Excess fat around the waist, as indicated by a high waist-to-hip ratio (WHR), is associated with poorer cognitive test scores and an increased risk of attention and memory impairment in recently postmenopausal women, according to a study published in the journal Menopause.
A new study from the KEEPS-Cog trial (part of the Kronos Early Estrogen Prevention Study) found that women with higher waist-to-hip ratios at baseline performed worse on several cognitive domains compared with participants with lower WHRs, even among women of normal overall body weight.
Specifically, the analysis found that higher baseline WHR was associated with subsequent declines in one cognitive domain—visual attention and executive function—over the four-year follow-up. Other domains of memory and thinking showed less pronounced or inconsistent dynamics in relation to WHR.
The mechanism of this association, according to the authors and review sources, is likely related to visceral (internal) fat, which accumulates around organs and produces pro-inflammatory cytokines and reduces insulin sensitivity — factors that contribute to chronic inflammation and metabolic disorders. The drop in estrogen levels after menopause exacerbates these processes, as estrogen has neuroprotective effects and affects the regulation of metabolism.
The researchers also tested whether hormone replacement therapy (oral or transdermal) altered this association, and found that hormone replacement therapy did not significantly protect against the negative effects of central obesity on cognitive performance in this group of women. This suggests that high WHR remains a risk factor regardless of hormone use in early postmenopausal women.
Experts emphasize the practical significance of the findings: preventing the accumulation of visceral fat before menopause — through dietary control, regular physical activity, and combating risk factors for metabolic diseases — may help reduce the likelihood of future cognitive decline. In a press release from The Menopause Society, the authors call for research into the effects of controlling central obesity on brain health in early postmenopausal women.
