Exercise Capacity and Body Mass as Predictors of Mortality Among Male Veterans With Type 2 Diabetes

Stanford University, Palo Alto, California, United States
Diabetes care (Impact Factor: 8.42). 06/2007; 30(6):1539-43. DOI: 10.2337/dc06-2397
Source: PubMed


To demonstrate the relation of exercise capacity and BMI to mortality in a population of male veterans with type 2 diabetes.
After excluding two underweight patients (BMI <18.5 kg/m2), the study population comprised 831 consecutive patients with type 2 diabetes (mean age 61 +/- 9 years) referred for exercise testing for clinical reasons between 1995 and 2006. Exercise capacity was determined from a maximal exercise test and measured in metabolic equivalents (METs). Patients were classified both according to BMI category (18.5-24.9, 25.0-29.9, and > or =30 kg/m2) and by exercise capacity (<5.0 or > or =5.0 maximal METs). The association among exercise capacity, BMI, other clinical variables, and all-cause mortality was assessed by Cox proportional hazards. Study participants were followed for mortality up to 30 June 2006.
During a mean follow-up of 4.8 +/- 3.0 years, 112 patients died, for an average annual mortality rate of 2.2%. Each 1-MET increase in exercise capacity conferred a 10% survival benefit (hazard ratio 0.90 [95% CI 0.82-0.98]; P = 0.01), but BMI was not significantly associated with mortality. After adjustment for age, ethnicity, examination year, BMI, presence of cardiovascular disease (CVD), and CVD risk factors, diabetic patients achieving <5 maximal METs were 70% more likely to die (1.70 [1.13-2.54]) than those achieving > or =5 maximal METs.
There was a strong inverse association between exercise capacity and mortality in this cohort of men with documented diabetes, and this relationship was independent of BMI.

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    • "In general, these findings are in accord with previous reports that show associations between fitness and mortality risk in apparently healthy individuals (11) and in those with CVD (14,29), hypertension (30), and DM (15–18) and extend previous reports of an inverse exercise capacity–mortality association in individuals with type 2 DM. In addition, the current study adds to the existing body of literature in that we assessed the effect of exercise capacity on mortality risk in patients with diabetes burdened by additional risk factors. "
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    ABSTRACT: To assess the association between BMI, fitness, and mortality in African American and Caucasian men with type 2 diabetes and to explore racial differences in this association. We used prospective observational data from Veterans Affairs Medical Centers in Washington, DC, and Palo Alto, California. Our cohort (N = 4,156; mean age 60 ± 10.3 years) consisted of 2,013 African Americans (mean age, 59.5 ± 9.9 years), 2,000 Caucasians (mean age, 60.8 ± 10.5 years), and 143 of unknown race/ethnicity. BMI, cardiac risk factors, medications, and peak exercise capacity in metabolic equivalents (METs) were assessed during 1986 and 2010. All-cause mortality was assessed across BMI and fitness categories. There were 1,074 deaths during a median follow-up period of 7.5 years. A paradoxic BMI-mortality association was observed, with significantly higher risk among those with a BMI between 18.5 and 24.9 kg/m(2) (hazard ratio [HR] 1.70 [95% CI 1.36-2.1]) compared with the obese category (BMI ≥ 35 kg/m(2)). This association was accentuated in African Americans (HR 1.95 [95% CI 1.44-2.63]) versus Caucasians (HR 1.53 [1.0-2.1]). The fitness-mortality risk association for the entire cohort and within BMI categories was inverse, independent, and graded. Mortality risks were 12% lower for each 1-MET increase in exercise capacity, and ~35-55% lower for those with an exercise capacity >5 METs compared with the least fit (≤ 5 METs). CONCLUSIONS A paradoxic BMI-mortality risk association was observed in African American and Caucasian patients with diabetes. The exercise capacity-mortality risk association was inverse, independent, and graded in all BMI categories but was more potent in those with a BMI ≥ 25 kg/m(2).
    Full-text · Article · Mar 2012 · Diabetes care
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    • "In addition, the result of a study examining 2,316 diabetic patients for 15 years reported that a reduction of each 1 MET (metabolic equivalent) in cardiopulmonary fitness resulted in a 20% increase of mortality rate, and cardiopulmonary fitness under 8.8 MET significantly increased the diabetes mortality [14,15]. McAuley et al. [16] demonstrated that people with low level of cardiopulmonary fitness (under 5 MET) had an 80% increase in mortality rate. If standardized guidelines report the minimal level of physical fitness to prevent MetS, diabetes or cardiovascular disease, these guidelines sigfnificantly will help reducing the prevalence of metabolic diseases as well as maintaining or promoting healthy life. "
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    ABSTRACT: The purpose of the current study was to investigate the association of obesity level, physical fitness level, hemoglobin A1c (HbA1c) level and metabolic syndrome (MetS) risk factors among Korean adults. A total of 557 adults (272 males and 285 females) who underwent medical check-up at local hospital were recruited. In addition to regular health check-up, cardiopulmonary fitness, muscular endurance were measured and their association were analyzed. The prevalence of MetS was 31.7% for males and 23.7% for females. Females with the higher muscular endurance had lower waist circumference, triglyceride level, and HbA1c level than those with the lower muscular endurance. Males with the higher level of cardiopulmonary fitness had lower diastolic blood pressure, lower high-sensitivity C-reactive protein level and higher high density lipoprotein cholesterol level than males with the lower level of cardiopulmonary fitness. Females with the higher level of cardiopulmonary fitness had lower body weight, body mass index, systolic blood pressure, and fasting blood glucose level than females with the lower level of cardiopulmonary fitness. Participants with the higher level of adiposity and the lower level of physical fitness were 5.26 times (95% confidence interval [CI], 2.19 to 12.62), 5.71 times (95% CI, 2.23 to 14.60) more likely to have MetS, respectively, in male and female compared to participants who were neither obese nor have the lower level of fitness. This study suggests that maintaining a healthy body weight as well as a certain level of fitness is important for the prevention of MetS.
    Full-text · Article · Jun 2010 · Korean Diabetes Journal
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    • "Yet information on the influence of fitness on mortality in patients having both diabetes and CVD remains largely unexplored. A previous report from the Veterans Exercise Testing Study (VETS) provided compelling evidence that moderate to high levels of fitness can reduce all-cause mortality risk in diabetic men [6]. This report, however, did not specifically examine the subgroup of diabetic patients with CVD, nor did it include a comparison group of men without diabetes and CVD. "
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    ABSTRACT: We assessed joint associations of cardiorespiratory fitness and diabetes, cardiovascular disease (CVD), or both with all-cause mortality. High-fitness eliminated mortality risk in diabetes (P<0.001) and halved risk of death in diabetes/CVD (P<0.001). Fitness was a potent effect modifier in the association of diabetes and CVD to mortality.
    Full-text · Article · Jul 2009 · Diabetes research and clinical practice
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