Combinations of BMI and cardiorespiratory fitness categories: trends between 1995 and 2020 and associations with CVD incidence and mortality and all-cause mortality in 471 216 adults

Abstract

Aims To describe time trends in combinations of cardiorespiratory fitness (CRF) and body mass index (BMI) status, and to analyse their associations with cardiovascular disease (CVD) incidence and mortality and all-cause mortality. Methods and results Prospective cohort study with data from occupational health screenings in Swedish employees, including n = 471 216 (aged 18–74 years) between 1995 and 2020, and n = 169 989 in risk analyses. Cardiorespiratory fitness was estimated from a submaximal cycle test. High CRF was defined as top quartile, and low CRF as bottom quartile. Body mass index was used to define normal weight (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), and obesity (≥30 kg/m2). Outcome data (CVD incidence and mortality, all-cause mortality) were obtained from national registers. From 1995 to 2020, the combination of obesity + low CRF increased from 2.1% to 5.3% (relative increase 154%) whereas the combination of normal weight + high CRF decreased from 13.2% to 9.3% (−30%) (both P < 0.001). Negative changes were more pronounced in men, younger ages, and non-university educated. At the end of the period, prevalence of obesity + low CRF were higher in men vs. women (3.1% vs. 2.2%), older vs. younger (3.7% vs. 1.7%), and in non-university vs. university educated (5.0% vs. 0.3%), all P-value <0.001. Having a high CRF attenuated the risk of all three outcomes in all BMI categories, especially in individuals with obesity (hazard ratio 3.90 vs. 6.67 for CVD mortality). Both a low BMI and a high CRF prolonged age of onset for all three outcomes. Conclusions The combination of obesity with low CRF has increased markedly since the mid-90s, with clear implications for increased CVD morbidity and mortality, and all-cause mortality.

Mediation of lifestyle-associated variables on the association between occupation and incident cardiovascular disease

“…We have previously compared the predictive power of CRF scaled to different body size measurements in relation to CVD incidence and all-cause mortality (Eriksson et al, 2021), indicating a stronger predictive power of CRF scaled to kg or waist circumference than to height squared. Together with the increased prevalence of both obesity and low CRF in the study population (Hemmingsson et al, 2021), this further highlights the importance to target obesity and low CRF in future health interventions.…”

An Investigation of the Utility of Waist Circumference Predicting Cardiorespiratory Fitness in School Children: A Cross-Sectional Study

“…CRF, whose low level is strongly and independently related to all-cause mortality in adults [19,20], is an important predictor of human health. In adolescents, it is a predictor of, e.g., cardiometabolic health, premature cardiovascular disease, academic achievements and mental health [21].…”

Sex differences in the non-linear association between BMI and LDL cholesterol in type 2 diabetes

“…High body mass index (BMI) is a reliable obesity marker which has been used in numerous studies. A large cohort study suggests that high BMI is associated with the occurrence of cardiovascular diseases (CVD) (1). Overweight and obesity affect all individuals but are especially common among people with diabetes.…”