Body mass index and risk of dementia: Analysis of individual-level data from 1.3 million individuals

Higher midlife body mass index (BMI) is suggested to increase the risk of dementia, but weight loss during the preclinical dementia phase may mask such effects. We examined this hypothesis in 1,349,857 dementia-free participants from 39 cohort studies. BMI was assessed at baseline. Dementia was asce...

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Published inAlzheimer's & dementia Vol. 14; no. 5; pp. 601 - 609
Main Authors Kivimäki, Mika, Luukkonen, Ritva, Batty, G. David, Ferrie, Jane E., Pentti, Jaana, Nyberg, Solja T., Shipley, Martin J., Alfredsson, Lars, Fransson, Eleonor I., Goldberg, Marcel, Knutsson, Anders, Koskenvuo, Markku, Kuosma, Eeva, Nordin, Maria, Suominen, Sakari B., Theorell, Töres, Vuoksimaa, Eero, Westerholm, Peter, Westerlund, Hugo, Zins, Marie, Kivipelto, Miia, Vahtera, Jussi, Kaprio, Jaakko, Singh-Manoux, Archana, Jokela, Markus
Format Journal Article
LanguageEnglish
Published United States Elsevier Inc 01.05.2018
Elsevier, Inc
Subjects
Aged
Bias
Body Mass Index
Cohort Studies
Cohort study
Data Interpretation, Statistical
Dementia
Dementia - etiology
Female
Global Health
Humans
Individ och samhälle VIDSOC
Individual and Society VIDSOC
Male
Middle Aged
Obesity
Obesity - complications
Risk Factors
Time Factors
Weight Loss - physiology
Body mass index
Obesity
Cohort study
Bias
Dementia
Online AccessGet full text
ISSN1552-5260
1552-5279
1552-5279
DOI10.1016/j.jalz.2017.09.016

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Abstract Higher midlife body mass index (BMI) is suggested to increase the risk of dementia, but weight loss during the preclinical dementia phase may mask such effects. We examined this hypothesis in 1,349,857 dementia-free participants from 39 cohort studies. BMI was assessed at baseline. Dementia was ascertained at follow-up using linkage to electronic health records (N = 6894). We assumed BMI is little affected by preclinical dementia when assessed decades before dementia onset and much affected when assessed nearer diagnosis. Hazard ratios per 5-kg/m2 increase in BMI for dementia were 0.71 (95% confidence interval = 0.66–0.77), 0.94 (0.89–0.99), and 1.16 (1.05–1.27) when BMI was assessed 10 years, 10-20 years, and >20 years before dementia diagnosis. The association between BMI and dementia is likely to be attributable to two different processes: a harmful effect of higher BMI, which is observable in long follow-up, and a reverse-causation effect that makes a higher BMI to appear protective when the follow-up is short. •Data from 1.3 million adults from 39 prospective cohort studies were pooled for the analyses.•Higher BMI was associated with increased risk of dementia when the follow-up was long.•When follow-up was short, lower BMI was linked to increased dementia risk probably due to reverse causation.
AbstractList Higher midlife body mass index (BMI) is suggested to increase the risk of dementia, but weight loss during the preclinical dementia phase may mask such effects.INTRODUCTIONHigher midlife body mass index (BMI) is suggested to increase the risk of dementia, but weight loss during the preclinical dementia phase may mask such effects.We examined this hypothesis in 1,349,857 dementia-free participants from 39 cohort studies. BMI was assessed at baseline. Dementia was ascertained at follow-up using linkage to electronic health records (N = 6894). We assumed BMI is little affected by preclinical dementia when assessed decades before dementia onset and much affected when assessed nearer diagnosis.METHODSWe examined this hypothesis in 1,349,857 dementia-free participants from 39 cohort studies. BMI was assessed at baseline. Dementia was ascertained at follow-up using linkage to electronic health records (N = 6894). We assumed BMI is little affected by preclinical dementia when assessed decades before dementia onset and much affected when assessed nearer diagnosis.Hazard ratios per 5-kg/m2 increase in BMI for dementia were 0.71 (95% confidence interval = 0.66-0.77), 0.94 (0.89-0.99), and 1.16 (1.05-1.27) when BMI was assessed 10 years, 10-20 years, and >20 years before dementia diagnosis.RESULTSHazard ratios per 5-kg/m2 increase in BMI for dementia were 0.71 (95% confidence interval = 0.66-0.77), 0.94 (0.89-0.99), and 1.16 (1.05-1.27) when BMI was assessed 10 years, 10-20 years, and >20 years before dementia diagnosis.The association between BMI and dementia is likely to be attributable to two different processes: a harmful effect of higher BMI, which is observable in long follow-up, and a reverse-causation effect that makes a higher BMI to appear protective when the follow-up is short.CONCLUSIONSThe association between BMI and dementia is likely to be attributable to two different processes: a harmful effect of higher BMI, which is observable in long follow-up, and a reverse-causation effect that makes a higher BMI to appear protective when the follow-up is short.
Higher midlife body mass index (BMI) is suggested to increase the risk of dementia, but weight loss during the preclinical dementia phase may mask such effects. We examined this hypothesis in 1,349,857 dementia-free participants from 39 cohort studies. BMI was assessed at baseline. Dementia was ascertained at follow-up using linkage to electronic health records (N = 6894). We assumed BMI is little affected by preclinical dementia when assessed decades before dementia onset and much affected when assessed nearer diagnosis. Hazard ratios per 5-kg/m increase in BMI for dementia were 0.71 (95% confidence interval = 0.66-0.77), 0.94 (0.89-0.99), and 1.16 (1.05-1.27) when BMI was assessed 10 years, 10-20 years, and >20 years before dementia diagnosis. The association between BMI and dementia is likely to be attributable to two different processes: a harmful effect of higher BMI, which is observable in long follow-up, and a reverse-causation effect that makes a higher BMI to appear protective when the follow-up is short.
INTRODUCTION: Higher midlife body mass index (BMI) is suggested to increase the risk of dementia, but weight loss during the preclinical dementia phase may mask such effects. METHODS: We examined this hypothesis in 1,349,857 dementia-free participants from 39 cohort studies. BMI was assessed at baseline. Dementia was ascertained at follow-up using linkage to electronic health records (N = 6894). We assumed BMI is little affected by preclinical dementia when assessed decades before dementia onset and much affected when assessed nearer diagnosis. RESULTS: Hazard ratios per 5-kg/m(2) increase in BMI for dementia were 0.71 (95% confidence interval = 0.66-0.77), 0.94 (0.89-0.99), and 1.16 (1.05-1.27) when BMI was assessed 10 years, 10-20 years, and >20 years before dementia diagnosis. CONCLUSIONS: The association between BMI and dementia is likely to be attributable to two different processes: a harmful effect of higher BMI, which is observable in long follow-up, and a reverse-causation effect that makes a higher BMI to appear protective when the follow-up is short.
Introduction: Higher midlife body mass index (BMI) is suggested to increase the risk of dementia, but weight loss during the preclinical dementia phase may mask such effects. Methods: We examined this hypothesis in 1,349,857 dementia-free participants from 39 cohort studies. BMI was assessed at baseline. Dementia was ascertained at follow-up using linkage to electronic health records (N = 6894). We assumed BMI is little affected by preclinical dementia when assessed decades before dementia onset and much affected when assessed nearer diagnosis. Results: Hazard ratios per 5-kg/m2 increase in BMI for dementia were 0.71 (95% confidence interval = 0.66-0.77), 0.94 (0.89-0.99), and 1.16 (1.05-1.27) when BMI was assessed 10 years, 10-20 years, and >20 years before dementia diagnosis. Conclusions: The association between BMI and dementia is likely to be attributable to two different processes: a harmful effect of higher BMI, which is observable in long follow-up, and a reverse-causation effect that makes a higher BMI to appear protective when the follow-up is short.
Introduction: Higher midlife body mass index (BMI) is suggested to increase the risk of dementia, but weight loss during the preclinical dementia phase may mask such effects. Methods: We examined this hypothesis in 1,349,857 dementia-free participants from 39 cohort studies. BMI was assessed at baseline. Dementia was ascertained at follow-up using linkage to electronic health records (N = 6894). We assumed BMI is little affected by preclinical dementia when assessed decades before dementia onset and much affected when assessed nearer diagnosis. Results: Hazard ratios per 5-kg/m(2) increase in BMI for dementia were 0.71 (95% confidence interval = 0.66-0.77), 0.94 (0.89-0.99), and 1.16 (1.05-1.27) when BMI was assessed 10 years, 10-20 years, and >20 years before dementia diagnosis. Conclusions: The association between BMI and dementia is likely to be attributable to two different processes: a harmful effect of higher BMI, which is observable in long follow-up, and a reverse-causation effect that makes a higher BMI to appear protective when the follow-up is short. 
• Data from 1.3 million adults from 39 prospective cohort studies were pooled for the analyses. • Higher BMI was associated with increased risk of dementia when the follow-up was long. • When follow-up was short, lower BMI was linked to increased dementia risk probably due to reverse causation.
Introduction: Higher midlife body mass index (BMI) is suggested to increase the risk of dementia, but weight loss during the preclinical dementia phase may mask such effects. Methods: We examined this hypothesis in 1,349,857 dementia-free participants from 39 cohort studies. BMI was assessed at baseline. Dementia was ascertained at follow-up using linkage to electronic health records (N = 6894). We assumed BMI is little affected by preclinical dementia when assessed decades before dementia onset and much affected when assessed nearer diagnosis. Results: Hazard ratios per 5-kg/m2 increase in BMI for dementia were 0.71 (95% confidence interval = 0.66-0.77), 0.94 (0.89-0.99), and 1.16 (1.05-1.27) when BMI was assessed 10 years, 10-20 years, and >20 years before dementia diagnosis. Conclusions: The association between BMI and dementia is likely to be attributable to two different processes: a harmful effect of higher BMI, which is observable in long follow-up, and a reverse-causation effect that makes a higher BMI to appear protective when the follow-up is short. 
Introduction Higher midlife body mass index (BMI) is suggested to increase the risk of dementia, but weight loss during the preclinical dementia phase may mask such effects. Methods We examined this hypothesis in 1,349,857 dementia‐free participants from 39 cohort studies. BMI was assessed at baseline. Dementia was ascertained at follow‐up using linkage to electronic health records (N = 6894). We assumed BMI is little affected by preclinical dementia when assessed decades before dementia onset and much affected when assessed nearer diagnosis. Results Hazard ratios per 5‐kg/m2 increase in BMI for dementia were 0.71 (95% confidence interval = 0.66–0.77), 0.94 (0.89–0.99), and 1.16 (1.05–1.27) when BMI was assessed 10 years, 10‐20 years, and >20 years before dementia diagnosis. Conclusions The association between BMI and dementia is likely to be attributable to two different processes: a harmful effect of higher BMI, which is observable in long follow‐up, and a reverse‐causation effect that makes a higher BMI to appear protective when the follow‐up is short. Highlights Data from 1.3 million adults from 39 prospective cohort studies were pooled for the analyses. Higher BMI was associated with increased risk of dementia when the follow‐up was long. When follow‐up was short, lower BMI was linked to increased dementia risk probably due to reverse causation.
Higher midlife body mass index (BMI) is suggested to increase the risk of dementia, but weight loss during the preclinical dementia phase may mask such effects. We examined this hypothesis in 1,349,857 dementia-free participants from 39 cohort studies. BMI was assessed at baseline. Dementia was ascertained at follow-up using linkage to electronic health records (N = 6894). We assumed BMI is little affected by preclinical dementia when assessed decades before dementia onset and much affected when assessed nearer diagnosis. Hazard ratios per 5-kg/m2 increase in BMI for dementia were 0.71 (95% confidence interval = 0.66–0.77), 0.94 (0.89–0.99), and 1.16 (1.05–1.27) when BMI was assessed 10 years, 10-20 years, and >20 years before dementia diagnosis. The association between BMI and dementia is likely to be attributable to two different processes: a harmful effect of higher BMI, which is observable in long follow-up, and a reverse-causation effect that makes a higher BMI to appear protective when the follow-up is short. •Data from 1.3 million adults from 39 prospective cohort studies were pooled for the analyses.•Higher BMI was associated with increased risk of dementia when the follow-up was long.•When follow-up was short, lower BMI was linked to increased dementia risk probably due to reverse causation.
Introduction: Higher midlife body mass index (BMI) is suggested to increase the risk of dementia, but weight loss during the preclinical dementia phase may mask such effects. Methods: We examined this hypothesis in 1,349,857 dementia-free participants from 39 cohort studies. BMI was assessed at baseline. Dementia was ascertained at follow-up using linkage to electronic health records (N = 6894). We assumed BMI is little affected by preclinical dementia when assessed decades before dementia onset and much affected when assessed nearer diagnosis. Results: Hazard ratios per 5-kg/m(2) increase in BMI for dementia were 0.71 (95% confidence interval = 0.66-0.77), 0.94 (0.89-0.99), and 1.16 (1.05-1.27) when BMI was assessed 10 years, 10-20 years, and >20 years before dementia diagnosis. Conclusions: The association between BMI and dementia is likely to be attributable to two different processes: a harmful effect of higher BMI, which is observable in long follow-up, and a reverse-causation effect that makes a higher BMI to appear protective when the follow-up is short. (C) 2017 The Authors. Published by Elsevier Inc. on behalf of the Alzheimer's Association.
Author Singh-Manoux, Archana
Kivimäki, Mika
Goldberg, Marcel
Pentti, Jaana
Theorell, Töres
Knutsson, Anders
Kivipelto, Miia
Jokela, Markus
Nordin, Maria
Koskenvuo, Markku
Fransson, Eleonor I.
Westerholm, Peter
Kuosma, Eeva
Shipley, Martin J.
Vahtera, Jussi
Vuoksimaa, Eero
Nyberg, Solja T.
Luukkonen, Ritva
Kaprio, Jaakko
Alfredsson, Lars
Suominen, Sakari B.
Westerlund, Hugo
Batty, G. David
Ferrie, Jane E.
Zins, Marie
AuthorAffiliation k Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
m Folkhälsan Research Center, Folkhälsan, Helsinki, Finland
j Population-based Epidemiologic Cohort Unit, UMS 011, Inserm, Villejuif, France
d Centre for Cognitive Ageing and Cognitive Epidemiology, Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
i Division of Epidemiology, Stress Research Institute, Stockholm University, Stockholm, Sweden
n School of Health and Education, University of Skövde, Skövde, Sweden
f Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
h School of Health Sciences and Welfare, Jönköping University, Jönköping, Sweden
r Department of Neurobiology, Karolinska Institute, Stockholm, Sweden
u Institute of Behavioral Sciences, University of Helsinki, Helsinki, Finland
p Institute for Molecular Medicine (FIMM), University of Helsinki, Helsinki, Finland
t University of Turku, Turku, Finland
g Centre for Occupational and Environmental Medicine, Sto
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– name: h School of Health Sciences and Welfare, Jönköping University, Jönköping, Sweden
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  organization: Turku University Hospital, Turku, Finland
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2018 The Alzheimer's Association
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Issue 5
Keywords Body mass index
Obesity
Cohort study
Bias
Dementia
Language English
License This is an open access article under the CC BY license.
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Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.
This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
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  publication-title: J Negat Results Biomed
  doi: 10.1186/s12952-016-0062-z
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Snippet Higher midlife body mass index (BMI) is suggested to increase the risk of dementia, but weight loss during the preclinical dementia phase may mask such...
Introduction Higher midlife body mass index (BMI) is suggested to increase the risk of dementia, but weight loss during the preclinical dementia phase may mask...
• Data from 1.3 million adults from 39 prospective cohort studies were pooled for the analyses. • Higher BMI was associated with increased risk of dementia...
Introduction: Higher midlife body mass index (BMI) is suggested to increase the risk of dementia, but weight loss during the preclinical dementia phase may...
INTRODUCTION: Higher midlife body mass index (BMI) is suggested to increase the risk of dementia, but weight loss during the preclinical dementia phase may...
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StartPage 601
SubjectTerms Aged
Bias
Body Mass Index
Cohort Studies
Cohort study
Data Interpretation, Statistical
Dementia
Dementia - etiology
Female
Global Health
Humans
Individ och samhälle VIDSOC
Individual and Society VIDSOC
Male
Middle Aged
Obesity
Obesity - complications
Risk Factors
Time Factors
Weight Loss - physiology
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Title Body mass index and risk of dementia: Analysis of individual-level data from 1.3 million individuals
URI https://dx.doi.org/10.1016/j.jalz.2017.09.016
https://onlinelibrary.wiley.com/doi/abs/10.1016%2Fj.jalz.2017.09.016
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Volume 14
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