Abstract
Introduction: Mild cognitive impairment (MCI) is a prodromal stage of dementia. The association of body mass index (BMI) and progression to Alzheimer's disease (AD) in MCI subjects according to age, sex, and cognitive intervention remains unknown. We investigated the relationship between BMI and the risk of progression to AD in subjects with MCI, as well as the effect of BMI on progression to AD depending on age, sex, cognitive intervention, and chronic diseases.Methods: Three hundred and eighty-eight MCI subjects were followed for 36.3 ± 18.4 months, prospectively. They underwent neuropsychological testing more than twice during the follow-up period. The MCI subjects were categorized into underweight, normal weight, overweight, and obese subgroups. The associations between baseline BMI and progression to AD over the follow-up period were estimated using Cox proportional hazard regression models. Data were analyzed after stratification by age, sex, cognitive intervention, and chronic diseases.Results: After adjustment for the covariates, the underweight MCI group had a higher risk of progression to AD [hazard ratio (HR): 2.38, 95% confidence interval (CI): 1.17–4.82] relative to the normal weight group. After stratifying by age, sex, cognitive intervention, and chronic diseases, this effect remained significant among females (HR: 3.15, 95% CI: 1.40–7.10), the older elderly ≥75 years old (HR: 3.52, 95% CI: 1.42–8.72), the non-intervention group (HR: 3.06, 95%CI: 1.18–7.91), and the hypertensive group (HR: 4.71, 95% CI: 1.17–18.99).Conclusion: These data indicate that underweight could be a useful marker for identifying individuals at increased risk for AD in MCI subjects. This association is even stronger in females, older elderly subjects, the non-cognitive intervention group, and the hypertensive group.
Highlights
Mild cognitive impairment (MCI) is a prodromal stage of dementia
We followed a cohort of MCI subjects prospectively to investigate the relationship between baseline body mass index (BMI) status and the risk of progression to Alzheimer’s disease (AD) in MCI subjects, as well as the effect of BMI on progression to AD depending on age, sex, cognitive intervention status, and chronic diseases
Prior to adjustment for covariates, the results of the Cox proportional hazard model showed that the underweight group had a higher risk of progression to AD relative to the normal weight group
Summary
Mild cognitive impairment (MCI) is a prodromal stage of dementia. The association of body mass index (BMI) and progression to Alzheimer’s disease (AD) in MCI subjects according to age, sex, and cognitive intervention remains unknown. A recent study of 228 MCI subjects reported that the overweight or obese group had a reduced risk of both dementia and AD, while the underweight group had a higher risk of dementia but not AD, compared to the normal weight group [8]. Other study has investigated this relationship in MCI subjects, suggesting that, the underweight group had a higher risk while the obese group had a lower risk of AD compared to the normal weight group [9]. These two studies did not consider the heterogeneity of MCI subjects. The impact of BMI on the onset of AD may be different in individuals who have received cognitive intervention compared to a non-intervention group
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