Sex differences in body mass index and waist circumference trajectories and dementia risk: the HUNT4 70+ study

Ekaterina Zotcheva^{1

2}, Bjørn Heine Strand^{3

4

5}, Vegard Skirbekk^{3

5

6}, Kay Deckers⁷, Steinar Krokstad^{8

9}, Gill Livingston^{10

11}, Archana Singh-Manoux^{10

12}, Geir Selbæk^{3

4

13}

Affiliations

¹ Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Aldring Og Helse, PO Box 2136, 3103, Tønsberg, Norway. ekaterina.zotcheva@aldringoghelse.no.
² Department of Geriatric Medicine, Oslo University Hospital, Nydalen, OUS HF, Ullevål Sykehus, PO Box 4956, 0424, Oslo, Norway. ekaterina.zotcheva@aldringoghelse.no.
³ Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Aldring Og Helse, PO Box 2136, 3103, Tønsberg, Norway.
⁴ Department of Geriatric Medicine, Oslo University Hospital, Nydalen, OUS HF, Ullevål Sykehus, PO Box 4956, 0424, Oslo, Norway.
⁵ Department of Physical Health and Ageing, Norwegian Institute of Public Health, Skøyen, PO Box 222, 0213, Oslo, Norway.
⁶ Centre for Fertility and Health, Norwegian Institute of Public Health, PO Box 222, 0213, SkøyenOslo, Norway.
⁷ Department of Psychiatry and Neuropsychology, Mental Health and Neuroscience Research Institute (MHeNs), Alzheimer Centrum Limburg, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands.
⁸ Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, HUNT Research Centre, Norwegian University of Science and Technology, PO Box 8905, 7491, Trondheim, Norway.
⁹ Levanger Hospital, Nord-Trøndelag Hospital Trust, PO Box 333, 7601, Levanger, Norway.
¹⁰ Division of Psychiatry, University College London, 149 Tottenham Ct Rd, London, W1 T7 NF, UK.
¹¹ North London NHS Foundation Trust, 4 St Pancras Way, London, NW1 OPE, UK.
¹² Epidemiology of Ageing and Neurodegenerative Diseases, U1153 Inserm, Université Paris Cité, 10 Avenue de Villemin, 75010, Paris, France.
¹³ Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Blindern, PO Box 1072, 0316, Oslo, Norway.

PMID: 40259151
PMCID: PMC12972498
DOI: 10.1007/s11357-025-01660-3

Sex differences in body mass index and waist circumference trajectories and dementia risk: the HUNT4 70+ study

Ekaterina Zotcheva et al. Geroscience. 2026 Feb.

. 2026 Feb;48(1):405-419.

doi: 10.1007/s11357-025-01660-3. Epub 2025 Apr 22.

Authors

Affiliations

¹ Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Aldring Og Helse, PO Box 2136, 3103, Tønsberg, Norway. ekaterina.zotcheva@aldringoghelse.no.
² Department of Geriatric Medicine, Oslo University Hospital, Nydalen, OUS HF, Ullevål Sykehus, PO Box 4956, 0424, Oslo, Norway. ekaterina.zotcheva@aldringoghelse.no.
³ Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Aldring Og Helse, PO Box 2136, 3103, Tønsberg, Norway.
⁴ Department of Geriatric Medicine, Oslo University Hospital, Nydalen, OUS HF, Ullevål Sykehus, PO Box 4956, 0424, Oslo, Norway.
⁵ Department of Physical Health and Ageing, Norwegian Institute of Public Health, Skøyen, PO Box 222, 0213, Oslo, Norway.
⁶ Centre for Fertility and Health, Norwegian Institute of Public Health, PO Box 222, 0213, SkøyenOslo, Norway.
⁷ Department of Psychiatry and Neuropsychology, Mental Health and Neuroscience Research Institute (MHeNs), Alzheimer Centrum Limburg, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands.
⁸ Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, HUNT Research Centre, Norwegian University of Science and Technology, PO Box 8905, 7491, Trondheim, Norway.
⁹ Levanger Hospital, Nord-Trøndelag Hospital Trust, PO Box 333, 7601, Levanger, Norway.
¹⁰ Division of Psychiatry, University College London, 149 Tottenham Ct Rd, London, W1 T7 NF, UK.
¹¹ North London NHS Foundation Trust, 4 St Pancras Way, London, NW1 OPE, UK.
¹² Epidemiology of Ageing and Neurodegenerative Diseases, U1153 Inserm, Université Paris Cité, 10 Avenue de Villemin, 75010, Paris, France.
¹³ Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Blindern, PO Box 1072, 0316, Oslo, Norway.

PMID: 40259151
PMCID: PMC12972498
DOI: 10.1007/s11357-025-01660-3

Erratum in

Correction to: Sex differences in body mass index and waist circumference trajectories and dementia risk: the HUNT4 70+ study.
Zotcheva E, Strand BH, Skirbekk V, Deckers K, Krokstad S, Livingston G, Singh-Manoux A, Selbæk G. Zotcheva E, et al. Geroscience. 2025 Oct;47(5):6661-6662. doi: 10.1007/s11357-025-01753-z. Geroscience. 2025. PMID: 40524031 Free PMC article. No abstract available.

Abstract

We examined associations between body mass index (BMI), waist circumference (WC), and dementia risk, and differences in BMI and WC trajectories before dementia diagnosis. We included 9,739 participants (54% women) aged 70+ from the Trøndelag Health Study (HUNT4 70+). BMI was measured four times (1984-2019) and WC three times (1995-2019). Dementia diagnoses were clinically assessed at HUNT4 70+ . Women and men with dementia had higher midlife BMI and WC than those without dementia. These differences diminished closer to diagnosis, especially in women. Midlife obesity in both sexes and midlife overweight, high WC, and overweight/obesity with high WC in men were linked to higher dementia risk. Lower dementia risk was observed with late-life overweight for both sexes, late-life high WC in women, late-life overweight/obesity with normal WC in men or high WC in women. Adiposity measures and their changes influence dementia risk differently in women and men.

Keywords: Adiposity; Anthropometric measures; Cognitive impairment; Life-course perspective; Population-based study.

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Conflict of interest statement

Declarations. Conflicts of interest: EZ, BHS, VS, KD, SK, GL and ASM declare no conflicts of interest. GS has participated in Advisory Board meetings for Roche, Eli-Lilly and Eisai regarding disease-modifying drugs for Alzheimer’s disease. GS has received honoraria for delivering lectures at symposia sponsored by Eisai and Eli-Lilly.

Figures

**Fig. 1**
Flowchart showing study sample selection from the Trøndelag Health Study (HUNT)

**Fig. 2**
Trajectories of body mass index (BMI) from HUNT1 to HUNT4 and trajectories of waist circumference (WC) from HUNT2 to HUNT4 in women and men according to dementia status at HUNT4. Adjusted for age, educational attainment, marital status, physical activity, smoking, symptoms of anxiety or depression, and APOE ɛ4 status. Data on adjustment variables are imputed using multiple imputation. Abbreviations: HUNT: The Trøndelag Health Study, HUNT1: 1984–86, HUNT2: 1995–97, HUNT3: 2006–08, HUNT4: 2017–19

**Fig. 3**
Predicted probability of dementia at HUNT4 by body mass index (BMI) and waist circumference (WC) for women and men at the four HUNT Study waves. Adjusted for age, educational attainment, marital status, physical activity, smoking, symptoms of anxiety or depression, and APOE ɛ4 status. Data on adjustment variables are imputed using multiple imputation. Abbreviations: HUNT: The Trøndelag Health Study, HUNT1: 1984–86, HUNT2: 1995–97, HUNT3: 2006–08, HUNT4: 2017–19

**Fig. 4**
Odds ratios for dementia at HUNT4 associated with combinations of body mass index (BMI) and waist circumference (WC) at HUNT2, HUNT3, and HUNT4 for women and men. Normal WC normal BMI is the reference category. Adjusted for age, educational attainment, marital status, physical activity, smoking, symptoms of anxiety or depression, and APOE ɛ4 status. Data on adjustment variables are imputed using multiple imputation. Abbreviations: HUNT: The Trøndelag Health Study, HUNT2: 1995–97, HUNT3: 2006–08, HUNT4: 2017–19

See this image and copyright information in PMC

References

1. GBD. Dementia Forecasting Collaborators. Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019. Lancet Public Health. 2019;2022(7):e105–25. 10.1016/s2468-2667(21)00249-8. - DOI - PMC - PubMed
1. Livingston G, Huntley J, Liu KY, Costafreda SG, Selbæk G, Alladi S, et al. Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. Lancet. 2024;404:572–628. 10.1016/s0140-6736(24)01296-0. - DOI - PubMed
1. Rosenau C, Köhler S, Soons LM, Anstey KJ, Brayne C, Brodaty H, et al. Umbrella review and Delphi study on modifiable factors for dementia risk reduction. Alzheimers Dement. 2024;20:2223–39. 10.1002/alz.13577. - DOI - PMC - PubMed
1. Albanese E, Launer LJ, Egger M, Prince MJ, Giannakopoulos P, Wolters FJ, et al. Body mass index in midlife and dementia: Systematic review and meta-regression analysis of 589,649 men and women followed in longitudinal studies. Alzheimers Dement: Diagn Assess Dis Monit. 2017;8:165–78. 10.1016/j.dadm.2017.05.007. - DOI - PMC - PubMed
1. Qu Y, Hu HY, Ou YN, Shen XN, Xu W, Wang ZT, et al. Association of body mass index with risk of cognitive impairment and dementia: a systematic review and meta-analysis of prospective studies. Neurosci Biobehav Rev. 2020;115:189–98. 10.1016/j.neubiorev.2020.05.012. - DOI - PubMed

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Sex differences in body mass index and waist circumference trajectories and dementia risk: the HUNT4 70+ study

Affiliations

Sex differences in body mass index and waist circumference trajectories and dementia risk: the HUNT4 70+ study

Authors

Affiliations

Erratum in

Abstract

Conflict of interest statement

Figures

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical