Central obesity and increased risk of dementia more than three decades later.
BACKGROUND
Numerous reports show that a centralized distribution of adiposity is a more dangerous risk factor for cardiovascular disease and diabetes than total body obesity. No studies have evaluated whether the same pattern exists with dementia. The objective was to evaluate the association between midlife central obesity and risk of dementia three decades later.


METHODS
A longitudinal analysis was conducted of 6,583 members of Kaiser Permanente of Northern California who had their sagittal abdominal diameter (SAD) measured in 1964 to 1973. Diagnoses of dementia were from medical records an average of 36 years later, January 1, 1994, to June 16, 2006. Cox proportional hazard models adjusted for age, sex, race, education, marital status, diabetes, hypertension, hyperlipidemia, stroke, heart disease, and medical utilization were conducted.


RESULTS
A total of 1,049 participants (15.9%) were diagnosed with dementia. Compared with those in the lowest quintile of SAD, those in the highest had nearly a threefold increased risk of dementia (hazard ratio, 2.72; 95% CI, 2.33-3.33), and this was only mildly attenuated after adding body mass index (BMI) to the model (hazard ratio, 1.92; 95% CI, 1.58-2.35). Those with high SAD (>25 cm) and normal BMI had an increased risk (hazard ratio, 1.89; 95% CI, 0.98-3.81) vs those with low SAD (<25 cm) and normal BMI (18.5-24.9 kg/m(2)), whereas those both obese (BMI >30 kg/m(2)) and with high SAD had the highest risk of dementia (HR, 3.60; 95% CI, 2.85-4.55).


CONCLUSIONS
Central obesity in midlife increases risk of dementia independent of diabetes and cardiovascular comorbidities. Fifty percent of adults have central obesity; therefore, mechanisms linking central obesity to dementia need to be unveiled.
Whitmer
R A
RA
Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA 94612, USA. rachel.whitmer@kp.org
Gustafson
D R
DR
Barrett-Connor
E
E
Haan
M N
MN
Gunderson
E P
EP
Yaffe
K
K
D050153:Abdominal Fat / Q000378:metabolism / Q000503:physiopathology; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000378:metabolism*; D000886:Anthropometry / Q000379:methods; D015992:Body Mass Index; D002140:California / Q000453:epidemiology; D015984:Causality; D015331:Cohort Studies; D015897:Comorbidity; D003704:Dementia / Q000453:epidemiology* / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology* / Q000503:physiopathology; D016016:Proportional Hazards Models; D012307:Risk Factors; D040242:Risk Reduction Behavior