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The current standard measure of cardiorespiratory fitness introduces confounding by body mass: the DR's EXTRA study.
MedLine Citation:
PMID:  22105518     Owner:  NLM     Status:  Publisher    
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.
K Savonen; B Krachler; M Hassinen; P Komulainen; V Kiviniemi; T A Lakka; R Rauramaa
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-11-22
Journal Detail:
Title:  International journal of obesity (2005)     Volume:  -     ISSN:  1476-5497     ISO Abbreviation:  -     Publication Date:  2011 Nov 
Date Detail:
Created Date:  2011-11-22     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101256108     Medline TA:  Int J Obes (Lond)     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
1] Kuopio Research Institute of Exercise Medicine, Kuopio, Finland [2] Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland.
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