Association of adiposity status and changes in early to mid-adulthood with incidence of Alzheimer's disease - PubMed (original) (raw)

. 2008 Nov 15;168(10):1179-89.

doi: 10.1093/aje/kwn229. Epub 2008 Oct 3.

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Association of adiposity status and changes in early to mid-adulthood with incidence of Alzheimer's disease

May A Beydoun et al. Am J Epidemiol. 2008.

Abstract

Adiposity status and change are potential risk factors for Alzheimer's disease (AD). The authors used data on 2,322 participants in the Baltimore Longitudinal Study of Aging to analyze the relation between AD incidence and adiposity in Cox proportional hazards models, with adjustment for sociodemographic factors and smoking status. Body mass index (BMI; weight (kg)/height (m)(2)) and waist circumference at specific ages were predicted by empirical Bayes estimators from mixed-effects regression models. After a median of 23.4 years of follow-up between 1958 and 2006, 187 participants developed AD. Among men, being underweight (BMI <or=18.5) at age 30, 40, or 45 years increased the likelihood of AD (hazard ratio (HR) = 5.76, 95% confidence interval (CI): 2.07, 16.00); among women, being obese (BMI >or=30) at age 30, 40, or 45 years and jointly centrally obese (waist circumference >or=80th percentile) at age 30, 35, or 50 years increased AD risk (HR = 6.57, 95% CI: 1.96, 22.02). Women who lost weight (BMI change <10th percentile) between ages 30 and 45 years were also at increased risk (HR = 2.02, 95% CI: 1.06, 3.85). Weight gain among men (BMI change >90th percentile) between ages 30 and 50 years increased AD risk (HR = 3.70, 95% CI: 1.43, 9.56). Future studies should identify age- and gender-specific optimal weights and weight-loss strategies for preventing AD and investigate potential mechanisms.

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Figures

Figure 1.

Figure 1.

Procedures used for inclusion and exclusion of Baltimore Longitudinal Study of Aging (BLSA) participants in analyses of the relation between adiposity and Alzheimer's disease (AD) risk, 1958–2006. Sample 1 was used for prediction of body mass index/waist circumference with linear mixed models; samples 2a and 2b were used for fitting Cox proportional hazards models and constructing Kaplan-Meier survival curves. Solid line: subjects included in analysis; dashed line: subjects not included in analysis.

Figure 2.

Figure 2.

Kaplan-Meier survival curve for time to incident Alzheimer's disease by adiposity risk status (elevated body mass index and waist circumference (obese at age 30, 40, or 45 years and in upper quintile of waist circumference at age 30, 35, or 50 years) vs. no elevation) among women, Baltimore Longitudinal Study of Aging, 1958–2006. The hazard ratio was 6.57 (95% confidence interval: 1.96, 22.02; P < 0.01; log-rank test: P = 0.0003). Failure was defined as first diagnosis of incident Alzheimer's disease at or after age 50 years. Hazard ratios were adjusted for education, race/ethnicity, smoking status, and year of birth.

Figure 3.

Figure 3.

Kaplan-Meier survival curve for time to incident Alzheimer's disease by adiposity risk status (significant decrease in body mass index (change <10th percentile) during any 5-year interval between ages 35 and 45 years vs. none) among women, Baltimore Longitudinal Study of Aging, 1958–2006. The hazard ratio was 2.02 (95% confidence interval: 1.06, 3.85; P < 0.05; log-rank test: P = 0.0266). Failure was defined as first diagnosis of incident Alzheimer's disease at or after age 50 years. Hazard ratios were adjusted for education, race/ethnicity, smoking status, and year of birth.

Figure 4.

Figure 4.

Kaplan-Meier survival curve for time to incident Alzheimer's disease by adiposity risk status (underweight (at age 30, 40, or 45 years vs. not underweight) among men, Baltimore Longitudinal Study of Aging, 1958–2006. The hazard ratio was 5.76 (95% confidence interval: 2.07, 16.00; P < 0.001; log-rank test: P = 0.001). Failure was defined as first diagnosis of incident Alzheimer's disease at or after age 50 years. Hazard ratios were adjusted for education, race/ethnicity, smoking status, and year of birth.

Figure 5.

Figure 5.

Kaplan-Meier survival curve for time to incident Alzheimer's disease by adiposity risk status (increase in body mass index (change >90th percentile) during any 5-year interval between ages 30 and 50 years vs. no increase) among men, Baltimore Longitudinal Study of Aging, 1958–2006. The hazard ratio was 3.70 (95% confidence interval: 1.43, 9.56; P < 0.01; log-rank test P = 0.0166). Failure was defined as first diagnosis of incident Alzheimer's disease at or after age 50 years. Hazard ratios were adjusted for education, race/ethnicity, smoking status, and year of birth.

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