Prevalence of Metabolic Syndrome Risk Factors in High School and NCAA Division I Football Players
Steffes, Gary D.; Megura, Alex E.; Adams, James; Claytor, Randal P.; Ward, Rose M.; Horn, Thelma S.; Potteiger, Jeffrey A. Journal of Strength and Conditioning Research. 2013. 27(7): 1749-1757.
Take Home Message: Elevated body mass index and percent body fat predict for the presence of several cardiovascular risk factors for metabolic syndrome in college and high school football players. Increased activity levels in these athletes does not necessarily protect against these risk factors.
It is important for allied health professionals to recognize people who are at greater risk for developing cardiovascular disease and intervene before complications occur. Although athletes attain high levels of physical activity, they are not immune to cardiovascular disease. It is important for us to determine which athletes may have metabolic syndrome (MetSyn), a set of key risk factors for cardiovascular disease, so that we can direct prevention programs to reduce the athlete’s risk of cardiovascular disease. This study aimed to determine the prevalence of MetSyn in high school and college level football players and, secondarily, to determine if percent body fat percent (%FAT) and/or body mass index (BMI) predicted MetSyn. The authors examined 123 male football players from 7 different high schools and 82 male football players from one university. They assessed %FAT, waist circumference, resting systolic and diastolic blood pressure, fasting serum lab work (including high-density lipoproteins level, triglycerides, and blood glucose). The authors defined MetSyn based on the American Heart Association/National Heart, Lung, and Blood Institute criteria: waist circumference > 102 cm, triglycerides > 150mg/dL, high-density lipoproteins < 40mg/dL, blood pressure > 130/85, and fasting glucose > 100mg/dL. They also classified participants based on their playing level (high school vs. college) and by position: "Big" = offensive and defensive lineman; "Athletic" = quarterbacks, tight ends, running backs, and linebackers; and "Skilled" = wide receivers and defensive backs. The authors reported that a high school player was more likely to be obese based on %FAT than a college player. Also, very few of the “Skilled” or “Athletic” players were obese. The authors found that 6.8% of participants had MetSyn. Participants in the “Big” category accounted for 92.3% of those with MetSyn. Finally, the authors reported that both BMI and %FAT strongly correlated with mean arterial blood pressure and BMI correlated with level of triglycerides, high-density lipoprotein, and waist circumference.
Despite high levels of physical activity, high school and college football offensive/defensive lineman are more likely to have MetSyn, which may predispose them to subsequent cardiovascular disease. We’ve known that this may be true among professional football players because a 1994 study reported that former NFL lineman had a 52% greater risk of death from heart disease compared with the rest of the population. The current study may suggest that the elevated risk for cardiovascular disease is not just among the more experienced lineman but even high school lineman. Overall, the authors found that an athlete with an elevated BMI was more likely to have components of MetSyn than a player with lower BMI. During the preparticipation physical exam we may be able to identify these risk factors in an inexpensive, noninvasive way and refer our athletes for further evaluation and treatment. All members of the sports medicine team should be mindful of these findings when evaluating athletes. This study further highlights that we need to be concerned about the long-term health of our athletes because the presence of MetSyn, joint trauma, or multiple concussions may increase the risk of chronic diseases/impairments that diminish the athlete’s quality of life (e.g., cardiovascular disease, osteoarthritis, neurocognitive impairment).
Questions for Discussion: Do you routinely calculate BMI and/or obtain estimates of %FAT in your athletes? Do you aggressively manage cardiovascular risk factors as part of comprehensive treatment of your athletes?
Written by: Michelle Noreski, DO and Marc I. Harwood, MD
Reviewed by: Jeffrey Driban
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