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January 14, 2020; 94 (2) ArticleOpen Access

Body mass index, diet, physical inactivity, and the incidence of dementia in 1 million UK women

Sarah Floud, Rachel F. Simpson, Angela Balkwill, Anna Brown, Adrian Goodill, John Gallacher, Cathie Sudlow, Phillip Harris, Albert Hofman, Sarah Parish, Gillian K. Reeves, Jane Green, Richard Peto, Valerie Beral
First published December 18, 2019, DOI: https://doi.org/10.1212/WNL.0000000000008779
Sarah Floud
From the Cancer Epidemiology Unit (S.F., R.F.S., A.B., A.B., A.G., G.K.R., J.G., V.B.) and MRC Population Health Research Unit (S.P.), Nuffield Department of Population Health (R.P.), and Department of Psychiatry (J.G.), University of Oxford; Centre for Medical Informatics (C.S.), Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK; Royal Prince Alfred Hospital (P.H.), Sydney, Australia; and Department of Epidemiology (A.H.), Harvard T.H. Chan School of Public Health, Boston, MA.
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Rachel F. Simpson
From the Cancer Epidemiology Unit (S.F., R.F.S., A.B., A.B., A.G., G.K.R., J.G., V.B.) and MRC Population Health Research Unit (S.P.), Nuffield Department of Population Health (R.P.), and Department of Psychiatry (J.G.), University of Oxford; Centre for Medical Informatics (C.S.), Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK; Royal Prince Alfred Hospital (P.H.), Sydney, Australia; and Department of Epidemiology (A.H.), Harvard T.H. Chan School of Public Health, Boston, MA.
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Angela Balkwill
From the Cancer Epidemiology Unit (S.F., R.F.S., A.B., A.B., A.G., G.K.R., J.G., V.B.) and MRC Population Health Research Unit (S.P.), Nuffield Department of Population Health (R.P.), and Department of Psychiatry (J.G.), University of Oxford; Centre for Medical Informatics (C.S.), Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK; Royal Prince Alfred Hospital (P.H.), Sydney, Australia; and Department of Epidemiology (A.H.), Harvard T.H. Chan School of Public Health, Boston, MA.
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Anna Brown
From the Cancer Epidemiology Unit (S.F., R.F.S., A.B., A.B., A.G., G.K.R., J.G., V.B.) and MRC Population Health Research Unit (S.P.), Nuffield Department of Population Health (R.P.), and Department of Psychiatry (J.G.), University of Oxford; Centre for Medical Informatics (C.S.), Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK; Royal Prince Alfred Hospital (P.H.), Sydney, Australia; and Department of Epidemiology (A.H.), Harvard T.H. Chan School of Public Health, Boston, MA.
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Adrian Goodill
From the Cancer Epidemiology Unit (S.F., R.F.S., A.B., A.B., A.G., G.K.R., J.G., V.B.) and MRC Population Health Research Unit (S.P.), Nuffield Department of Population Health (R.P.), and Department of Psychiatry (J.G.), University of Oxford; Centre for Medical Informatics (C.S.), Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK; Royal Prince Alfred Hospital (P.H.), Sydney, Australia; and Department of Epidemiology (A.H.), Harvard T.H. Chan School of Public Health, Boston, MA.
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John Gallacher
From the Cancer Epidemiology Unit (S.F., R.F.S., A.B., A.B., A.G., G.K.R., J.G., V.B.) and MRC Population Health Research Unit (S.P.), Nuffield Department of Population Health (R.P.), and Department of Psychiatry (J.G.), University of Oxford; Centre for Medical Informatics (C.S.), Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK; Royal Prince Alfred Hospital (P.H.), Sydney, Australia; and Department of Epidemiology (A.H.), Harvard T.H. Chan School of Public Health, Boston, MA.
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Cathie Sudlow
From the Cancer Epidemiology Unit (S.F., R.F.S., A.B., A.B., A.G., G.K.R., J.G., V.B.) and MRC Population Health Research Unit (S.P.), Nuffield Department of Population Health (R.P.), and Department of Psychiatry (J.G.), University of Oxford; Centre for Medical Informatics (C.S.), Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK; Royal Prince Alfred Hospital (P.H.), Sydney, Australia; and Department of Epidemiology (A.H.), Harvard T.H. Chan School of Public Health, Boston, MA.
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Phillip Harris
From the Cancer Epidemiology Unit (S.F., R.F.S., A.B., A.B., A.G., G.K.R., J.G., V.B.) and MRC Population Health Research Unit (S.P.), Nuffield Department of Population Health (R.P.), and Department of Psychiatry (J.G.), University of Oxford; Centre for Medical Informatics (C.S.), Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK; Royal Prince Alfred Hospital (P.H.), Sydney, Australia; and Department of Epidemiology (A.H.), Harvard T.H. Chan School of Public Health, Boston, MA.
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Albert Hofman
From the Cancer Epidemiology Unit (S.F., R.F.S., A.B., A.B., A.G., G.K.R., J.G., V.B.) and MRC Population Health Research Unit (S.P.), Nuffield Department of Population Health (R.P.), and Department of Psychiatry (J.G.), University of Oxford; Centre for Medical Informatics (C.S.), Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK; Royal Prince Alfred Hospital (P.H.), Sydney, Australia; and Department of Epidemiology (A.H.), Harvard T.H. Chan School of Public Health, Boston, MA.
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Sarah Parish
From the Cancer Epidemiology Unit (S.F., R.F.S., A.B., A.B., A.G., G.K.R., J.G., V.B.) and MRC Population Health Research Unit (S.P.), Nuffield Department of Population Health (R.P.), and Department of Psychiatry (J.G.), University of Oxford; Centre for Medical Informatics (C.S.), Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK; Royal Prince Alfred Hospital (P.H.), Sydney, Australia; and Department of Epidemiology (A.H.), Harvard T.H. Chan School of Public Health, Boston, MA.
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Gillian K. Reeves
From the Cancer Epidemiology Unit (S.F., R.F.S., A.B., A.B., A.G., G.K.R., J.G., V.B.) and MRC Population Health Research Unit (S.P.), Nuffield Department of Population Health (R.P.), and Department of Psychiatry (J.G.), University of Oxford; Centre for Medical Informatics (C.S.), Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK; Royal Prince Alfred Hospital (P.H.), Sydney, Australia; and Department of Epidemiology (A.H.), Harvard T.H. Chan School of Public Health, Boston, MA.
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Jane Green
From the Cancer Epidemiology Unit (S.F., R.F.S., A.B., A.B., A.G., G.K.R., J.G., V.B.) and MRC Population Health Research Unit (S.P.), Nuffield Department of Population Health (R.P.), and Department of Psychiatry (J.G.), University of Oxford; Centre for Medical Informatics (C.S.), Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK; Royal Prince Alfred Hospital (P.H.), Sydney, Australia; and Department of Epidemiology (A.H.), Harvard T.H. Chan School of Public Health, Boston, MA.
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Richard Peto
From the Cancer Epidemiology Unit (S.F., R.F.S., A.B., A.B., A.G., G.K.R., J.G., V.B.) and MRC Population Health Research Unit (S.P.), Nuffield Department of Population Health (R.P.), and Department of Psychiatry (J.G.), University of Oxford; Centre for Medical Informatics (C.S.), Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK; Royal Prince Alfred Hospital (P.H.), Sydney, Australia; and Department of Epidemiology (A.H.), Harvard T.H. Chan School of Public Health, Boston, MA.
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Valerie Beral
From the Cancer Epidemiology Unit (S.F., R.F.S., A.B., A.B., A.G., G.K.R., J.G., V.B.) and MRC Population Health Research Unit (S.P.), Nuffield Department of Population Health (R.P.), and Department of Psychiatry (J.G.), University of Oxford; Centre for Medical Informatics (C.S.), Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK; Royal Prince Alfred Hospital (P.H.), Sydney, Australia; and Department of Epidemiology (A.H.), Harvard T.H. Chan School of Public Health, Boston, MA.
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Citation
Body mass index, diet, physical inactivity, and the incidence of dementia in 1 million UK women
Sarah Floud, Rachel F. Simpson, Angela Balkwill, Anna Brown, Adrian Goodill, John Gallacher, Cathie Sudlow, Phillip Harris, Albert Hofman, Sarah Parish, Gillian K. Reeves, Jane Green, Richard Peto, Valerie Beral
Neurology Jan 2020, 94 (2) e123-e132; DOI: 10.1212/WNL.0000000000008779

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    Figure 1 Dementia detection rate ratio by period of follow-up for obese vs desirable BMI (30+ vs 20–24.9 kg/m2)

    Stratified by year of birth and year reporting exposure and adjusted for region of residence, educational qualifications, area deprivation, height, smoking, alcohol consumption, use of menopausal hormones, and physical activity. BMI = body mass index; CI = confidence interval.

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    Figure 2 Dementia detection rate ratio by period of follow-up for low vs desirable BMI (<20 vs 20–24.9 kg/m2)

    Stratified by year of birth and year reporting exposure and adjusted for region of residence, educational qualifications, area deprivation, height, smoking, alcohol consumption, use of menopausal hormones, and physical activity. BMI = body mass index; CI = confidence interval.

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    Figure 3 Dementia detection rate ratio by period of follow-up for those with the lowest fifth of caloric intake vs higher intakes

    Stratified by year of birth and year reporting exposure and adjusted for region of residence, educational qualifications, area deprivation, height, smoking, alcohol consumption, use of menopausal hormones, and physical activity. CI = confidence interval.

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    Figure 4 Dementia detection rate ratio by period of follow-up in inactive vs active women

    Stratified by year of birth and year reporting exposure and adjusted for region of residence, educational qualifications, area deprivation, height, smoking, alcohol consumption, use of menopausal hormones, and body mass index. CI = confidence interval.

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    Figure 5 Dementia detection rate ratio after 15+ years of follow-up by hospital-specified type of dementia

    Stratified by year of birth and year reporting exposure and adjusted for region of residence, educational qualifications, area deprivation, height, smoking, alcohol consumption, and use of menopausal hormones. For body mass index (BMI) and caloric intake analyses, also adjusted for physical activity. For physical activity analysis, also adjusted for BMI. CI = confidence interval.

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    Figure 6 Probability of first admission to hospital with dementia by time since first mention of dementia in primary care

    CI = confidence interval.

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