# 1. Read the paper by Must, et al (1992): Long-term morbidity and mortality of overweight adolescents. NEJM, 327:1350-55. Questions Based on the table and formulas below,

1. Read the paper by Must, et al (1992): Long-term morbidity and mortality of overweight adolescents. NEJM, 327:1350-55.

Questions Based on the table and formulas below, calculate, label AND state the meaning of your answer (interpret) in a sentence:

Number of Participants

CHD Deaths

Person-years of observation

Overweight

238

40

9,329

Not overweight

270

30

10,980

Risk Ratio = a/(a + b)

c/(c + d)

AR%= (Incidence in exposed – Incidence in unexposed) x 100

​​​Incidence in exposed

1. Complete the 2×2 table based on the information above: (4 points)

CHD Deaths

Alive

Total

Overweight

a

b

238

Not overweight

c

d

270

Total

a+c

b+d

508

a =

b =

c =

d =

a+c =

​​b+d =

a) The risk of coronary heart disease (CHD) death in participants who were overweight as adolescents and in participants who were not. (8 points)

b) The risk ratio of CHD death associated with having been overweight in adolescence. (4 points)

c) The attributable risk percent for having been overweight in adolescence. Attributable risk estimates the amount or proportion of disease (here: death) that can be attributed to a specific exposure. (4 points)

d) The rate ratio of CHD death for individuals overweight at adolescence compared to lean adolescents. (4 points)

e) The risk difference of CHD death comparing overweight and lean adolescents. (4 points)

2. Based on your calculations, what can you conclude about the effect of being overweight during adolescence on the future risk of coronary heart disease? Decide whether this should be interpreted as “risk of death”. (2 points)

3. Now turn to the Must et al., paper.

a) Compare the crude RR of all-cause mortality associated with overweight in adolescence between men and women in Table 2. What do you conclude? (2 points)

b) Do you think it would be appropriate to show an overall RR of mortality associated with obesity, combining men and women?Explain why or why not. (3 points)

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