老年体重指数、快速体重减轻、载脂蛋白Eε4与认知衰退和新发痴呆症风险
Late-Life Body Mass Index, Rapid Weight Loss, Apolipoprotein E ε4 and the Risk of Cognitive Decline and Incident Dementia.
作者信息
Bell S P, Liu D, Samuels L R, Shah A S, Gifford K A, Hohman T J, Jefferson A L
机构信息
Angela L. Jefferson, PhD, Vanderbilt Memory and Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, 1207 17th Avenue South, Suite 204, Nashville, TN 37212, Phone: 615-322-8676 Fax: 615-343-1302, Email:
出版信息
J Nutr Health Aging. 2017;21(10):1259-1267. doi: 10.1007/s12603-017-0906-3.
OBJECTIVES
To examine the effect of late-life body mass index (BMI) and rapid weight loss on incident mild cognitive impairment (MCI) and Alzheimer's disease (AD).
DESIGN
Prospective longitudinal cohort study.
SETTING
National Alzheimer's Coordinating Center (NACC) Uniform Data Set, including 34 past and current National Institute on Aging-funded AD Centers across the United States.
PARTICIPANTS
6940 older adults (n=5061 normal cognition [NC]; n=1879 MCI).
MEASUREMENTS
BMI (kg/m2) and modified Framingham Stroke Risk Profile (FSRP) score (sex, age, systolic blood pressure, anti-hypertension medication, diabetes mellitus, cigarette smoking, prevalent cardiovascular disease, atrial fibrillation) were assessed at baseline. Cognition and weight were assessed annually.
RESULTS
Multivariable binary logistic regression, adjusting for age, sex, race, education, length of follow-up, and modified FSRP related late-life BMI to risk of diagnostic conversion from NC to MCI or AD and from MCI to AD. Secondary analyses related late-life BMI to diagnostic conversion in the presence of rapid weight loss (>5% decrease in 12 months) and apolipoprotein E (APOE) ε4. During a mean 3.8-year follow-up period, 12% of NC participants converted to MCI or AD and 49% of MCI participants converted to AD. Higher baseline BMI was associated with a reduced probability of diagnostic conversion, such that for each one-unit increase in baseline BMI there was a reduction in diagnostic conversion for both NC (OR=0.977, 95%CI 0.958-0.996, p=0.015) and MCI participants (OR=0.962, 95%CI 0.942-0.983, p<0.001). The protective effect of higher baseline BMI did not persist in the setting of rapid weight loss but did persist when adjusting for APOE ε4.
CONCLUSIONS
Higher late-life BMI is associated with a lower risk of incident MCI and AD but is not protective in the presence of rapid weight loss.
目的
研究晚年体重指数（BMI）及快速体重减轻对轻度认知障碍（MCI）和阿尔茨海默病（AD）发病的影响。
设计
前瞻性纵向队列研究。
地点
国家阿尔茨海默病协调中心（NACC）统一数据集，包括美国34个过去和现在由美国国立衰老研究所资助的AD中心。
参与者
6940名老年人（n = 5061名认知正常[NC]；n = 1879名MCI）。
测量指标
在基线时评估BMI（kg/m²）和改良的弗雷明汉卒中风险概况（FSRP）评分（性别、年龄、收缩压、抗高血压药物、糖尿病、吸烟、心血管疾病史、心房颤动）。每年评估认知和体重。
结果
多变量二元逻辑回归分析，校正年龄、性别、种族、教育程度、随访时间以及改良的FSRP后，晚年BMI与从NC诊断转变为MCI或AD以及从MCI诊断转变为AD的风险相关。二次分析将晚年BMI与存在快速体重减轻（12个月内体重下降>5%）和载脂蛋白E（APOE）ε4时的诊断转变相关联。在平均3.8年的随访期内，12%的NC参与者转变为MCI或AD，49%的MCI参与者转变为AD。较高的基线BMI与诊断转变概率降低相关，即基线BMI每增加一个单位，NC参与者（OR = 0.977，95%CI 0.958 - 0.996，p = 0.015）和MCI参与者（OR = 0.962，95%CI 0.942 - 0.983，p < 0.001）的诊断转变均减少。较高基线BMI的保护作用在快速体重减轻情况下未持续存在，但在校正APOE ε4后持续存在。
结论
晚年较高的BMI与MCI和AD发病风险较低相关，但在存在快速体重减轻时无保护作用。
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