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American Journal of Epidemiology Advance Access originally published online on October 3, 2008
American Journal of Epidemiology 2008 168(10):1179-1189; doi:10.1093/aje/kwn229
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American Journal of Epidemiology Published by the Johns Hopkins Bloomberg School of Public Health 2008.

ORIGINAL CONTRIBUTIONS

Association of Adiposity Status and Changes in Early to Mid-Adulthood With Incidence of Alzheimer's Disease

May A. Beydoun, April Lhotsky, Youfa Wang, Gloria Dal Forno, Yang An, E. Jeffrey Metter, Luigi Ferrucci, Richard O'Brien and Alan B. Zonderman

Correspondence to Dr. Alan B. Zonderman, NIH Biomedical Research Center, National Institute on Aging, Intramural Research Program, 251 Bayview Blvd., Suite 100, Room 04B136, Baltimore, MD 21224 (e-mail: zondermana{at}mail.nih.gov).

Received for publication May 9, 2008. Accepted for publication July 3, 2008.

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 ≤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 ≥30) at age 30, 40, or 45 years and jointly centrally obese (waist circumference ≥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.

adiposity; aging; Alzheimer disease; body mass index

Abbreviations: AD, Alzheimer's disease; BMI, body mass index; CI, confidence interval; HR, hazard ratio


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