title: Prognostic impact of abdominal fat distribution and cardiorespiratory fitness in asymptomatic type 2 diabetics.
abstract: BACKGROUND
  Impaired cardiorespiratory fitness (CRF) is a potent risk factor for mortality in diabetes, and may modify the relation between adiposity and mortality. We evaluated the interaction between CRF and abdominal adiposity distribution with all-cause mortality, myocardial infarction or stroke in patients with diabetes.
  
  
  METHODS
  We studied 294 type 2 diabetics without known coronary artery disease. CRF was quantified in metabolic equivalents by maximal treadmill testing, and categorized as low CRF (first tertile) or high CRF (second and third tertiles). Abdominal fat was quantified as subcutaneous or visceral adipose tissue from non-enhanced computed tomography scans. Association of CRF, adiposity distribution and their interaction with all-cause mortality, myocardial infarction or stroke was assessed by Cox proportional-hazard models.
  
  
  RESULTS
  There were 31 (11%) events during 62 ± 12 months. Low CRF was significantly associated with event risk before and after adjustment for each measure of adiposity (hazard ratio 3.79, 95% confidence interval 1.79-8.01, p < 0.001). CRF level was inversely correlated with subcutaneous (r = -0.44, p < 0.001) but not visceral adipose tissue (r = -0.06, p = 0.31). Absolute event rates increased progressively across visceral adipose tissue tertiles, but decreased across subcutaneous tertiles. However, within each tertile of both adiposity measures, increased events were observed in the low compared with the high CRF group; this trend was also observed in an adjusted multivariate proportional hazards model.
  
  
  CONCLUSIONS
  Although subcutaneous and visceral adipose tissues differed in their association with CRF levels and absolute event rates, lower baseline CRF in type 2 diabetics was significantly associated with higher risk of all-cause mortality, myocardial infarction or stroke, regardless of abdominal adiposity pattern.
authors: Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center and The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel barakzmd@gmail.com.
authors: Barak
authors: B
authors: Zafrir
authors: Department of Diagnostic Radiology, McGill University Health Centre, Montreal, Canada.
authors: Alla
authors: A
authors: Khashper
authors: Department of Radiology, Lady Davis Carmel Medical Center and The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors: Tamar
authors: T
authors: Gaspar
authors: Department of Cardiology, Bnai Zion Medical Center, Haifa, Israel.
authors: Idit
authors: I
authors: Dobrecky-Mery
authors: Department of Radiology, Lady Davis Carmel Medical Center and The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors: Mali
authors: M
authors: Azencot
authors: Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center and The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors: Basil S
authors: BS
authors: Lewis
authors: Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center and The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors: Ronen
authors: R
authors: Rubinshtein
authors: Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center and The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors: David A
authors: DA
authors: Halon
mesh_terms: D050154:Adiposity; D000368:Aged; D058070:Asymptomatic Diseases; D002423:Cause of Death; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology*; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006339:Heart Rate; D006801:Humans; D050152:Intra-Abdominal Fat / Q000000981:diagnostic imaging / Q000503:physiopathology*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D009203:Myocardial Infarction / Q000401:mortality; D010809:Physical Fitness; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000401:mortality; D050507:Subcutaneous Fat, Abdominal / Q000000981:diagnostic imaging / Q000503:physiopathology*; D013997:Time Factors
keywords: Body mass index; abdominal fat; adipose tissue; fitness; type 2 diabetes mellitus