90 research outputs found
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
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; 71445 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
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Demographic characteristics and health behaviors of study participants by detailed exposure status (NÂ =Â 1456). (DOC 91 kb
Socio-demographic characteristics for GAZEL men, at time of each life event
<p>Note: Cells may not always add up to 100% or total N due to rounding and/or missing data</p
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Percentage of heavy drinkers around time of stressful life events, separately for women and men.
Associations between alcohol, tobacco and cannabis use and daily job exposure to the public, taking no daily exposure as reference category, in 16,566 men and 17,426 women.
<p>Associations between alcohol, tobacco and cannabis use and daily job exposure to the public, taking no daily exposure as reference category, in 16,566 men and 17,426 women.</p
Adjusted odds ratios (95% confidence interval) for the prevalence of cardiovascular risk factors at inclusion in participants with bad work environment according to their past experience of unemployment.
Adjusted odds ratios (95% confidence interval) for the prevalence of cardiovascular risk factors at inclusion in participants with bad work environment according to their past experience of unemployment.</p
Adjusted odds ratios (95% confidence interval) for the prevalence of cardiovascular risk factors in participants at inclusion according to their current experience of unemployment.
Adjusted odds ratios (95% confidence interval) for the prevalence of cardiovascular risk factors in participants at inclusion according to their current experience of unemployment.</p
Percentages of excluded participants for each cardiovascular risk factor.
Percentages of excluded participants for each cardiovascular risk factor.</p
Adjusted odds ratios (95% confidence interval) for the prevalence of cardiovascular risk factors in participants at inclusion according to the duration of their past experience of unemployment.
Adjusted odds ratios (95% confidence interval) for the prevalence of cardiovascular risk factors in participants at inclusion according to the duration of their past experience of unemployment.</p
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