Combinations of BMI and cardiorespiratory fitness categories: trends between 1995 and 2020 and associations with CVD incidence and mortality and all-cause mortality in 471 216 adults.Show others and affiliations
2022 (English)In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 29, no 6, p. 959-967Article in journal (Refereed) Published
Abstract [en]
AIMS: To describe time trends in combinations of cardiorespiratory fitness (CRF) and body mass index (BMI) status, and to analyse their associations with cardiovascular disease (CVD) incidence and mortality and all-cause mortality.
METHODS AND RESULTS: Prospective cohort study with data from occupational health screenings in Swedish employees, including n = 471 216 (aged 18-74 years) between 1995 and 2020, and n = 169 989 in risk analyses. Cardiorespiratory fitness was estimated from a submaximal cycle test. High CRF was defined as top quartile, and low CRF as bottom quartile. Body mass index was used to define normal weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obesity (≥30 kg/m2). Outcome data (CVD incidence and mortality, all-cause mortality) were obtained from national registers. From 1995 to 2020, the combination of obesity + low CRF increased from 2.1% to 5.3% (relative increase 154%) whereas the combination of normal weight + high CRF decreased from 13.2% to 9.3% (-30%) (both P < 0.001). Negative changes were more pronounced in men, younger ages, and non-university educated. At the end of the period, prevalence of obesity + low CRF were higher in men vs. women (3.1% vs. 2.2%), older vs. younger (3.7% vs. 1.7%), and in non-university vs. university educated (5.0% vs. 0.3%), all P-value <0.001. Having a high CRF attenuated the risk of all three outcomes in all BMI categories, especially in individuals with obesity (hazard ratio 3.90 vs. 6.67 for CVD mortality). Both a low BMI and a high CRF prolonged age of onset for all three outcomes.
CONCLUSIONS: The combination of obesity with low CRF has increased markedly since the mid-90s, with clear implications for increased CVD morbidity and mortality, and all-cause mortality.
Place, publisher, year, edition, pages
Oxford University Press, 2022. Vol. 29, no 6, p. 959-967
Keywords [en]
BMI, Cardiorespiratory fitness, Cardiovascular disease, Mortality, Obesity
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Medicine/Technology
Identifiers
URN: urn:nbn:se:gih:diva-6826DOI: 10.1093/eurjpc/zwab169ISI: 000790035000001PubMedID: 34669922OAI: oai:DiVA.org:gih-6826DiVA, id: diva2:1605209
Projects
HPI-gruppen
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2018-00384Swedish Heart Lung Foundation, 20180636Swedish Armed Forces, AF 922 09152021-10-222021-10-222022-05-19