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Lancet Public Health. 2017 May 19;2(6):e277-e285. doi: 10.1016/S2468-2667(17)30074-9. eCollection 2017 Jun.

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.

Author information

1
Department of Epidemiology and Public Health, University College London, London, UK; Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Finnish Institute of Occupational Health, Helsinki, Finland. Electronic address: m.kivimaki@ucl.ac.uk.
2
Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
3
Department of Epidemiology and Public Health, University College London, London, UK; School of Social and Community Medicine, University of Bristol, Bristol, UK.
4
Centre for Occupational and Environmental Medicine, Stockholm County Council, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
5
Department of Epidemiology and Public Health, University College London, London, UK.
6
Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Stress Research Institute, Stockholm University, Stockholm, Sweden; School of Health Sciences, Jönköping University, Jönköping, Sweden.
7
Inserm UMS 011, Population-Based Epidemiological Cohorts Unit, Villejuif, France.
8
Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
9
Department of Public Health, University of Helsinki, Helsinki, Finland.
10
Stress Research Institute, Stockholm University, Stockholm, Sweden; Department of Psychology, Umeå University, Umeå, Sweden.
11
Finnish Institute of Occupational Health, Helsinki, Finland.
12
Department of Public Health and Department of Psychology, University of Copenhagen, Copenhagen, Denmark; National Research Centre for the Working Environment, Copenhagen, Denmark.
13
Department of Epidemiology and Public Health, University College London, London, UK; Inserm U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France.
14
Department of Public Health, University of Turku, Turku, Finland; Folkhälsan Research Center, Helsinki, Finland; University of Skövde, Skövde, Sweden.
15
Department of Public Health, University of Turku, Turku, Finland; Turku University Hospital, Turku, Finland.
16
Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
17
Stress Research Institute, Stockholm University, Stockholm, Sweden.
18
Department of Epidemiology and Public Health, University College London, London, UK; National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK.
19
Department of Epidemiology and Public Health, University College London, London, UK; MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK.
20
Department of Epidemiology and Public Health, University College London, London, UK; 1st Department of Medicine, Semmelweis University Faculty of Medicine, Budapest, Hungary.
21
Institute of Behavioral Sciences, University of Helsinki, Helsinki, Finland.

Abstract

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:

We pooled individual-participant data for BMI and incident cardiometabolic multimorbidity from 16 prospective cohort studies from the USA and Europe. Participants included in the analyses were 35 years or older and had data available for BMI at baseline and for type 2 diabetes, coronary heart disease, and stroke at baseline and follow-up. We excluded participants with a diagnosis of diabetes, coronary heart disease, or stroke at or before study baseline. According to WHO recommendations, we classified BMI into categories of healthy (20·0-24·9 kg/m2), overweight (25·0-29·9 kg/m2), class I (mild) obesity (30·0-34·9 kg/m2), and class II and III (severe) obesity (≥35·0 kg/m2). We used an inclusive definition of underweight (<20 kg/m2) 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.

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