February 28, 1994

Excess Body WeightAn Under-recognized Contributor to Dyslipidemia in White American Women

Author Affiliations

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

Arch Intern Med. 1994;154(4):401-410. doi:10.1001/archinte.1994.00420040061010

Background:  Whether the association between excess body weight and dyslipidemia is consistent across different age ranges in women has yet to be determined.

Methods:  The relationship between body weight adjusted for height as calculated by body mass index (BMI; kilograms per square meter) and serum lipid and lipoprotein levels in white women was examined using crosssectional data from the Second National Health and Nutrition Examination Survey. Mean lipid levels were determined for six different categories of BMI: (1) 21.0 or less; (2) 21.1 to 23.0; (3) 23.1 to 25.0; (4) 25.1 to 27.0; (5) 27.1 to 30.0; and (6) more than 30.0, and three age groups: premenopausal women, 20 through 44 years; perimenopausal women, 45 through 59 years; and postmenopausal women, 60 through 74 years.

Results:  Compared with BMI category 2, a BMI in category 5 for premenopausal women was associated with 0.46 mmol/L (18 mg/dL) higher total cholesterol levels, 0.68 mmol/L (26 mg/dL) higher non—high-density lipoprotein (HDL) cholesterol levels, and 0.44 mmol/L (17 mg/ dL) higher low-density lipoprotein (LDL) cholesterol levels. For perimenopausal women and postmenopausal women the same change in BMI was associated with much smaller differences in total cholesterol of 0.16 and 0.16 mmol/L (6 and 5 mg/dL), non-HDL of 0.24 and 0.20 mmol/L (9 and 8 mg/dL), and LDL levels of 0.13 and 0.03 mmol/L (5 and 1 mg/dL). More impressively, rising BMI was associated with consistently higher triglyceride levels of 0.54 to 0.40 mmol/L (48 to 35 mg/dL) and consistently lower HDL levels of 0.23 to 0.13 mmol/L (9 to 5 mg/dL), in all three age groups.

Conclusion:  For young women, excess body weight was associated with higher total, non-HDL and LDL-cholesterol levels, higher triglyceride levels, and lower HDL-cholesterol levels. In older women, although similar differences in triglyceride levels and HDL-cholesterol levels were observed, excess body weight was associated with smaller differences in total, non-HDL, and LDL cholesterol. More striking than the weightassociated differences in total, non-HDL, and LDL-cholesterol levels were the differences in these lipid parameters observed with age alone. Specifically, age category differences were twofold to eightfold greater than differences observed between categories of BMI within a given age. Nevertheless, because the lower HDL cholesterol concentrations associated with excess body weight were age independent, total cholesterol-HDL cholesterol ratios were highest in obese postmenopausal women. Although age and hormonal status are important affecters of lipoprotein risk factors, body weight also worsens the degree of dyslipidemia in white women.(Arch Intern Med. 1994;154:401-410)