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

Mika Kivimäki; Eeva Kuosma; Jane E. Ferrie; Ritva Luukkonen; Solja T. Nyberg; Lars Alfredsson; G. David Batty; Eric J. Brunner; Eleonor Fransson; Marcel Goldberg; Anders Knutsson; Markku Koskenvuo; Maria Nordin; Tuula Oksanen; Jaana Pentti; Reiner Rugulies; Martin J. Shipley; Archana Singh-Manoux; Andrew Steptoe; Sakari B. Suominen; Töres Theorell; Jussi Vahtera; Marianna Virtanen; Peter Westerholm; Hugo Westerlund; Marie Zins; Mark Hamer; Joshua A. Bell; Adam G. Tabak; Markus Jokela

doi:10.1016/S2468-2667(17)30074-9

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

Mika Kivimäki^*, Eeva Kuosma, Jane E. Ferrie, Ritva Luukkonen, Solja T. Nyberg, Lars Alfredsson, G. David Batty, Eric J. Brunner, Eleonor Fransson, Marcel Goldberg, Anders Knutsson, Markku Koskenvuo, Maria Nordin, Tuula Oksanen, Jaana Pentti, Reiner Rugulies, Martin J. Shipley, Archana Singh-Manoux, Andrew Steptoe, Sakari B. SuominenTöres Theorell, Jussi Vahtera, Marianna Virtanen, Peter Westerholm, Hugo Westerlund, Marie Zins, Mark Hamer, Joshua A. Bell, Adam G. Tabak, Markus Jokela

^*Corresponding author af dette arbejde

Institut for Folkesundhedsvidenskab

140 Citationer (Scopus)

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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.

nterpretation: 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.

Originalsprog	Engelsk
Tidsskrift	The Lancet Public Health
Vol/bind	2
Udgave nummer	6
Sider (fra-til)	e277-e285
Antal sider	9
ISSN	2468-2667
DOI	https://doi.org/10.1016/S2468-2667(17)30074-9
Status	Udgivet - jun. 2017

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Kivimäki, M., Kuosma, E., Ferrie, J. E., Luukkonen, R., Nyberg, S. T., Alfredsson, L., Batty, G. D., Brunner, E. J., Fransson, E., Goldberg, M., Knutsson, A., Koskenvuo, M., Nordin, M., Oksanen, T., Pentti, J., Rugulies, R., Shipley, M. J., Singh-Manoux, A., Steptoe, A., ... Jokela, M. (2017). 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. The Lancet Public Health, 2(6), e277-e285. https://doi.org/10.1016/S2468-2667(17)30074-9

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. / Kivimäki, Mika; Kuosma, Eeva; Ferrie, Jane E. et al.

I: The Lancet Public Health, Bind 2, Nr. 6, 06.2017, s. e277-e285.

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

Kivimäki, M, Kuosma, E, Ferrie, JE, Luukkonen, R, Nyberg, ST, Alfredsson, L, Batty, GD, Brunner, EJ, Fransson, E, Goldberg, M, Knutsson, A, Koskenvuo, M, Nordin, M, Oksanen, T, Pentti, J, Rugulies, R, Shipley, MJ, Singh-Manoux, A, Steptoe, A, Suominen, SB, Theorell, T, Vahtera, J, Virtanen, M, Westerholm, P, Westerlund, H, Zins, M, Hamer, M, Bell, JA, Tabak, AG & Jokela, M 2017, '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', The Lancet Public Health, bind 2, nr. 6, s. e277-e285. https://doi.org/10.1016/S2468-2667(17)30074-9

@article{ed3d4dd2ee3248c6a648deaa54cc4995,

title = "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",

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.nterpretation: 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.",

author = "Mika Kivim{\"a}ki and Eeva Kuosma and Ferrie, {Jane E.} and Ritva Luukkonen and Nyberg, {Solja T.} and Lars Alfredsson and Batty, {G. David} and Brunner, {Eric J.} and Eleonor Fransson and Marcel Goldberg and Anders Knutsson and Markku Koskenvuo and Maria Nordin and Tuula Oksanen and Jaana Pentti and Reiner Rugulies and Shipley, {Martin J.} and Archana Singh-Manoux and Andrew Steptoe and Suominen, {Sakari B.} and T{\"o}res Theorell and Jussi Vahtera and Marianna Virtanen and Peter Westerholm and Hugo Westerlund and Marie Zins and Mark Hamer and Bell, {Joshua A.} and Tabak, {Adam G.} and Markus Jokela",

year = "2017",

month = jun,

doi = "10.1016/S2468-2667(17)30074-9",

language = "English",

volume = "2",

pages = "e277--e285",

journal = "The Lancet Public Health",

issn = "2468-2667",

publisher = "Elsevier",

number = "6",

}

TY - JOUR

T1 - Overweight, obesity, and risk of cardiometabolic multimorbidity

T2 - pooled analysis of individual-level data for 120 813 adults from 16 cohort studies from the USA and Europe

AU - Kivimäki, Mika

AU - Kuosma, Eeva

AU - Ferrie, Jane E.

AU - Luukkonen, Ritva

AU - Nyberg, Solja T.

AU - Alfredsson, Lars

AU - Batty, G. David

AU - Brunner, Eric J.

AU - Fransson, Eleonor

AU - Goldberg, Marcel

AU - Knutsson, Anders

AU - Koskenvuo, Markku

AU - Nordin, Maria

AU - Oksanen, Tuula

AU - Pentti, Jaana

AU - Rugulies, Reiner

AU - Shipley, Martin J.

AU - Singh-Manoux, Archana

AU - Steptoe, Andrew

AU - Suominen, Sakari B.

AU - Theorell, Töres

AU - Vahtera, Jussi

AU - Virtanen, Marianna

AU - Westerholm, Peter

AU - Westerlund, Hugo

AU - Zins, Marie

AU - Hamer, Mark

AU - Bell, Joshua A.

AU - Tabak, Adam G.

AU - Jokela, Markus

PY - 2017/6

Y1 - 2017/6

N2 - 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.nterpretation: 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.

AB - 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.nterpretation: 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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U2 - 10.1016/S2468-2667(17)30074-9

DO - 10.1016/S2468-2667(17)30074-9

M3 - Journal article

AN - SCOPUS:85019950348

SN - 2468-2667

VL - 2

SP - e277-e285

JO - The Lancet Public Health

JF - The Lancet Public Health

IS - 6

ER -