To establish causal evidence for the association of adiposity-related metabolic abnormalities with brain volumes, and the risks of dementia and stroke, we applied 1- and 2-sample Mendelian randomization (MR) analyses using up to 336,309 UK Biobank participants. We used 3 classes of genetic instruments, which all increase body mass index but are associated with different metabolic profiles (unfavorable, neutral and favorable). We validated the instruments using anthropometric and cardio-metabolic traits. Both metabolically unfavorable and metabolically neutral adiposity associated with lower gray matter volume (GMV, -9.28 cm3, -12.90 to -5.66 and -12.02 cm3, -20.07 to -3.97, respectively). Metabolically favorable adiposity was tentatively associated with a higher GMV (16.21 cm3, -0.21 to 32.68). No causal evidence was seen for white matter and hippocampal volume, and volume of white matter hyperintensities, or with the risks of dementia and stroke (all p > 0.60). These findings suggest that obesity-related metabolic abnormalities may contribute to GMV atrophy, warranting further studies.
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