The Body Mass Index‐Mortality Relationship in White and African American Women

Abstract

STEYENS, JUNE, MICHAEL W. PLANKEY, DAYID F. WILLIAMSON, MICHAEL J. THUN, PHILIP F. RUST, YUKO PALESCH. The body mass index-mortality relationship in white and African American women. Obes Res. 1998;6:268-277. Objective: To examine the association of body mass index to all-cause and cardiovascular disease (CYD) mortality in white and African American women. Research methods and procedures:Women who were members of the American Cancer Society Prevention Study I were examined in 1959 to 1960 and then followed 12 years for vital status. Data for this analysis were from 8,142 black and 100,000 white women. Body mass index (BMI) was calculated from reported height and weight. Associations were examined using Cox proportional hazards modeling with some analyses stratified by smoking (current or never) and educational status (less than complete high school or high school graduate).Results: There was a significant interaction between ethnicity and BMI for both all-cause (p<0.05) and CYD mortality (p<0.00l). BMI (as a continuous variable) was associated with all-cause mortality in white women in all four groups defined by smoking and education. In black women with less than a high school education, there were no significant associations between BMI mortality. For high schooleducated black women, there was a significant association between BMI and all-cause mortality. Among never smoking women with at least a high school education, models using the lowest BMI as the reference indicated a 40% Submitted for publication April 2, 1997. Accepted for publication February 9, 1998. From the 'Departments of Nutrition and Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, NC; tDepartments of Biometry and Psychiatry, Medical University of South Carolina, Charleston, SC; :j:National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA; and §American Cancer Society, Atlanta, GA. Reprint requests to Dr. June Stevens, Departments of Nutrition and Epidemiology, CB 7400, University of North Carolina, Chapel Hill, NC 27599. Copyright © 1998 NAASO.268 OBESITY RESEARCH Vol. 6 NO.4 July 1998 higher risk of all-cause mortality at a BMI of 35.9 in black women vs. 27.3 in white women. Discussion:The impact of BMI on mortality was modified by educational level in black women; however, BMI was a less potent risk factor in black women than in white women in the same category of educational status.

Body mass index and all-cause mortality in a nationwide US cohort

“…A number of other studies that have examined the relationship in black women have found obesity weakly associated with mortality, 7,28,29 but there is some suggestion that education may modify the mortality/obesity relationship in black women 28 with stronger associations among high school graduates, a status characterizing the vast majority of black subjects in this cohort.…”

Reduction of Ovarian and Oviductal Cancers in Calorie-Restricted Laying Chickens

“…Birds, like mammals, have a lower incidence of cancer and improved life expectancy when given a diet restricted in calories (35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45). Mortality rates were significantly higher in birds on the calorie-dense diet than for those fed a calorie-restricted diet.…”

“…A positive association between excess body weight and mortality has been shown in both humans and animals. (35)(36)(37)(38)(39). Human mortality due to cardiovascular disease for example has long been associated with excess body weight (40).…”

Obesity and C-reactive Protein Levels Among White, Black, and Hispanic US Adults

“…Moreover, among certain racial and ethnic minority populations such as African Americans, the rate of death from cardiovascular disease is substantially higher than the rate in whites (4,5). Paradoxically, while the prevalence of obesity and the rate of cardiovascular death is higher in African Americans, a number of studies have suggested that obesity has less of an adverse impact on all-cause and cardiovascular mortality in African Americans than in white populations in the United States (3)(4)(5)(6)(7)(8). The racial difierences are most striking in women, where the relative risk of all-cause and cardiovascular mortality associated with the highest categories of BMI can be severalfold higher in white women compared to African American women (8).…”

“…Despite obesity's disproportionately high prevalence in African Americans and Hispanic American (1,2), studies suggest that its adverse impact on cardiovascular risk and mortality may be reduced in some minority populations (3)(4)(5)(6)(7)(8). For example, even though African Americans have a higher prevalence of hypertension and diabetes than white Americans, evidence suggests that the associations between obesity and these cardiovascular risk factors are steeper in white Americans than in African Americans…”