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Overweight, obesity, and risk of cardiometabolic multimorbidity: pooled analysis of individual-level data for 120 813 adults from 16 cohort studies from the USA and Europe
Department of Epidemiology and Public Health, University College London, London, United Kingdom / Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland / Finnish Institute of Occupational Health, Helsinki, Finland.
Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
Department of Epidemiology and Public Health, University College London, London, United Kingdom / School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland .
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2017 (English)In: The Lancet Public Health, ISSN 2468-3667, Vol. 2, no 6, p. e277-e285Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Although overweight and obesity have been studied in relation to individual cardiometabolic diseases, their association with risk of cardiometabolic multimorbidity is poorly understood. Here we aimed to establish the risk of incident cardiometabolic multimorbidity (ie, at least two from: type 2 diabetes, coronary heart disease, and stroke) in adults who are overweight and obese compared with those who are a healthy weight.

METHODS: ) to achieve sufficient case numbers for analysis. The main outcome was cardiometabolic multimorbidity (ie, developing at least two from: type 2 diabetes, coronary heart disease, and stroke). Incident cardiometabolic multimorbidity was ascertained via resurvey or linkage to electronic medical records (including hospital admissions and death). We analysed data from each cohort separately using logistic regression and then pooled cohort-specific estimates using random-effects meta-analysis.

FINDINGS: Participants were 120  813 adults (mean age 51·4 years, range 35-103; 71 445 women) who did not have diabetes, coronary heart disease, or stroke at study baseline (1973-2012). During a mean follow-up of 10·7 years (1995-2014), we identified 1627 cases of multimorbidity. After adjustment for sociodemographic and lifestyle factors, compared with individuals with a healthy weight, the risk of developing cardiometabolic multimorbidity in overweight individuals was twice as high (odds ratio [OR] 2·0, 95% CI 1·7-2·4; p<0·0001), almost five times higher for individuals with class I obesity (4·5, 3·5-5·8; p<0·0001), and almost 15 times higher for individuals with classes II and III obesity combined (14·5, 10·1-21·0; p<0·0001). This association was noted in men and women, young and old, and white and non-white participants, and was not dependent on the method of exposure assessment or outcome ascertainment. In analyses of different combinations of cardiometabolic conditions, odds ratios associated with classes II and III obesity were 2·2 (95% CI 1·9-2·6) for vascular disease only (coronary heart disease or stroke), 12·0 (8·1-17·9) for vascular disease followed by diabetes, 18·6 (16·6-20·9) for diabetes only, and 29·8 (21·7-40·8) for diabetes followed by vascular disease.

INTERPRETATION: The risk of cardiometabolic multimorbidity increases as BMI increases; from double in overweight people to more than ten times in severely obese people compared with individuals with a healthy BMI. Our findings highlight the need for clinicians to actively screen for diabetes in overweight and obese patients with vascular disease, and pay increased attention to prevention of vascular disease in obese individuals with diabetes.

FUNDING: NordForsk, Medical Research Council, Cancer Research UK, Finnish Work Environment Fund, and Academy of Finland.

Place, publisher, year, edition, pages
2017. Vol. 2, no 6, p. e277-e285
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Individual and Society VIDSOC
Identifiers
URN: urn:nbn:se:his:diva-14981DOI: 10.1016/S2468-2667(17)30074-9ISI: 000425586500011PubMedID: 28626830Scopus ID: 2-s2.0-85019950348OAI: oai:DiVA.org:his-14981DiVA, id: diva2:1193056
Available from: 2018-03-26 Created: 2018-03-26 Last updated: 2018-07-26Bibliographically approved

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Suominen, Sakari B.

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