High cholesterol is a risk factor for the development of cardiovascular disease (CVD).1 Given the growing global epidemic of overweight and obesity,2 the relationship between obesity (measured in BMI) and the risk of high cholesterol is an important consideration. According to the World Health Organization (WHO) guidelines, BMI is categorized into three classes: <25 kg/m2 (normal weight), 25 – 30 kg/m2 (overweight), and ≥30 kg/m2 (obesity).3 Several large population-based cross-sectional surveys evaluated the association between BMI and cholesterol levels.4-6
A 1999 cross-sectional survey using the Third National Health Examination Survey (NHANES III) studied the relationship between weight and the prevalence of health conditions (n= 16,884).4 The prevalence of high cholesterol was higher among people who were overweight or obese, compared to normal weight people, but this increased risk was statistically significant only among overweight people. A more recent survey of 195,005 adults from the 2001 Behavioral Risk Factor Surveillance System found that being overweight or obese was significantly associated with high cholesterol, diabetes, high blood pressure, asthma, arthritis, and poor health status.5 When compared to adults with normal weight, adults with a BMI of 25 – 29.9 kg/m2, 30 – 39.9 kg/m2, and ≥40 kg/m2 showed an odds ratio of 1.53 (95% confidence interval [CI] [1.43 – 1.57]), 1.91 (95% CI [1.80 – 2.01]), and 1.88 (95% CI [1.67 – 2.13]), respectively, for high cholesterol.
A population-based cross-sectional survey using the WHO Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) Project analyzed 27 populations with 48,283 subjects aged 25 – 64 years.6 The study found that hypercholesterolemia defined as 6.5 mmol/L (251 mg/dL) was positively associated with BMI, among young adults, but less so in older adults. In males between 25 and 44 years of age and females between 25 and 49 years of age the prevalence of hypercholesterolemia increased continuously as BMI increased. The odds ratio, for example, of having hypercholesterolemia for an overweight man between age 25 and 29 was 2.3 (95% confidence interval [CI], 1.80 – 3.02), and for an obese man of the same age was 3.4 (95% CI, 2.26 – 5.16) compared to man of normal weight. Compared to older men of normal weight, the risk of high cholesterol among overweight men 60 to 64 was 1.3 (1.07 – 1.55) and for obese men of the same age was 1.2 (0.93 – 1.55). Multiple logistic regression analyses found a negative statistically significant effect modification regarding age and BMI on the risk of hypocholesteremia (p<0.001). Based on these data, high cholesterol seems to be increasingly related to advancing age and less related to BMI for older men and women. Finding the strongest effect of obesity on the risk of hypercholesterolemia in young adults aged 25 – 39 years, the study recommended that future public health measures focus on preventing obesity in young adults.
Weight loss may improve lipid profiles in overweight or obese adults.7 According to the 2013 overweight and obesity management guidelines by the American Heart Association, the American College of Cardiology, and The Obesity Society, a dose-dependent relationship was found between the amount of weight loss and an improvement in lipid profile in overweight or obese adults, regardless of cardiovascular disease risk status. Depending on the degree of weight loss, improvements can be seen in low-density lipoprotein cholesterol, triglycerides, and high-density lipoprotein cholesterol levels.
References
- Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the management of blood cholesterol: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. J Am Coll Cardiol. 2018.
- Afshin A, Forouzanfar MH, Reitsma MB, et al. Health effects of overweight and obesity in 195 countries over 25 Years. N Engl J Med. 2017;377(1):13-27.
- Sellen, D. (1998). Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. WHO Technical Report Series No. 854. Pp. 452. (WHO, Geneva, 1995.) Swiss Fr 71.00. J Bio Sci, 30(1), 135-144.
- Must A, Spadano J, Coakley EH, Field AE, Colditz G, Dietz WH. The disease burden associated with overweight and obesity. JAMA. 1999;282(16):1523-1529.
- Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA. 2003;289(1):76-79.
- Gostynski M, Gutzwiller F, Kuulasmaa K, et al. Analysis of the relationship between total cholesterol, age, body mass index among males and females in the WHO MONICA Project. Int J Obes Relat Metab Disord. 2004;28(8):1082-1090.
- Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation. 2014;129(25 Suppl 2):S102-138.
