Obesity Paradox and Cardiorespiratory Fitness in 12,417 Male Veterans Aged 40 to 70 Years

McAuley, Paul; Kokkinos, Peter; Oliveira, Ricardo B.; Emerson, Brian; Myers, Jonathan

doi:10.4065/mcp.2009.0562

Cited by 188 publications

(124 citation statements)

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“…However, the level of fitness might modulate the mortality risk of obesity. In fact, among those within the same strata of low, moderate, or high cardiorespiratory fitness, overweight and obese men consistently had lower mortality than normal weight men, in groups of middle-aged and older male veterans (McAuley et al 2010(McAuley et al , 2009. This is consistent with our results which showed that beyond the age of 65, in a cohort of high functioning older men and women, obesity operated in a different Table 4 Hazard ratios of allcause mortality according to adiposity measurement quintiles in men, further adjusted for number of medications and self-rated socioeconomic status, in addition to age, physical activity, smoker status, history of cancer, diabetes, and heart disease *p<0.05 Numbers are expressed as mean (SD) a The fourth quintile of relative abdominal fat had the lowest all-cause mortality direction regarding longevity than in midlife.…”

Section: Discussionmentioning

confidence: 93%

Survival benefit of abdominal adiposity: a 6-year follow-up study with Dual X-ray absorptiometry in 3,978 older adults

Lee

Auyeung

Kwok

et al. 2011

AGE

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In contrast to that in the middle-aged, higher body mass index (BMI) in older people is associated with higher survival rates. Yet, BMI makes no distinction between fat elsewhere and abdominal fat, the latter being metabolically more harmful. We hypothesized that overall adiposity might be protective in old age, but that central fat might offset that benefit and remained harmful as in the middle-aged. Three thousand nine hundred seventy-eight Chinese elderly ≥65 years had demographics, medical conditions, physical activity, and body composition by DXA recorded at baseline. Overall adiposity was measured as whole body fat%, and abdominal adiposity as waist circumference, waisthip ratio, and relative abdominal fat (RAF) (relative abdominal fat = abdominal fat according to anatomical landmarks/whole body fat). Deaths within 1 year from baseline were excluded from analysis. All-cause and cardiovascular mortality were analyzed using Cox regression, adjusted for covariates. The lowest quintile of adiposity measurements was used for comparison. After a mean follow-up of 72.3 months, 13.7% men and 4.5% women had died. In men, the highest two quintiles of whole body fat % and the upper four quintiles of RAF were associated with significantly lower all-cause mortality, and adjusted hazard ratio (95% CI) in ascending quintiles of RAF compared with the lowest quintile was 0.62 (0.43-0.89), 0.58 (0.4-0.85), 0.52 (0.36-0.77), and 0.67 (0.47-0.96). No relationship was found between abdominal adiposity and cardiovascular mortality in both genders. Higher whole body fat % as well as higher proportion of abdominal fat was associated with lower all-cause mortality in men. No such relation was found in women.

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Section: Discussionmentioning

confidence: 93%

Survival benefit of abdominal adiposity: a 6-year follow-up study with Dual X-ray absorptiometry in 3,978 older adults

Lee

Auyeung

Kwok

et al. 2011

AGE

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“…15 Investigators increasingly reference an obesity paradox among individuals with chronic diseases, whereby obese persons have higher survival rates compared to non-obese individuals. [16][17][18][19][20][21][22][23][24] Mechanisms for this obesity paradox are not fully understood, but proposed explanations include: 1) sick individuals lose weight and become frail as a result of underlying illnesses that cause wasting; 25 2) obese, sick individuals may have greater cardiorespiratory fitness (a proxy for physical wellness) than non-obese individuals who are also sick, but more likely to be frail and unfit, 26 which is supported by a "surplus calorie theory" hypothesizing that the obese have increased calorie reserves resulting in higher serum lipid levels, less protein/muscle breakdown and less uremia; 27 3) healthy individuals without major disease or injuries experience monotonically increasing mortality risk from excess adiposity, and individuals with major diseases or injuries experience monotonically decreasing mortality risk from excess adiposity; 28,29 4) older obese individuals receive more aggressive treatment that may lead to a potentially false appearance that obesity is protective; and 5) methodological concerns related to residual confounding, survivor bias, and lead-time bias. 25,[30][31][32] Regarding diabetes, it is widely acknowledged that body weight can be influenced by disease duration and weight loss (both intentional and unintentional) following diabetes development/diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Body-Mass Index and All-Cause Mortality in US Adults With and Without Diabetes

et al. 2013

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BACKGROUND: Previous studies found normal weight compared to overweight/obese adults with type 2 diabetes had a higher mortality risk, and body-mass index (BMI)-mortality studies do not typically account for baseline diabetes status. OBJECTIVE: To determine if diabetes influences the BMI-mortality relationship. DESIGN: Using a prospective study design, we analyzed data from a nationally representative sample of US adults participating in the National Health Interview Survey from 1997 to 2002, and followed for mortality through 2006. PARTICIPANTS: Excluding those with heart disease or cancer, our final analytic sample included 74,710 (34,805 never smoker) adults. MAIN MEASURES: BMI was calculated from selfreported height and weight. Diabetes status was based on self-reported diagnosis from a health professional. We used direct age standardization to calculate allcause mortality rates and adjusted Cox models for allcause mortality hazard ratios by BMI quintile; this was done separately for adults with diabetes and without diabetes. KEY RESULTS: Among never smokers, mean age was 50.1 years and 43 % were men. Mean BMI was 27.4 kg/m 2 , 26 % were obese, and 2,035 (5 %) reported diagnosed diabetes. After 9 years, there were 4,355 deaths (754 of 4,740 with diabetes; 3,601 of 69,970 without) among 74,710 participants, and 1,238 (247 of 2,035 with diabetes; 991 of 32,770 without) among 34,805 never smokers. We observed a qualitative interaction with diabetes on the BMImortality relationship (p=0.002). Death rates were substantially higher among participants with diabetes compared to those without diabetes across all BMI quintiles. However, death rates in participants with diabetes fell with increasing BMI quintile, while rates followed a J-shaped curve among those without diabetes. In adjusted Cox models, BMI was positively associated with mortality in adults without diabetes, but inversely associated with mortality among participants with diabetes. CONCLUSIONS: Mortality increased with increasing BMI in adults without diabetes, but decreased with increasing BMI among their counterparts with diabetes. Future studies need to be better designed to answer the question of whether normal weight adults with diabetes have a higher risk of mortality, by minimizing the possibility of reverse causation. Future studies should also account for prevalent diabetes in all investigations of the BMI-mortality relationship.

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“…This observation has been made in healthy men and women, those with suspected or known CVD, and those with comorbid conditions, including obesity, T2DM, hypertension, and lipid abnormalities. [12][13][14][15][16][17][18][19][20][21][22][23] In a growing number of studies, CRF has been demonstrated to be a more powerful predictor of mortality risk than traditional risk factors such as hypertension, smoking, obesity, hyperlipidemia, and T2DM. In addition, CRF has been shown to be a more powerful predictor of risk than other exercise test variables, including ST-segment depression, symptoms, and hemodynamic responses.…”

Section: Overview Of Crf and Health Outcomesmentioning

confidence: 99%

Importance of Assessing Cardiorespiratory Fitness in Clinical Practice: A Case for Fitness as a Clinical Vital Sign: A Scientific Statement From the American Heart Association

Ross¹,

Blair²,

Arena³

et al. 2016

Circulation

1,681

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ABSTRACT:Mounting evidence has firmly established that low levels of cardiorespiratory fitness (CRF) are associated with a high risk of cardiovascular disease, all-cause mortality, and mortality rates attributable to various cancers. A growing body of epidemiological and clinical evidence demonstrates not only that CRF is a potentially stronger predictor of mortality than established risk factors such as smoking, hypertension, high cholesterol, and type 2 diabetes mellitus, but that the addition of CRF to traditional risk factors significantly improves the reclassification of risk for adverse outcomes. The purpose of this statement is to review current knowledge related to the association between CRF and health outcomes, increase awareness of the added value of CRF to improve risk prediction, and suggest future directions in research. Although the statement is not intended to be a comprehensive review, critical references that address important advances in the field are highlighted. The underlying premise of this statement is that the addition of CRF for risk classification presents health professionals with unique opportunities to improve patient management and to encourage lifestyle-based strategies designed to reduce cardiovascular risk. These opportunities must be realized to optimize the prevention and treatment of cardiovascular disease and hence meet the American Heart Association's 2020 goals.M ounting evidence over the past 3 decades has firmly established that low levels of cardiorespiratory fitness (CRF) are associated with a high risk of cardiovascular disease (CVD) and all-cause mortality, as well as mortality rates attributable to various cancers, especially of the breast and colon/digestive tract. [1][2][3][4] Importantly, improvements in CRF are associated with reduced mortality risk.5 Although CRF is now recognized as an important marker of cardiovascular health, it is currently the only major risk factor not routinely assessed in clinical practice.In 2013, the American Heart Association and the American College of Cardiology jointly released new guidelines for the prevention and treatment of coronary artery disease.6 Although CRF is the fourth-leading risk factor for CVD and has long been established as a significant prognostic marker, 7 it was excluded from the risk calculator. The authors of the guidelines noted that the evidence that CRF would enhance risk classification was inconclusive, and thus, the added contribution of CRF to determine CVD risk was uncertain. There is, however, a large body of epidemiological and clinical evidence demonstrating not only that CRF is a potentially stronger predictor of mortality than established risk factors such as smoking, hypertension, high cholesterol, and type 2 diabetes mellitus (T2DM), but that the addition of CRF to traditional risk factors significantly improves the reclassification of risk for adverse outcomes.

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Obesity Paradox and Cardiorespiratory Fitness in 12,417 Male Veterans Aged 40 to 70 Years

Abstract: Fitness altered the obesity paradox. Overweight and obese men had increased longevity only if they registered high fitness.

Cited by 188 publications

References 43 publications

Survival benefit of abdominal adiposity: a 6-year follow-up study with Dual X-ray absorptiometry in 3,978 older adults

Survival benefit of abdominal adiposity: a 6-year follow-up study with Dual X-ray absorptiometry in 3,978 older adults

Body-Mass Index and All-Cause Mortality in US Adults With and Without Diabetes

Importance of Assessing Cardiorespiratory Fitness in Clinical Practice: A Case for Fitness as a Clinical Vital Sign: A Scientific Statement From the American Heart Association

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