Effects of body fatness and physical activity on cardiovascular risk: Risk prediction using the bioelectrical impedance method

Abstract

Aims: 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.

Keywords

Bioelectrical impedance body composition cardiovascular diseases physical activity myocardial infarction obesity

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References

Kannel WB , Wilson PW , Nam BH , D'Agostino RB Risk stratification of obesity as a coronary risk factor. Am J Cardiol 2002;90:697—701.

Jonsson S. , Hedblad B. , Engstrom G. , Nilsson P. , Berglund G. , Janzon L. Influence of obesity on cardiovascular risk: Twenty-three-year follow-up of 22,025 men from an urban Swedish population . Int J Obes Relat Metab Disord 2002;26:1046—53.

Grundy SM Obesity, metabolic syndrome, and cardiovascular disease. J Clin Endocrinol Metab 2004;89:2595—600.

Bioelectrical impedance analysis in body composition measurement: National Institutes of Health Technology Assessment Conference Statement. Am J Clin Nutr 1996;64(3 Suppl.):524S—532S.

Heitmann BL

Impedance: A valid method in assessment of body composition?

Eur J Clin Nutr 1994;48:228—40.

Singh RB , Niaz MA , Beegom R. , Wander GS , Thakur AS , Rissam HS Body fat percent by bioelectrical impedance analysis and risk of coronary artery disease among urban men with low rates of obesity: The Indian paradox . J Am Coll Nutr 1999;18:268—73.

Lahmann PH , Lissner L. , Gullberg B. , Berglund G. A prospective study of adiposity and all-cause mortality: the Malmo Diet and Cancer Study . Obes Res 2002;10:361—9.

Blair SN , Brodney S. Effects of physical inactivity and obesity on morbidity and mortality: Current evidence and research issues. Med Sci Sports Exerc 1999;31(11 Suppl.):S646—62.

Powell KE , Thompson PD , Caspersen CJ , Kendrick JS Physical activity and the incidence of coronary heart disease. Annu Rev Public Health 1987;8:253—87.

10.

Tremblay A. , Doucet E. , Imbeault P. , Mauriege P. , Despres JP , Richard D. Metabolic fitness in active reduced-obese individuals. Obes Res 1999;7:556—63.

11.

Lee CD , Blair SN , Jackson AS Cardiorespiratory fitness, body composition, and all-cause and cardiovascular disease mortality in men. Am J Clin Nutr 1999 ;69:373—80.

12.

Hu FB , Willett WC , Li T. , Stampfer MJ , Colditz GA , Manson JE Adiposity as compared with physical activity in predicting mortality among women. N Engl J Med 2004;351:2694—703.

13.

Berglund G. , Elmstahl S. , Janzon L. , Larsson SA The Malmo Diet and Cancer Study: Design and feasibility. J Intern Med 1993;233:45—51.

14.

Manjer J. , Carlsson S. , Elmstahl S. , Gullberg B. , Janzon L. , Lindstrom M. , et al. The Malmo Diet and Cancer Study: Representativity, cancer incidence and mortality in participants and non-participants. Eur J Cancer Prev 2001;10: 489—99.

15.

Chobanian AV , Bakris GL , Black HR , Cushman WC , Green LA , Izzo JL Jr , et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 report. JAMA 2003;289:2560—72.

16.

Wallström P. Diet, lifestyle, antioxidants, and biomarkers of cancer risk: An epidemiological report from the Malmö Diet and Cancer cohort . Dissertation, Lund University, Malmö; 2002.

17.

Taylor HL , Jacobs DR , Jr. Schucker B. , Knudsen J. , Leon AS , Debacker G. A questionnaire for the assessment of leisure time physical activities. J Chronic Dis 1978 ;31:741—55.

18.

The National Board of Health and Welfare. Värdering av diagnoskvaliteten för akut hjärtinfarkt i patientregistret 1997 och 1995 (Evaluation of quality of diagnosis of acute myocardial infarction, inpatient register 1997 and 1995, in Swedish). Stockholm : Socialstyrelsen; 2000 .

19.

The National Board of Health and Welfare. Centre of Epidemiology. Causes of death 1995. Stockholm: Author; 1997.

20.

Jerntorp P. , Berglund G. registry in Malmo, Sweden. Stroke 1992;23:357—61.

21.

International Classification of Diseases, Ninth revision (ICD-9) . Geneva: WHO; 1977.

22.

Engstrom G. , Jerntorp I. , Pessah-Rasmussen H. , Hedblad B. , Berglund G. , Janzon L. Geographic distribution of stroke incidence within an urban population: Relations to socio-economic circumstances and prevalence of cardiovascular risk factors. Stroke 2001;32:1098—103.

23.

Willett WC , Dietz WH , Colditz GA Guidelines for healthy weight. N Engl J Med 1999;341:427—34.

24.

Menard S. Applied logistic regression analysis. Sage University Paper series no 07-106. Thousand Oaks, CA Sage Publications; 1995.

25.

World Health Organization. Obesity: Preventing and managing the global epidemic. Report of a WHO consultation. Geneva, 3—5 June. Geneva: WHO; 2000.

26.

Tanaka S. , Togashi K. , Rankinen T. , Perusse L. , Leon AS , Rao DC , et al. Sex differences in the relationships of abdominal fat to cardiovascular disease risk among normal-weight white subjects. Int J Obes Relat Metab Disord 2004 ;28:320—3.

27.

Engstrom G. , Hedblad B. , Stavenow L. , Jonsson S. , Lind P. , Janzon L. , et al. Incidence of obesity-associated cardiovascular disease is related to inflammation-sensitive plasma proteins: A population-based cohort study. Arterioscler Thromb Vasc Biol 2004;24:1498—502.

28.

Geffken DF , Cushman M. , Burke GL , Polak JF , Sakkinen PA , Tracy RP Association between physical activity and markers of inflammation in a healthy elderly population . Am J Epidemiol 2001;153:242—50.

29.

Klein S. , Fontana L. , Young VL , Coggan AR , Kilo C. , Patterson BW , et al. Absence of an effect of liposuction on insulin action and risk factors for coronary heart disease. N Engl J Med 2004;350:2549—57.

30.

Richardson MT , Leon AS , Jacobs DR, Jr. Ainsworth BE , Serfass R. Comprehensive evaluation of the Minnesota Leisure Time Physical Activity Questionnaire. J Clin Epidemiol 1994;47:271—81.

31.

Lichtman SW , Pisarska K. , Berman ER , Pestone M. , Dowling H. , Offenbacher E. , et al. Discrepancy between self-reported and actual caloric intake and exercise in obese subjects. N Engl J Med 1992;327:1893—8.