{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T18:10:16Z","timestamp":1785435016804,"version":"3.56.0"},"reference-count":52,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T00:00:00Z","timestamp":1785024000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the Fundamental Research Funds for the Central Universities","award":["22120230370"],"award-info":[{"award-number":["22120230370"]}]},{"name":"China Association of Higher Educaiton","award":["24BJ0303"],"award-info":[{"award-number":["24BJ0303"]}]},{"award":["24BJ0303"],"award-info":[{"award-number":["24BJ0303"]}],"id":[{"id":"https:\/\/ror.org\/04vr5fc04","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>While the relationship between body mass index (BMI) and physical fitness in youth often follows an inverted U-shape, populations-based data from sub-plateau settings remain scarce. This study characterized the cross-sectional BMI\u2013fitness association among 14,744 students (9931 females) at a single university in Gansu Province, China (altitude ~1483 m). Fitness was assessed across seven components (vital capacity, speed, power, flexibility, endurance, and muscular strength\/endurance) and summarized as a standardized Physical Fitness Index (PFI). Overweight\/obesity prevalence was 11.2% (males 18.3%, females 7.7%)\u2014lower than the 14.0% national average for same-aged university students. BMI displayed a monotonic inverse association with PFI; underweight and normal-weight groups performed comparably, while overweight and obese groups showed progressively lower PFI, with a stronger association in males (\u03b2 = \u22120.46) than females (\u03b2 = \u22120.36). The weight-normalized vital capacity index (VCWI)\u2014a derived indicator of pulmonary function\u2014showed the strongest inverse correlation (males r = \u22120.47; females r = \u22120.40). Associations were most pronounced for VCWI and endurance, whereas flexibility exhibited a negligible BMI-related gradient. These findings describe a cohort-specific pattern, emphasizing the need for broader investigation of regional variations, and should not be interpreted as evidence of an altitude-mediated effect.<\/jats:p>","DOI":"10.3390\/life16081235","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T01:26:23Z","timestamp":1785115583000},"page":"1235","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association Between Body Mass Index and Physical Fitness Among University Students in a Sub-Plateau Region of Gansu Province, China: A Cross-Sectional Study"],"prefix":"10.3390","volume":"16","author":[{"given":"Ming","family":"Chen","sequence":"first","affiliation":[{"name":"School of Humanities and Social Sciences, Shanghai Lida University, Shanghai 201608, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linlin","family":"Zhao","sequence":"additional","affiliation":[{"name":"School of Physical Education, Shanghai Normal University, Shanghai 200234, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liting","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Physical Education, Tongji University, Shanghai 200092, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingxia","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Physical Education, Tongji University, Shanghai 200092, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaqi","family":"Kong","sequence":"additional","affiliation":[{"name":"Department of Physical Education, Tongji University, Shanghai 200092, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qin","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Physical Education, Tongji University, Shanghai 200092, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,26]]},"reference":[{"key":"ref_1","unstructured":"GBD 2021 Adolescent BMI Collaborators (2025). Global, regional, and national prevalence of child and adolescent overweight and obesity, 1990\u20132021, with forecasts to 2050: A forecasting study for the Global Burden of Disease Study 2021. Lancet, 405, 785\u2013812."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Chen, X., Cui, J., Zhang, Y., and Peng, W. (2020). The association between BMI and health-related physical fitness among Chinese college students: A cross-sectional study. BMC Public Health, 20.","DOI":"10.1186\/s12889-020-08517-8"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Sun, F., He, Q., Sun, X., and Wang, J. (2022). The Association between Body Mass Index and Muscular Fitness in Chinese College Freshmen. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph192114060"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Wu, H., Lin, P., Zeng, G., and Chen, F. (2024). Associations between body mass index and physical fitness indicators among Chinese university students: A multicenter cross-sectional study. BMC Sports Sci. Med. Rehabil., 16.","DOI":"10.1186\/s13102-024-01024-y"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1038\/s41430-018-0321-9","article-title":"Structural and functional body components in athletic health and performance phenotypes","volume":"73","author":"Silva","year":"2019","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"103740","DOI":"10.1016\/j.numecd.2024.09.010","article-title":"Visceral adiposity: A major mediator of the relationship between epicardial adiposity and cardiorespiratory fitness in adults","volume":"35","author":"Chartrand","year":"2025","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Cossio-Bolanos, M., Vidal-Espinoza, R., Albornoz, C.U., Fuentes-Lopez, J., Sanchez-Macedo, L., Andruske, C.L., Sulla-Torres, J., and Campos, R.G. (2022). Relationship between the body mass index and the ponderal index with physical fitness in adolescent students. BMC Pediatr., 22.","DOI":"10.1186\/s12887-022-03296-0"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Kljajevic, V., Stankovic, M., Dordevic, D., Trkulja-Petkovic, D., Jovanovic, R., Plazibat, K., Orsolic, M., Curic, M., and Sporis, G. (2021). Physical Activity and Physical Fitness among University Students-A Systematic Review. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19010158"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Huang, Z., Wang, W., Huo, K., Wang, Y., and Tian, K. (2025). Physical fitness status and influencing factors among college students aged 19~22 in Shandong province, China: A cross-sectional study. BMC Public Health, 25.","DOI":"10.1186\/s12889-025-22350-x"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Sun, J., Lin, C., Wang, L., Bi, C., and Qiao, B. (2024). A comparative study on the physical fitness of college students from different grades and majors in Jiangxi province. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0308483"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1186\/s12944-025-02623-5","article-title":"Diagnostic performance of anthropometric measurements for identifying obesity in high-altitude pediatric populations: Evidence from tibet via bioelectrical impedance analysis","volume":"24","author":"Nie","year":"2025","journal-title":"Lipids Health Dis."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Zhang, Y., Su, F., Song, Y., and Lu, J. (2022). Associations between Physical Fitness Index and Body Mass Index in Tibetan Children and Adolescents in Different High-Altitude Areas: Based on a Study in Tibet, China. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph191610155"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Peng, N., Li, J., Liu, B., Yan, X., and Ouzhu, N. (2025). Normal-weight obesity in high-altitude youth: Gender disparities and protective effects of native adaptation. PLoS ONE, 20.","DOI":"10.1371\/journal.pone.0328992"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"OR-41","DOI":"10.14428\/ebr.v1i2.9703","article-title":"OR-041 Infection of Different Altitudes on College Students\u2019 Body Shape","volume":"1","author":"Qiu","year":"2018","journal-title":"Exerc. Biochem. Rev."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2631713","DOI":"10.1155\/2019\/2631713","article-title":"Correlates of Overweight in Children and Adolescents Living at Different Altitudes: The Peruvian Health and Optimist Growth Study","volume":"2019","author":"Santos","year":"2019","journal-title":"J. Obes."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1002\/oby.20499","article-title":"Ascent to altitude as a weight loss method: The good and bad of hypoxia inducible factor activation","volume":"22","author":"Palmer","year":"2014","journal-title":"Obesity"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1093\/cdn\/nzac057.003","article-title":"Effects of an Overnight, 8-Hour Low Oxygen Exposure on Energy Intake and Resting Energy Expenditure in Healthy, Normal Weight Adults","volume":"6","author":"Baker","year":"2022","journal-title":"Curr. Dev. Nutr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e13192","DOI":"10.1111\/obr.13192","article-title":"Hypoxia, energy balance, and obesity: An update","volume":"22","author":"Kayser","year":"2021","journal-title":"Obes. Rev."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1007\/s40279-023-01954-6","article-title":"Women at Altitude: Sex-Related Physiological Responses to Exercise in Hypoxia","volume":"54","author":"Raberin","year":"2024","journal-title":"Sports Med."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Li, Y., Shi, N., and Tao, Y. (2025). Associations between body mass index and health-related physical fitness among Chinese university students: A cross-sectional study. Front. Sports Act. Living, 7.","DOI":"10.3389\/fspor.2025.1638381"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"624","DOI":"10.3934\/publichealth.2021050","article-title":"Differences in the prevalence of physical activity and cardiovascular risk factors between people living at low (<1001 m) compared to moderate (1001\u20132000 m) altitude","volume":"8","author":"Burtscher","year":"2021","journal-title":"AIMS Public Health"},{"key":"ref_22","first-page":"78","article-title":"The Influence of Sublatitude on Sports Coaching","volume":"28","author":"Zhao","year":"2005","journal-title":"J. Beijing Sport Univ."},{"key":"ref_23","unstructured":"Ganzhou District People\u2019s Government (2026, June 27). Ganzhou Overview, Available online: http:\/\/www.gsgz.gov.cn\/gzgk\/201812\/t20181220_154455.html."},{"key":"ref_24","unstructured":"Oxford Reference (2026). Altitude Training, Oxford University Press. Available online: https:\/\/www.oxfordreference.com\/display\/10.1093\/oi\/authority.20110803095406207."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1089\/ham.2007.8308","article-title":"Physical fitness and hematological changes during acclimatization to moderate altitude: A retrospective study","volume":"8","author":"Brothers","year":"2007","journal-title":"High Alt. Med. Biol."},{"key":"ref_26","unstructured":"Ministry of Education of the People\u2019s Republic of China (2026, July 21). Notification on Issuing the National Student Physical Health Standard (2014 Revision). Available online: https:\/\/www.csh.moe.edu.cn\/wtzx\/zcwj\/20141226\/2c909e854a8490a4014a84fda9b4001d.html."},{"key":"ref_27","first-page":"42","article-title":"An Exploratory Study on the Physical Health Evaluation Standards of Chinese Children and Adolescents under the Background of \u201cIntegration of Sports and Education\u201d","volume":"41","author":"Ji","year":"2021","journal-title":"China Sport Sci."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Yin, S., Jin, P., He, Q., and Zhi, Y. (2025). Physical Fitness Index and body mass index: A cross-sectional study based on 1.3 million college students. PLoS ONE, 20.","DOI":"10.1371\/journal.pone.0335194"},{"key":"ref_29","first-page":"101560","article-title":"Secular trends in physical fitness and cardiovascular risks among Chinese college students: An analysis of five successive national surveys between 2000 and 2019","volume":"58","author":"Cai","year":"2025","journal-title":"Lancet Reg. Health West Pac."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e001153","DOI":"10.1136\/bmjnph-2024-001153","article-title":"Dietary habits and complex food relations in Northwest China: A population-based network analysis","volume":"8","author":"Hui","year":"2025","journal-title":"BMJ Nutr. Prev. Health"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"718","DOI":"10.2337\/db08-1098","article-title":"Reduced adipose tissue oxygenation in human obesity: Evidence for rarefaction, macrophage chemotaxis, and inflammation without an angiogenic response","volume":"58","author":"Pasarica","year":"2009","journal-title":"Diabetes"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Heinonen, I.H., Boushel, R., and Kalliokoski, K.K. (2016). The Circulatory and Metabolic Responses to Hypoxia in Humans\u2014With Special Reference to Adipose Tissue Physiology and Obesity. Front. Endocrinol., 7.","DOI":"10.3389\/fendo.2016.00116"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1007\/s11154-024-09910-z","article-title":"The role of tissue oxygenation in obesity-related cardiometabolic complications","volume":"26","author":"Li","year":"2025","journal-title":"Rev. Endocr. Metab. Disord."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"S\u00e1nchez, C.A.R., Pardo-Rodriguez, D., Mancera-Soto, E., Le\u00f3n, L., Paulucio, D., D\u2019Alessandro, A., Santos, C.G.M., Cristancho, E., Monnerat, G., and Ramos-Caballero, D.M. (2025). Metabolic insights into hypoxia adaptation in adolescent athletes at different altitudes: A cross-sectional study. Front. Mol. Biosci., 12.","DOI":"10.3389\/fmolb.2025.1571103"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Camacho-Cardenosa, A., Camacho-Cardenosa, M., Burtscher, M., Martinez-Guardado, I., Timon, R., Brazo-Sayavera, J., and Olcina, G. (2018). High-Intensity Interval Training in Normobaric Hypoxia Leads to Greater Body Fat Loss in Overweight\/Obese Women than High-Intensity Interval Training in Normoxia. Front. Physiol., 9.","DOI":"10.3389\/fphys.2018.00060"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1340","DOI":"10.1249\/MSS.0000000000001228","article-title":"Muscle Protein Turnover and the Molecular Regulation of Muscle Mass during Hypoxia","volume":"49","author":"Pasiakos","year":"2017","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Guo, T., Shen, S., Yang, S., and Yang, F. (2024). The relationship between BMI and physical fitness among 7451 college freshmen: A cross-sectional study in Beijing, China. Front. Physiol., 15.","DOI":"10.3389\/fphys.2024.1435157"},{"key":"ref_38","first-page":"2524","article-title":"Differences of food intakes with gender, the year in college and body mass index among university students in Beijing, China","volume":"121","author":"Cheng","year":"2019","journal-title":"Br. Food J."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1177\/1557988317750990","article-title":"Overweight and Obesity Among Chinese College Students: An Exploration of Gender as Related to External Environmental Influences","volume":"12","author":"Jiang","year":"2018","journal-title":"Am. J. Mens. Health"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Fu, T., Wang, J., Xu, S., Yu, J., and Sun, G. (2022). Media Internalized Pressure and Restrained Eating Behavior in College Students: The Multiple Mediating Effects of Body Esteem and Social Physique Anxiety. Front. Psychol., 13.","DOI":"10.3389\/fpsyg.2022.887124"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2292","DOI":"10.1001\/jama.2016.6361","article-title":"Trends in Obesity Prevalence Among Children and Adolescents in the United States, 1988\u20131994 Through 2013\u20132014","volume":"315","author":"Ogden","year":"2016","journal-title":"JAMA"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1111\/ijpo.12039","article-title":"Sex differences in obesity incidence: 20-year prospective cohort in South Africa","volume":"11","author":"Lundeen","year":"2016","journal-title":"Pediatr. Obes."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1210\/jc.2018-01421","article-title":"Sex Differences in Glucose and Fatty Acid Metabolism in Asians Who Are Nonobese","volume":"104","author":"Chan","year":"2019","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"21633","DOI":"10.1038\/s41598-024-72973-0","article-title":"A detailed analysis of body composition in relation to cardiopulmonary exercise test indices","volume":"14","author":"Karlsson","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e011628","DOI":"10.1161\/JAHA.118.011628","article-title":"Influence of 2-Methoxyestradiol and Sex on Hypoxia-Induced Pulmonary Hypertension and Hypoxia-Inducible Factor-1-alpha","volume":"8","author":"Docherty","year":"2019","journal-title":"J. Am. Heart Assoc."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"R848","DOI":"10.1152\/ajpregu.00077.2018","article-title":"Mitochondrial basis for sex-differences in metabolism and exercise performance","volume":"314","author":"Ferreira","year":"2018","journal-title":"Am. J. Physiol. Regul. Integr. Comp. Physiol."},{"key":"ref_47","unstructured":"Central Committee of the Communist Party of China, and State Council of the People\u2019s Republic of China (2026, July 21). \u201cHealthy China 2030\u201d Planning Outline, Available online: https:\/\/www.gov.cn\/zhengce\/2016-10\/25\/content_5124174.htm."},{"key":"ref_48","unstructured":"Ministry of Education of the People\u2019s Republic of China (2026, July 21). Basic Standards for Sports Work in Higher Education Institutions, Available online: http:\/\/www.moe.gov.cn\/srcsite\/A17\/moe_938\/s3273\/201406\/t20140612_171180.html."},{"key":"ref_49","unstructured":"Ministry of Education of the People\u2019s Republic of China, National Development and Reform Commission, Ministry of Finance, Ministry of Human Resources and Social Security, and General Administration of Sport of China (2026, July 21). Student Physical Fitness Strengthening Plan, Available online: https:\/\/hudong.moe.gov.cn\/srcsite\/A17\/moe_938\/s3273\/202511\/t20251119_1420840.html."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Song, Z.Y., Song, X.L., Chen, L., Jiang, J.N., Zhang, Y., Liu, J.Y., Wang, R.L., Qin, Y., Dong, Z.Q., and Guo, T.J. (2025). Environmental greenness, physical activity, and their synergistic effects on vital capacity weight index in children and adolescents exposed to PM2.5 and O3 in economically developed provinces of China. BMC Public Health, 25.","DOI":"10.1186\/s12889-025-24439-9"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"114361","DOI":"10.1016\/j.isci.2025.114361","article-title":"Effects of high-intensity interval and moderate-intensity continuous training on overweight or obese college students: A systematic review and meta-analysis","volume":"29","author":"Chen","year":"2026","journal-title":"Iscience"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1007\/s11154-025-09986-1","article-title":"Looking beyond fat in obesity: The frequently overlooked importance of muscle mass","volume":"26","author":"Hegazi","year":"2025","journal-title":"Rev. Endocr. Metab. Disord."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/8\/1235\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T04:14:51Z","timestamp":1785298491000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/8\/1235"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,26]]},"references-count":52,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["life16081235"],"URL":"https:\/\/doi.org\/10.3390\/life16081235","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,26]]}}}