Obesity measures and heart disease risks— the risks of overtraining and being underweight

Benjamin Hubert; Aroued Khelifi; Paul  Matthieu; Håkan Lane; Shreyansh  Shailaan; Samuel Engst; Charalambos Plousiou; April Htoon; Huda Amer

doi:10.55225/hppa.693

Autor

Benjamin Hubert Uniwersytet Johana Gutenberga w Moguncji, Niemcy
Aroued Khelifi Uniwersytet w Susie, Wyższy Instytut Zarządzania w Susie, Wydział Business Intelligence, Susa, Tunezja
Paul Matthieu Uniwersytet Johana Gutenberga w Moguncji, Niemcy
Håkan Lane Uniwersytet Johana Gutenberga w Moguncji, Niemcy https://orcid.org/0000-0001-6113-9637
Shreyansh Shailaan Sir Seewoosagur Ramgoolam Medical College, Wydział Zdrowia Publicznego, Vacoas-Phoenix, Mauritius https://orcid.org/0009-0000-6317-7717
Samuel Engst Sztokholmski Instytut Technologiczny, Katedra Analityki Danych Medycznych, Sztokholm, Szwecja
Charalambos Plousiou Narodowy Uniwersytet Kapodistriasa w Atenach, Ateny, Grecja https://orcid.org/0009-0002-4183-0230
April Htoon Uniwersytet Atilim, Wydział Lekarski, Ankara, Turcja https://orcid.org/0009-0005-5416-9092
Huda Amer Uniwersytet Atilim, Wydział Lekarski, Ankara, Turcja https://orcid.org/0009-0005-2609-648X

DOI:

https://doi.org/10.55225/hppa.693

Słowa kluczowe:

cardiovascular disease, body mass index, waist-to-height ratio, physical activity, CKM syndrome, obesity

Abstrakt

Purpose: Obesity and abnormal fat distribution are major components of the Cardiovascular–Kidney–Metabolic (CKM) syndrome and are strongly associated with cardiovascular disease (CVD). However, the comparative performance of different anthropometric measures and the modifying role of physical activity remain incompletely defined. We aimed to examine the associations between body mass index (BMI), body fat percentage (BFP), waist-to-height ratio (WHtR), physical activity, and prevalent CVD in a large population-based cohort.
Materials and methods: We conducted a cross-sectional analysis of UK Biobank participants aged 40–69 years. After excluding individuals with missing data, N = 489909 participants were included. Prevalent CVD was defined as a history of angina, myocardial infarction, or stroke at baseline assessment. Multivariable logistic regression models were used to evaluate associations between anthropometric measures and CVD, adjusting for age, sex, smoking status, and major comorbidities. Physical activity was analyzed by type and duration. Results are reported as odds ratios (OR) with 95% confidence intervals (CI).
Results: BMI showed a U-shaped association with CVD, with higher prevalence observed at both low (<18.5 kg/m²) and high (>25 kg/m²) values. WHtR was positively associated with CVD across its range, whereas BFP provided little additional predictive value after adjustment. Moderate physical activity was associated with lower odds of CVD, while very high volumes of vigorous activity showed no additional benefit and were associated with slightly higher CVD prevalence.

Statystyka pobrań

Statystyki pobrań nie są jeszcze dostępne

Bibliografia

Roth GA, Mensah GA, Fuster V. The global burden of cardiovascular diseases and risks: A compass for global action. J Am Coll Cardiol. 2020;76(25):2980-2981. doi: 10.1016/j.jacc.2020.11.021. DOI: https://doi.org/10.1016/j.jacc.2020.11.021 Google Scholar

GBD 2015 Obesity Collaborators. Health effects of overweight and obesity in 195 countries over 25 years. NEJM. 2017;377(1):13-27. doi: 10.1056/NEJMoa1614362. DOI: https://doi.org/10.1056/NEJMoa1614362 Google Scholar

Di Angelantonio E, Bhupathiraju SN, Wormser D, et al. Body-mass index and all-cause mortality: Individual-participant-data meta-analysis of 239 prospective studies in four continents. Lancet. 2016;388(10046):776-786. doi: 10.1016/S0140-6736(16)30175-1. DOI: https://doi.org/10.1016/S0140-6736(16)30175-1 Google Scholar

Libby P. Inflammation in atherosclerosis. Arterioscler Thromb Vasc Biol. 2012;32(9):2045-2051. doi: 10.1161/atvbaha.108.179705. DOI: https://doi.org/10.1161/ATVBAHA.108.179705 Google Scholar

Kahn BB, Flier JS. Obesity and insulin resistance. J Clin Invest. 2000;106(4):473-481. doi: 10.1172/JCI10842. DOI: https://doi.org/10.1172/JCI10842 Google Scholar

Vanhoutte PM, Shimokawa H, Tang EH, Feletou M. Endothelial dysfunction and vascular disease. Acta Physiol. 2009;196(2):193-222. doi: 10.1111/j.1748-1716.2009.01964.x. DOI: https://doi.org/10.1111/j.1748-1716.2009.01964.x Google Scholar

Mozaffarian D. Dietary and policy priorities for cardiovascular disease, diabetes, and obesity: A comprehensive review. Circulation. 2016;133(2):187-225. doi: 10.1161/CIRCULATIONAHA.115.018585. DOI: https://doi.org/10.1161/CIRCULATIONAHA.115.018585 Google Scholar

Powell KE, King AC, Buchner DM, et al. The scientific foundation for the physical activity guidelines for Americans. J Phys Act Health. 2018 Dec 17;16(1):1-11. doi: 10.1123/jpah.2018-0618. DOI: https://doi.org/10.1123/jpah.2018-0618 Google Scholar

Lavie CJ, Milani RV, Ventura HO. Obesity and cardiovascular disease: Risk factor, paradox, and impact of weight loss. J Am Coll Cardiol. 2009;53(21):1925-1932. doi: 10.1016/j.jacc.2008.12.068. DOI: https://doi.org/10.1016/j.jacc.2008.12.068 Google Scholar

Aune D, Sen A, Norat T, et al. Body mass index, abdominal fatness, and heart failure incidence and mortality: A systematic review and dose–response meta-analysis of prospective studies. Circulation. 2016;133(7):639-649. doi: 10.1161/CIRCULATIONAHA.115.016801. DOI: https://doi.org/10.1161/CIRCULATIONAHA.115.016801 Google Scholar

Ndumele CE, Rangaswami J, Chow SL, et al. Cardiovascular-kidney-metabolic health: A presidential advisory from the American Heart Association. Circulation. 2023;148(20):1606-1635. doi: 10.1161/CIR.0000000000001184. DOI: https://doi.org/10.1161/CIR.0000000000001184 Google Scholar

Yusuf S, Hawken S, Ounpuu S, et al. Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries: A case-control study. Lancet. 2005;366(9497):1640-1649. doi: 10.1016/S0140-6736(05)67663-5. DOI: https://doi.org/10.1016/S0140-6736(05)67663-5 Google Scholar

World Health Organization. Body mass index – BMI. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. 2022. Accessed September 2025. Google Scholar

Cleveland Clinic. Body mass index (BMI). https://my.clevelandclinic.org/health/articles/9464-body-mass-index-bmi. Updated September 5, 20222. Accessed September 20, 2025. Google Scholar

Obesity Medicine Association. What is the gold standard for determining body fat? https://obesitymedicine.org/blog/what-is-the-gold-standard-for-determining-body-fat/. 2025. Accessed September 2025. Google Scholar

Grinker JA. Body composition measurement: Accuracy, validity, and comparability. In: Marriott BM, Grumstrup-Scott J, eds. Body Composition and Physical Performance: Applications for the Military Services. Washington (DC): National Academies Press; 1990. https://www.ncbi.nlm.nih.gov/books/NBK235949/. Accessed September 20, 2025. Google Scholar

Ashwell M, Gibson S. Waist-to-height ratio as an indicator of ‘early health risk’: Simpler and more predictive than using a ‘matrix’ based on BMI and waist circumference. BMJ Open. 2016;6(3):e010159. doi: 10.1136/bmjopen-2015-010159. DOI: https://doi.org/10.1136/bmjopen-2015-010159 Google Scholar

Tian D, Meng J. Exercise for prevention and relief of cardiovascular disease: Prognoses, mechanisms, and approaches. Oxid Med Cell Longev. 2019;(1):3756750. doi: 10.1155/2019/3756750. DOI: https://doi.org/10.1155/2019/3756750 Google Scholar

Lobelo F, Young DR, Sallis R, et al. Routine assessment and promotion of physical activity in healthcare settings: A scientific statement from the American Heart Association. Circulation. 2018;137(18):e495-522. doi: 10.1161/CIR.0000000000000559. DOI: https://doi.org/10.1161/CIR.0000000000000559 Google Scholar

Batacan Jr RB, Duncan MJ, Dalbo VJ, Buitrago GL, Fenning AS. Effect of different intensities of physical activity on cardiometabolic markers and vascular and cardiac function in adult rats fed with a high-fat high-carbohydrate diet. J Sport Health Sci. 2018;7(1):109-119. doi: 10.1016/j.jshs.2016.08.001. DOI: https://doi.org/10.1016/j.jshs.2016.08.001 Google Scholar

Buttar HS, Li T, Ravi N. Prevention of cardiovascular diseases: Role of exercise, dietary interventions, obesity and smoking cessation. Exp Clin Cardiol. 2005;10(4):229-249. Google Scholar

Ashwell M, Gibson S. Comments on the article ‘Optimum waist circumference-height indices for evaluating adult adiposity: An analytic review’: Consideration of relationship to cardiovascular risk factors and to the public health message. Obes Rev. 2020;21(9): e13074. doi: 10.1111/obr.13074. DOI: https://doi.org/10.1111/obr.13074 Google Scholar

MedlinePlus. Aging changes in the heart and blood vessels. https://medlineplus.gov/ency/article/004006.htm. Updated 2024. Accessed September 20, 2025. Google Scholar

Aune D, Schlesinger S, Norat T, Riboli E. Body mass index, abdominal fatness, and the risk of sudden cardiac death: A systematic review and dose-response meta-analysis of prospective studies. Eur J Epidemiol. 2018;33(8):711-722. doi: 10.1007/s10654-017-0353-9. DOI: https://doi.org/10.1007/s10654-017-0353-9 Google Scholar

Curtis AB, Karki R, Hattoum A, Sharma UC. Arrhythmias in patients ≥80 years of age: Pathophysiology, management, and outcomes. J Am Coll Cardiol. 2018;71(18):2041-2057. doi: 10.1016/j.jacc.2018.03.019. DOI: https://doi.org/10.1016/j.jacc.2018.03.019 Google Scholar

Springer J, Springer JI, Anker SD. Muscle wasting and sarcopenia in heart failure and beyond: Update 2017. ESC Heart Fail. 2017;4(4):492-498. doi: 10.1002/ehf2.12237. Translating Knowledge of Foundational Drivers of Obesity into Practice: Proceedings of a Workshop Series DOI: https://doi.org/10.1002/ehf2.12237 Google Scholar

The science, strengths, and limitations of body mass index. In: Callahan EA, ed. Translating Knowledge of Foundational Drivers of Obesity into Practice: Proceedings of a Workshop Series. Washington (DC): National Academies Press; 2023. https://www.ncbi.nlm.nih.gov/books/NBK594362/. Published July 31, 2023. Accessed September 20, 2025. Google Scholar

Sudlow C, Gallacher J, Allen N, et al. UK biobank: An open access resource for identifying the causes of a wide range of complex diseases of middle and old age. PLoS Med. 2015;12(3):e1001779. doi: 10.1371/journal.pmed.1001779. DOI: https://doi.org/10.1371/journal.pmed.1001779 Google Scholar

Whitlock G, Lewington S, Sherliker P, et al. Body-mass index and cause-specific mortality in 900 000 adults: Collaborative analyses of 57 prospective studies. Lancet. 2009;373(9669):1083-1096. doi: 10.1016/S0140-6736(09)60318-4. DOI: https://doi.org/10.1016/S0140-6736(09)60318-4 Google Scholar

Kuk JL, Katzmarzyk PT, Nichaman MZ, Church TS, Blair SN, Ross R. Visceral fat is an independent predictor of all‐cause mortality in men. Obesity. 2006;14(2):336-341. doi: 10.1038/oby.2006.43. DOI: https://doi.org/10.1038/oby.2006.43 Google Scholar

Piercy KL, Troiano RP. Physical activity guidelines for Americans from the US Department of Health and Human Services: Cardiovascular benefits and recommendations. Circ Cardiovasc Qual Outcomes. 2018;11(11):e005263. doi: 10.1161/CIRCOUTCOMES.118.005263. DOI: https://doi.org/10.1161/CIRCOUTCOMES.118.005263 Google Scholar