EXCESS BODY-WEIGHT - AN UNDERRECOGNIZED CONTRIBUTOR TO HIGH BLOOD CHOLESTEROL LEVELS IN WHITE AMERICAN MEN

Background: The influence of body weight on serum lipids is often over looked in clinical practice. Methods: The association between body wei ght adjusted for height as calculated by body-mass index (BMI) and ser um lipid and lipoprotein levels in white men was examined using the se cond National Health and Nutrition Examination Survey (NHANES II). Lip id 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) 2 5.1 to 27.0 kg/m2, (5) 27.1 to 30.0 k g/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 7 4 years). Results: Using linear trend analysis, changes in BMI from ca tegories 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 lipopr otein (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 differ ences 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 ch olesterol levels (higher by 0.37 mmol/L [14 mg/dL] [P<.01] and 0.25 mm ol/L [10 mg/dL] [P<.01], respectively), whereas the LDL cholesterol le vels were unchanged. Although advancing age may blunt the BMI-associat ed 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. Conclusions: Excess body weight is associated with delete rious 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 ch olesterol 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 w eight.