Exercise Capacity and Body Composition as Predictors of Mortality Among Men With Diabetes

OBJECTIVE — To quantify the relation of fitness to mortality among men with diabetes, adjusted for BMI and within levels of BMI. RESEARCH DESIGN AND METHODS — In this observational cohort study, we cal-culated all-cause death rates in men with diabetes across quartiles of fitness and BMI categories. Study participants were 2,196 men with diabetes (average age 49.3 years, SD 9.5) who under-went a medical examination, including a maximal exercise test, during 1970 to 1995, with mortality follow-up to 31 December 1996. RESULTS — We identified 275 deaths during 32,161 person-years of observation. Risk of all-cause mortality was inversely related to fitness. For example, in the fully adjusted model, the risk of mortality was 4.5 (2.6–7.6), 2.8 (1.6–4.7), and 1.6 (0.93–2.76) for the first, second, and third fitness quartiles, respectively, with the fourth quartile (highest fitness level) as the referent (P for trend 0.0001). There was no significant trend across BMI categories for mortality after adjustment for fitness. Similar results were found when the fitness-mortality relation was exam-ined within levels of body composition. In normal-weight men with diabetes, the relative risks of mortality were 6.6 (2.8–15.0), 3.2 (1.4–7.0), and 2.2 (1.1–4.6) for the first, second, and thir