Associations of Cardiorespiratory Fitness and Obesity With Risks of Impaired Fasting Glucose and Type 2 Diabetes in Men

  1. Duck-chul Lee, PHD1,
  2. Xuemei Sui, MD1,
  3. Timothy S. Church, MD2,
  4. I.-Min Lee, MD34 and
  5. Steven N. Blair, PED15
  1. 1Department of Exercise Science, University of South Carolina, Columbia, South Carolina
  2. 2Pennington Biomedical Research Center, Baton Rouge, Louisiana
  3. 3Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
  4. 4Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
  5. 5Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina
  1. Corresponding author: Duck-chul Lee, lee23{at}


OBJECTIVE—The purpose of this study was to examine the associations of cardiorespiratory fitness (hereafter fitness) and various obesity measures with risks of incident impaired fasting glucose (IFG) and type 2 diabetes.

RESEARCH DESIGN AND METHODS—This was a prospective cohort study of 14,006 men (7,795 for the analyses of IFG), who did not have an abnormal electrocardiogram or a history of heart attack, stroke, cancer, or diabetes.

RESULTS—Of the men, 3,612 (39,610 person-years) and 477 (101,419 person-years) developed IFG and type 2 diabetes, respectively. Compared with the least fit 20% in multivariate analyses, IFG and type 2 diabetes risks in the most fit 20% were 14 and 52% lower, respectively (both P < 0.001). Men with BMI ≥30.0 kg/m2, waist girth >102.0 cm, or percent body fat ≥25 had 2.7-, 1.9-, and 1.3-fold higher risks for type 2 diabetes, respectively, compared with those for nonobese men (all P < 0.01), and the results for IFG were similar. In the combined analyses, obese unfit (least fit 20%) men had a 5.7-fold higher risk for type 2 diabetes compared with normal-weight fit (most fit 80%) men. We observed similar trends for the joint associations of BMI and fitness with IFG and those of waist girth or percent body fat and fitness with both IFG and type 2 diabetes.

CONCLUSIONS—Low fitness and obesity increased the risks of IFG and type 2 diabetes by approximately similar magnitudes. When considered simultaneously, fitness attenuated but did not eliminate the increased risks of IFG and type 2 diabetes associated with obesity, and the highest risk was found in obese and unfit men.


  • Published ahead of print at on 4 November 2008.

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    • Accepted October 24, 2008.
    • Received July 24, 2008.
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  1. Diabetes Care vol. 32 no. 2 257-262
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