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Association between late-life body mass index and dementia

The Kame Project

From the Department of Psychiatry (T.F.H.), University of Pittsburgh, PA; the Department of Epidemiology and Biostatistics (A.R.B., E.S., Y.W.), University of South Florida, Tampa; and the Group Health Center for Health Studies (E.B.L.), University of Washington, Seattle.

Address correspondence and reprint requests to Dr. Tiffany F. Hughes, Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara St., Pittsburgh, PA 15213 hughest2{at}upmc.edu

Objective: To examine the association between body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) and risk of dementia and its subtypes in late life.

Methods: Participants were members of the Kame Project, a population-based prospective cohort study of 1,836 Japanese Americans living in King County, WA, who had a mean age of 71.8 years and were dementia-free at baseline (1992–1994), and were followed for incident dementia through 2001. Cox proportional hazards models were used to estimate the risk of dementia, Alzheimer disease (AD), and vascular dementia (VaD) controlling for demographic and lifestyle characteristics and vascular comorbidities as a function of baseline BMI, WC, and WHR and change in BMI over time.

Results: Higher baseline BMI was significantly associated with a reduced risk of AD (hazard ratio [HR] = 0.56, 95% confidence interval [CI] = 0.33–0.97) in the fully adjusted model. Slower rate of decline in BMI was associated with a reduced risk of dementia (HR = 0.37, 95% CI = 0.14–0.98), with the association stronger for those who were overweight or obese (HR = 0.18, 95% CI = 0.05–0.58) compared to normal or underweight (HR = 1.00, 95% CI = 0.18–5.66) at baseline.

Conclusion: Higher baseline body mass index (BMI) and slower declining BMI in late life are associated with a reduced risk of dementia, suggesting that low BMI or a faster decline in BMI in late life may be preclinical indicators of an underlying dementing illness, especially for those who were initially overweight or obese.

Abbreviations: AD = Alzheimer disease; BMI = body mass index; CI = confidence interval; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th edition; HR = hazard ratio; VaD = vascular dementia; WC = waist circumference; WHR = waist-to-hip ratio.

Disclosure: The authors report no disclosures.

Received November 4, 2008. Accepted in final form February 13, 2009.

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