title: Association of multiple adiposity exposures and cardiorespiratory fitness with all-cause mortality in men: the Cooper Center Longitudinal Study.
abstract: OBJECTIVE
  To examine the additive effects of an increased number of positive adiposity exposures on all-cause mortality in men before and after stratification by cardiorespiratory fitness (CRF) level.
  
  
  METHODS
  A total of 36,836 men underwent a physical examination at the Cooper Clinic from January 1, 1971, through December 31, 2006. Exposures included body mass index, waist circumference, percentage of body fat, and CRF as determined by duration of a maximal exercise test. Participants were identified as being either obese (positive) or nonobese (negative) for each adiposity exposure and then grouped into 4 categories: group 1, negative for all adiposity exposures; group 2, positive for any 1 exposure; group 3, positive for any 2 exposures; and group 4, positive for all exposures. Then CRF was grouped as fit or unfit on the basis of the upper 80% and lower 20% of the age-standardized CRF distribution as previously reported in the Cooper Center Longitudinal Study. Hazard ratios were computed with Cox regression analysis.
  
  
  RESULTS
  A total of 2294 deaths occurred during a mean ± SD of 15.5 ± 8.1 years of follow-up. Adjusted hazard ratios across adiposity groups were 1.0 (referent), 1.05, 1.37, and 1.87 for groups 1 through 4, respectively (P for trend <.001). Mortality rates were significantly lower within each of the first 3 adiposity groups in fit compared with unfit men (P<.009 for all comparisons).
  
  
  CONCLUSIONS
  An increasing number of positive adiposity exposures were associated with increased mortality in men. Because moderate to high CRF attenuated mortality rates in all adiposity groups, measurement of CRF should be included for identifying men at increased risk for all-cause mortality.
authors.affiliation: Department of Education, The Cooper Institute, Dallas, TX. Electronic address: sfarrell@cooperinst.org.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Farrell
authors.affiliation: Department of Research, The Cooper Institute, Dallas, TX.
authors.forename: Carrie E
authors.initials: CE
authors.lastname: Finley
authors.affiliation: Department of Kinesiology, The University of North Texas, Denton.
authors.forename: Allen W
authors.initials: AW
authors.lastname: Jackson
authors.affiliation: Center for Human Nutrition, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.
authors.forename: Gloria L
authors.initials: GL
authors.lastname: Vega
authors.affiliation: Department of Kinesiology, The University of North Texas, Denton.
authors.forename: James R
authors.initials: JR
authors.lastname: Morrow
mesh_terms: D000273:Adipose Tissue / Q000502:physiology; D050154:Adiposity / Q000502:physiology*; D000328:Adult; D015992:Body Mass Index; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009765:Obesity / Q000401:mortality; D010809:Physical Fitness / Q000502:physiology*; D016016:Proportional Hazards Models; D055105:Waist Circumference / Q000502:physiology