Fitness Determines Longevity Regardless Of Body Fat

There were 450 deaths during a mean follow-up of 12 years and 31 236 person-years of exposure. Death rates per 1000 person-years, adjusted for age, sex, and examination year were 13.9, 13.3, 18.3, and 31.8 across BMI groups of 18.5-24.9, 25.0-29.9, 30.0-34.9, and 35.0, respectively (P = .01 for trend), 13.3 and 18.2 for normal and high waist circumference (88 cm in women; 102 cm in men) (P = .004), 13.7 and 14.6 for normal and high percent body fat (30% in women; 25% in men) (P = .51), and 32.6, 16.6, 12.8, 12.3, and 8.1 across incremental fifths of fitness (P < .001 for trend). The association between waist circumference and mortality persisted after further adjustment for smoking, baseline health status, and BMI (P = .02) but not after additional adjustment for fitness (P = .86). Fitness predicted mortality risk after further adjustment for smoking, baseline health, and either BMI, waist circumference, or percent body fat (P < .001 for trend).