Abstract
Disclosure: H.M. Heshmati: None.
Background: Sumo wrestling is an ancient and sacred traditional sport in Japan. It has 2,000 years history and recently became a worldwide sport. Sumo wrestlers are the heaviest athletes in the World. Because of their unhealthy lifestyle and high body weight, sumo wrestlers are predisposed to develop several comorbidities that can shorten their life expectancy. This review presents an update on the lifestyle, comorbidities, and longevity of sumo wrestlers. Methods: A systematic search of literature was conducted using the search terms sumo wrestlers, lifestyle, comorbidities, and longevity. Results: The top ranked sumo wrestlers are from Japan and Mongolia. The number of sumo wrestlers in Japan is approximately 650. Although professional sumo wrestling traditionally forbids women from competitions and ceremonies, female sumo wrestlers do exist and thrive. Sumo wrestlers have a high resting energy expenditure because of large organ and tissue masses, but their average energy intake (around 4,000 calories/day in most cases, but up to 10,000 calories/day in some exceptional cases) exceeds their energy expenditure over a long period of time (e.g., since childhood). Sumo wrestlers eat massive quantities of high-protein chankonabe-chicken, fish and tofu (and sometimes horse) stew to provide, as much as possible, the necessary power to wrestle through increase in muscle mass rather than fat mass. Sumo wrestlers have to weigh more than 100 kg to improve performance and win a game. The average weight of sumo wrestlers is over 160 kg with an average body mass index over 47 kg/m². Sumo wrestlers need enough body fat to cushion the impact of tackling and to prevent trauma. Sumo wrestlers also have high bone mineral content and high bone mineral density. Many sumo wrestlers are at increased risk of multiple injuries including fractures (mainly in the lower extremities). The heavy weight and the high fat mass (especially visceral fat) expose the sumo wrestlers to the development of several comorbidities such as hypertension, dyslipidemia, prediabetes, type 2 diabetes, ischemic heart disease, nonalcoholic fatty liver disease, osteoarthritis, and cancers. However, with intensive daily exercise, most sumo wrestlers can maintain normal serum glucose and triglycerides levels but without completely correcting their insulin resistance or normalizing their low serum high-density lipoprotein cholesterol levels. Japanese sumo wrestlers aged 35-74 years have a significantly higher mortality rate in comparison to the control population. Their life expectancy is around 65 years, at least 10 years shorter than controls. Cardiovascular diseases are the major cause of death in these people. Conclusion: Sumo wrestlers are exposed to multiple injuries and can develop several comorbidities that significantly shorten their life expectancy. Sumo wrestling is a unique situation where strength and sacrifice coexist.
Presentation: Saturday, July 12, 2025