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Aim: Our aim was to assess the associations between cardiorespiratory fitness (CRF) and body mass index (BMI) in youth and five-year mortality following the diagnosis of 18 site-specific cancers in men. Methods: We collected data on all men who underwent military conscription at ages 16-25 from 1968 through 2005 in Sweden. CRF was assessed as maximal aerobic workload on a cycle ergometer test and was classified as low, moderate, or high. BMI (kg/m2) was classified as underweight (30). Data was cross-linked on individual level through the Swedish unique identification number with follow-up data from national registers with high validity containing information on cancer diagnosis and mortality. Follow-up started at diagnosis and continued until death, emigration, five years after diagnosis, or end of follow-up (2019-12-31), whichever happened earliest. Time-to-event multivariable Cox regression analyses included CRF and BMI as well as age, year, and site of conscription and age at diagnosis. For CRF, primary analyses tested linear trends with categorical comparisons for interpretation while categorical comparisons were primary analyses for BMI. Results: 84,621 cancer cases were included in the main analyses. The mean age at diagnosis of any cancer was 53 years and follow-up data were available during a mean of 6.5 years. Lower CRF and higher BMI were independently associated with higher mortality for several cancer sites (table 1). Conclusion: We report clinically relevant, dose-dependent associations between CRF and BMI in youth and 5-year mortality after diagnosis of 18 site-specific cancers in men. The associations with mortality may be due to both direct cancer inhibition and an improved tolerance to withstand cancer treatment. These results further strengthen the incentive for promoting a healthy lifestyle during the whole lifespan of the population. Table 1. Five-year mortality by cardiorespiratory fitness (CRF) and body mass index (BMI). Cardiorespiratory fitness (ref = low) BMI (ref = normal weight), *= p Citation Format: Aron Onerup, Kirsten Mehlig, Agnes af Geijerstam, Elin Ekblom-Bak, Hans-Georg Kuhn, Lauren Lissner, Mats Börjesson, Maria Åberg. Cardiorespiratory fitness and BMI in youth and five-year mortality after site-specific cancer in men: a population-based cohort study with register linkage. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5770.

Overweight and obesity have been identified as risk factors for severe COVID-19; however, prospective cohort studies investigating the association between overweight early in life and severity of COVID-19 are lacking.This study included 1,551,670 Swedish men, born between 1950 and 1987, with BMI registered at age 18 years. They were followed until January 9, 2021. COVID-19 cases and comorbidities were identified through the National Patient, Intensive Care, and Cause of Death registries. Outcomes included the following: 1) hospitalization; 2) intensive care unit admission; and 3) death.The study found 4,315 cases (mean age = 56.4 years [SD 8.8]) of patients hospitalized because of COVID-19, of which 729 were admitted to an intensive care unit, and altogether there were 224 deaths. The risk for hospital admission increased with higher values of BMI at age 18 years, despite adjustment for comorbidities, from an odds ratio (OR) of 1.19 (95% CI: 1.08-1.31) at BMI = 22.5 to 25 to an OR of 1.68 (95% CI: 1.39-2.02) at BMI ≥ 30, compared with BMI = 18.5 to 20. ORs for intensive care unit admission were 1.44 (95% CI: 1.13-1.84) at BMI = 22.5 to 25 and 2.61 (95% CI: 1.73-3.93) at BMI ≥ 30.Higher BMI in early adulthood was associated with severe COVID-19 many years later, with a risk increase starting already at BMI ≥ 22.5. This underlines the necessity of preventive actions against overweight in youth to offer protection against coming viral pandemics.

ObjectiveTo investigate the possible connection between cardiorespiratory fitness (CRF) and muscle strength in early adulthood and severity of COVID-19 later in life.DesignProspective registry-based cohort study.Participants1 559 187 Swedish men, undergoing military conscription between 1968 and 2005 at a mean age of 18.3 (SD 0.73) years.Main outcome measuresHospitalisation, intensive care or death due to COVID-19 from March to September 2020, in relation to CRF and muscle strength.ResultsHigh CRF in late adolescence and early adulthood had a protective association with severe COVID-19 later in life with OR (95% CI) 0.76 (0.67 to 0.85) for hospitalisation (n=2 006), 0.61 (0.48 to 0.78) for intensive care (n=445) and 0.56 (0.37 to 0.85) for mortality (n=149), compared with the lowest category of CRF. The association remains unchanged when controlled for body mass index (BMI), blood pressure, chronic diseases and parental education level at baseline, and incident cardiovascular disease before 2020. Moreover, lower muscle strength in late adolescence showed a linear association with a higher risk of all three outcomes when controlled for BMI and height.ConclusionsPhysical fitness at a young age is associated with severity of COVID-19 many years later. This underscores the necessity to increase the general physical fitness of the population to offer protection against future viral pandemics.