title: Effects of body fatness and physical activity on cardiovascular risk: risk prediction using the bioelectrical impedance method.
abstract: OBJECTIVE
  To explore the effects of body fat percentage (BF%) on incidence of and mortality from cardiovascular disease (CVD) and to study the cardio-protective effect of physical activity in relation to BF%.
  
  
  METHODS
  A total of 26,942 men and women, aged 45-73 years, without history of CVD were followed up for incidence of coronary events (CE), ischaemic stroke, and CVD mortality over seven years in relation to sex-specific quartiles (Q1-Q4) of BF%. The cardio-protective effect of leisure-time physical activity was studied in relation to BF%.
  
  
  RESULTS
  In men, the relative risk (RR) for CE and CVD mortality increased progressively with BF%. RR for CE in Q4 was 1.37 (95% confidence interval: 1.07-1.74), adjusted for age, height, smoking, high alcohol intake, and physical activity, compared with Q1. In women, BF% was significantly associated with incidence of CE and stroke. BF% was more strongly correlated to body mass index (BMI) (r = 0.83) and waist circumference (r = 0.76) in women than in men (r = 0.59 and r = 0.66, respectively). BF% was a stronger risk factor than BMI in women, and equally strong as waist circumference. A significant interaction (p = 0.013 for incidence of CE, p = 0.026 for ischaemic stroke) was found between BF% and sex. The raised cardiovascular risk was reduced by physical activity in subjects with high BF%.
  
  
  CONCLUSIONS
  BF% is a risk factor for CE, ischaemic stroke, and CVD mortality. An interaction between BF% and sex suggests that BF% is a stronger CVD risk factor in women. The raised cardiovascular risk associated with high BF% is reduced by physical activity.
authors.affiliation: Department of Clinical Sciences in Malmö, Epidemiological Research Group, Malmö University Hospital, 205 02 Malmö, Sweden. susanna.calling@med.lu.se
authors.forename: Susanna
authors.initials: S
authors.lastname: Calling
authors.forename: Bo
authors.initials: B
authors.lastname: Hedblad
authors.forename: Gunnar
authors.initials: G
authors.lastname: Engström
authors.forename: Göran
authors.initials: G
authors.lastname: Berglund
authors.forename: Lars
authors.initials: L
authors.lastname: Janzon
mesh_terms: D050154:Adiposity; D000368:Aged; D001823:Body Composition; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D015331:Cohort Studies; D017097:Electric Impedance; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D009765:Obesity / Q000150:complications*; D011379:Prognosis; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D013548:Sweden / Q000453:epidemiology; D049629:Waist-Hip Ratio