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Midlife and late-life obesity and the risk of dementia: cardiovascular health study
Fitzpatrick AL, Kuller LH, Lopez OL, Diehr P, O'Meara ES, Longstreth WT, Luchsinger JA.. Archives of neurology, 2009-03-01
Topic: Risk, prevention and care in population studies
Background While high adiposity in middle age appears to be related to greater dementia risk, studies exploring this association in the elderly are conflicting. Objective To evaluate associations between midlife and late-life obesity and risk of dementia. Design Prospective study with mean follow-up of 5.4 years (1992-1994 through 1999). Setting Community-dwelling sample in 4 US sites recruited from Medicare eligibility files. Participants A total of 2798 adults without dementia (mean age, 74.7 years; 59.1% women) participating in the Cardiovascular Health Study who underwent magnetic resonance imaging were measured for height and weight at baseline at age 65 years or older (late life), and self-reported weight at age 50 years (midlife). Body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) was calculated at both times. Main outcome measures Dementia, Alzheimer disease, and vascular dementia classified by a multidisciplinary committee using standardized criteria. Results Classification resulted in 480 persons with incident dementia, 245 with Alzheimer disease (no vascular dementia), and 213 with vascular dementia (with or without Alzheimer disease). In evaluations of midlife obesity, an increased risk of dementia was found for obese (BMI >30) vs normal-weight (BMI 20-25) persons, adjusted for demographics (hazard ratio [HR], 1.39; 95% confidence interval [CI], 1.03-1.87) and for cardiovascular risk factors (1.36; 0.94-1.95). The risk estimates were reversed in assessments of late-life BMI. Underweight persons (BMI 25-30) was not associated (0.92; 0.72-1.18) and being obese reduced the risk of dementia (0.63; 0.44-0.91) compared with those with normal BMI. Conclusion These results help explain the "obesity paradox" as differences in dementia risk across time are consistent with physical changes in the trajectory toward disability.
Key findings
- Results Classification resulted in 480 persons with incident dementia, 245 with Alzheimer disease (no vascular dementia), and 213 with vascular dementia (with or without Alzheimer disease).
- In evaluations of midlife obesity, an increased risk of dementia was found for obese (BMI >30) vs normal-weight (BMI 20-25) persons, adjusted for demographics (hazard ratio [HR], 1.39; 95% confidence interval [CI], 1.03-1.87) and for cardiovascular risk factors (1.36; 0.94-1.95).
- Underweight persons (BMI 25-30) was not associated (0.92; 0.72-1.18) and being obese reduced the risk of dementia (0.63; 0.44-0.91) compared with those with normal BMI.
- Conclusion These results help explain the "obesity paradox" as differences in dementia risk across time are consistent with physical changes in the trajectory toward disability.
Why it matters
In 2,798 older US adults followed for an average of 5.4 years, people who reported being obese at age 50 had a higher risk of dementia than normal-weight people (hazard ratio 1.39; 95% CI 1.03-1.87), though the link was no longer clear after adjusting for cardiovascular risk factors (1.36; 0.94-1.95). For weight measured at 65 or older, the pattern reversed: obesity was linked to a lower dementia risk (0.63; 0.44-0.91). The authors say this "obesity paradox" fits physical changes on the path toward disability, so it is an association, not evidence that weight gain in old age protects the brain.
Study details
- Participants2,798
- Effect size59.1%
- Evidence strengthLow
How this study scored 61/100
Published in a peer-reviewed journal. Scored zero for study design and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Archives of neurology) |
| Journal's citation record | 3 / 4 | Archives of Neurology: journal h-index 353 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2009 — within 20 year(s) of the newest study here |
| Sample size | 3 / 4 | 2,798 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 6 / 7 | Cited 797 times (OpenAlex, 2026-10-10) |
| Citations per year | 4 / 5 | 41.9 citations a year over 19 year(s) since 2009 |
| Impact for its field and year | 5 / 6 | Cited 21.3× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 4 / 6 | Cited by 62 other studies in this library |
| Still being cited | 3 / 4 | Cited 139 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Jose Alejandro Luchsinger: h-index 78 (OpenAlex, whole career) |
| Institution's track record | 3 / 3 | University of Washington: institution h-index 3,540 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 3 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 19273752) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 61 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
- DOI: 10.1001/archneurol.2008.582
- PubMed: 19273752
- Original source →
- Free full text: PubMed Central →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record names 7 authors; APA and Vancouver show the first six, BibTeX and the downloads carry all of them. Check the citation against the original before you use it.
APA 7th
Fitzpatrick, A. L., Kuller, L. H., Lopez, O. L., Diehr, P., O'Meara, E. S., Longstreth, W. T., et al. (2009). Midlife and late-life obesity and the risk of dementia: cardiovascular health study. Archives of neurology. https://doi.org/10.1001/archneurol.2008.582
Vancouver
Fitzpatrick AL, Kuller LH, Lopez OL, Diehr P, O'Meara ES, Longstreth WT, et al. Midlife and late-life obesity and the risk of dementia: cardiovascular health study. Archives of neurology. 2009. doi:10.1001/archneurol.2008.582. PMID: 19273752.
BibTeX
@article{fitzpatrick2009-19273752,
author = {Fitzpatrick, A. L. and Kuller, L. H. and Lopez, O. L. and Diehr, P. and O'Meara, E. S. and Longstreth, W. T. and Luchsinger, J. A.},
title = {{Midlife and late-life obesity and the risk of dementia: cardiovascular health study}},
journal = {Archives of neurology},
year = {2009},
doi = {10.1001/archneurol.2008.582},
pmid = {19273752},
url = {https://doi.org/10.1001/archneurol.2008.582}
}
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