and various types of outcome variables. The general definition and identification result also allow us to develop sensitivity analysis in the context of commonly used models, which enables applied researchers to formally assess the robustness of their empirical conclusions to violations of the key assumption. We illustrate our approach by applying it to the Job Search Intervention Study. We also offer easy-to-use software that implements all our proposed methods. PsycINFO Database Record (c) 2010 APA, all rights reserved.
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                Author and article information

                Journal
                American Journal of Physiology-Heart and Circulatory Physiology
                American Journal of Physiology-Heart and Circulatory Physiology
                American Physiological Society
                0363-6135
                1522-1539
                November 01 2014
                November 01 2014
                : 307
                : 9
                : H1269-H1276
                Affiliations
                [1 ]Department of Medical Sciences, Division of Internal Medicine and Chronobiology Unit, IRCCS Scientific Institute and Regional General Hospital “Casa Sollievo della Sofferenza,” San Giovanni Rotondo, Italy;
                [2 ]Department of Medical Sciences, Geriatrics Unit and Gerontology-Geriatrics Research Laboratory, IRCCS Scientific Institute and Regional General Hospital “Casa Sollievo della Sofferenza,” San Giovanni Rotondo, Italy;
                [3 ]Euro-Mediterranean Institute of Sciences and Technology (IEMEST), Palermo, Italy;
                [4 ]UCL Institute for Liver and Digestive Health, Division of Medicine, Royal Free Campus, University College London, London, United Kingdom; and
                [5 ]UCL Centre of Epidemiology for Child Health, UCL Institute of Child Health, University College London, London, United Kingdom
                Article
                10.1152/ajpheart.00175.2014
                25172902
                0172e763-f721-4a1c-a942-2ffadbfba975
                © 2014
                History

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