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An Underrecognized Contributor to High Blood Cholesterol Levels in White American Men

Margo A. Denke, MD; Christopher T. Sempos, PhD; Scott M. Grundy, MD, PhD

Arch Intern Med. 1993;153(9):1093-1103.

Abstract
Background
The influence of body weight on serum Lipids is often overlooked in clinical practice.

Methods
The association between body weight adjusted for height as calculated by body-mass index (BMI) and se[ill]um lipid and lipoprotein levels in white men was examined using the second National Health and Nutrition Examination Survey (NHANES II). Lipid results were categorized into six different levels of BMI: (1) 21.0 kg/m² or lower, (2) 21.1 to 23.0 kg/m², (3) 23.1 to 25.0 kg/m², (4) 25.1 to 27.0 kg/m², (5) 27.1 to 30.0 kg/m², and (6) greater than 30.0 kg/m², and three age groups: (1) young men (20 through 44 years), (2) middle-aged men (45 through 59 years), and (3) older men (60 through 74 years).

Results
Using linear trend analysis, changes in BMI from categories 2 to 5 in young men were associated with a total cholesterol level 0.59 mmol/L (23 mg/dL) higher (P<.01), a non—high-density lipoprotein (non-HDL) cholesterol level 0.70 mmol/L (27 mg/dL) higher (P<.01), and a low-density lipoprotein (LDL) cholesterol level 0.59 mmol/L (23 mg/ dL) higher (P=.03). For middle-aged men and older men, the same change in BMI was associated with smaller but still significant differences in total cholesterol levels (higher by 0.31 mmol/L [12 mg/dL] [P<.01] and 0.28 mmol/L [11 mg/dL] [P<.01], respectively) and non-HDL cholesterol levels (higher by 0.37 mmol/L [14 mg/dL] [P<.01] and0.25mmol/L[10mg/dL] [P<.01],respectively),whereas the LDL cholesterol levels were unchanged. Although advancing age may blunt the BMI-associated differences in total and LDL cholesterol levels, the BMI-associated differences in triglyceride levels (higher by 0.70 to 1.33 mmol/L [62 to 118 mg/dL] [P<.001]) and HDL cholesterol levels (lower by 0.18 to 0.39 mmol/L [7 to 15 mg/dL] [P<.001]) were of similar magnitude in all age groups.

Conclusion
Excess body weight is associated with deleterious changes in the lipoprotein profile. Higher BMI was associated at all ages with higher plasma triglyceride level, lower HDL cholesterol level, and higher total and non-HDL cholesterol levels. In young men, the higher total cholesterol level was reflected mainly in the LDL cholesterol level; in middle-aged and older men, in the non-HDL fraction. Programs to reduce coronary heart disease by improving lipid levels should include more emphasis on achieving and maintaining ideal body weight.

(Arch Intern Med. 1993;153:1093-1103)

Author Affiliations
From the The Center for Human Nutrition (Drs Denke and Grundy) and the Departments of Internal Medicine (Drs Denke and Grundy), Biochemistry (Dr Grundy), and Clinical Nutrition (Dr Grundy), University of Texas Southwestern Medical Center at Dallas; and the Division of Health Examination Statistics, National Center for Health Statistics, Centers for Disease Control, Hyattsville, Md (Dr Sempos).

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