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American Journal of Clinical Nutrition, Vol. 69, No. 3, 373-380, March 1999
© 1999 American Society for Clinical Nutrition

Original Research Communications

Cardiorespiratory fitness, body composition, and all-cause and cardiovascular disease mortality in men1,2,3

Chong Do Lee, Steven N Blair and Andrew S Jackson

Background: Cardiorespiratory fitness and body fatness are both related to health, but their interrelation to all-cause and cardiovascular disease (CVD) mortality is unknown.

Objective: We examined the health benefits of leanness and the hazards of obesity while simultaneously considering cardiorespiratory fitness.

Design: This was an observational cohort study. We followed 21925 men, aged 30–83 y, who had a body-composition assessment and a maximal treadmill exercise test. There were 428 deaths (144 from CVD, 143 from cancer, and 141 from other causes) in an average of 8 y of follow-up (176742 man-years).

Results: After adjustment for age, examination year, cigarette smoking, alcohol intake, and parental history of ischemic heart disease, unfit (low cardiorespiratory fitness as determined by maximal exercise testing), lean men had double the risk of all-cause mortality of fit, lean men (relative risk: 2.07; 95% CI: 1.16, 3.69; P = 0.01). Unfit, lean men also had a higher risk of all-cause and CVD mortality than did men who were fit and obese. We observed similar results for fat and fat-free mass in relation to mortality. Unfit men had a higher risk of all-cause and CVD mortality than did fit men in all fat and fat-free mass categories. Similarly, unfit men with low waist girths (<87 cm) had greater risk of all-cause mortality than did fit men with high waist girths (>=99 cm).

Conclusions: The health benefits of leanness are limited to fit men, and being fit may reduce the hazards of obesity.

Key Words: Body composition • cardiorespiratory fitness • epidemiology • mortality • cardiovascular disease mortality • all-cause mortality • fat mass • fat-free mass • waist girth • men




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[Abstract] [PDF]

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 Diabetes CareHome page
T. S. Church, Y. J. Cheng, C. P. Earnest, C. E. Barlow, L. W. Gibbons, E. L. Priest, and S. N. Blair
Exercise Capacity and Body Composition as Predictors of Mortality Among Men With Diabetes
Diabetes Care, January 1, 2004; 27(1): 83 - 88.
[Abstract] [Full Text] [PDF]

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 Scand J Public HealthHome page
E. I. M. Fransson, L. S. Alfredsson, U. H. de Faire, A. Knutsson, and P. J. M. Westerholm
Leisure time, occupational and household physical activity, and risk factors for cardiovascular disease in working men and women: the WOLF study
Scand J Public Health, October 1, 2003; 31(5): 324 - 333.
[Abstract] [PDF]

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 JAMAHome page
J. M. Jakicic, B. H. Marcus, K. I. Gallagher, M. Napolitano, and W. Lang
Effect of Exercise Duration and Intensity on Weight Loss in Overweight, Sedentary Women: A Randomized Trial
JAMA, September 10, 2003; 290(10): 1323 - 1330.
[Abstract] [Full Text] [PDF]

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 Arch Intern MedHome page
J. E. Gerich
Clinical Significance, Pathogenesis, and Management of Postprandial Hyperglycemia
Arch Intern Med, June 9, 2003; 163(11): 1306 - 1316.
[Abstract] [Full Text] [PDF]

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 Arch Intern MedHome page
J. E. Donnelly, J. O. Hill, D. J. Jacobsen, J. Potteiger, D. K. Sullivan, S. L. Johnson, K. Heelan, M. Hise, P. V. Fennessey, B. Sonko, et al.
Effects of a 16-Month Randomized Controlled Exercise Trial on Body Weight and Composition in Young, Overweight Men and Women: The Midwest Exercise Trial
Arch Intern Med, June 9, 2003; 163(11): 1343 - 1350.
[Abstract] [Full Text] [PDF]

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 QJMHome page
V. Press, I. Freestone, and C.F. George
Physical activity: the evidence of benefit in the prevention of coronary heart disease
QJM, April 1, 2003; 96(4): 245 - 251.
[Full Text] [PDF]

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 J. Clin. Pathol.Home page
M Labib
The investigation and management of obesity
J. Clin. Pathol., January 1, 2003; 56(1): 17 - 25.
[Abstract] [Full Text] [PDF]

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 Postgrad. Med. J.Home page
M J Franz, H Warshaw, A E Daly, J Green-Pastors, M S Arnold, and J Bantle
Evolution of diabetes medical nutrition therapy
Postgrad. Med. J., January 1, 2003; 79(927): 30 - 35.
[Abstract] [Full Text] [PDF]

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 RadiologyHome page
R. M. Friedenberg
Obesity
Radiology, December 1, 2002; 225(3): 629 - 632.
[Full Text] [PDF]

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 Am J EpidemiolHome page
J. Stevens, J. Cai, K. R. Evenson, and R. Thomas
Fitness and Fatness as Predictors of Mortality from All Causes and from Cardiovascular Disease in Men and Women in the Lipid Research Clinics Study
Am. J. Epidemiol., November 1, 2002; 156(9): 832 - 841.
[Abstract] [Full Text] [PDF]

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 Arterioscler. Thromb. Vasc. Bio.Home page
T.S. Church, C.E. Barlow, C.P. Earnest, J.B. Kampert, E.L. Priest, and S.N. Blair
Associations Between Cardiorespiratory Fitness and C-Reactive Protein in Men
Arterioscler. Thromb. Vasc. Biol., November 1, 2002; 22(11): 1869 - 1876.
[Abstract] [Full Text] [PDF]

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 The Diabetes EducatorHome page
M. J. Franz
2002 Diabetes Nutrition Recommendations: Grading the Evidence
The Diabetes Educator, September 1, 2002; 28(5): 756 - 766.
[PDF]

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 Mayo Clin Proc.Home page
S. N. Blair and M. Z. Nichaman
The Public Health Problem of Increasing Prevalence Rates of Obesity and What Should Be Done About It
Mayo Clin. Proc., February 1, 2002; 77(2): 109 - 113.
[PDF]

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 Diabetes CareHome page
M. J. Franz, J. P. Bantle, C. A. Beebe, J. D. Brunzell, J.-L. Chiasson, A. Garg, L. A. Holzmeister, B. Hoogwerf, E. Mayer-Davis, A. D. Mooradian, et al.
Evidence-Based Nutrition Principles and Recommendations for the Treatment and Prevention of Diabetes and Related Complications
Diabetes Care, January 1, 2002; 25(1): 148 - 198.
[Full Text] [PDF]

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 Am J EpidemiolHome page
J. M. Hootman, C. A. Macera, B. E. Ainsworth, M. Martin, C. L. Addy, and S. N. Blair
Association among Physical Activity Level, Cardiorespiratory Fitness, and Risk of Musculoskeletal Injury
Am. J. Epidemiol., August 1, 2001; 154(3): 251 - 258.
[Abstract] [Full Text] [PDF]

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 Clin. DiabetesHome page
M. J. Franz
The Answer to Weight Loss Is Easy--Doing It Is Hard!
Clin. Diabetes, July 1, 2001; 19(3): 105 - 109.
[Abstract] [Full Text] [PDF]

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 Arch Intern MedHome page
F. B. Hu, M. F. Leitzmann, M. J. Stampfer, G. A. Colditz, W. C. Willett, and E. B. Rimm
Physical Activity and Television Watching in Relation to Risk for Type 2 Diabetes Mellitus in Men
Arch Intern Med, June 25, 2001; 161(12): 1542 - 1548.
[Abstract] [Full Text] [PDF]

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 J. Appl. Physiol.Home page
J. F. Horowitz and S. Klein
Oxidation of nonplasma fatty acids during exercise is increased in women with abdominal obesity
J Appl Physiol, December 1, 2000; 89(6): 2276 - 2282.
[Abstract] [Full Text] [PDF]

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 Journals of Gerontology Series A: Biological Sciences and Medical SciencesHome page
R. Roubenoff and V. A. Hughes
Sarcopenia: Current Concepts
J. Gerontol. A Biol. Sci. Med. Sci., December 1, 2000; 55(12): 716M - 724.
[Abstract] [Full Text]

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 Arch Intern MedHome page
National Task Force on the Prevention and Treatmen
Overweight, Obesity, and Health Risk
Arch Intern Med, April 10, 2000; 160(7): 898 - 904.
[Abstract] [Full Text] [PDF]

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 J. Appl. Physiol.Home page
T. Rankinen, L. Perusse, J. Gagnon, Y. C. Chagnon, A. S. Leon, J. S. Skinner, J. H. Wilmore, D. C. Rao, and C. Bouchard
Angiotensin-converting enzyme ID polymorphism and fitness phenotype in the HERITAGE Family Study
J Appl Physiol, March 1, 2000; 88(3): 1029 - 1035.
[Abstract] [Full Text] [PDF]

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 J. Appl. Physiol.Home page
F. W. Booth, S. E. Gordon, C. J. Carlson, and M. T. Hamilton
Waging war on modern chronic diseases: primary prevention through exercise biology
J Appl Physiol, February 1, 2000; 88(2): 774 - 787.
[Abstract] [Full Text] [PDF]

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 JAMAHome page
J. P. Koplan and W. H. Dietz
Caloric Imbalance and Public Health Policy
JAMA, October 27, 1999; 282(16): 1579 - 1581.
[Full Text] [PDF]


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