Changes in Fitness and Fatness on the Development of Cardiovascular Disease Risk Factors

Q: What are the key findings of this study?

Improving fitness reduced the risk of incident hypertension by 28%, metabolic syndrome by 52%, and hypercholesterolemia by 30%, whereas gaining body fat increased these risks by 27%, 71%, and 48%.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Healthy adults at risk for cardiovascular disease risk factors (n=3148). Intervention: Changes in cardiorespiratory fitness (maximal METs) and body fatness (percent body fat and BMI) vs. Fitness loss or fatness loss groups (and combined fitness gain/fatness loss reference group). Primary outcome: Incident hypertension, metabolic syndrome, and hypercholesterolemia (28% lower risk of hypertension, 52% lower risk of metabolic syndrome, and 30% lower risk of hypercholesterolemia for improving fitness vs fitness loss; 27%, 71%, and 48% higher risk for gaining percent body fat vs fat loss, p=<0.05 for trend).

Q: What does this research mean for the field?

Improving cardiorespiratory fitness reduces the risk of incident hypertension, metabolic syndrome, and hypercholesterolemia by 28%, 52%, and 30% respectively, whereas gaining body fat increases these risks by 27%, 71%, and 48%. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To examine the independent and combined associations of changes in cardiorespiratory fitness and fatness with the incidence of hypertension, metabolic syndrome, and hypercholesterolemia.

Duck-chul Lee; Xuemei Sui; Timothy S. Church; Carl J. Lavie; Andrew S. Jackson; Steven N. Blair

doi:10.1016/j.jacc.2011.11.013

February 1, 2012Journal of the American College of CardiologyOpen Access

Changes in Fitness and Fatness on the Development of Cardiovascular Disease Risk Factors

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Key result

Improving fitness linked to ~52% lower risk of incident metabolic syndrome, while fat gain increases risk.

28% lower risk of hypertension, 52% lower risk of metabolic syndrome, and 30% lower risk of hypercholesterolemia for improving fitness vs fitness loss; 27%, 71%, and 48% higher risk for gaining percent body fat vs fat loss
P<0.05 for trend
n=3,148

Why the study?

The relative and combined contributions of fitness and fatness to health are controversial, and few studies had examined how changes in fitness and fatness relate to the subsequent development of CVD risk factors.

Do independent and combined changes in cardiorespiratory fitness and body fatness affect the subsequent development of hypertension, metabolic syndrome, and hypercholesterolemia in healthy adults?

Key Points

To examine the independent and combined associations of changes in cardiorespiratory fitness and fatness with the incidence of hypertension, metabolic syndrome, and hypercholesterolemia.
Followed 3,148 healthy adults (mean age 42.3 years) who completed at least three clinical examinations, with a mean interval of 2.1 years between the initial two evaluations.
Assessed fitness using a maximal treadmill test and measured fatness via percent body fat and body mass index, categorizing changes between exams into loss, stable, or gain groups.
Tracked incident CVD risk factors over a 6-year follow-up period (mean follow-up of 6.1 years for hypertension, 6.6 years for metabolic syndrome, and 6.3 years for hypercholesterolemia).
During follow-up, 752 participants developed hypertension, 426 developed metabolic syndrome, and 597 developed hypercholesterolemia, representing incidence rates of 39.2, 20.5, and 30.1 per 1,000 person-years, respectively.
Maintaining or improving fitness was associated with a 26% to 28% lower risk of hypertension, 42% to 52% lower risk of metabolic syndrome, and 26% to 30% lower risk of hypercholesterolemia compared to losing fitness, whereas gaining body fat increased these risks by 27%, 71%, and 48% (all p for trend <0.05).
In joint analyses, the heightened risks linked to fat gain were attenuated when fitness was maintained or improved, and the risks linked to fitness loss were somewhat attenuated when fatness was reduced.

Study Design

Type

Cohort (n=3,148)

Multicenter

No

Structured PICO

Do independent and combined changes in cardiorespiratory fitness and body fatness affect the subsequent development of hypertension, metabolic syndrome, and hypercholesterolemia in healthy adults?

P

Population

3,148 healthy adults (mean age 42.3 years, 16.7% female) free of baseline CVD, diabetes, hypertension, metabolic syndrome, and hypercholesterolemia, followed for a mean of 6.1 to 6.6 years after a second clinical examination.

E

Exposure

Changes in objectively-measured cardiorespiratory fitness (assessed via maximal treadmill testing in METs using a modified Balke protocol) and body fatness (assessed via 7-site skinfold percent body fat and BMI) between the first and second examinations (mean interval 2.1 years), categorized into thirds (loss, stable, or gain) and analyzed continuously per 1-unit change.

C

Comparator

Reference exposure categories: participants in the 'loss' group for fitness or fatness analyses, and the combined 'fitness gain and fatness loss' group in joint analyses.

O

Outcome

Incident hypertension (resting BP ≥140/90 mm Hg or physician-diagnosed), metabolic syndrome (≥3 NCEP ATP III criteria), and hypercholesterolemia (total cholesterol ≥240 mg/dL or physician-diagnosed) during a mean follow-up of 6.1, 6.6, and 6.3 years after the second examination.surrogate

Main Result

Effect estimate: 28% lower risk of hypertension, 52% lower risk of metabolic syndrome, and 30% lower risk of hypercholesterolemia for improving fitness vs fitness loss; 27%, 71%, and 48% higher risk for gaining percent body fat vs fat loss

p-value: p=<0.05 for trend

Both maintaining or improving cardiorespiratory fitness and preventing body fat gain independently and jointly reduce the risk of developing hypertension, metabolic syndrome, and hypercholesterolemia in healthy adults.

Limitations

Population consists primarily of well-educated, non-Hispanic whites from middle-to-upper socioeconomic strata, limiting generalizability
Lack of information on whether changes in fitness and fatness were intentional
Lack of data on medications and diet information, which may have biased results through misclassification of outcomes
Population consists primarily of well-educated, non-Hispanic whites from middle-to-upper socioeconomic strata
No information on whether changes in fitness and fatness were intentional
Lack of data on medications and diet information which may have caused misclassification of outcomes

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Implication

Fitness gains and fat loss may inform prevention; extends baseline associations to changes but leaves causality open.

Abstract

Objectives Our aim was to examine the independent and combined associations of changes in fitness and fatness with the subsequent incidence of the cardiovascular disease (CVD) risk factors of hypertension, metabolic syndrome, and hypercholesterolemia. Background The relative and combined contributions of fitness and fatness to health are controversial, and few studies are available on the associations of changes in fitness and fatness with the development of CVD risk factors. Methods We followed 3,148 healthy adults who received at least three medical examinations. Fitness was determined by a maximal treadmill test. Fatness was expressed by percent body fat and body mass index. Changes in fitness and fatness between the first and second examinations were categorized into loss, stable, or gain groups. Results During the 6-year follow-up after the second examination, 752, 426, and 597 adults developed hypertension, metabolic syndrome, and hypercholesterolemia, respectively. Maintaining or improving fitness was associated with lower risk of developing each outcome, whereas increasing fatness was associated with higher risk of developing each outcome, after adjusting for possible confounders and fatness or fitness for each other (all p for trend <0.05). In the joint analyses, the increased risks associated with fat gain appeared to be attenuated, although not completely eliminated, when fitness was maintained or improved. In addition, the increased risks associated with fitness loss were also somewhat attenuated when fatness was reduced. Conclusions Both maintaining or improving fitness and preventing fat gain are important to reduce the risk of developing CVD risk factors in healthy adults.

Discussion

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Cite This Study

Lee et al. (2012) conducted a cohort in Healthy adults at risk for cardiovascular disease risk factors (n=3,148). Changes in cardiorespiratory fitness (maximal METs) and body fatness (percent body fat and BMI) vs. Fitness loss or fatness loss groups (and combined fitness gain/fatness loss reference group) was evaluated on Incident hypertension, metabolic syndrome, and hypercholesterolemia (28% lower risk of hypertension, 52% lower risk of metabolic syndrome, and 30% lower risk of hypercholesterolemia for improving fitness vs fitness loss; 27%, 71%, and 48% higher risk for gaining percent body fat vs fat loss, p=<0.05 for trend). Improving fitness reduced the risk of incident hypertension by 28%, metabolic syndrome by 52%, and hypercholesterolemia by 30%, whereas gaining body fat increased these risks by 27%, 71%, and 48%.

synapsesocial.com/papers/6af18f404f09e92e86757d63 https://doi.org/10.1016/j.jacc.2011.11.013

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Changes in Fitness and Fatness on the Development of Cardiovascular Disease Risk Factors

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Changes in Fitness and Fatness on the Development of Cardiovascular Disease Risk Factors

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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