Exercise capacity and body composition as predictors of mortality among men with diabetes.
OBJECTIVE
To quantify the relation of fitness to mortality among men with diabetes, adjusted for BMI and within levels of BMI.


METHODS
In this observational cohort study, we calculated all-cause death rates in men with diabetes across quartiles of fitness and BMI categories. Study participants were 2,196 men with diabetes (average age 49.3 years, SD 9.5) who underwent a medical examination, including a maximal exercise test, during 1970 to 1995, with mortality follow-up to 31 December 1996.


RESULTS
We identified 275 deaths during 32,161 person-years of observation. Risk of all-cause mortality was inversely related to fitness. For example, in the fully adjusted model, the risk of mortality was 4.5 (2.6-7.6), 2.8 (1.6-4.7), and 1.6 (0.93-2.76) for the first, second, and third fitness quartiles, respectively, with the fourth quartile (highest fitness level) as the referent (P for trend <0.0001). There was no significant trend across BMI categories for mortality after adjustment for fitness. Similar results were found when the fitness-mortality relation was examined within levels of body composition. In normal-weight men with diabetes, the relative risks of mortality were 6.6 (2.8-15.0), 3.2 (1.4-7.0), and 2.2 (1.1-4.6) for the first, second, and third quartiles of fitness, respectively, as compared with the fourth quartile (P for trend <0.0001). We found similar results in the overweight and obese weight categories.


CONCLUSIONS
There was a steep inverse gradient between fitness and mortality in this cohort of men with documented diabetes, and this association was independent of BMI.
Church
Timothy S
TS
The Cooper Institute, Dallas, Texas. Cooper Clinic, Dallas, Texas 75230, USA. tchurch@cooperinst.org
Cheng
Yiling J
YJ
Earnest
Conrad P
CP
Barlow
Carolyn E
CE
Gibbons
Larry W
LW
Priest
Elisa L
EL
Blair
Steven N
SN
D001794:Blood Pressure; D001823:Body Composition; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002423:Cause of Death; D002784:Cholesterol / Q000097:blood; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000401:mortality / Q000503:physiopathology*; D015444:Exercise / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012907:Smoking; D013997:Time Factors
D002784:Cholesterol