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Body mass index over the adult life course and cognition in late midlife: the Whitehall II Cohort Study

¹ From the INSERM U687-IFR69, Villejuif, France (SS and AS-M); the Department of Epidemiology and Public Health, University College, London, United Kingdom (MK, MJS, MGM, and AS-M); and the Centre de Gérontologie, Hôpital Ste Perine, AP-HP, Paris, France (AS-M).

² Supported by a "European Young Investigator Award" from the European Science Foundation (to AS-M); the Academy of Finland projects 117604, 124322, and 124271 (to MK); a Medical Research Council research professorship (to MGM), and a grant from the British Heart Foundation (MJS). The Whitehall II Study is supported by grants from the British Medical Research Council; the British Heart Foundation; the British Health and Safety Executive; the British Department of Health; the National Heart, Lung, and Blood Institute (grant HL36310); the National Institute on Aging (grant AG13196); the Agency for Health Care Policy and Research (grant HS06516); and the John D and Catherine T MacArthur Foundation Research Networks on Successful Midlife Development and Socioeconomic Status and Health.

³ Reprints not available. Address correspondence to S Sabia, INSERM U687-IFR69, Hopital Paul Brousse, 16 Avenue Paul Vaillant Couturier, Bâtiment 15/16, 94807 Villejuif Cedex, France. E-mail: severine.sabia{at}inserm.fr.

Background: The extent to which cognition in late midlife is influenced by lifetime obesity is unclear.

Objective: We examined the association between body mass index (BMI) over the adult life course and cognition in late midlife and assessed the cumulative effects of obesity and underweight.

Design: Data from the Whitehall II Study were examined. BMI at 25 y (early adulthood) was self-reported at phase 1 and was measured in early midlife (mean age = 44 y; phase 1) and in late midlife (mean age = 61 y; phase 7). Cognition (n = 5131) was assessed in late midlife (phase 7) by using the Mini-Mental State Examination and tests of memory and executive function, all of which were standardized to T scores (mean ± SD: 50 ± 10).

Results: Both underweight and obesity were associated with lower cognition in late midlife and with early adulthood, early midlife, and late midlife measures of BMI. Being obese at 2 or 3 occasions was associated with lower Mini-Mental State Examination scores and scores of memory and executive function in analyses adjusted for age, sex, and education [difference (95% CI) in mean T scores compared with normal-weight group: –1.51 (–2.77, –0.25), –1.27 (–2.46, –0.07), and –1.35 (–2.45, –0.24), respectively]. Participants who were underweight at 2 occasions from early adulthood to late midlife had lower executive function [difference (95% CI) in mean T score: –4.57 (–6.94, –2.20)]. A large increase in BMI from early to late midlife was associated with lower executive function.

Conclusions: Long-term obesity and long-term underweight in adulthood are associated with lower cognitive scores in late midlife. Public health messages should promote a healthy weight at all ages.