Visceral adipose tissue accumulation, cardiorespiratory fitness, and features of the metabolic syndrome

Background: It has been suggested that overweight and obese individuals with an adequate level of cardiorespiratory fitness (CRF), the so-called fat and fit, are at reduced risk of coronary heart disease and type 2 diabetes mellitus. Methods: To determine whether individuals with lowCRF have more visceral adipose tissue (AT) accumulation compared with individuals with high CRF and to verify whether low CRF is associated with a poorer metabolic profile, we performed a cross-sectional study of 169 asymptomatic men without diabetes mellitus (mean +/- SD body mass index [calculated as weight in kilograms divided by height in meters squared], 25.9 +/- 4.4; and mean +/- SD age, 37.1 +/- 14.0 years). Abdominal AT accumulation, CRF, and indexes of plasma glucose-insulin homeostasis and of the lipoprotein-lipid profile were measured. Results: More visceral AT accumulation was observed among men in the lowest tertile of CRF compared with men in the highest tertile of CRF (mean +/- SD, 139.6 +/- 70.2cm(2) vs 74.7 +/- 41.6 cm(2); P < .001). Overall, the plasma lipoprotein-lipid profiles were more favorable in men with a high CRF compared with individuals with a low CRF, as men with a low CRF had higher triglyceride (mean +/- SD, 161 +/- 73 mg/dL vs 99 +/- 45 mg/dL; P < 001) and apolipoprotein B (mean +/- SD, 106 +/- 23 mg/dL vs 89 +/- 24 mg/dL; P <. 009) levels and an increased total cholesterol-high-density lipoprotein cholesterol ratio (mean +/- SD, 5.27 +/- 1.00 vs 3.96 +/- 1.17; P =. 002) than men with high CRF. After matching individuals with similar body mass index values but with high or low CRF, men with low CRF were characterized by more visceral AT accumulation than men with high CRF (mean +/- SD, 114.4 +/- 59.9 cm(2) vs 87.8 +/- 49.1 cm(2); P <. 007) and by a poorer metabolic profile. However, when matched for visceral AT accumulation, such differences were no longer statistically significant. Conclusion: This study underlines the importance of visceral AT accumulation in the previously reported association between CRF and metabolic complications predictive of coronary heart disease and type 2 diabetes mellitus.