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Abstract
Objective: The relation of overweight to dementia is controversial. We aimed to examine the association of midlife overweight and obesity with dementia, Alzheimer disease (AD), and vascular dementia (VaD) in late life, and to verify the hypothesis that genetic and early-life environmental factors contribute to the observed association.
Methods: From the Swedish Twin Registry, 8,534 twin individuals aged ≥65 (mean age 74.4) were assessed to detect dementia cases (DSM-IV criteria). Height and weight at midlife (mean age 43.4) were available in the Registry. Data were analyzed as follows: 1) unmatched case-control analysis for all twins using generalized estimating equation (GEE) models and 2) cotwin matched case-control approach for dementia-discordant twin pairs by conditional logistic regression taking into account lifespan vascular disorders and diabetes.
Results: Among all participants, dementia was diagnosed in 350 subjects, and 114 persons had questionable dementia. Overweight (body mass index [BMI] >25–30) and obesity (BMI >30) at midlife were present in 2,541 (29.8%) individuals. In fully adjusted GEE models, compared with normal BMI (20–25), overweight and obesity at midlife were related to dementia with odds ratios (ORs) (95% CIs) of 1.71 (1.30–2.25) and 3.88 (2.12–7.11), respectively. Conditional logistic regression analysis in 137 dementia-discordant twin pairs led to an attenuated midlife BMI-dementia association. The difference in ORs from the GEE and the matched case-control analysis was statistically significant (p = 0.019).
Conclusions: Both overweight and obesity at midlife independently increase the risk of dementia, AD, and VaD. Genetic and early-life environmental factors may contribute to the midlife high adiposity–dementia association.
Footnotes
-
Study funding: Funded by The National Institute on Aging (R01-AG08724), the Swedish Research Councils (FAS-09-0632), and the Swedish Brain Power. Also supported in part by funds from the Gamla Tjänarinnor, the Bertil Stohnes Foundation, the Demensfonden, the Loo and Hans Ostermans Foundation, and the Foundation for Geriatric Diseases at Karolinska Institutet.
-
- AD=
- Alzheimer disease;
- BMI=
- body mass index;
- CERAD=
- Consortium to Establish a Registry for Alzheimer's Disease;
- CI=
- confidence interval;
- DSM-IV=
- Diagnostic and Statistical Manual of Mental Disorders, 4th edition;
- DZ=
- dizygotic;
- GEE=
- generalized estimating equation;
- ICD=
- International Classification of Diseases;
- IDR=
- Inpatient Discharge Registry;
- MMSE=
- Mini-Mental State Examination;
- MZ=
- monozygotic;
- OR=
- odds ratio;
- VaD=
- vascular dementia
- Received June 22, 2010.
- Accepted January 28, 2011.
- Copyright © 2011 by AAN Enterprises, Inc.
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