Comorbidity network analysis related to obesity in middle-aged and older adults: findings from Korean population-based survey data

Abstract

Objectives: To systematically quantify obesity-related comorbidities, we analyzed comorbidity network analysis using data from the 7 th Korea National Health and Nutrition Examination Survey. Methods: The study included 11,712 subjects aged 45 to 80 (5,075 men and 6,637 women). Prevalent disease means that a subject with specific disease has been diagnosed by a doctor and is currently being treated. Comorbidity network analysis was analyzed for diseases with a prevalence of 1% or more, including overweight and obesity. We estimated the observed-toexpected ratio of all possible disease pairs as comorbidity strength. Through comorbidity network analysis, we visualized the obesity-related comorbidities. Results: In population over 45 years old, those with a BMI over 25.0 kg/m 2 were 37.3%. Of prevalent diseases, the most common disease was hypertension (42.3%), followed by dyslipidemia (17.4%) and diabetes (17.0%). The comorbidity (e.g., two or more diseases) risk in overweight and obesity subjects was 2.1 times (95% CI 1.9-2.3) higher than in normal weight subjects. Metabolic diseases such as hypertension, dyslipidemia, diabetes, and osteoarthritis were directly associated with overweight and obesity, the probability of coexistence for each of the four diseases was 1.3 times higher than expected. In addition, hypertension and dyslipidemia frequently coexisted in overweight and obese women along with other diseases. In obese men, dyslipidemia and diabetes were the major diseases in the comorbidity network. Conclusions: Our results provide evidence that the management of metabolic components is justified in obese individuals. In addition, our results will help prioritize interventions for comorbidity reduction in terms of public health.

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

“…In a Korean study of 12 000 adults, participants who had overweight or obesity were twice as likely to have simple multimorbidity (two or more of 30 diseases) than participants with healthy weight. 16 In an Australian study of 4865 women, participants with obesity were about three times as likely to have an “increasing multimorbidity trajectory” (based on changes in 18 self-reported conditions). 10 In a register-based study of more than 150 000 patients with one or more diseases, the prevalence ratio for multimorbidity (two or more of 82 diseases) between participants with obesity and those with healthy weight was 1·3.…”

“…We did an observational study and used pooled prospective data from two Finnish cohort studies: the Health and Social Support Study (HeSSup) 15 and the Finnish Public Sector Study (FPS). 16 In HeSSup, 64 797 men and women aged 20–54 years and living in Finland were sent a survey between June 7, 1998, and May 23, 2000; or Jan 7 and Aug 12, 2003. Responders were linked electronically to national hospitalisation and mortality registers until Dec 31, 2015.…”

“…We did an observational study and used pooled prospective data from two Finnish cohort studies: the Health and Social Support Study (HeSSup) 15 and the Finnish Public Sector Study (FPS). 16 In HeSSup, 64 797 men and women aged 20-54 years and living in Finland were sent a survey between June 7, 1998, and May 23, 2000; or Jan 7 and To examine the robustness and generalisability of our findings, we repeated our main analyses in an independent cohort from the UK Biobank. This cohort included 502 665 adults aged 38-73 years, identified from National Health Service (NHS) records in the UK, who participated in baseline examination between March 13, 2006, and Oct 1, 2010, and who were followed-up for hospital admissions and deaths until March 31, 2021. Ethical approval was obtained from local committees on the ethics of human research.…”

“…5,6,28 The greater than 12 times increased risk of complex multimorbidity and the five times increased risk of simple multimorbidity associated with obesity in the Finnish cohorts and among those with class 3 obesity in the UK Biobank cohort are similar to effect estimates for multimorbidity from obesity-related diseases in other studies. 10,[14][15][16][17] The IPD-Work multicohort study, which defined multimorbidity as at least two of myocardial infarction, stroke, and type 2 diabetes, found a four times increased risk of multimorbidity in participants with class 1 obesity and an almost 15 times increased risk in the those with class 2 and class 3 obesity compared with participants with healthy weight. 15 Other studies that have used multimorbidity definitions including diseases related and unrelated to obesity have observed lower effect estimates.…”

“… 15 A study of more than 11 000 adults found that participants who had overweight or obesity were twice as likely to have comorbidities, including hypertension, dyslipidaemia, unspecified diabetes, and osteoarthritis. 16 A large cohort study of patients aged 45–64 years in the USA found that the most prevalent disease clusters included hypertension and dorsalgia in people with healthy weight; together with joint disorders, dyslipidaemia, type 2 diabetes, sleep disorders, and chronic kidney disease in people who had overweight or obesity. 17 However, few studies have characterised a wide range of obesity-related conditions that result in complex multimorbidity (four or more comorbid diseases).…”