Associations of fitness and fatness with mortality in Russian and American men in the lipids research clinics study

Stevens, June; Evenson, Kelly R.; Thomas, Olivia; Cai, Jun; Thomas, Ratna P.

doi:10.1038/sj.ijo.0802770

Cited by 62 publications

(50 citation statements)

References 21 publications

(22 reference statements)

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“…55 Another report also derived from the Lipid Research Clinics Study separately studied a sample of Russian and US men and obtained identical conclusions: while obese and unfit men had a significantly increased risk of CVD mortality (P<0.05), obese but fit did not (P≥0.05). 56 We found 1 study in which the results did not support the fat-but-fit paradigm. 57 This study is based on the National Health and Nutrition Examination Survey (NHANES) data and examined the combined effect of obesity and cardiorespiratory fitness level on CVD risk factors, particularly dyslipidemia, insulin resistance, and elevated C-reactive protein.…”

Section: Circulation Researchmentioning

confidence: 38%

“…38, 40 Duncan defined fit as having a high cardiorespiratory fitness level (top 40%); however, this is different from the definition used in all the studies discussed above, 44,45,47,[49][50][51][55][56][57] in which unfit was considered when having a low cardiorespiratory fitness level (20% least fit or bottom quintile in ageand sex-based cardiorespiratory fitness) and fit when having a medium or high cardiorespiratory fitness level (80% most fit). Taking the standard definition used in the fat-but-fit literature 44,45,47,[49][50][51][55][56][57] together with the figures provided by Duncan from the NHANES, 63 we can calculate that the prevalence of fat-but-fit individuals in United States would be ≈17%, which within the whole adult population would be equivalent to ≈24 million people. In our opinion, this is a sizeable number of people who, because of their higher cardiorespiratory fitness level, are at a markedly decreased risk of CVD mortality, even if they are obese.…”

Section: How Many? Prevalence Of Fat-but-fitmentioning

confidence: 96%

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Obesity and Cardiovascular Disease

Ortega

Lavie

Blair

2016

Circulation Research

838

603

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T here is overall agreement in the scientific and clinical community that obesity is one of the major public health problems of this century. The first documented reports on obesity date from the end of the 19th century and the beginning of the 20th century.1-3 From these days to date, >57 000 articles have been published in PubMed including the term obesity in the title, with these figures being 3× larger when searching by obesity also in the abstract. Figure 1 graphically Abstract: The prevalence of obesity has increased worldwide over the past few decades. In 2013, the prevalence of obesity exceeded the 50% of the adult population in some countries from Oceania, North Africa, and Middle East. Lower but still alarmingly high prevalence was observed in North America (≈30%) and in Western Europe (≈20%). These figures are of serious concern because of the strong link between obesity and disease. In the present review, we summarize the current evidence on the relationship of obesity with cardiovascular disease (CVD), discussing how both the degree and the duration of obesity affect CVD. Although in the general population, obesity and, especially, severe obesity are consistently and strongly related with higher risk of CVD incidence and mortality, the one-sizefits-all approach should not be used with obesity. There are relevant factors largely affecting the CVD prognosis of obese individuals. In this context, we thoroughly discuss important concepts such as the fat-but-fit paradigm, the metabolically healthy but obese (MHO) phenotype and the obesity paradox in patients with CVD. About the MHO phenotype and its CVD prognosis, available data have provided mixed findings, what could be partially because of the adjustment or not for key confounders such as cardiorespiratory fitness, and to the lack of consensus on the MHO definition. In the present review, we propose a scientifically based harmonized definition of MHO, which will hopefully contribute to more comparable data in the future and a better understanding on the MHO subgroup and its CVD prognosis. (Circ Res.

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Section: Circulation Researchmentioning

confidence: 38%

Section: How Many? Prevalence Of Fat-but-fitmentioning

confidence: 96%

Obesity and Cardiovascular Disease

Ortega

Lavie

Blair

2016

Circulation Research

838

603

View full text Add to dashboard Cite

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“…If so, it would imply that interventions to prevent unfavorable lipid profiles should focus on CVF as well as adiposity. In adults, both fatness and fitness predict future mortality (6); in fact, the effects of CVF may even be more robust than the effects of fatness (7). There is some recent evidence that both fatness and fitness are related to unfavorable CVD risk factor status in youths (8).…”

mentioning

confidence: 99%

Relations of Body Fatness and Cardiovascular Fitness to Lipid Profile in Black and White Adolescents

et al. 2005

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High body fatness is associated with unfavorable cardiovascular disease risk profiles in juveniles. However, the degree to which the deleterious effects attributed to fatness may actually be due to the low cardiovascular fitness (CVF) that is usually confounded with fatness is not known. This study determined in 14-to 18-y-old (n ϭ 398) youths the degree to which percentage body fat (%BF) and CVF explained variability in lipids and lipoproteins. Blood samples were taken after a 12-h fast. %BF was measured with dual-energy x-ray absorptiometry. CVF was determined with a multistage treadmill test. The degree to which %BF and CVF explained variance in outcome variables was determined by regression analyses, controlling for demographic variables before entering %BF or CVF and their interactions with race and sex. Because %BF and CVF were highly correlated (r ϭ -0.69, p Ͻ 0.001), they were first entered separately in the regression models before being considered together. Both higher %BF and lower CVF were associated with unfavorable concentrations of total cholesterol to HDLC ratio and triglycerides. However, the effects of %BF and CVF were not additive; once %BF was in the regression model, CVF did not explain additional variance. For Lp(a), only %BF explained a significant portion of the variance. For triglycerides, there was a %BF by race interaction, such that the deleterious effects of high %BF were greater in whites than in blacks. These results suggest that interventions to improve lipid profile in youths should be designed primarily to minimize fatness. Pathophysiologic processes underlying CVD begin in childhood (1,2), suggesting that preventive measures should begin early in life. Observational studies have shown that childhood adiposity is associated with an unfavorable lipid profile (3,4), which continues into adulthood (4). However, less is known about the role of CVF. Because of the strong inverse correlation between CVF and fatness (5), it is possible that deleterious consequences ascribed to adiposity may be partially due to the influence of low CVF, which is frequently unmeasured. If so, it would imply that interventions to prevent unfavorable lipid profiles should focus on CVF as well as adiposity. In adults, both fatness and fitness predict future mortality (6); in fact, the effects of CVF may even be more robust than the effects of fatness (7). There is some recent evidence that both fatness and fitness are related to unfavorable CVD risk factor status in youths (8).Another issue concerns the degree to which the relations are similar for different races and sexes. We recently reported that the deleterious consequences on insulin levels of high fatness and low fitness are more clearly seen in boys than in girls (5). With respect to lipid profile, there is some evidence that the deleterious consequences of excess adiposity are clearer in white than in black youths (9), but little is known about the degree to which this is also true for CVF.

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“…Only one study from Russia investigated the risks of cardiovascular and all-cause death associated with BMI (25). It included only men and found no association with all-cause mortality.…”

Section: Bmi and All-cause Mortality In Menmentioning

confidence: 99%

Determinants of Cardiovascular and All-Cause Mortality in Northwest Russia: A 10-Year Follow-Up Study

Sidorenkov

Nilssen

Grjibovski

2012

Annals of Epidemiology

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PURPOSE:To study the factors associated with high cardiovascular (CVD) and allcause mortality in Russia. METHODS:A prospective cohort study of 1966 men and 1738 women aged 18 years or more was performed in Arkhangelsk. The baseline examination was in 1999-2000. An average follow-up was 10.2 years. Information on life-style, marital, educational and psycho-social status was self-reported in a questionnaire. Data on risk factors were collected in a medical examination which included blood sampling. RESULTS:To the October 2010 a total of 147 male and 95 women deaths occurred. In 59 male and 20 female deaths where diagnosis was made by a forensic pathologist, the autopsy data were studied to extract information on post-mortem Blood Alcohol Concentration (BAC). A positive BAC was found in 21(36%) of male and 6(30%) of female deaths. Women reporting a consumption of 80g alcohol or more at least monthly and a consumption of 5 alcohol units or more on one drinking episode had higher risk of cardiovascular death than abstainers (RR was 5.06 (1.54-16.7) and 3.21 (1.07-9.58), respectively). ApoB/ApoA1-ratio was the strongest predictor of CVD and all-cause death in men ), respectively) and CVD death in women: RR 3.12 (1. 08-8.98). Men with obesity and university education had 40% lower risk of all-cause death. Low serum albumin was associated with high mortality in both genders. CONCLUSIONS:Hazardous alcohol consumption is an independent risk factor of CVD mortality also in women. The mechanisms behind its damaging effect are yet not clear.Nutritional factors such as serum albumin are important. Further studies are needed.3

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Associations of fitness and fatness with mortality in Russian and American men in the lipids research clinics study

Cited by 62 publications

References 21 publications

Obesity and Cardiovascular Disease

Obesity and Cardiovascular Disease

Relations of Body Fatness and Cardiovascular Fitness to Lipid Profile in Black and White Adolescents

Determinants of Cardiovascular and All-Cause Mortality in Northwest Russia: A 10-Year Follow-Up Study

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