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‘Fat but powerful’ paradox: association of muscle power and adiposity markers with all-cause mortality in older adults from the EXERNET multicentre study
  1. Julian Alcazar1,2,
  2. David Navarrete-Villanueva3,4,
  3. Asier Mañas1,2,
  4. Alba Gómez-Cabello3,5,6,
  5. Raquel Pedrero-Chamizo7,
  6. Luis M Alegre1,2,
  7. Gerardo Villa8,
  8. Narcís Gusi2,9,10,
  9. Marcela González-Gross6,7,
  10. Jose Antonio Casajús3,4,6,
  11. German Vicente-Rodriguez3,6,11,
  12. Ignacio Ara1,2
  1. 1GENUD Toledo Research Group, Universidad de Castilla-La Mancha, Toledo, Spain
  2. 2CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
  3. 3GENUD Research Group, University of Zaragoza, Zaragoza, Spain
  4. 4Faculty of Health Sciences, Department of Physiatry and Nursing, University of Zaragoza, Zaragoza, Spain
  5. 5Centro Universitario de la Defensa, Zaragoza, Spain
  6. 6Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
  7. 7ImFine Research Group, Department of Health and Human Performance, Universidad Politécnica de Madrid, Madrid, Spain
  8. 8Institute of Biomedicine (IBIOMED), University of León, León, Spain
  9. 9International Institute for Aging, Cáceres, Spain
  10. 10Physical Activity and Quality of Life Research Group (AFYCAV), Faculty of Sport Sciences, University of Extremadura, Cáceres, Spain
  11. 11Faculty of Health and Sport Sciences, Department of Physiatry and Nursing, University of Zaragoza, Huesca, Spain
  1. Correspondence to Dr Ignacio Ara, Universidad de Castilla-La Mancha - Campus de Toledo, Toledo 13001, Castilla-La Mancha, Spain; ignacio.ara{at}


Objectives To assess the influence of muscle power and adiposity on all-cause mortality risk and to evaluate the ‘fat but powerful’ (F+P) (or ‘fat but fit’) paradox in older adults.

Methods A total of 2563 older adults (65‒91 years old) from the EXERNET multicentre study were included. Adiposity (body mass index (BMI), waist circumference, body fat percentage (BF%) and fat index), allometric and relative power (sit-to-stand muscle power test) and various covariates (age, sex, hypertension, smoking status and walking and sitting times per day) were registered at baseline. All-cause mortality was recorded during a median follow-up of 8.9 years. Participants were classified into four groups: lean and powerful (L+P), F+P, lean but weak and fat and weak (F+W). Cox proportional hazard regression models and adjusted HRs were calculated.

Results According to BMI and waist circumference, all-cause mortality risk was reduced in the F+P (HR=0.55 and 0.63, p=0.044 and 0.049, respectively) and L+P (HR=0.57 and 0.58, p=0.043 and 0.025, respectively) groups. According to BF%, all-cause mortality decreased in the L+P group (HR=0.53; p=0.021), and a trend for a reduction was reported in the F+P group (HR=0.57; p=0.060). According to fat index, a survival benefit was only noted in the L+P group (HR=0.50; p=0.049). Higher levels of relative power reduced all-cause mortality risk among older people (HR=0.63 and 0.53, p=0.006 and 0.011, respectively).

Conclusion Powerful older people exhibited a reduced 9-year all-cause mortality regardless of BMI, waist circumference and BF%. Obesity according to fat index blunted the survival benefits of being powerful.

  • aging/ageing
  • power
  • death
  • body composition
  • fat

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  • Twitter @JulianAlcazr, @luismalegre

  • Contributors All authors were involved in data collection, analysis, writing and revision of the manuscript, and approved the final version submitted.

  • Funding This work was supported by the Universidad de Zaragoza (UZ 2008-BIO-01); Gobierno de Aragón (Grant DGAIIU/1/20 to D.N.); Ministerio de Sanidad, Servicios Sociales e Igualdad (147/2011); Ministerio de Trabajo y Asuntos Sociales Sociales-IMSERSO (104/07); Centro Universitario de la Defensa de Zaragoza (UZCUD2016-BIO-01); Ministerio de Economía, Industria y Competitividad (DEP2016-78309-R); and the Biomedical Research Networking Center on Frailty and Healthy Aging (CIBERFES) and FEDER funds from the European Union (Grant CB16/10/00477). All the authors are members of EXERNET ( which supported this research by funding of the Ministerio de Educación y Ciencia (Red EXERNET DEP2005-00046) and Consejo Superior de Deportes (09/UPB/19 and 45/UPB/20).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Clinical Research Ethics Committee of Aragón (18/2008) and the Ethical Committee of the University Hospital Fundación Alcorcón (50/2016).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement The data that support the findings of this study are available from the corresponding author on reasonable request.

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