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

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

Related Post:

Evaluating Four Body Fat Assessments Among Adolescents

Steffes GD, Megura AE, Adams J, Claytor RP, Ward RM, Horn TS, & Potteiger JA (2013). Prevalence of Metabolic Syndrome Risk Factors in High School and NCAA Division I Football Players. Journal of Strength and Conditioning Research, 27 (7), 1749-57 PMID: 22996023