title: Addition of Cardiorespiratory Fitness Within an Obesity Risk Classification Model Identifies Men at Increased Risk of All-Cause Mortality.
abstract: OBJECTIVE
  Guidelines for identification of obesity-related risk which stratify disease risk using specific combinations of body mass index and waist circumference. Whether the addition of cardiorespiratory fitness, an independent predictor of disease risk, provides better risk prediction of all-cause mortality within current body mass index and waist circumference categories is unknown. The study objective was to determine whether the addition of cardiorespiratory fitness improves prediction of all-cause mortality risk classified by the combination of body mass index and waist circumference.
  
  
  METHODS
  We performed a prospective observational study using data from the Aerobics Center Longitudinal Study. A total of 31,267 men (mean age, 43.9 years; standard deviation, 9.4 years) who completed a baseline medical examination between 1974 and 2002 were included. The main outcome measure was all-cause mortality. Participants were grouped using body mass index- and waist circumference-specific threshold combinations: normal body mass index: 18.5 to 24.9 kg/m(2), waist circumference threshold of 90 cm; overweight body mass index: 25.0 to 29.9 kg/m(2), waist circumference threshold of 100 cm, and obese body mass index: 30.0 to 34.9 kg/m(2), waist circumference threshold of 110 cm. Participants were classified using cardiorespiratory fitness as unfit or fit, where unfit was the lowest fifth of the age-specified distribution of maximal exercise test time on the treadmill among the entire Aerobics Center Longitudinal Study population.
  
  
  RESULTS
  A total of 1399 deaths occurred over a follow-up of 14.1 ± 7.4 years, for a total of 439,991 person-years of observation. Men who were unfit and had normal body mass index with waist circumference <90 cm and ≥90 cm had 95% (hazard ratio [HR], 1.95; 95% confidence interval [CI], 1.34-2.83) and 163% (HR, 2.63; 95% CI, 1.58-4.40) higher mortality risk than men who were fit, respectively (P <.05). Men who were unfit and overweight had 41% (HR, 1.41; 95% CI, 1.04-1.90) higher mortality risk with a waist circumference <100 cm (P <.05), but were at no greater risk (HR, 1.30; 95% CI, 0.92-1.84) if their waist circumference was ≥100 cm (P = .14). Men who were unfit and obese were not at increased mortality risk (HR, 1.37; 95% CI, 0.90-2.09) with a waist circumference <110 cm (P = .14), but were at 111% (HR, 2.11; 95% CI, 1.31-3.42) increased risk with a waist circumference ≥110 cm (P <.05).
  
  
  CONCLUSIONS
  For most of the body mass index and waist circumference categories, inclusion of cardiorespiratory fitness allowed for improved identification of men at increased mortality risk.
authors.affiliation: School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada.
authors.forename: T Alexander
authors.initials: TA
authors.lastname: Ricketts
authors.affiliation: Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia.
authors.forename: Xuemei
authors.initials: X
authors.lastname: Sui
authors.affiliation: Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, La.
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Lavie
authors.affiliation: Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia.
authors.forename: Steven N
authors.initials: SN
authors.lastname: Blair
authors.affiliation: School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada. Electronic address: rossr@queensu.ca.
authors.forename: Robert
authors.initials: R
authors.lastname: Ross
mesh_terms: D000328:Adult; D015992:Body Mass Index; D000072599:Cardiorespiratory Fitness; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009765:Obesity / Q000145:classification* / Q000175:diagnosis / Q000401:mortality; D011446:Prospective Studies; D018570:Risk Assessment; D013781:Texas / Q000453:epidemiology; D055105:Waist Circumference
keywords: Fitness; Health risk; Mortality; Obesity