OBJECTIVE: To test the hypothesis that an elevated ratio of subscapular to triceps skinfold thickness (SFR), a measure of truncal obesity, is associated with increased incidence of stroke independent of overweight. DESIGN: Data from the NHANES I Epidemiologic Follow-up Study were analyzed. SUBJECTS: A cohort of 3652 women and 3284 men with complete data who had no history of stroke at baseline in 1971-1975. MEASUREMENTS: Incidence of stroke diagnosed at hospital discharge or death during the follow-up period through 1992; triceps and subscapular skinfold thickness (SSF) and body mass index (BMI) at baseline. RESULTS: In a complex relationship, higher SFR was associated with a mildly but significantly increased incidence of stroke only in white male former smokers. In white men, SSF showed a U-shaped association with stroke risk. In white men, stroke risk was elevated in the top quartile of BMI only in never smokers. In black women, stroke risk was significantly elevated in the bottom compared to the top quartile of BMI. No significant associations were seen in white women or black men. CONCLUSIONS: In white men, SSF showed a U-shaped association with stroke risk, which was elevated in the top quartile of BMI only in never smokers. Surprisingly, stroke risk was elevated in black women with the lowest BMI. More studies of these associations are needed, especially in black women. International Journal of Obesity (2001) 25, 628-638 | 
