In 2006, a newspaper report indicated an increased prevalence of cardiovascular disease and early mortality in retired professional football players compared to professional baseball players. This study included 69 professional football players from a 2008 National Football League training camp and 155 professional baseball players from an American League 2009 spring training site who volunteered to participate in a study of cardiovascular and metabolic risk factors. The prevalence of body mass index ≥30 kg/m 2 , waist circumference ≥100 cm, waist/height ratio >0.5, blood pressure ≥130/85 mm Hg, triglycerides ≥150 mg/dl, triglycerides/high-density lipoprotein cholesterol ratio >3.5, high-density lipoprotein cholesterol ≤40 mg/dl, and alanine aminotransferase ≥40 IU/L was determined in baseball players and compared to measurements obtained in a matched cohort from the National Health and Nutrition Examination Survey (NHANES), professional football players, and linemen and nonlinemen subsets. In conclusion, professional baseball players had favorable cardiovascular parameters, with the exception of an increased prevalence of hypertension, compared to the reference population, and professional baseball players had decreased measures of obesity, hyperglycemia, and the cardiometabolic syndrome compared to professional football lineman.
A print media report in 2006 indicated an increased prevalence of cardiovascular (CV) disease and early mortality in professional football players compared to professional baseball players. Several medical studies have since investigated CV and metabolic risk factors in National Football League (NFL) players compared to the general population. These analyses, although limited by methodologic issues, demonstrated a relatively high prevalence of CV risk factors and the cardiometabolic syndrome in heavier current professional players, despite their young ages and high levels of exercise. They report that heavier professional football players have early-onset risk factors for CV and metabolic diseases that may ultimately contribute to early demise.
In contrast, there has been no formal investigation regarding the CV status of professional baseball players reported in published medical research. Baseball players presumably should not be subject to increased risk, as most players do not appear to be overweight. In fact, the size difference, combined with their rigorous exercise programs and presumed focus on proper nutrition and well-being, should be protective for baseball players, thereby minimizing their risk for CV disease, obesity, and fatty liver disease. Baseball players should be as healthy as, if not healthier than, the general population.
The lack of information regarding the well-being of the professional baseball players merits further investigation. Therefore, we obtained cardiometabolic parameters, measures of obesity and insulin resistance, and alanine aminotransferase (ALT) levels in current professional baseball players. Elevated ALT has also been shown to be a biomarker for fatty liver disease and to be associated with increased CV risk. We compared these parameters in baseball players to those from an age- and gender-matched control group from the National Health and Nutrition Examination Survey (NHANES) III, a validated reference group for the general population, to ascertain their health status. We postulated that professional baseball players would have decreased risk for CV and metabolic diseases compared to the general population. Furthermore, we hypothesized that current professional baseball players would have fewer risk factors for CV and metabolic diseases than current professional football players.
Methods
We prospectively collected data from 155 minor league players, aged 18 to 36 years (mean age 23 years), from 1 professional baseball organization. All subjects consented to participate, and all results were blinded. Venous blood was collected and placed in standard collection tubes and transferred the same day to LabCorp (Phoenix, Arizona). Each player’s weight, height, waist measurement midway between the lower rib margin and the superior iliac crest, and cardiometabolic parameters were obtained. Body mass index was calculated as weight in kilograms divided by the square of height in meters, and waist/height ratio was calculated by dividing waist size by height. Waist circumference and waist/height ratio are reported because they are better measures of visceral obesity than body mass index in muscular athletes. Cardiometabolic syndrome was defined by the presence of ≥3 of the following markers: (1) blood pressure ≥130/85 mm Hg, (2) fasting glucose ≥100 mg/dl, (3) triglycerides ≥150 mg/dl, (4) waist circumference ≥100 cm, and (5) high-density lipoprotein (HDL) cholesterol ≤40 mg/dl. Furthermore, because a triglycerides/HDL cholesterol ratio >3.5 has previously been found to be an accurate measure of insulin resistance, this ratio was also determined for all players.
In this study, we defined elevated ALT as ≥40 IU/L. Recent studies have suggested that ALT ≥30 IU/L may be a better cut-off value to assess ALT elevations. However, we used the cut-off value of ≥40 IU/L to define elevation because this was the value used in the NHANES III survey. We compared the data obtained from the professional baseball players to those of men aged 20 to 29 years from the NHANES III database.
We have previously published similar data from a single 2008 NFL team using a similar method. Therefore, we compared our baseball player population to the same football player population. We extended the comparison to the subsets of linemen and nonlinemen to players on the baseball team. Linemen were defined as defensive tackles and ends and offensive guards, tackles, and centers. Nonlinemen were all other players.
SAS version 9.1 (SAS Institute Inc., Cary, North Carolina), was used for statistical analysis. Chi-square or Fisher’s exact tests were used, with p values <0.05 considered statistically significant. Institutional review board approval was obtained through Saint Luke’s Hospital of Kansas City (Institutional Review Board number 09-313, number 07-134, JHH, principal investigator).
Results
Comparisons of cardiometabolic markers, waist/height ratio >0.5, triglycerides/HDL cholesterol ratio >3.5, and ALT ≥40 IU/L are listed for the baseball players versus the NHANES III population, the baseball players versus the football players, the baseball players compared to the lineman, and the baseball players compared to the nonlinemen in Tables 1 to 4 , respectively.
| Variable | Baseball Players | NHANES | p Value |
|---|---|---|---|
| BMI ≥30 kg/m 2 | 7 (5%) | 67 (21%) | <0.001 |
| Waist circumference ≥100 cm | 11 (7%) | 85 (26%) | <0.001 |
| Waist/height ratio >0.5 | 37 (23%) | 176 (55%) | <0.001 |
| Fasting glucose ≥100 mg/dl | 13 (8%) | 21 (7%) | 0.574 |
| BP ≥130/85 mm Hg | 82 (53%) | 53 (17%) | <0.001 |
| Triglycerides/HDL-C ratio >3.5 | 16 (10%) | 32 (22%) | 0.005 |
| HDL-C ≤40 mg/dl | 26 (17%) | 102 (34%) | <0.001 |
| Triglycerides ≥150 mg/dl | 15 (10%) | 34 (24%) | 0.001 |
| ALT ≥40 IU/L | 13 (8%) | 61 (20%) | 0.001 |
| Cardiometabolic syndrome | 9 (6%) | 27 (10%) | 0.161 |
| Variable | Baseball Players | Football Players | p Value |
|---|---|---|---|
| BMI ≥30 kg/m 2 | 7 (5%) | 35 (51%) | <0.001 |
| Waist circumference ≥100 cm | 11 (7%) | 26 (38%) | <0.001 |
| Waist/height ratio >0.5 | 37 (24%) | 36 (52%) | <0.001 |
| Fasting glucose ≥100 mg/dl | 13 (8%) | 13 (19%) | 0.024 |
| BP ≥130/85 mm Hg | 82 (53%) | 19 (28%) | <0.001 |
| Triglycerides/HDL-C ratio >3.5 | 16 (10%) | 7 (12%) | 0.745 |
| HDL-C ≤40 mg/dl | 26 (17%) | 6 (10%) | 0.226 |
| Triglycerides ≥150 mg/dl | 15 (10%) | 8 (12%) | 0.637 |
| ALT ≥40 IU/L | 13 (8%) | 4 (6%) | 0.499 |
| Cardiometabolic syndrome | 9 (6%) | 4 (6%) | 1.000 |
| Variable | Baseball Players | Football Linemen | p Value |
|---|---|---|---|
| BMI ≥30 kg/m 2 | 7 (5%) | 19 (100%) | <0.001 |
| Waist circumference ≥100 cm | 11 (7%) | 18 (95%) | <0.001 |
| Waist/height ratio >0.5 | 37 (24%) | 18 (95%) | <0.001 |
| Fasting glucose ≥100 mg/dl | 13 (8%) | 5 (26%) | 0.031 |
| BP ≥130/85 mm Hg | 82 (53%) | 9 (47%) | 0.648 |
| Triglycerides/HDL-C ratio >3.5 | 16 (10%) | 3 (19%) | 0.393 |
| HDL-C ≤40 mg/dl | 26 (17%) | 3 (19%) | 0.737 |
| Triglycerides ≥150 mg/dl | 15 (10%) | 3 (16%) | 0.422 |
| ALT ≥40 IU/L | 13 (8%) | 4 (21%) | 0.096 |
| Cardiometabolic syndrome | 9 (6%) | 4 (22%) | 0.033 |
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