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Response to ‘More fuel in the obesity paradox debate’: fatness, fitness, stiffness and blood pressure

International Journal of Obesity volume 37, pages 320–321 (2013)Cite this article

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We appreciate the thoughtful comments made by Dr Anyfanti et al.1 and agree with the notion that fitness could be an important variable to consider in the relationship between blood pressure (BP), obesity and cardiovascular risk. It is well accepted that regular aerobic exercise and higher levels of fitness enhance arterial hemodynamics (for example, reduce large artery stiffness and increase nitric oxide bioavailability). These improvements should translate to increased systolic BP (SBP) amplification (brachial SBP—central SBP);2 in other words, fitter people should have low central SBP compared with unfit people, with similar upper arm SBP. To our knowledge, the extent to which this physiological milieu may be modified by (or associated with) body fatness has not been tested. However, this is an important question given the strong relationship between aortic stiffness3 and central BP4 with cardiovascular mortality.

Data on fitness were not available to test fatness interactions in our healthy or patient cohorts. However, maximal oxygen uptake at peak exercise intensity (VO2max) was recorded in 61 (n=25 females) of the healthy participants. Although this sample size was too small to satisfactorily establish whether an interaction effect was evident, both waist and VO2max were independent predictors of both aortic stiffness (standardized β (95% CI)=0.30 (0.01–0.09; P=0.014 and β=−0.34 (−0.09 to −0.01); P<0.001, respectively) and SBP amplification (β=0.25 (0.009–0.25); P=0.036 and β=0.47 (0.12–0.36); P<0.001, respectively) when tested by multiple regression analysis. Although, large, longitudinal studies are required to confirm this finding, this preliminary analysis supports a possible influence of arterial stiffness and central BP in the paradoxical nexus of fitness, fatness and cardiovascular risk.

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References

  1. Anyfanti P, Doumas M, Gavriilaki E, Triantafyllou A, Nikolaidou B . More fuel in the obesity paradox debate. Int J Obesity 2013; 37: 320.

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Authors and Affiliations

  1. Menzies Research Institute Tasmania, University of Tasmania, Hobart, TAS, Australia

    J E Sharman

  2. Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Princess Alexandra Hospital, Brisbane, QLD, Australia

    M Stowasser

  3. School of Human Movement Studies, Brisbane, TAS, Australia

    O O Kolade, J S Coombes & R G Fassett

  4. Renal Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia

    R G Fassett

  5. Cleveland Clinic, Cleveland, OH, USA

    T H Marwick

Authors
  1. J E Sharman
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  2. M Stowasser
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  3. O O Kolade
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  4. J S Coombes
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  5. R G Fassett
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  6. T H Marwick
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Correspondence to J E Sharman.

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Sharman, J., Stowasser, M., Kolade, O. et al. Response to ‘More fuel in the obesity paradox debate’: fatness, fitness, stiffness and blood pressure. Int J Obes 37, 320–321 (2013). https://doi.org/10.1038/ijo.2012.44

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