Fit and Fat?

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

Hypertension, Metabolic Syndrome, and Hypercholesterolemia

Duck-chul Lee, PhD^_*,_*, Xuemei Sui, MD^_*,Timothy S. Church, MD, Carl J. Lavie, MD,Andrew S. Jackson, PED^|| and Steven N. Blair, PED^_*,

^_* Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
 Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
 Department of Preventive Medicine Research, Pennington Biomedical Research Center, Baton Rouge, Louisiana
 Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School–University of Queensland School of Medicine, New Orleans, Louisiana
^|| Department of Health and Human Performance, University of Houston, Houston, Texas

Manuscript received September 12, 2011; revised manuscript received November 7, 2011, accepted November 12, 2011.

^_* Reprint requests and correspondence: Dr. Duck-chul Lee, Department of Exercise Science, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, South Carolina 29208 (Email: lee23@mailbox.sc.edu).

Objectives: This study sought 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 up 3,148 healthy adults who received at least 3 medical examinations. Fitness was determined by using 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.

Key Words: body fatness • cardiorespiratory fitness • hypercholesterolemia • hypertension • metabolic syndrome

J Am Coll Cardiol, 2012; 59:665-672, doi:10.1016/j.jacc.2011.11.013
© 2012 by the American College of Cardiology Foundation