Teenagers fit little, obesity, or a combination of both are more likely to develop chronic disability later in life, study finds published online today in Annals of Internal Medicine.

"[T]His cohort study with more than one million teens revealed that low cardiorespiratory fitness and obesity are strongly associated with the payment of a disability pension. because of a wide range of diseases and causes later in life, "writes Pontus Henriksson, PhD, Department of Biosciences and Nutrition, Karolinska Institute, Stockholm, Sweden, and colleagues.

Noncommunicable diseases such as cardiovascular diseases, musculoskeletal disorders, psychiatric disorders and cancer are the leading causes of disability and premature death and place a growing burden on society. Thus, the identification of early-life and potentially modifiable risk factors is of great importance to public health efforts to control these chronic diseases, write the authors.

Obesity in adolescence has been linked to the subsequent perception of a disability pension. However, there is little evidence to assess the link between physical fitness in adolescence and later chronic disability, or between the combination of cardiorespiratory fitness and obesity with disability, researchers report.

For the present study, Henriksson and his colleagues examined data on cardiorespiratory fitness and weight in 1,079,128 male adolescents aged 16 to 19 enrolled in the conscription register of the Swedish military service. They examined the results with the help of data from other related national registries to determine beneficiaries of a disability pension due to illness.

According to the authors, on a median follow-up of 28.3 years, 54,304 men benefited from an invalidity pension.

Low cardiorespiratory fitness was strongly associated with late disability. For example, adolescents in the lowest fitness decile had a confidence interval of 3.74 (95% confidence interval). [CI], 3.55 – 3.95) is more likely to receive a disability pension for all cases than for the top decile.

Obesity was also associated with a risk of later disability, with the greatest risks being observed for severe obesity (body mass index). [BMI] ≥40 kg / m2). Adolescents with severe obesity had a higher risk of receiving a disability pension for all causes 3.21 times (95% CI, 2.49 – 4.15) compared to those with normal weight.

In contrast, better cardiorespiratory fitness has reduced the risk of later disability in all categories of BMI. For example, the risk of receiving a disability pension for all causes was similar among very fit adolescents with obesity (risk ratio [HR], 2.27 [CI, 1.94 – 2.66]) and adolescents who are unfit for normal weight (HR, 2.64 [CI, 2.53 – 2.76]). However, the risk was much higher in obese adolescents who were not fit (HR, 4.67 [CI, 4.21 – 5.17]).

Henriksson and his colleagues recognize that physical fitness is influenced not only by physical activity, but also by other environmental factors and genetics, but they also highlight the implications of this study for public health.

The authors note several limitations, including the lack of data on smoking and alcohol consumption. Moreover, as the study population was exclusively male, the possibility of generalizing it to women could be limited.

"While other well-designed studies are needed to provide additional evidence, these findings underscore the importance of good cardiorespiratory fitness and healthy body weight in adolescence." ", they conclude.

This study was funded by a grant from the Karolinska Institute. The authors did not reveal any relevant financial relationship.

Ann Intern Med. Posted online February 11, 2019. Full Text

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