Rosengren Annika, Skoog Ingmar, Gustafson Deborah, Wilhelmsen Lars
Department of Medicine, Sahlgrenska University Hospital/Ostra, Göteborg, Sweden.
Arch Intern Med. 2005 Feb 14;165(3):321-6. doi: 10.1001/archinte.165.3.321.
Previous studies have shown that risk factors commonly associated with coronary disease, stroke, and other vascular disorders also predict dementia. We investigated the longitudinal relationship between body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) and risk of hospital discharge or death certificate diagnosis of dementia.
A total of 7402 men who were 47 to 55 years old in 1970 to 1973, without prior stroke or myocardial infarction, derived from a population sample of 9998 men were prospectively followed up until 1998. Two hundred fifty-four men (3.4%) had a hospital discharge diagnosis or a death certificate diagnosis of dementia: 176 with a primary diagnosis or cause of death and 78 with a secondary diagnosis.
The relationship between BMI and dementia as a primary diagnosis was J-shaped, and men with a BMI between 20.00 and 22.49 had the lowest risk. Subsequently, after adjustment for smoking, blood pressure, serum cholesterol level, diabetes mellitus, and social class, the risk increased linearly in men who had a BMI of 22.50 to 24.99 (multiple-adjusted hazard ratio [HR], 1.73; 95% confidence interval [CI], 0.92-3.25), 25.00 to 27.49 (HR, 1.93; 95% CI, 1.03-3.63), 27.50 to 29.99 (HR, 2.30; 95% CI, 1.18-4.47), and 30.00 or greater (HR, 2.54; 95% CI, 1.20-5.36) (P for linear trend = .03). Men with a BMI less than 20.00 had a nonsignificantly elevated risk (HR, 2.19; 95% CI, 0.77-6.25).
A J-shaped relationship was observed between BMI and dementia, such that a BMI less than 20 and an increasing BMI of 22.5 or greater were associated with increased risk from midlife to old age of a primary hospital diagnosis of dementia. Overweight and obesity could be major preventable factors in the development of dementia.
既往研究表明，通常与冠心病、中风及其他血管疾病相关的危险因素也可预测痴呆。我们调查了体重指数（BMI，计算方法为体重千克数除以身高米数的平方）与痴呆的出院诊断或死亡证明诊断风险之间的纵向关系。
1970年至1973年，从9998名男性的人群样本中选取了7402名年龄在47至55岁之间、无既往中风或心肌梗死病史的男性进行前瞻性随访，直至1998年。254名男性（3.4%）有痴呆的出院诊断或死亡证明诊断：176例为主要诊断或死因，78例为次要诊断。
BMI与作为主要诊断的痴呆之间的关系呈J形，BMI在20.00至22.49之间的男性风险最低。随后，在对吸烟、血压、血清胆固醇水平、糖尿病和社会阶层进行调整后，BMI为22.50至24.99的男性风险呈线性增加（多因素调整风险比[HR]，1.73；95%置信区间[CI]，0.92 - 3.25），25.00至27.49的男性（HR，1.93；95% CI，1.03 - 3.63），27.50至29.99的男性（HR，2.30；95% CI, 1.18 - 4.47），以及30.00及以上的男性（HR，2.54；95% CI，1.20 - 5.36）（线性趋势P值 = 0.03）。BMI小于20.00的男性风险虽有升高但无统计学意义（HR，2.19；95% CI，0.77 - 6.25）。
观察到BMI与痴呆之间呈J形关系，即BMI小于20以及BMI在22.5及以上且不断增加与中年至老年时痴呆的主要医院诊断风险增加相关。超重和肥胖可能是痴呆发生发展中的主要可预防因素。
