The hypothesis that body fatness modifies the relation between
dietary cholesterol and 25-year coronary mortality was examined in a cohort of 1,792 middle-aged men employed by the Western Electric Company in Chicago. Relative risks of coronary death (and 95% confidence intervals) associated with a 225 mg/day greater intake of
dietary cholesterol for men with a subscapular skinfold thickness less than or equal to 14, 15-20, and greater than or equal to 21 mm were 1.44 (1.10-1.90), 1.07 (0.84-1.36), and 0.95 (0.76-1.20), respectively, after adjustment for age; serum total
cholesterol level; systolic blood pressure; cigarette smoking; family history of
cardiovascular disease; evidence of major organ system disease at baseline; and intake of
saturated fatty acids,
polyunsaturated fatty acids, energy, and
ethanol. Adjusted relative risks associated with a 15-mm greater subscapular skinfold thickness for men with a
dietary cholesterol intake less than or equal to 649, 650-799, and greater than or equal to 800 mg/day were 1.76 (1.04-2.98), 1.64 (1.04-2.57), and 1.00 (0.69-1.55), respectively. Fatter men apparently did not benefit from a diet lower in
cholesterol, while men who ate a diet high in
cholesterol apparently did not benefit from
leanness. These results support the hypothesis that body fatness modifies the relation between
dietary cholesterol and coronary mortality, perhaps because leaner men are more responsive than fatter men to the effects of
dietary cholesterol on the concentration of
low density lipoprotein cholesterol.