Our purpose was to determine the association between abdominal fat and cardiorespiratory fitness (CRF) on markers of metabolic syndrome (MetS) total cholesterol (TC), high-density lipoprotein (HDL-C), low-density lipoprotein (LDL-C), triglycerides (TG), glucose, and blood pressure. We conducted a retrospective study on 165 adults (108 men) in which correlations between waist girth (WG), CRF and blood variables were determined. The cohort was partitioned by gender into quartiles and again by WG and differences in markers of MetS were compared across quartiles by ANOVA and by ANCOVA to determine the influence of CRF. Males in the lowest WG quartile exhibited greater HDL-C and lower diastolic blood pressure vs. the highest quartile (p < 0.05). TG were lower in the lowest vs. the third and highest quartile (p < 0.05), and glucose was greater in the highest vs. the first and second quartiles (p < 0.05). Females in the second WG quartile exhibited higher HDL-C vs. the highest quartile, and TG, glucose, systolic and diastolic blood pressure were lower in the lowest vs. the highest quartile (p < 0.05). After adjusting for CRF, diastolic blood pressure across WG in males were no longer significant, and    HLD-C and TG quartile differences were no longer significant in females. We confirm WG as an important correlate of clinical markers of MetS in adults. CRF mitigates relationships between WG and clinical markers of cardio-metabolic risk in men and women.


Metabolic Syndrome, Cardiovascular Fitness, Body Fat, Waist Circumference,


  1. S.M. Grundy, N.J. Stone, A.L. Bailey, C. Beam, K.K. Birtcher, R.S. Blumenthal, L.T. Braun, S. de Ferranti, J. Faiella-Tommasino, D.E. Forman, R. Goldberg, P.A. Heidenreich, M.A. Hlatky, D.W. Jones, D. Lloyd-Jones, N. Lopez-Pajares, C.E. Ndumele, C.E. Orringer, C.A. Peralta, J.J. Saseen, S.C. Smith Jr, L. Sperling, S.S. Virani, J. Yeboah, AHA /ACC /AACVPR /AAPA /ABC /ACPM /ADA /AGS /APhA /ASPC /NLA /PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, Circulation, 139 (2019) e1046–e1081.
  2. G. Hirode, R.J. Wong, Trends in the Prevalence of Metabolic Syndrome in the United States, 2011-2016, JAMA, 323(24) (2020) 2526-2528.
  3. United States Census Bureau. DP05: Table US Population 2021 [Available from: https://data.census.gov/cedsci/table?q=United%20States&g=0100000US&tid=ACSDP1Y2019.DP05&hidePreview=true
  4. C.S. Fox, J.M. Massaro, U. Hoffmann, K.M. Pou, P. Maurovich-Horvat, C.Y. Liu, et al., Abdominal visceral and subcutaneous adipose tissue compartments: association with metabolic risk factors in the Framingham Heart Study, Circulation, 116(1) (2007) 39-48.
  5. World Health Organization. Waist circumference and waist-hip ratio: report of a WHO expert consultation Geneva: World Health Organization; 2008 Available from: http://apps.who.int/iris/bitstream/handle/10665/44583/9789241501491_eng.pdf;jsessionid=7A7C8D42296F177220B0755E5E306046?sequence=1
  6. American College of Sports Medicine, (2021) ACSM's guidelines for exercise testing and prescription, Wolters Kluwer, USA.
  7. A.J. Hanley, A.J. Karter, K. Williams, A. Festa, R.B. D'Agostino, Jr., L.E. Wagenknecht, et al., Prediction of type 2 diabetes mellitus with alternative definitions of the metabolic syndrome: the Insulin Resistance Atherosclerosis Study, Circulation, 112(24) (2005) 3713-3721.
  8. R. Jurca, M.J. Lamonte, T.S. Church, C.P. Earnest, S.J. Fitzgerald, C.E. Barlow, et al., Associations of muscle strength and fitness with metabolic syndrome in men, Medicine & Science in Sports & Exercise, 36(8) (2004) 1301-1307.
  9. C. Lorenzo, M. Okoloise, K. Williams, M.P. Stern, S.M. Haffner, The metabolic syndrome as predictor of type 2 diabetes: the San Antonio Heart Study, Diabetes Care, 26(11) (2003) 3153-3159.
  10. P. Kokkinos, C. Faselis, L. Sidossis, J. Zhang, I. Babu, H. Samuele, A. Ahmed, P. Karasik, A. Pittaras, M. Doumas, C. Grassos, S. Rosenberg, J. Myershi, Exercise blood pressure, cardiorespiratory fitness and mortality risk, Progress in Cardiovascular Diseases, 67 (2021) 11-17.
  11. Y. Ezzatvar, R. Ramírez-Vélez, M.L. Sáez de Asteasu, N. Martínez-Velilla, F. Zambom-Ferraresi, F. Lobelo, et al., Cardiorespiratory fitness and all-cause mortality in adults diagnosed with cancer: systematic review and meta-analysis, Scandinavian Journal of Medicine & Science in Sports, 31(9) (2021) 1745-1752.
  12. D.C. Lee, X. Sui, F.B. Ortega, Y-S. Kim, T.S. Church, R.A. Winett, U. Ekelund, P.T. Katzmarzyk, S.N Blair, Comparisons of leisure-time physical activity and cardiorespiratory fitness as predictors of all-cause mortality in men and women, British Journal of Sports Medicine, 45(6) (2011) 504-510.
  13. P.T. Katzmarzyk, T.S. Church, S.N. Blair, Cardiorespiratory fitness attenuates the effects of the metabolic syndrome on all-cause and cardiovascular disease mortality in men, Archives of internal medicine, 164(10) (2004) 1092-1097.
  14. M.A. Wewege, J.M. Thom, K.A. Rye, B.J. Parmenter, Aerobic, resistance or combined training: A systematic review and meta-analysis of exercise to reduce cardiovascular risk in adults with metabolic syndrome, Atherosclerosis, 274 (2018) 162-171.
  15. L.A. Kaminsky, R. Arena, T.M. Beckie, P.H. Brubaker, T.S. Church, D.E. Forman, et al., The importance of cardiorespiratory fitness in the United States: the need for a national registry: a policy statement from the American Heart Association, Circulation, 127(5) (2013) 652-662.
  16. M.J. LaMonte, C.E. Barlow, R. Jurca, J.B. Kampert, T.S. Church, S.N. Blair, Cardiorespiratory fitness is inversely associated with the incidence of metabolic syndrome: a prospective study of men and women, Circulation, 112(4) (2005) 505-512.
  17. P.T. Katzmarzyk, A.S. Leon, J.H. Wilmore, J.S. Skinner, D.C. Rao, T. Rankinen, C. Bouchard, Targeting the metabolic syndrome with exercise: evidence from the HERITAGE Family Study, Medicine & Science in Sports & Exercise, 35(10) (2003) 1703-1709.
  18. N. Pattyn, V.A. Cornelissen, S.R.T. Eshghi, L. Vanhees, The Effect of Exercise on the Cardiovascular Risk Factors Constituting the Metabolic Syndrome: A Meta-analysis of Controlled Trials, Sports Medicine, 43(2) (2013) 121-133.
  19. M.H. Whaley, J.B. Kampert, H.W. Kohl, 3rd, S.N. Blair, Physical fitness and clustering of risk factors associated with the metabolic syndrome, Medicine & Science in Sports & Exercise, 31(2) (1999) 287-293.
  20. S.M. Grundy, C.E. Barlow, S.W. Farrell, G.L. Vega, W.L. Haskell, Cardiorespiratory fitness and metabolic risk, American Journal of Cardiology, 109(7) (2012) 988-993.
  21. C.H. Saely, P. Rein, H. Drexel, The metabolic syndrome and risk of cardiovascular disease and diabetes: experiences with the new diagnostic criteria from the International Diabetes Federation, Hormone and Metabolic Research, 39(9) (2007) 642-650.
  22. K. Shuval, C.E. Finley, C.E. Barlow, K.P. Gabriel, D. Leonard, H.W. Kohl, 3rd, Sedentary behavior, cardiorespiratory fitness, physical activity, and cardiometabolic risk in men: the Cooper Center Longitudinal Study, Mayo Clinic Proceedings, 89(8) (2014) 1052-1062.
  23. S. Wannamethee, A. Shaper, L. Lennon, R.W. Morris, Metabolic syndrome vs Framingham Risk Score for prediction of coronary heart disease, stroke, and type 2 diabetes mellitus, Archives of Internal Medicine, 165(22) (2005) 2644-2650.
  24. G.O. Matheson, M. Klügl, J.Dvorak, L. Engebretsen, W.H. Meeuwisse, M. Schwellnus, S.N. Blair, W. van Mechelen, W. Derman, M. Börjesson, F. Bendiksen, R. Weiler, Responsibility of sport and exercise medicine in preventing and managing chronic disease: applying our knowledge and skill is overdue, British Journal of Sports Medicine, 45(16) (2011) 1272-1282.
  25. R.B. Batacan, Jr., M.J. Duncan, V.J. Dalbo, P.S. Tucker, A.S. Fenning, Effects of high-intensity interval training on cardiometabolic health: a systematic review and meta-analysis of intervention studies, British Journal of Sports Medicine, 51(6) (2017) 494-503.
  26. C.P. Earnest, N.M. Johannsen, D.L. Swift, C.J. Lavie, S.N. Blair, T.S. Church, Dose effect of cardiorespiratory exercise on metabolic syndrome in postmenopausal women, American Journal of Cardiology, 111(12) (2013) 1805-1811.
  27. K.S. Weston, U. Wisloff, J.S. Coombes, High-intensity interval training in patients with lifestyle-induced cardiometabolic disease: a systematic review and meta-analysis, British Journal of Sports Medicine, 48(16) (2014) 1227-1234.