Association of Cumulative Metabolic Burden With Brain Perfusion, Volume and Cerebral Small Vessel Disease: A Brain Magnetic Resonance Imaging‐Based Study

AIMS: To investigate the association of cumulative metabolic burden with cerebral blood flow (CBF), brain volume and cerebral small vessel disease (CSVD) markers. MATERIALS AND METHODS: A total of 1233 participants (579 males; mean age, 57.31 ± 9.97 years) were included from the Kailuan Study. Cumulative systolic blood pressure, fasting blood glucose, low-density lipoprotein cholesterol, body mass index and C-reactive protein from 2006 to 2020 were calculated, and cumulative metabolic burden was determined using confirmatory factor analysis. Brain MRI scans began in December 2020. CBF and brain volumes were quantified using arterial spin labelling and 3D T1-weighted MRI, and two radiologists independently assessed CSVD markers. Generalized linear or logistic regression analyses were used to evaluate the associations of cumulative metabolic burden with CBF, brain volume and CSVD. RESULTS: Greater cumulative metabolic burden was associated with lower CBF in whole brain (-2.87 [-3.40, -2.35]), total grey matter (GM) (-2.64 [-3.21, -2.07]), total white matter (WM) (-3.55 [-4.03, -3.06]), frontal (-2.13 [-2.71, -1.55]), parietal (-3.19 [-3.82, -2.57]), temporal (-2.53 [-3.08, -1.97]), occipital lobes (-2.61 [-3.31, -1.91]) and hippocampus (-2.36 [-2.92, -1.81]), as well as decreased total GM (-2.52 [-4.34, -0.70]), frontal (-0.83 [-1.53, -0.14]), parietal (-0.66 [-1.01, -0.30]), temporal (-0.80 [-1.28, -0.33]) and occipital lobes volumes (-0.42 [-0.74, -0.10]). It was also associated with higher odds of total CSVD burden (1.35 [1.15, 1.58]), lacunes (1.62 [1.25, 2.10]) and enlarged perivascular spaces (2.01 [1.59, 2.55]). CONCLUSION: A greater cumulative metabolic burden was associated with reduced CBF and volume, and higher CSVD burden.