Impact of white adipose tissue on brain structure, perfusion, and cognitive function in patients with severe obesity: The BARICO study

Introduction: While underlying pathophysiology linking obesity to brain health is not completely understood, white adipose tissue (WAT) is considered a key player. In obesity, WAT becomes dysregulated, showing hyperplasia, hypertrophy and eventually inflammation. This disbalance leads to dysregulated secretion of adipokines influencing both (cardio)vascular and brain health. Within this study we investigated the association between omental (oWAT) and subcutaneous WAT (scWAT) with brain structure, perfusion and cognition in adults with severe obesity. Methods: Within the cross-sectional BARICO study, brain structure, perfusion and cognitive function were measured before bariatric surgery (BS) using MRI and cognitive assessments. During BS, oWAT and scWAT depots were collected and analyzed by histopathology. Number and diameter of adipocytes were quantified together with amount of crown-like structures (CLS) as indication of inflammation. Blood samples were collected to analyze adipokines and inflammatory markers. Neuroimaging outcomes included brain volumes, cortical thickness, white matter (WM) integrity, WM hyperintensities, cerebral blood flow using arterial spin labeling (ASL) and the ASL spatial coefficient of variation (sCoV), reflecting cerebrovascular health. Results: 71 patients were included (mean age 45.1±5.8 years; 83.1% women; mean BMI 40.8±3.8). scWAT showed more CLS (Z=-2.72, p<0.01, r=-0.24) and hypertrophy compared to oWAT (F(1,64)=3.99, p