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Original Research

Open Access


  • Shinuk Kim1

1College of Kyedang General Education, Sangmyung University, Cheonan, Republic of Korea

DOI: 10.15586/jomh.v16i2.251 Vol.16,Issue 2,May 2020 pp.39-49

Published: 04 May 2020

*Corresponding Author(s): Shinuk Kim E-mail:

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Background and objective

The role of physical activity (PA) and fitness with respect to the relationship between sarcopenic obe-sity and cardiovascular disease (CVD) risk in Korean men is poorly understood. This study investi-gated whether or not PA and cardiorespiratory fitness (CRF) attenuate the synergistic impact of sarcopenic obesity on CVD risk in a sample of Korean men aged 40 years and older.

Material and methods

This study analyzed data (n=3089 men aged 40 years and older) obtained from the KNHANES IV and V. Participants were classified into four groups: the absence of both sarcopenia and obesity called optimal body composition, the presence of sarcopenia only, the presence of obesity only, or the coex-istence of sarcopenia and obesity defined as sarcopenic obesity. The 10-year Framingham risk score model was used to estimate CVD risk, which was classified into low (<10%), intermediate (10–20%), and high (>20%) categories. PA was assessed with the Korean version of the International Physical Activity Questionnaire. CRF was estimated using nonexercise-based health indicators such as gender, age, resting heart rate, and PA score.


Logistic regression analyses showed that the odds ratios (ORs) for ≥10% 10-year CVD risk were sig-nificantly higher in the order of obesity (OR=1.717, p<0.001), sarcopenia (OR=2.290, p<0.001), and sarcopenic obesity (OR=3.568, p<0.001) compared to optimal (OR=1). The ORs of ≥10% 10-year CVD risk remained statistically significant even after adjustment for age, education, and income but were no longer significant after additional adjustment for PA and CRF.


The current findings suggest that high PA and CRF attenuate the synergistic impact of sarcopenia and obesity on CVD risk in Korean men, implying a clinical importance of interventions targeting low PA and poor CRF for men with sarcopenic obesity. 


cardiovascular disease; obesity; physical activity; physical fitness; sarcopenia

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1. Cercato C, Fonseca FA. Cardiovascular risk and obesity. Diabetol Metab Syndr 2019;11:74.

2. Chin SO, Rhee SY, Chon S, et al. Sarcopenia is independently associated with cardiovascular dis-ease in older Korean adults: The Korea National Health and Nutrition Examination Survey (KNHANES) from 2009. PLoS One 2013; 8(3):e60119. 0060119

3. Batsis JA, Villareal DT. Sarcopenic obesity in older adults: Aetiology, epidemiology and treatment strategies. Nat Rev Endocrinol 2018;14(9):513–37.

4. Baumgartner RN, Wayne SJ, Waters DL, et al. Sarcopenic obesity predicts instrumental activities of daily living disability in the elderly. Obes Res 2004;12(12):1995–2004.

5. Stephen WC, Janssen I. Sarcopenic-obesity and cardiovascular disease risk in the elderly. J Nutr Health Aging 2009;13(5):460–6.

6. Atkins JL, Whincup PH, Morris RW, et al. Sarcopenic obesity and risk of cardiovascular dis-ease and mortality: A population-based cohort study of older men. J Am Geriatr Soc 2014;62(2): 253–60.

7. Sanada K, Chen R, Willcox B, et al. Association of sarcopenic obesity predicted by anthropomet-ric measurements and 24-y all-cause mortality in elderly men: The Kuakini Honolulu Heart Program. Nutrition 2018;46:97–102. https://doi. org/10.1016/j.nut.2017.09.003

8. Wilson PW, D’Agostino RB, Levy D, et al. Prediction of coronary heart disease using risk fac-tor categories. Circulation 1998;97(18):1837–47.

9. Koolhaas CM, Dhana K, Schoufour JD, et al. Physical activity and cause-specific mortality: The Rotterdam Study. Int J Epidemiol 2018;47(5): 1705–13.

 10. Kokkinos P, Myers J. Exercise and physical activ-ity: Clinical outcomes and applications. Circulation 2010;122(16):1637–48.

 11. Kokkinos P, Myers J, Faselis C, et al. Exercise capacity and mortality in older men: A 20-year follow-up study. Circulation 2010;122(8):790–7. 110.938852

 12. Minder CM, Shaya GE, Michos ED, et al. Relation between self-reported physical activity level, fitness, and cardiometabolic risk. Am J Cardiol 2014;113(4):637–43. 2013.11.010

 13. Arija V, Villalobos F, Pedret R, et al. Effectiveness of a physical activity program on cardiovascular disease risk in adult primary health-care users: The “Pas-a-Pas” community intervention trial. BMC Public Health 2017;17(1):576. https://doi. org/10.1186/s12889-017-4485-3

 14. Kim J-H, Cho JJ, Park YS. Relationship between sarcopenic obesity and cardiovascular disease risk as estimated by the Framingham risk score. J Korean Med Sci 2015;30(3):264–71. https://doi. org/10.3346/jkms.2015.30.3.264

 15. Kweon S, Kim Y, Jang MJ, et al. Data resource profile: The Korea National Health and Nutrition Examination Survey (KNHANES). Int J Epidemiol 2014;43(1):69–77.

 16. Lee YH, Jung KS, Kim SU, et al. Sarcopaenia is associated with NAFLD independently of obe-sity and insulin resistance: Nationwide surveys (KNHANES 2008–2011). J Hepatol 2015;63(2): 486–93.

 17. Fox CS, Massaro JM, Hoffmann U, et al. Abdominal visceral and subcutaneous adipose tissue compartments: Association with metabolic risk factors in the Framingham Heart Study. Circulation 2007;116(1):39–48. 10.1161/CIRCULATIONAHA.106.675355

 18. Cho GJ, Yoo HJ, Hwang SY, et al. Differential relationship between waist circumference and mortality according to age, sex, and body mass index in Korean with age of 30–90 years; a nation-wide health insurance database study. BMC Med 2018;16(1):131.

 19. Sayer AA, Syddall H, Martin H, et al. The devel-opmental origins of sarcopenia. J Nutr Health Aging 2008;12(7):427–32.

 20. Lee SY, Park HS, Kim DJ, et al. Appropriate waist circumference cutoff points for central obe-sity in Korean adults. Diabetes Res Clin Pract 2007;75(1):72–80. 2006.04.013

 21. Sohn C, Kim J, Bae W. The framingham risk score, diet, and inflammatory markers in Korean men with metabolic syndrome. Nutr Res Pract 2012;6(3): 246–53. 2012.6.3.246

 22. Chun MY. Validity and reliability of Korean ver-sion of international physical activity question-naire short form in the elderly. Korean J Fam Med 2012;33(3):144. 2012.33.3.144

 23. Jurca R, Jackson AS, LaMonte MJ, et al. Assessing cardiorespiratory fitness without performing exercise testing. Am J Prev Med 2005;29(3):185–93.

 24. Farmer RE, Mathur R, Schmidt AF, et al. Associations between measures of sarcopenic obesity and risk of cardiovascular disease and mortality: A cohort study and mendelian ran-domization analysis using the UK Biobank. J Am Heart Assoc 2019;8(13):e011638. 10.1161/JAHA.118.011638

 25. Byeon CH, Kang KY, Kang SH, et al. Sarcopenia is associated with Framingham risk score in the Korean population: Korean National Health and Nutrition Examination Survey (KNHANES) 2010–2011. J Geriatr Cardiol 2015;12(4):366–72.

 26. Fukuda T, Bouchi R, Takeuchi T, et al. Sarcopenic obesity assessed using dual energy X-ray absorpti-ometry (DXA) can predict cardiovascular disease in patients with type 2 diabetes: A retrospective observational study. Cardiovasc Diabetol 2018; 17(1):55.

 27. Han P, Yu H, Ma Y, et al. The increased risk of sarcopenia in patients with cardiovascular risk factors in suburb-dwelling older Chinese using the AWGS definition. Sci Rep 2017;7(1):9592.

 28. Tabibi H, As’habi A, Najafi I, et al. Prevalence of dynapenic obesity and sarcopenic obesity and their associations with cardiovascular disease risk fac-tors in peritoneal dialysis patients. Kidney Res Clin Pract 2018;37(4):404–13.

j. krcp.18.0064

 29. Khazem S, Itani L, Kreidieh D, et al. Reduced lean body mass and cardiometabolic diseases in adult males with overweight and obesity: A piolt study. Int J Environ Res Public Health 2018;5(12):2754.

 30. Tyrovolas S, Panagiotakos D, Georgousopoulou E, Chrysohoou C, Tousoulis D, Haro JM, Pitsavos 

C. Skeletal muscle mass in relation to 10 year car-diovascular disease incidence among middle aged and older adults: The ATTICA study. J Epidemiol Community Health 2020;74:26–31. https://doi. org/10.1136/jech-2019-212268

 31. Hwang B, Lim JY, Lee J, et al. Prevalence rate and associated factors of sarcopenic obesity in korean elderly population. J Korean Med Sci 2012;27(7): 748–55.

 32. Ryu M, Jo J, Lee Y, et al. Association of physical activity with sarcopenia and sarcopenic obesity in community-dwelling older adults: The Fourth Korea National Health and Nutrition Examination Survey. Age Ageing 2013;42(6):734–40.

 33. Munoz-Arribas A, Mata E, Pedrero-Chamizo R, et al. Sarcopenic obesity and physical fitness in octogenarians: The multi-center EXERNET Project. Nutr Hosp 2013;28(6):1877–83.

 34. Pedrero-Chamizo R, Gomez-Cabello A, Melendez A, et al. Higher levels of physical fitness are associ-ated with a reduced risk of suffering sarcopenic obesity and better perceived health among the elderly: The EXERNET multi-center study. J Nutr Health Aging 2015;19(2):211–17. 10.1007/s12603-014-0530-4

 35. Mora S, Lee IM, Buring JE, et al. Association of physical activity and body mass index with novel and traditional cardiovascular biomarkers in women. JAMA 2006;295(12):1412–19.

 36. Farrell SW, Barlow CE, Willis BL, et al. Cardiorespiratory fitness, different measures of adi-posity, and cardiovascular disease mortality risk in women. J Womens Health (Larchmt) 2020;29(3): 319–26. 2019.7793

 37. Williams PT. Physical fitness and activity as sepa-rate heart disease risk factors: A meta-analysis. Med Sci Sports Exerc 2001;33(5):754–61.

 38. Nystoriak MA, Bhatnagar A. Cardiovascular effects and benefits of exercise. Front Cardiovasc Med 2018;5:135. 2018.00135

 39. Al-Mallah MH, Sakr S, Al-Qunaibet A. Cardiorespiratory fitness and cardiovascular disease prevention: An update. Curr Atheroscler Rep 2018;20(1):1.

018- 0711-4

 40. Lavie CJ, Kachur S, Sui X. Impact of fitness and changes in fitness on lipids and survival. Prog Cardiovasc Dis 2019;62(5):431–35.

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