Fitness, fatness, and cardiovascular risk factors in type 2 diabetes: look ahead study.

PURPOSE Most studies comparing the effects of fitness and fatness on cardiovascular (CVD) risk have been done with young, healthy participants with low rates of obesity and high levels of fitness. The present study examined the association of cardiorespiratory fitness and obesity with CVD risk factors in an ethnically diverse sample of overweight/obese individuals with type 2 diabetes. METHOD Baseline data from Look AHEAD, a study of 5145 overweight or obese individuals with type 2 diabetes, were used to examine the association of BMI categories (overweight, class I, II, or III obesity) and cardiorespiratory fitness (assessed with a maximal graded exercise test and categorized by age- and gender-specific quintiles) on cardiovascular risk factors and on the odds of having hypertension, hyperlipidemia, or HbA1c > or = 7%. RESULTS BMI categories and fitness quintiles were highly associated with each other (P < 0.0001), with the heaviest participants being the least fit. Only 2-3% of participants had class III obesity and were in the two fittest quintiles or, conversely, were overweight and in the two least-fit quintiles. When fitness and BMI were included in the same model (adjusting for age, smoking, diabetes duration, and race), HbA1c, ankle/brachial index (ABI), and Framingham risk score were most strongly associated with fitness. Systolic blood pressure was most strongly associated with BMI category. Similar results occurred when waist circumference and fitness were considered together. CONCLUSION In this large, ethnically diverse sample of overweight/obese individuals with type 2 diabetes, fitness and fatness were highly related to each other but seemed to have different impact on specific CVD risk factors.

[1]  R. Levy,et al.  Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. , 1972, Clinical chemistry.

[2]  H. P. Hopp,et al.  Cardiorespiratory fitness and cardiovascular disease risk factors in postmenopausal women. , 1998, Medicine and science in sports and exercise.

[3]  D. Seals,et al.  Influence of body fatness on the coronary risk profile of physically active postmenopausal women. , 1998, Metabolism: clinical and experimental.

[4]  A S Jackson,et al.  Cardiorespiratory fitness, body composition, and all-cause and cardiovascular disease mortality in men. , 1999, The American journal of clinical nutrition.

[5]  Robert Ross,et al.  Reduction in Obesity and Related Comorbid Conditions after Diet-Induced Weight Loss or Exercise-Induced Weight Loss in Men , 2000, Annals of Internal Medicine.

[6]  R B D'Agostino,et al.  Primary and subsequent coronary risk appraisal: new results from the Framingham study. , 2000, American heart journal.

[7]  Steven Blair,et al.  Low Cardiorespiratory Fitness and Physical Inactivity as Predictors of Mortality in Men with Type 2 Diabetes , 2000, Annals of Internal Medicine.

[8]  J. Wilmore,et al.  Fitness, fatness, and estimated coronary heart disease risk: the HERITAGE Family Study. , 2001, Medicine and science in sports and exercise.

[9]  T. Rice,et al.  FAMILIAL RESEMBLANCE FOR SEVEN YEAR CHANGES IN MUSCULOSKELETAL FITNESS , 2001 .

[10]  J. Stevens,et al.  Fitness and fatness as predictors of mortality from all causes and from cardiovascular disease in men and women in the lipid research clinics study. , 2002, American journal of epidemiology.

[11]  S. Blair,et al.  The relation of body mass index, cardiorespiratory fitness, and all-cause mortality in women. , 2002, Obesity research.

[12]  Karen C Johnson,et al.  Look AHEAD (Action for Health in Diabetes): design and methods for a clinical trial of weight loss for the prevention of cardiovascular disease in type 2 diabetes. , 2003, Controlled clinical trials.

[13]  S. Blair,et al.  Cardiorespiratory fitness attenuates the effects of the metabolic syndrome on all-cause and cardiovascular disease mortality in men. , 2004, Archives of internal medicine.

[14]  S. Blair,et al.  Exercise capacity and body composition as predictors of mortality among men with diabetes. , 2004, Diabetes care.

[15]  J. Manson,et al.  Adiposity as compared with physical activity in predicting mortality among women. , 2005, The New England journal of medicine.

[16]  J. Tuomilehto,et al.  Physical activity, cardiovascular risk factors, and mortality among Finnish adults with diabetes. , 2005, Diabetes care.

[17]  S. Blair,et al.  Cardiorespiratory fitness and body mass index as predictors of cardiovascular disease mortality among men with diabetes. , 2005, Archives of internal medicine.

[18]  Ankle-Brachial Index and Subclinical Cardiac and Carotid Disease The Multi-Ethnic Study of Atherosclerosis , 2005 .

[19]  D. Seals,et al.  Fatness Is a Better Predictor of Cardiovascular Disease Risk Factor Profile Than Aerobic Fitness in Healthy Men , 2005, Circulation.

[20]  Ian Janssen,et al.  Metabolic syndrome, obesity, and mortality: impact of cardiorespiratory fitness. , 2005, Diabetes care.

[21]  Philip Greenland,et al.  Prevalence and cardiovascular disease correlates of low cardiorespiratory fitness in adolescents and adults. , 2005, JAMA.

[22]  W. Herman,et al.  Impact of active versus usual algorithmic titration of basal insulin and point-of-care versus laboratory measurement of HbA1c on glycemic control in patients with type 2 diabetes: the Glycemic Optimization with Algorithms and Labs at Point of Care (GOAL A1C) trial. , 2006, Diabetes care.

[23]  George A. Bray,et al.  Baseline characteristics of the randomised cohort from the Look AHEAD (Action for Health in Diabetes) study , 2006, Diabetes & vascular disease research.

[24]  P. Ridker,et al.  Association of physical activity and body mass index with novel and traditional cardiovascular biomarkers in women. , 2006, JAMA.

[25]  Jeroen J. Bax,et al.  The long-term prognostic value of the resting and postexercise ankle-brachial index. , 2006, Archives of internal medicine.