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Guidelines on Overweight and Obesity: Electronic Textbook ![]() |
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Dyslipidemia manifested by:
High total cholesterol | High triglycerides |
Low high-density lipoprotein cholesterol | Normal
to elevated low-density lipoprotein cholesterol | Small, dense
low-density lipoprotein particles
High total cholesterolThe relationship of the
age-adjusted prevalence of high total cholesterol, defined as
Figure 3. NHANES III Age-Adjusted Prevalence of High Blood Cholesterol* According To Body Mass Index ![]()
At each BMI level, the
prevalence of high blood cholesterol is greater in women than in men. In a
smaller sample, higher body weight is associated with higher levels of total
serum cholesterol in both men (133) and women
(134) at levels of BMI > 25. Several large
longitudinal studies also provide evidence that overweight, obesity, and weight
gain are associated with increased cholesterol levels (135-137). In women, the
incidence of hypercholesterolemia also increases with increasing BMI (138). In addition, the pattern of fat
distribution appears to affect cholesterol levels independently of total
weight. Total cholesterol levels are usually higher in persons with predominant
abdominal obesity, defined as a waist-to-hip circumference ratio of
High triglyceridesThe strong association of triglyceride levels with BMI has been shown in both cross-sectional and longitudinal studies, for both sexes and all age groups (133, 134, 140, 141). In three adult age groups, namely, 20 to 44 years, 45 to 59 years, and 60 to 74 years, higher levels of BMI, ranging from 21 or less to more than 30, have been associated with increasing triglyceride levels; the difference in triglycerides ranged from 61 to 65 mg/dL (0.68 to 0.74 mmol/L) in women (134) and 62 to 118 mg/dL (0.70 to 1.33 mmol/L) in men (133). Low high-density lipoprotein cholesterol
HDL-cholesterol levels at all
ages and weights are lower in men than in women. Although low HDL-cholesterol
in this study was defined as < 35 mg/dL (0.91 mmol/L) in men and < 45
mg/dL (1.16 mmol/L) in women (2), the panel accepts the definition of low HDL-cholesterol as
35 mg/dL for men and women used by the National Cholesterol Education Program's
Second Report of the Expert Panel on the Detection, Evaluation, and
Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II
Report) (2). Cross-sectional studies have
reported that HDL-cholesterol levels are lower in men and women with higher BMI
(143,144).
Longitudinal studies have found that changes in BMI are associated with changes
in HDL-cholesterol. A BMI change of 1 unit is associated with an
HDL-cholesterol change of 1.1 mg/dL for young adult men and an HDL-cholesterol
change of 0.69 mg/dL for young adult women (145). Figure 4. NHANES III Age-Adjusted Prevalence of Low HDL-Cholesterol* According To Body Mass Index ![]()
Normal to elevated low-density lipoprotein cholesterolThe link between total serum
cholesterol and CHD is largely due to low-density lipoprotein (LDL). A
high-risk LDL-cholesterol is defined as a serum concentration of
Small, dense low-density lipoprotein particlesFew large-scale epidemiological data are available on small, dense LDL particles (147-149). Clinical studies have shown that small, dense LDL particles are particularly atherogenic and tend to be present in greater proportion in hypertriglyceridemic patients with insulin resistance syndrome associated with abdominal obesity (148-152). |