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Analysis of the relationship between total cholesterol, age, body mass index among males and females in the WHO MONICA Project


OBJECTIVE: To explore the relationship between hypercholesterolaemia, age and BMI among females and males.

DESIGN: Population-based cross-sectional survey.

SUBJECTS: The data came from the initial surveys of the WHO MONICA Project. In all, 27 populations with 48 283 subjects (24 017 males and 24 266 females) aged 25–64 y were used for the analysis.

MEASUREMENTS: Total cholesterol, weight, height, BMI, prevalence of hypercholesterolaemia (PHC) defined as cholesterol ≥6.5 mmol/l, and the prevalence of obesity (POB) defined as BMI ≥30 kg/m2.

RESULTS: PHC increased with age, with PHC in males being significantly higher than in females at age range 25–49 y and significantly lower than in females at age range 50–64 y. Age-related increase in hypercholesterolaemia was steeper in females than in males. There was a statistically significant positive association between hypercholesterolaemia and BMI. Multiple logistic regression analysis revealed a negative statistically significant (P<0.001) effect modification involving age and BMI on the risk of having hypercholesterolaemia both in females and males. The relation between PHC and BMI became weaker in higher age groups, with no statistically significant association in females aged 50–64 y.

CONCLUSION: Public health measures should be directed at the prevention of obesity in young adults since the strongest effect of obesity on the risk of hypercholesterolaemia has been found in subjects aged 25–39 y.

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We thank Annette Dobson, MD, the University of Queensland, for her thoughtful comments on an earlier draft of the manuscript.

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Correspondence to M Gostynski.



Sites and key personnel of contributing MONICA Centres.


University of Western Australia, Nedlands: MST Hobbs (Principal Investigator), K Jamrozik (Co-Principal Investigator), PL Thompson, BK Armstrong


Ghent State University, Ghent: G De Backer (Principal Investigator), I De Craene, F van Onsem, L van Parys, S De Henauw, D De Bacquer

Free University of Brussels, Brussels: M Kornitzer (Principal Investigator), L Berghmans, L Bara, P de Smet

Interuniversity Association for the Prevention of Cardiovascular Diseases, Brussels: M Jeanjean (Principal Investigator), C Brohet, HE Kulbertus, S Degre, F Lavenne, D Jansens, F Lefebvre, D Beck, G Wunsch, F Bertrand, M van Houte, B Rime, G Rorive, R Hannot, A Adrienne, A Luyckx


Dalhousie University, Halifax, Nova Scotia: HK Wolf (Principal Investigator), RD Gregor (Co-Principal Investigator), IR Bata, B Brownell, K Webber


Beijing Heart, Lung and Blood Vessel Research Institute, Beijing: Wu Zhaosu (Principal Investigator), Wu Yingkai (Former Principal Investigator), Yao Chonghua, Zhang Ruisong

Czech Republic

Institute for Clinical and Experimental Medicine, Prague: Z Skodová (Principal Investigator), Z Písa, L Berka, Z Cícha, J Cerovská, R Emrová, M Hoke, M Hronkova, J Pikhartová, D Grafnetter, R Poledne, P Vojtísek, J Vorlicek, E Wiesner


National Public Health Institute, Helsinki: J Tuomilehto (Principal Investigator), P Puska (Former Principal Investigator), E Vartiainen, H Korhonen, P Jousilahti


National Institute of Health and Medical Research, INSERM U258, Paris: P Ducimetiere (Country Coordinator), JL Richard (Former Country Coordinator), A Bingham, T Lang

Department of Epidemiology and Public Health, INSERM U508, Pasteur Institute, Lille: P Amouyel (Principal Investigator), D Cottel, MC Nuttens (Former Principal Investigator), N Marecaux, J Dallongeville, J-L Salomez (Former Principal Investigator), M Montaye (Principal Investigator), C Steclebout


Bremen Institute for Prevention Research and Social Medicine, Bremen: E Greiser (Principal Investigator), B Herman (Co-Principal Investigator), G Stüdemann

Department of Clinical and Social Medicine of the University Medical Clinic, Heidelberg: E Nüssel (Principal Investigator), E Ostör-Lamm (Co-Principal Investigator), R Scheidt, W Morgenstern, M Stadler, M Ganowa

GSF-Institute for Epidemiology, Munich and Institute for Epidemiology and Social Medicine, University of Münster: U Keil (Principal Investigator), M Tietze, R Banos, A Döring, B Filipiak

Centre for Epidemiology & Health Research, Berlin: W Barth (Principal Investigator), L Heinemann (Principal Investigator), J Muche, S Schmalfuβ, A Assmann, S Böthig, G Voigt, S Brasche, D Quietzsch, E Classen


National Institute of Cardiology, Budapest: J Duba (Principal Investigator), I Gyarfas (Former Principal Investigator)

Medical University of Pecs, Institute of Public Health, Pécs: I Ember, J Tényi, I Szilard


Heart Preventive Clinic, Reykjavik: N Sigfusson (Principal Investigator), II Gudmundsdottir, I Stefansdottir, Th Thorsteinsson, H Sigvaldason


National Institute of Health, Rome: A Menotti (Country Coordinator), S Giampaoli, A Verdecchia

SM Goretti Hospital, Latina: G Righetti (Principal Investigator), B De Pasquale, P Di Raimo, E Forte, A Majetta

Institute of Cardiology, Regional Hospital, Udine: D Vanuzzo (Principal Investigator), GA Feruglio (Former Principal Investigator), L Pilotto, GB Cignacco, R Marini, G Zilio

Research Centre on Chronic Degenerative Diseases of the University of Milan: GC Cesana (Principal Investigator), M Ferrario (Principal Investigator), R Sega, P Mocarelli, P Brambilla


Institute of Health Studies, Department of Health and Social Security, Barcelona: S Sans (Principal Investigator), I Balaguer-Vintró (Former Principal Investigator), Ll Balañà, F González, JA Gomez, JM Borrás, A Rodés


University Institute of Social and Preventive Medicine, Lausanne: F Gutzwiller (Principal Investigator) (Zurich), M Rickenbach, V Wietlisbach, F Barazzoni, F Mainieri, B Tullen

United Kingdom

The Queen's University of Belfast, Northern Ireland: AE Evans (Principal Investigator), EE McCrum, T Falconer, S Cashman, C Patterson, M Kerr, D O'Reilly, A Scott, M McConville, I McMillan, D McMaster

University of Dundee, Scotland: H Tunstall-Pedoe (Principal Investigator), WCS Smith (Former Co-Principal Investigator), R Tavendale, I Crombie, C Brown, M Shewry, M-K Hannah

Royal Infirmary, Glasgow, Scotland: C Morrison (Co-Principal Investigator)


Stanford Center for Research in Disease Prevention, Stanford, California: SP Fortmann (Principal Investigator), A Varady, M Hull, M Hunter, A Schlagenhaft, P Wood

MONICA Management Centre—World Health Organization, Geneva: S Mendis (Responsible Officer), I Martin (Former Responsible Officer), I Gyarfas (Former Responsible Officer), Z Pisa (Former Responsible Officer), SRA Dodu (Former Responsible Officer), S Böthig (Former Responsible Officer), MJ Watson, M Hill, A Price

MONICA Data Centre—National Public Health Institute, Helsinki, Finland: K Kuulasmaa (Responsible Officer), J Tuomilehto (Former Responsible Officer), A Molarius, E Ruokokoski, V Moltchanov, H Tolonen

MONICA Quality Control Centre for Lipid Measurements—Laboratory for Atherosclerosis Research, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic: R Poledne (Responsible Officer), D Grafnetter (Responsible Officer)

MONICA Steering Committee: K Asplund (Chair), P Amouyel (Publications Coordinator), A Pajak, H Tunstall-Pedoe (Rapporteur), S Mendis, K Kuulasmaa, A Shatchkute (WHO, Copenhagen), A Evans. Consultants A Dobson. Previous Steering Committee Members: M Ferrario, M Hobbs, S Sans, F Gutzwiller, R Beaglehole, SP Fortmann, A Menotti, P Puska, SL Rywik, U Keil, and former Chiefs of CVD/HQ, Geneva (listed above), V Zaitsev (WHO, Copenhagen), J Tuomilehto. Former Consultants: Z Pisa, OD Williams (Birmingham, Alabama, USA), MJ Karvonen (Helsinki, Finland), RJ Prineas (Minneapolis, USA); M Feinleib (Bethesda, USA); FH Epstein (Zürich, Switzerland)

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Gostynski, M., Gutzwiller, F., Kuulasmaa, K. et al. Analysis of the relationship between total cholesterol, age, body mass index among males and females in the WHO MONICA Project. Int J Obes 28, 1082–1090 (2004).

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  • cholesterol
  • age
  • gender
  • body mass index
  • risk factors

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