A multidimensional functional fitness score has a stronger association with type 2 diabetes than obesity parameters in cross sectional data

Objectives

We examine here the association of multidimensional functional fitness with type 2 diabetes mellitus (T2DM) as compared to anthropometric indices of obesity such as body mass index (BMI) and waist to hip ratio (WHR) in a sample of Indian population.

Research design and method

We analysed retrospective data of 663 volunteer participants (285 males and 378 females between age 28 and 84), from an exercise clinic in which every participant was required to undergo a health related physical fitness (HRPF) assessment consisting of 15 different tasks examining 8 different aspects of functional fitness.

Results

The odds of being diabetic in the highest quartile of BMI were not significantly higher than that in the lowest quartile in either of the sexes. The odds of being a diabetic in the highest WHR quartile were significantly greater than the lowest quartile in females (OR = 4.54 (1.95, 10.61) as well as in males (OR = 3.81 (1.75, 8.3). In both sexes the odds of being a diabetic were significantly greater in the lowest quartile of HRPF score than the highest (males OR = 10.52 (4.21, 26.13); females OR = 10.50 (3.53, 31.35)). After removing confounding, the predictive power of HRPF was significantly greater than that of WHR. HRPF was negatively correlated with WHR, however for individuals that had contradicting HRPF and WHR based predictions, HRPF was the stronger predictor of T2DM.

Conclusion

The association of multidimensional functional fitness score with type 2 diabetes was significantly stronger than obesity parameters in a cross sectional self-selected sample from an Indian city.

Blind fish: An eye opener

Lay Summary: Different species of vertebrates have conditions similar to human obesity, insulin resistance and type 2 diabetes. Increasing number of studies are now revealing that the causes and interrelationships between these states are substantially different in different species. Comparative physiology may turn out to be an eye opener for evolutionary theories of diabetes.

Obesity induced insulin resistance is believed to be central to type 2 diabetes. Recent work on Mexican cavefish, Astyanax mexicanus, has revealed a hyperglycemic phenotype similar to human type 2 diabetes but here insulin resistance is the cause of obesity rather than an effect. Instead of developing diabetic complications, the hyperglycemic fish lead a healthy and long life. In addition to fish, insulin resistance in hibernating bears, dolphins, horses, bonnet macaques and chimpanzees demonstrate that the relationship between diet, obesity, insulin sensitivity and diabetes is widely different in different species. Evolutionary hypotheses about type 2 diabetes should explain these differences.