title: Change in body mass index and risk of incident Alzheimer disease.
abstract: OBJECTIVE
  To examine the association of change in body mass index (BMI) with risk of Alzheimer disease (AD).
  
  
  METHODS
  Nine hundred eighteen older Catholic clergy participating in the Religious Orders Study without dementia at baseline were studied. Outcome measures were the clinical diagnosis of AD and change in cognitive function.
  
  
  RESULTS
  During a mean follow-up of 5.5 years, 151 persons developed AD. BMI averaged 27.4 at baseline and declined in about half the participants. In a proportional hazards model adjusted for age, sex, and education, each 1-unit less of BMI at baseline was associated with about a 5% increase in the risk of AD (hazard ratio = 0.944; 95% CI = 0.908 to 0.981), and each 1-unit annual decline in BMI (about the 10th percentile) was associated with about a 35% increase in the risk of AD compared with a person experiencing no change in BMI (about the 50th percentile) (hazard ratio = 0.730; 95% CI = 0.625 to 0.852). The results were similar after controlling for chronic diseases and excluding persons who developed AD during the first 4 years of observation. Random effects models showed that the rate of cognitive decline increased by about 8% for each 1-unit less of BMI at baseline and declined an additional 40%/year in persons losing 1 unit of BMI/year compared with those with no change in BMI.
  
  
  CONCLUSIONS
  Declining body mass index (BMI) is associated with increased risk of incident Alzheimer disease (AD). Loss of BMI may reflect pathologic processes that contribute to the subsequent development of AD.
authors.affiliation: Rush Alzheimer's Disease Center, Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA. Aron_S_Buchman@rush.edu
authors.forename: A S
authors.initials: AS
authors.lastname: Buchman
authors.forename: R S
authors.initials: RS
authors.lastname: Wilson
authors.forename: J L
authors.initials: JL
authors.lastname: Bienias
authors.forename: R C
authors.initials: RC
authors.lastname: Shah
authors.forename: D A
authors.initials: DA
authors.lastname: Evans
authors.forename: D A
authors.initials: DA
authors.lastname: Bennett
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000453:epidemiology* / Q000503:physiopathology; D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology; D002100:Cachexia / Q000453:epidemiology* / Q000503:physiopathology; D015331:Cohort Studies; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D012307:Risk Factors; D012737:Sex Factors