Objective The purpose of this review was to assess the joint relationship of cardiorespiratory fitness (CRF) and Body Mass Index (BMI) on both cardiovascular disease (CVD) and all-cause mortality risk. Design A systematic review and meta-analysis was conducted. Pooled HR and 95% CI were calculated using a three-level restricted maximum likelihood estimation random-effects model with robust variance estimation. The reference group was normal weight-fit and was compared with normal weight-unfit, overweight-unfit and fit, and obese-unfit and fit. Data sources Electronic databases (PubMed/MEDLINE, Web of Science and SportDiscus) were searched following registration on PROSPERO. Eligibility criteria Articles meeting the following criteria were included: (1) published between January 1980 and February 2023, (2) prospective cohort study, (3) CRF assessed using a maximal or VO2peak exercise test, (4) BMI reported and directly measured, (5) joint impact of CRF and BMI on all-cause mortality or CVD mortality were analysed, and (6) the reference group was normal weight, fit individuals. Results 20 articles were included in the analysis resulting in a total of 398 716 observations. Compared with the reference group, overweight-fit (CVD HR (95% CI): 1.50 (0.82–2.76), all-cause HR: 0.96 (0.61–1.50)) and obese-fit (CVD: 1.62 (0.87–3.01), all-cause: 1.11 (0.88–1.40)) did not have a statistically different risk of mortality. Normal weight-unfit (CVD: 2.04 (1.32–3.14), all-cause: 1.92 (1.43–2.57)), overweight-unfit (CVD: 2.58 (1.48–4.52), all-cause: 1.82 (1.47–2.24)) and obese-unfit (CVD: 3.35 (1.17–9.61), all-cause: 2.04 (1.54–2.71)) demonstrated 2–3-fold greater mortality risks. Conclusions CRF is a strong predictor of CVD and all-cause mortality and attenuates risks associated with overweight and obesity. These data have implications for public health and risk mitigation strategies. Data are available upon reasonable request.

中文翻译：

---

心肺健康、体重指数和死亡率：系统评价和荟萃分析


目的 本综述的目的是评估心肺健康 （CRF） 和体重指数 （BMI） 对心血管疾病 （CVD） 和全因死亡风险的联合关系。设计 进行了系统评价和荟萃分析。合并 HR 和 95% CI 使用具有稳健方差估计的三级限制最大似然估计随机效应模型计算。参考组为正常体重-适合，并与正常体重-不-适合、超重-不-适合和适合、肥胖-不-适合和适合进行比较。数据来源 在 PROSPERO 上注册后检索电子数据库 （PubMed/MEDLINE、Web of Science 和 SportDiscus）。纳入资格标准 符合以下标准的文章： （1） 在 1980 年 1 月至 2023 年 2 月之间发表，（2） 前瞻性队列研究，（3） 使用最大或 VO2peak 运动测试评估 CRF，（4） BMI 报告和直接测量，（5） 分析 CRF 和 BMI 对全因死亡率或 CVD 死亡率的联合影响，以及 （6） 参考组体重正常， 适合个人。结果 共纳入 20 篇文献，共获得 398 716 篇观测结果。与参考组相比，超重健康 （CVD HR （95% CI）：1.50 （0.82-2.76），全因 HR：0.96 （0.61-1.50））和肥胖健康 （CVD：1.62 （0.87-3.01），全因：1.11 （0.88-1.40））没有统计学差异。正常体重不适（CVD：2.04 （1.32–3.14），全因：1.92 （1.43–2.57））、超重不适（CVD：2.58 （1.48–4.52），全因：1.82 （1.47–2.24））和肥胖不适（CVD：3.35 （1.17–9.61），全因：2.04 （1.54–2.71））显示死亡风险高出 2-3 倍。 结论 CRF 是 CVD 和全因死亡率的强预测指标，并降低了与超重和肥胖相关的风险。这些数据对公共卫生和风险缓解策略具有影响。数据可根据合理要求提供。