University of Oulu

Kivimäki, M., Strandberg, T., Pentti, J., Nyberg, S. T., Frank, P., Jokela, M., Ervasti, J., Suominen, S. B., Vahtera, J., Sipilä, P. N., Lindbohm, J. V., & Ferrie, J. E. (2022). Body-mass index and risk of obesity-related complex multimorbidity: An observational multicohort study. The Lancet Diabetes & Endocrinology, 10(4), 253–263.

Body-mass index and risk of obesity-related complex multimorbidity : an observational multicohort study

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Author: Kivimäki, Mika1,2,3; Strandberg, Timo4,5; Pentti, Jaana2,6,7;
Organizations: 1Department of Epidemiology and Public Health, University College London, London, UK
2Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
3Finnish Institute of Occupational Health, Helsinki, Finland
4Department of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
5Center for Life Course Health Research, University of Oulu, Oulu, Finland
6Department of Public Health, University of Turku, Turku, Finland
7Centre for Population Health Research, University of Turku, Turku, Finland
8Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
9Turku University Hospital, Turku, Finland
10School of Health Science, University of Skövde, Skövde, Sweden
11Bristol Medical School, University of Bristol, Bristol, UK
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.1 MB)
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Language: English
Published: Elsevier, 2022
Publish Date: 2022-06-27


Background: The accumulation of disparate diseases in complex multimorbidity makes prevention difficult if each disease is targeted separately. We aimed to examine obesity as a shared risk factor for common diseases, determine associations between obesity-related diseases, and examine the role of obesity in the development of complex multimorbidity (four or more comorbid diseases).

Methods: We did an observational study and used pooled prospective data from two Finnish cohort studies (the Health and Social Support Study and the Finnish Public Sector Study) comprising 114 657 adults aged 16–78 years at study entry (1998–2013). A cohort of 499 357 adults (aged 38–73 years at study entry; 2006–10) from the UK Biobank provided replication in an independent population. BMI and clinical characteristics were assessed at baseline. BMIs were categorised as obesity (≥30·0 kg/m²), overweight (25·0–29·9 kg/m²), healthy weight (18·5–24·9 kg/m²), and underweight (<18·5 kg/m²). Via linkage to national health records, participants were followed-up for death and diseases diagnosed according to the International Classification of Diseases 10th Revision (ICD-10). Hazard ratios (HRs) with 95% CIs and population attributable fractions (PAFs) for associations between BMI and multimorbidity were calculated.

Findings: Mean follow-up duration was 12·1 years (SD 3·8) in the Finnish cohorts and 11·8 years (1·7) in the UK Biobank cohort. Obesity was associated with 21 non-overlapping cardiometabolic, digestive, respiratory, neurological, musculoskeletal, and infectious diseases after Bonferroni multiple testing adjustment and ignoring HRs of less than 1·50. Compared with healthy weight, the confounder-adjusted HR for obesity was 2·83 (95% CI 2·74–2·93; PAF 19·9% [95% CI 19·3–20·5]) for developing at least one obesity-related disease, 5·17 (4·84–5·53; 34·4% [33·2–35·5]) for two diseases, and 12·39 (9·26–16·58; 55·2% [50·9–57·5]) for complex multimorbidity. The proportion of participants of healthy weight with complex multimorbidity by age 75 years was observed by age 55 years in participants with obesity, and degree of obesity was associated with complex multimorbidity in a dose–response relationship. Compared with obesity, the association between overweight and complex multimorbidity was more modest (HR 2·67, 95% CI 1·94–3·68; PAF 13·3% [95% CI 9·6–16·3]). The same pattern of results was observed in the UK Biobank cohort.

Interpretation: Obesity is associated with diverse, increasing disease burdens, and might represent an important target for multimorbidity prevention that avoids the complexities of multitarget preventive regimens.

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Series: The Lancet. Diabetes & endocrinology
ISSN: 2213-8587
ISSN-E: 2213-8595
ISSN-L: 2213-8587
Volume: 10
Issue: 4
Pages: 253 - 263
DOI: 10.1016/S2213-8587(22)00033-X
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: This study and MK were supported by the Wellcome Trust (221854/Z/20/Z), the UK Medical Research Council (MR/S011676/1), the US National Institute on Aging (R01AG056477), the Academy of Finland (329202), Helsinki Institute of Life Science (H970), and the Finnish Work Environment Fund (190424). STN was supported by NordForsk (75021) and the Finnish Work Environment Fund (190424). PF was supported by the Economic and Social Research Council and the Biotechnology and Sciences Research Council (ES/P000347/1). JV was supported by the Academy of Finland (321409 and 329240). PNS was supported by the Emil Aaltonen Foundation. JVL was supported by the Academy of Finland (339568).
Copyright information: © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.