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Fat versus Fit
Fat versus Fit
Fat versus Fit
Fat versus Fit
Fat versus Fit
Fat versus Fit
Fat versus Fit
Fat versus Fit
Fat versus Fit
Fat versus Fit
Fat versus Fit
Fat versus Fit
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Fat versus Fit

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  • 1. Cardiorespiratory Fitness and Adiposity as Mortality Predictors in Older Adults JAMA December 5, 2007
  • 2. Background <ul><li>32% of Americans are obese </li></ul><ul><li>Obesity is associated with a number of health problems </li></ul><ul><li>Vast majority of people do not exercise </li></ul><ul><li>These trends worsen with aging </li></ul><ul><li>There is little data regarding associations among obesity, physical activity and mortality </li></ul><ul><li>What is more important, fat or fitness? </li></ul>
  • 3. Methods <ul><li>Objective: determine the association among cardiorespiratory fitness, adiposity and mortality on older adults </li></ul><ul><li>Cohort Study: prospective study of 2,603 adults &gt; 60 yrs </li></ul><ul><ul><li>Had to achieve 85% HR on treadmill test to be included </li></ul></ul><ul><ul><li>Patients grouped into quintiles based on duration of test </li></ul></ul><ul><ul><li>Also grouped by BMI, waist circumference, body fat % and fat free mass </li></ul></ul><ul><li>Patients completed a comprehensive health evaluation, physical exam, blood lipids and glucose and EKG </li></ul>
  • 4. Methods Cont. <ul><li>Used METS (metabolic equivalent tasks) based on treadmill speed and grade to standardize interpretation </li></ul><ul><li>Outcome was all-cause mortality </li></ul><ul><li>Multivariate analysis performed using age, sex, exam year, smoking, abnormal exercise EKG and chronic medical conditions </li></ul>
  • 5. Results
  • 6. <ul><li>Table I - Highlights </li></ul><ul><li>20% women </li></ul><ul><li>BMI and waist circumference was the same for both groups </li></ul><ul><li>Treadmill time was 2 minutes less in decedents </li></ul><ul><li>HDL was 4 pts higher in survivors, as was incidence of hypercholesterolemia </li></ul><ul><li>Smoking was 5% more prevalent in decedents </li></ul>
  • 7. <ul><li>Table II - Highlights </li></ul><ul><li>Opposing trend in fitness quintile for lowest and highest BMI groups </li></ul><ul><li>HDL directly correlated w/ fitness quintile </li></ul><ul><li>Except in lowest quintile, smoking inversely correlated w/ fitness </li></ul><ul><li>Except in highest quintile, hypertension and cholesterol directly correlated w/ fitness </li></ul><ul><li>One BMI &gt; 35 actually made it 18 minutes </li></ul>
  • 8. <ul><li>Table IV - Highlights </li></ul><ul><li>J-shaped relationship between BMI and mortality </li></ul><ul><li>EKG changes, chronic medical conditions and waist circumference correlate w/ mortality </li></ul><ul><li>Percent body fat and fat free mass did not </li></ul>
  • 9. Table V <ul><li>Hazard ratios for fitness and adiposity -&gt; results show better fitness = better mortality </li></ul><ul><li>Initially adjusted for 1) age, sex, EKG changes, smoking, exam year and medical conditions </li></ul><ul><li>Additional adjustments for 2) BMI, 3) waist circumference, 4) percent body fat and 5) fat-free mass did not change the results </li></ul>
  • 10. Study Limitations <ul><li>Cohort -&gt; possibility of confounders </li></ul><ul><li>Homogeneous study group (white, educated, middle and upper class) </li></ul><ul><li>No info about diet or medication use </li></ul><ul><li>Fitness tested only once at outset of study </li></ul><ul><li>Does not really address association between a spot fitness check and daily cardiovascular exercise </li></ul><ul><li>Small number of women and few deaths within this group </li></ul>
  • 11. Conclusions <ul><li>Fitness is a strong predictor of overall mortality independent of body composition </li></ul><ul><li>Assuming an otherwise healthy individual, there is no association betw abdominal obesity and mortality when adjusted for fitness </li></ul><ul><li>Fit individuals who are obese had lower mortality than unfit normal-weight or lean individuals </li></ul><ul><li>Fat distribution and frame size may be more important than adiposity </li></ul><ul><li>There is a J-shaped relationship betw BMI and mortality, both before and after adjusting for fitness </li></ul>
  • 12. FIN

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