The current standard measure of cardiorespiratory fitness introduces confounding by body mass: the DR's EXTRA study
2012 (English)In: International Journal of Obesity, ISSN 0307-0565, E-ISSN 1476-5497, Vol. 36, no 8, 1135-1140 p.Article in journal (Refereed) Published
OBJECTIVE:Cardiorespiratory fitness is currently estimated by dividing maximal oxygen consumption (VO(2max)) by body weight (per-weight standard). However, the statistically correct way to neutralize the effect of weight on VO(2max) in a given population is adjustment for body weight by regression techniques (adjusted standard). Our objective is to quantify the bias introduced by the per-weight standard in a population distributed across different categories of body mass.
DESIGN:This is a cross-sectional study.
SUBJECTS AND METHODS:Baseline measures from participants of the Dose-Responses to Exercise Training Study (DR's EXTRA), 635 men (body mass index (BMI): 19-47 kg m(-2)) and 638 women (BMI: 16-49 kg m(-2)) aged 57-78 years who performed oral glucose tolerance tests and maximal exercise stress tests with direct measurement of VO(2max). We compare the increase in VO(2max) implied by the per-weight standard with the real increase of VO(2max) per kg body weight. A linear logistic regression model estimates odds for abnormal glucose metabolism (either impaired fasting glycemia or impaired glucose tolerance or Type 2 diabetes) of the least-fit versus most-fit quartile according to both per-weight standard and adjusted standard.
RESULTS:The per-weight standard implies an increase of VO(2max) with 20.9 ml min(-1) in women and 26.4 ml min(-1) in men per additional kg body weight. The true increase per kg is only 7.0 ml min(-1) (95% confidence interval: 5.3-8.8) and 8.0 ml min(-1) (95% confidence interval: 5.3-10.7), respectively. Risk for abnormal glucose metabolism in the least-fit quartile of the population is overestimated by 52% if the per-weight standard is used.
CONCLUSIONS:In comparisons across different categories of body mass, the per-weight standard systematically underestimates cardiorespiratory fitness in obese subjects. Use of the per-weight standard markedly inflates associations between poor fitness and co-morbidities of obesity.
International Journal of Obesity advance online publication, 22 November 2011; doi:10.1038/ijo.2011.212.
Place, publisher, year, edition, pages
London: Nature Publishing Group, 2012. Vol. 36, no 8, 1135-1140 p.
abnormal glucose metabolism, body mass, cardiorespiratory fitness, maximal oxygen uptake
Environmental Health and Occupational Health
IdentifiersURN: urn:nbn:se:umu:diva-53426DOI: 10.1038/ijo.2011.212PubMedID: 22105518OAI: oai:DiVA.org:umu-53426DiVA: diva2:511991