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Benoit J. Arsenault, MSc; Dominique Lachance, BSc; Isabelle Lemieux, PhD; Natalie Alméras, PhD; Angelo Tremblay, PhD; Claude Bouchard, PhD; Louis Pérusse, PhD; Jean-Pierre Després, PhD, FAHA

Arch Intern Med. 2007;167(14):1518-1525.

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 low CRF 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 ± 70.2 cm²vs 74.7 ± 41.6 cm²; 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 cm²vs 87.8 ± 49.1 cm²; 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.

Author Affiliations: Hôpital Laval Research Centre, Hôpital Laval (Mr Arsenault, Ms Lachance, and Drs Lemieux, Alméras, Tremblay, and Després), and Department of Anatomy and Physiology (Mr Arsenault) and Division of Kinesiology, Department of Social and Preventive Medicine (Drs Tremblay, Pérusse, and Després), Faculty of Medicine, Université Laval, Québec, Québec; and Pennington Biomedical Research Center, Louisiana State University, Baton Rouge (Dr Bouchard).

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