Reduced mortality associated with body mass index (BMI) in African Americans relative to Caucasians.

Although obesity is especially common in African-American women, the relationship between body mass index (BMI, kg/m2) and mortality primarily has been studied in Caucasians, and almost exclusively in average weight populations. In order to examine the relationship between race and mortality in a predominately overweight population, we assessed mortality in 6,602 parents of obese African-American and Caucasian subjects. Most parents of both races were overweight or obese: 87.8% of African-American mothers (mean BMI = 37.7) and 78.6% of Caucasian mothers (mean BMI = 34.9) had a BMI > or =27.3; 61.9% of African-American fathers (mean BMI = 31.5) and 63.6% of Caucasian fathers (mean BMI = 31.8) had a BMI > or =27.8. Even though African Americans had equivalent (fathers) or higher (mothers) average BMI and percentage overweight or obesity than Caucasians, unadjusted mortality rates were consistently lower in African Americans than in Caucasians. In a combined sample, income, age (linear, quadratic and cubic effects), gender, BMI (linear and quadratic), and race were significant predictors of mortality. Linear and quadratic effects of BMI were significant within race and in the combined sample, after controlling for the effects of all other predictor variables. Therefore, the mortality differences cannot be due to differences in age, income, BMI, or gender distributions. In addition, there was significant heterogeneity between races for all models examined, suggesting interactions between race and all other predictor variables. Moreover, there was a strong residual effect for race after accounting for the other variables. The highly selective and cross-sectional nature of this sample limits our ability to make specific BMI-associated risk estimates. However, the consistent differences between comparably ascertained racial groups sampled from the upper extreme of the BMI distribution provide support for a lower BMI-associated mortality rate in African Americans relative to Caucasians.