Abstract

Most prospective studies identify an increased mortality risk for adults of high body mass index (> 27 kg/m2) that is commonly attributed to the effects of excess body fat, and also identify an increased mortality risk for adults of low body mass index (< 21 kg/m2), an association that, if causal among healthy adults, is without adequate pathophysiologic support.

In this dissertation, I have conducted three studies that continue the investigation of adiposity in relation to mortality among never-smoking adults of the California Seventh-day Adventist population. Among never-smoking adults of the Adventist Mortality Study (1960-1985), the relation between body mass index (BMI) and all-cause mortality has been examined and the investigators found a direct positive relation among middle-aged men, older men, and middle-aged women, and a J-shaped relation among older women.

In the first study, I found that among 12,576 never-smoking women of the Adventist Mortality Study, the risk due to high BMI (> 27 kg/m2) was primarily due to cardiovascular disease and the risk due to low BMI (< 21 kg/m2) among older women was primarily due to cardiovascular and respiratory diseases. In the second study, I examined the relation between BMI and mortality among 20,346 never-smoking adults of the Adventist Health Study (1976-1988) and found a direct positive relation among middle-aged men, older men, middle-aged women, and a J-shaped relation among older women. Further study of the older women indicated that increased risk due to the lowest BMI (13.4-20.6 kg/m2) was only evident among those who had not used hormone replacement therapy, and that this risk was primarily due to cardiovascular and respiratory disease. In the third study, I related weight gain over a 17-year interval to all cause mortality among 6,030 never-smoking members of the 1960 and 1976 cohorts and found evidence implicating weight gain (> 10 kg) as a risk factor and that this risk remained evident for weight gains recorded at the sixth, seventh, and eighth decade.

The findings from these studies implicate obesity as a risk factor throughout adulthood and raise the possibility that lean older women can experience an increased mortality risk that may be due to their lower levels of adipose tissue-derived estrogens.

LLU Discipline

Epidemiology

Department

Epidemiology and Biostatistics

School

School of Public Health

First Advisor

Kristian D. Lindsted

Second Advisor

Gary E. Fraser

Third Advisor

Ella Haddad

Degree Name

Doctor of Public Health (DrPH)

Year Degree Awarded

1999

Date (Title Page)

1999

Language

English

Library of Congress/MESH Subject Headings

Body Weight; Obesity -- mortality; Smoking; Health Status Indicators; Health Surveys; Mortality.

Type

Dissertation

Page Count

xi; 136

Digital Format

PDF

Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.

Collection

Loma Linda University Electronic Theses and Dissertations

Collection Website

http://scholarsrepository.llu.edu/etd/

Repository

Loma Linda University. Del E. Webb Memorial Library. University Archives

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