Sex Differences in the Association Between Body Composition and Cognitive Performance in Adolescents With Type 1 Diabetes.

AIMS: Adolescents with type 1 diabetes are at increased risk of impaired cognitive function, particularly in tasks requiring memory, attention, and executive functioning. Given the emerging evidence that excess adiposity may impair cognition through metabolic and inflammatory pathways, we investigated the association between body composition components and spatial navigation in adolescents with type 1 diabetes.

METHODS

In this observational study, 64 adolescents (39 boys, mean age 15.9 ± 2.2 years) with type 1 diabetes completed spatial navigation assessment by the Virtual Morris Water Maze Task (vMWMT) and underwent body composition assessment via bioelectrical impedance analysis. Glycaemic control was evaluated through HbA1c measurement and continuous glucose monitoring metrics. Associations between vMWMT outcomes (time-to-first move, time-to-platform, and path length) and body composition components [body mass index (BMI) and muscle-to-fat ratio (MFR) z-scores] were analysed by sex-stratified correlation and multivariable linear regression models.

RESULTS

Mean BMI z-scores did not differ between sexes, whereas girls had lower muscle-to-fat ratio (MFR) z-scores than boys (-0.60 ± 0.84 vs. 0.25 ± 1.00, p < 0.001). The boys' longer time-to-first move and time-to-platform were positively correlated with lower MFR z-scores and higher HbA1c levels, greater time in marked hypoglycemia and in severe hyperglycemia and longer diabetes duration. Boys' diabetes duration predicted a longer time-to-first move (B = 0.064, p = 0.009), while both diabetes duration and a lower MFR z-score predicted a longer time-to-platform (R2 = 0.457, p < 0.001). The girls' longer time-to-platform was positively correlated with higher BMI z-scores. Their HbA1c levels at diabetes onset predicted longer time-to-first move (B = -3.46, p = 0.018), and their relatively higher BMI z-scores predicted longer time-to-platform (B = 9.33, p = 0.022).

CONCLUSIONS

Spatial navigation performance in adolescents with type 1 diabetes is influenced by body composition in boys and weight status in girls. Identifying and managing sex-specific risk factors may help optimise cognitive function in adolescents with type 1 diabetes.