THE INTERACTION OF FITNESS, FATNESS, AND CARDIOMETABOLIC RISK
Prevention
Background
Cardiorespiratory fitness is associated with an inverse relationship, while obesity a direct relationship with cardiovascular risk and all-cause mortality. The interaction between fitness, obesity (fatness), and cardiometabolic (CM) risk has not been fully explored.
Methods
We studied 2,634 Brazilian men and women referred for an employer-sponsored clinical heath exam. Obesity (fatness) was present if BMI >30 kg/m2 or Waist Circumference > 102 cm in men or >88 cm in women when BMI 25-30 kg/m2. Fitness was quantified by peak stage achieved on a maximal, symptom-limited Ellestad treadmill stress test, with those reaching stage 4 considered fit. Hepatic steatosis was assessed by ultrasound. We compared CM risk factors after stratifying patients into 4 groups: fit/normal weight, unfit/normal weight, fit/fat, and unfit/fat.
Results
About 23% of participants were obese (fat); 12% were unfit. Fitness and fatness were moderately correlated (r=-0.302), with 6.5% of the sample unfit/normal weight and 16% fit/fat. Treadmill stage achieved (fitness) was negatively associated with CM risk in overweight and obese patients, while BMI was positively associated with CM risk in fit patients (p<0.01). In instances of discordance between fitness and fatness, fatness was the primary determinant of CM risk profile (Table).
| CRP (mg/L) | Glucose (mg/dL) | SBP (mmHg) | DBP (mmHg) | Metabolic syndrome | Triglyceride to HDL ratio | Hepatic Steatosis | GGT (IU/L) | |
|---|---|---|---|---|---|---|---|---|
| Fit/normal weight | 1.0 | 88.7 | 114.8 | 75.0 | 9.7% | 2.8 | 25.1% | 35.8 |
| Unfit/normal weight | 1.4 | 87.5 | 112.7 | 73.8 | 10.8% | 2.7 | 19.9% | 29.9 |
| Fit/fat | 1.9 | 93.8 | 122.8 | 80.1 | 41.5% | 4.2 | 72.2% | 47.9 |
| Unfit/fat | 2.6 | 94.2 | 126.9 | 81.7 | 46.3& | 4.3 | 70.6% | 48.3 |
| P value for Unfit/normal weight vs fit/fat | P< 0.001 | p< 0.001 | P< 0.001 | P< 0.001 | P< 0.001 | P< 0.001 | P< 0.001 | P < 0.001 |
| P value for trend across all groups | P< 0.001 | p< 0.001 | p< 0.001 | p< 0.001 | p< 0.001 | p< 0.001 | P< 0.001 | P< 0.001 |
Conclusions
Fitness and fatness are both associated with cardiometabolic risk, however fatness is more strongly associated with risk when fitness and fatness are discordant.
Footnotes
ACC Moderated Poster Contributions
McCormick Place South, Hall A
Sunday, March 25, 2012, 11:00 a.m.-Noon
Session Title: Prevention: Clinical: Beyond Medications – What's New in Prevention
Abstract Category: 9. Prevention: Clinical
Presentation Number: 1185-331
