eprintid: 10145202 rev_number: 13 eprint_status: archive userid: 699 dir: disk0/10/14/52/02 datestamp: 2022-03-16 16:35:14 lastmod: 2022-05-01 14:25:40 status_changed: 2022-03-16 16:35:14 type: article metadata_visibility: show sword_depositor: 699 creators_name: Kivimäki, Mika creators_name: Strandberg, Timo creators_name: Pentti, Jaana creators_name: Nyberg, Solja T creators_name: Frank, Philipp creators_name: Jokela, Markus creators_name: Ervasti, Jenni creators_name: Suominen, Sakari B creators_name: Vahtera, Jussi creators_name: Sipilä, Pyry N creators_name: Lindbohm, Joni V creators_name: Ferrie, Jane E title: Body-mass index and risk of obesity-related complex multimorbidity: an observational multicohort study ispublished: pub divisions: UCL divisions: D12 divisions: B02 divisions: G19 note: © 2022 The Author(s). Published by Elsevier Ltd. under a Creative Commons license (https://creativecommons.org/licenses/by/4.0/). abstract: 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. FUNDING: Wellcome Trust, Medical Research Council, National Institute on Aging. date: 2022-04 date_type: published publisher: Elsevier BV official_url: https://doi.org/10.1016/S2213-8587(22)00033-X oa_status: green full_text_type: pub language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 1943348 doi: 10.1016/S2213-8587(22)00033-X medium: Print-Electronic pii: S2213-8587(22)00033-X lyricists_name: Frank, Philipp lyricists_name: Kivimaki, Mika lyricists_name: Ferrie, Jane lyricists_id: PFRAN46 lyricists_id: MJKIV95 lyricists_id: JEFER50 actors_name: Barczynska, Patrycja actors_id: PBARC91 actors_role: owner full_text_status: public publication: The Lancet Diabetes & Endocrinology volume: 10 number: 4 pagerange: 253-263 event_location: England citation: Kivimäki, Mika; Strandberg, Timo; Pentti, Jaana; Nyberg, Solja T; Frank, Philipp; Jokela, Markus; Ervasti, Jenni; ... Ferrie, Jane E; + view all <#> Kivimäki, Mika; Strandberg, Timo; Pentti, Jaana; Nyberg, Solja T; Frank, Philipp; Jokela, Markus; Ervasti, Jenni; Suominen, Sakari B; Vahtera, Jussi; Sipilä, Pyry N; Lindbohm, Joni V; Ferrie, Jane E; - view fewer <#> (2022) Body-mass index and risk of obesity-related complex multimorbidity: an observational multicohort study. The Lancet Diabetes & Endocrinology , 10 (4) pp. 253-263. 10.1016/S2213-8587(22)00033-X <https://doi.org/10.1016/S2213-8587%2822%2900033-X>. Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10145202/1/1-s2.0-S221385872200033X-main.pdf