Association between late-life body mass index and dementia The Kame Project

Department of Psychiatry, University of Pittsburgh, PA 15213, USA.
Neurology (Impact Factor: 8.29). 06/2009; 72(20):1741-6. DOI: 10.1212/WNL.0b013e3181a60a58
Source: PubMed


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.
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.
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.
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.

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Available from: Amy R. Borenstein (Graves)
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    • "Several epidemiologic studies also suggested that overweight and obesity in late life are associated with reduced risk for dementia [6] [7], whereas others have found that a higher BMI at older ages predicts dementia [8]. Because it is widely accepted that malnutrition and unintended weight loss not only occur MACM was involved in the conception and design of the study; generation, collection, assembly, analysis, and interpretation of data; and drafting of the manuscript. "
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    ABSTRACT: Objective: Although dementia and nutritional status have been shown to be strongly associated, differences in body composition (BC) among older people with dementia have not yet been firmly established. The aim of this study was to assess BC through conventional and vector bioimpedance analysis (BIA and BIVA, respectively) in a sample of institutionalized older men with and without dementia, in order to detect dementia-related BC changes. Methods: Forty-one institutionalized men ages ≥ 65 y (23 without dementia [CG] and 18 with dementia [DG]) were measured with BIA and interpreted with BIVA and predictive equations. Results: Age (74.4 and 75.7 y) and body mass index (22.5 and 23.6 kg/m(2)) were similar for DG and CG, respectively. Resistance and ratio of resistance to height did not differ significantly between the two groups. Reactance and ratio of reactance to height were 21.2% and 20.4% lower in DG than in CG. Phase angle was significantly lower in DG (mean = 4.0; 95% confidence interval [CI], 3.6°-4.3°) than in CG (mean = 4.7; 95% CI, 4.3°-5.1°). Mean fat mass index (6 and 7 kg/m(2)), and mean fat-free mass index (16.4 and 16.6 kg/m(2)) were similar in both groups. BIVA showed a significant downward migration of the ellipse in DG with respect to CG (T(2) = 15.1; P < 0.01). Conclusion: Conventional BIA showed no significant differences in BC between DG and CG, although reactance and ratio of reactance to height were about 21% lower in DG. Nevertheless, a body cell mass depletion and an increase in the ratio of extracellular to intracellular water were identified in DG using BIVA. BIVA reflects dementia-related changes in BC better than BIA.
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    • "The observed risk reduction of late-life obesity on dementia is viewed controversially and should probably be regarded as an absence of weight loss. Weight loss in itself might be viewed as a marker of disease progression [Gustafson et al., 2003; Atti et al., 2008; Dahl et al., 2008; Sturman et al., 2008; Hughes et al., 2009; Coin et al., 2012]. A relationship between underweight in midlife and dementia risk has also been described [Chiang et al., 2007; Whitmer, 2007; Beydoun et al., 2008a,b; Chen et al., 2010], but not in all studies [Loef and Walach, 2013]. "
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    • "A recent meta-analysis reported that, compared to normal weight, midlife obesity nearly doubles the risk of dementia later in life (Loef and Walach, 2013). Whereas obesity in midlife may confer an increased risk of later dementia, many studies have found an opposite effect in older adults (Atti et al., 2008; Chu et al., 2009; Dahl et al., 2008; Fitzpatrick et al., 2009; Hughes et al., 2009; West and Haan, 2009). Lower BMI has been associated with the development of Alzheimer's disease (Johnson et al., 2006) and a higher degree of AD pathology (Buchman et al., 2006). "
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