Objective: Overweight and obesity are epidemic in western societies, and increase risk for vascular diseases. Vascular factors also increase risk for Alzheimer’s disease (AD) and age-related degenerative brain processes. We examined the longitudinal relationship between cerebral atrophy and two indices of obesity - body mass index (BMI) and waist-to-hip ratio (WHR) - in a representative sample of elderly women over a 24-year period.
Design: A prospective, population-based sample of women enrolled in the Gothenburg Women’s Study (GWS) in Gothenburg, Sweden. The women were born in 1908, 1914, 1918, and 1922, and were followed from 1968 to 1992.
Materials and Methods: GWS participants (n=1462) were examined in 1968, 1974, 1980, and 1992. Each examination included a physical examination, blood tests, clinical anthropometric and blood pressure measurements, and a survey on demographic, lifestyle and medical factors. In 1992-93, a representative subsample of 290 participants took part in a psychiatric examination, computed tomography (CT) of the brain, and had complete longitudinal data on anthropometric measurements. Atrophy of the occipital, parietal, frontal, and temporal lobes was categorized using a three-point scale (normal, mild, and moderate or severe). For statistical analyses presented here, atrophy measurements were dichotomised and scored as no atrophy (n=146) versus mild plus moderate or severe atrophy (n=144). Mean comparisons and logistic regression analyses were used to evaluate the relationship between atrophy, and BMI and WHR.
Results: A high BMI at each examination year was associated with atrophy of the temporal lobe in women aged 70–84 years. BMI (mean (standard deviation)) in women with vs. without temporal atrophy was 24.8 (3.7) vs. 23.7 (3.4) kg/m2 in 1968 (age-adjusted p=0.058); 25.3 (3.7) vs. 24.0 (3.6) kg/m2 in 1974 (p=0.019); 25.8 (3.7) vs. 24.3 (3.6) kg/m2 in 1980 (p=0.004); and 27.0 (4.7) vs. 25.8 (3.8) kg/m2 in 1992 (p=0.007). There were no associations between anthropometric measures and atrophy of the occipital, parietal, or frontal lobes. In multivariate models including BMI, age, diastolic blood pressure, education, smoking, socioeconomic status, and any psychiatric disorder, only BMI and age were significant predictors of temporal atrophy. Each 1 kg/m2 increase in BMI increased the odds of temporal atrophy by 12-16% (p<0.02), and each year of advancing age increased the odds by 15-19% (p<0.005).
Conclusion: This study is the first to show a longitudinal relationship between high BMI and brain atrophy specifically localized in the temporal region, over a lengthy, 24-year follow-up period in elderly women. The relationship between BMI and temporal atrophy did not diminish after adjustment for multiple, previously reported, confounding factors. Since temporal atrophy is associated with AD, this finding may aid in the understanding of processes underlying AD pathology.
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