Cardiometabolic health, cortical thickness, and neurotransmitter systems: a large-scale multivariate study

Abstract

The link between brain health and risk/protective factors for non-communicable diseases (such as high blood pressure, high body mass index, diet, smoking, physical activity, etc.) is increasingly acknowledged. However, the specific effects that these factors have on brain health are still poorly understood, delaying their implementation in precision brain health. Here, we studied the multivariate relationships between risk factors for non-communicable diseases and brain structure, including cortical thickness (CT) and grey matter volume (GMV). Furthermore, we adopted a systems-level perspective to understand such relationships, by characterizing the cortical patterns (yielded in association to risk factors) with regards to brain morphological and functional features, as well as with neurotransmitter systems. Similarly, we related the pattern of risk/protective factors dimensions with a peripheral marker of inflammation. First, we identified latent dimensions linking a broad set of risk factors for non-communicable diseases to parcel-wise CT and GMV across the whole cortex. Data was obtained from the UK Biobank (n=7370, age range=46-81 years). We used regularized canonical correlation analysis (RCCA) embedded in a machine learning framework. This approach allows us to capture inter-individual variability in a multivariate association and to assess the generalizability of the model. The brain patterns (captured in association with risk/protective factors) were characterized from a multi-level perspective, by performing correlations (spin tests) between them and different brain patterns of structure, function, and neurotransmitter systems. The association between the risk/protective factors pattern and C-reactive protein (CRP, a marker of inflammation) was examined using Spearman correlation. We found two significant and partly replicable latent dimensions. One latent dimension linked cardiometabolic health to brain patterns of CT and GMV and was consistent across sexes. The other latent dimension linked physical robustness (including non-fat mass and strength) to patterns of CT and GMV, with the association to GMV being consistent across sexes and the association to CT appearing only in men. The CT and GMV patterns of both latent dimensions were associated to the binding potentials of several neurotransmitter systems. Finally, the cardiometabolic health dimension was correlated to CRP, while physical robustness was only very weakly associated to it. We observed robust, multi-level and multivariate links between both cardiometabolic health and physical robustness with respect to CT, GMV, and neurotransmitter systems. Interestingly, we found that cardiometabolic health and physical robustness are associated with not only increases in CT or GMV, but also with decreases of CT or GMV in some brain regions. Our results also suggested a role for low-grade chronic inflammation in the association between cardiometabolic health and brain structural health. These findings support the relevance of adopting a holistic perspective in health, by integrating neurocognitive and physical health. Moreover, our findings contribute to the challenge to the classical conceptualization of neuropsychiatric and physical illnesses as categorical entities. In this perspective, future studies should further examine the effects of risk/protective factors on different brain regions in order to deepen our understanding of the clinical significance of such increased and decreased CT and GMV.