Cigarette smoking as a confounder of the relationship between relative weight and long-term mortality

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.