Framingham Heart Study subjects were weighed, their stature measured,
and cigarette smoking histories obtained at the first biennial
examination starting in 1949. Of men under desirable weight (Metropolitan relative weight
[MRW], less than 100%), more than 80% were smokers, while only about
55% of the extremely overweight men were cigarette smokers. When age-,
smoking-, and MRW-specific mortalities for 26 years of follow-up were
calculated in these men, it was found that smokers had higher mortality
than nonsmokers but that in the smokers and nonsmokers, minimum
mortalities occurred for subjects who were initially in the "desirable weight"
group (MRW, 100% to 109%). Among cigarette smokers, lean men (MRW, less
than 100%) experienced considerably elevated mortality, often higher
than that in all but the most overweight cigarette smokers. These
findings suggest that elevated mortality in low-weight
American men results from the mortality risks associated with cigarette
smoking and demonstrates the need for controlling for cigarette smoking
when considering the relationship between relative weight and mortality(1).
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(1) "Cigarette smoking as a confounder of the relationship between relative weight and long-term mortality. The Framingham Heart Study" by Garrison RJ, Feinleib M, Castelli WP, McNamara PM.
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