ORIGINAL RESEARCH article
Front. Neurol.
Sec. Neuroepidemiology
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1624905
Sex-specific association between body mass index and cerebral microbleed progression in adults aged 50-85 years
Provisionally accepted
- 1School of Medicine, Inha University, Inchon, Republic of Korea
- 2Chonnam National University Medical School, Gwangju, Republic of Korea
- 3Chung-Ang University College of Medicine, Seoul, Republic of Korea
- 4Ewha Womans University College of Medicine, Seoul, Republic of Korea
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Previous studies have demonstrated sex differences in the association between body mass index (BMI) and hemorrhagic stroke. Cerebral microbleed (CMB) is a clinically important marker of bleeding-prone microangiopathy, which is associated with a risk of hemorrhagic stroke. No study has evaluated sex differences in the relationship between BMI and CMB. In this longitudinal study, we aimed to conduct sex-stratified analyses to assess whether sex modifies the effect of BMI on CMB progression.Volume of Cerebral Small Vessel Disease White Matter Changes), which enrolled patients aged 50 to 85 years with cerebral small vessel disease, was analyzed. Of the 256 subjects, 189 who underwent a 2-year follow-up brain MRI scan were included in the analysis. We used a generalized linear mixed model with a negative binomial distribution to assess the association between BMI and the 2-year change in CMB count, and conducted sex-stratified analyses to account for potential sex-specific effects.A total of 65 men and 124 women were analyzed. In the sex-stratified negative binomial model, a significant association was observed in women but not in men. In women, each 1 kg/m² increase in BMI was significantly associated with a decrease in the 2-year change in the number of total CMBs after adjustment for age and baseline CMB count (β = -0.120, 95% confidence interval [CI]: -0.202 to -0.037, p = 0.005). When CMBs were categorized into lobar and deep/infratentorial regions, significant associations were observed for both lobar (β = -0.114, 95% CI: -0.213 to -0.015, p = 0.024) and deep/infratentorial CMBs (β = -0.123, 95% CI: -0.222 to -0.023, p = 0.015). By contrast, no significant associations were identified between BMI and the 2-year change in CMB counts in men (all p >0.05).Higher BMI in later life was associated with less progression of CMBs in women, but not in men.
Keywords: Sex, Cerebral microbleeds (CMB), Body Mass Index, Cerebral small vessel disease, Women
Received: 09 May 2025; Accepted: 25 Aug 2025.
Copyright: © 2025 Yoon, Suh, Kim, Youn, Jeong and Choi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Seong Hye Choi, School of Medicine, Inha University, Inchon, Republic of Korea
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