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NEUROLOGY 2009;73:1559-1566
© 2009 American Academy of Neurology

Adiposity indicators and dementia over 32 years in Sweden

D. R. Gustafson, PhD, K. Bäckman, MS, M. Waern, MD, PhD, S. Östling, MD, PhD, X. Guo, MD, PhD, P. Zandi, PhD, M. M. Mielke, PhD, C. Bengtsson and I. Skoog, MD, PhD

From the Section for Psychiatry and Neurochemistry, Neuropsychiatric Epidemiology Unit (D.R.G., K.B., M.W., S.Ö., X.G., I.S.), and the Department of Primary Care (C.B.), Sahlgrenska Academy, University of Gothenburg, Sweden; the Department of Family and Community Medicine (D.R.G.), Medical College of Wisconsin, Milwaukee; Rush University Medical Center (D.R.G.), Chicago, IL; Department of Mental Health (P.Z.), Johns Hopkins Bloomberg School of Public Health, Baltimore; and Department of Psychiatry (M.M.M.), Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins University School of Medicine, Baltimore, MD.

Address correspondence and reprint requests to Dr. Deborah Gustafson, Institute for Neuroscience and Physiology, Section for Psychiatry and Neurochemistry, Wallinsgatan 6, 431 41 Mölndal, Sweden deborah.gustafson{at}neuro.gu.se

Background: High midlife and late-life adiposity may increase risk for dementia. Late-life decrease in body mass index (BMI) or body weight within several years of a dementia diagnosis has also been reported. Differences in study designs and analyses may provide different pictures of this relationship.

Methods: Thirty-two years of longitudinal body weight, BMI, waist circumference, and waist-to-hip ratio (WHR) data, from the Prospective Population Study of Women in Sweden, were related to dementia. A representative sample of 1,462 nondemented women was followed from 1968 at ages 38-60 years, and subsequently in 1974, 1980, 1992, and 2000, using neuropsychiatric, anthropometric, clinical, and other measurements. Cox proportional hazards regression models estimated incident dementia risk by baseline factors. Logistic regression models including measures at each examination were related to dementia among surviving participants 32 years later.

Results: While Cox models showed no association between baseline anthropometric factors and dementia risk, logistic models showed that a midlife WHR greater than 0.80 increased risk for dementia approximately twofold (odds ratio 2.22, 95% confidence interval 1.00-4.94, p = 0.049) among surviving participants. Evidence for reverse causality was observed for body weight, BMI, and waist circumference in years preceding dementia diagnosis.

Conclusions: Among survivors to age 70, high midlife waist-to-hip ratio may increase odds of dementia. Traditional Cox models do not evidence this relationship. Changing anthropometric parameters in years preceding dementia onset indicate the dynamic nature of this seemingly simple relationship. There are midlife and late-life implications for dementia prevention, and analytical considerations related to identifying risk factors for dementia.

ADCVD = AD with cerebrovascular disease; BMI = body mass index; DBP = diastolic blood pressure; DSM-III-R = Diagnostic and Statistical Manual of Mental Disorders, 3rd edition, revised; HAAS = Honolulu Asia Aging Study; PPSW = Prospective Population Study of Women; SBP = systolic blood pressure; SES = socioeconomic status; VaD = vascular dementia; WHR = waist-to-hip ratio.

Supplemental data at www.neurology.org

The research leading to these results has received funding from the EU FP7 project LipiDiDiet, Grant Agreement N° 211696; the National Institutes of Health/National Institutes on Aging; and the Swedish Research Council, Swedish Council for Working Life and Social Research, Swedish Alzheimer Association, Stiftelsen Söderström-Königska Sjukhemmet, Stiftelsen för Gamla Tjänarinnor, Hjalmar Svenssons Foundation, The Swedish Society of Medicine, The Göteborg Medical Society, the Lions Foundation, the Dr. Felix Neubergh Foundation, the Wilhelm and Martina Lundgren Foundation, the Elsa and Eivind Kison Sylvan Foundation, and the Alzheimer’s Association Zenith Award.

Disclosure: Author disclosures are provided at the end of the article.

Received March 31, 2009. Accepted in final form August 4, 2009.






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