Mukamal and colleagues1 found an inverse association between body mass index (BMI) and the risk of suicide death in a prospective cohort study of male health care professionals. The mechanism underlying this association, however, is not clearly understood. We suggest that one possibility might be related to the lower cholesterol levels associated with low BMI. Low cholesterol level may in fact indicate an at-risk population for parasuicide or completed suicide,2 and follow-up studies have found that individuals with lower cholesterol levels have an increased risk of completing suicide.3 Furthermore, the inheritance of defects leading to low cholesterol levels could predispose individuals to violent and suicidal behavior.4,5 In fact, in a recent study6 in which cholesterol content was measured in cortical and subcortical tissue of brains from 41 male suicide completers and 21 male controls, violent suicides were found to have lower gray matter cholesterol content overall compared with nonviolent suicides and controls.
Mascitelli L, Pezzetta F. Body Mass Index, Low Cholesterol Level, and Death From Suicide. Arch Intern Med. 2007;167(17):1907-1908. doi:10.1001/archinte.167.17.1907-b