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      Obesity and loss of disease-free years owing to major non-communicable diseases: a multicohort study

      , PhD a , * , , Prof, DSc c , , MSc a , d , , Prof, PhD e , f , h , , Prof, PhD i , j , , PhD h , k , , Prof, MD l , m , , PhD n , o , , PhD b , , Prof, PhD p , , Prof, MD a , , PhD a , e , , PhD h , , MD a , , PhD q , , MD h , , PhD h , r , , MD e , , MSc a , , Prof, PhD a , , Prof, PhD q , s , , MSc c , , PhD d , t , , Prof, MD d , u , , Prof, MD h , , Prof, MD d , , Prof, MD g , , Prof, PhD h , , MD l , m , , Prof, PhD v ,   , PhD c , w , , PhD x , , PhD c , y , , Prof, FMedSci a , c

      The Lancet. Public Health

      Elsevier, Ltd

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          Obesity increases the risk of several chronic diseases, but the extent to which the obesity-related loss of disease-free years varies by lifestyle category and across socioeconomic groups is unclear. We estimated the number of years free from major non-communicable diseases in adults who are overweight and obese, compared with those who are normal weight.


          We pooled individual-level data on body-mass index (BMI) and non-communicable diseases from men and women with no initial evidence of these diseases in European cohort studies from the Individual-Participant-Data Meta-Analysis in Working Populations consortium. BMI was assessed at baseline (1991–2008) and non-communicable diseases (incident type 2 diabetes, coronary heart disease, stroke, cancer, asthma, and chronic obstructive pulmonary disease) were ascertained via linkage to records from national health registries, repeated medical examinations, or self-report. Disease-free years from age 40 years to 75 years associated with underweight (BMI <18·5 kg/m 2), overweight (≥25 kg/m 2 to <30 kg/m 2), and obesity (class I [mild] ≥30 kg/m 2 to <35 kg/m 2; class II–III [severe] ≥35 kg/m 2) compared with normal weight (≥18·5 kg/m 2 to <25 kg/m 2) were estimated.


          Of 137 503 participants from ten studies, we excluded 6973 owing to missing data and 10 349 with prevalent disease at baseline, resulting in an analytic sample of 120 181 participants. Of 47 127 men, 211 (0·4%) were underweight, 21 468 (45·6%) normal weight, 20 738 (44·0%) overweight, 3982 (8·4%) class I obese, and 728 (1·5%) class II–III obese. The corresponding numbers among the 73 054 women were 1493 (2·0%), 44 760 (61·3%), 19 553 (26·8%), 5670 (7·8%), and 1578 (2·2%), respectively. During 1 328 873 person-years at risk (mean follow-up 11·5 years [range 6·3–18·6]), 8159 men and 8100 women developed at least one non-communicable disease. Between 40 years and 75 years, the estimated number of disease-free years was 29·3 (95% CI 28·8–29·8) in normal-weight men and 29·4 (28·7–30·0) in normal-weight women. Compared with normal weight, the loss of disease-free years in men was 1·8 (95% CI −1·3 to 4·9) for underweight, 1·1 (0·7 to 1·5) for overweight, 3·9 (2·9 to 4·9) for class I obese, and 8·5 (7·1 to 9·8) for class II–III obese. The corresponding estimates for women were 0·0 (−1·4 to 1·4) for underweight, 1·1 (0·6 to 1·5) for overweight, 2·7 (1·5 to 3·9) for class I obese, and 7·3 (6·1 to 8·6) for class II–III obese. The loss of disease-free years associated with class II–III obesity varied between 7·1 and 10·0 years in subgroups of participants of different socioeconomic level, physical activity level, and smoking habit.


          Mild obesity was associated with the loss of one in ten, and severe obesity the loss of one in four potential disease-free years during middle and later adulthood. This increasing loss of disease-free years as obesity becomes more severe occurred in both sexes, among smokers and non-smokers, the physically active and inactive, and across the socioeconomic hierarchy.


          NordForsk, UK Medical Research Council, US National Institute on Aging, Academy of Finland, Helsinki Institute of Life Science, and Cancer Research UK.

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          Most cited references 42

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          Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013.

          In 2010, overweight and obesity were estimated to cause 3·4 million deaths, 3·9% of years of life lost, and 3·8% of disability-adjusted life-years (DALYs) worldwide. The rise in obesity has led to widespread calls for regular monitoring of changes in overweight and obesity prevalence in all populations. Comparable, up-to-date information about levels and trends is essential to quantify population health effects and to prompt decision makers to prioritise action. We estimate the global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013. We systematically identified surveys, reports, and published studies (n=1769) that included data for height and weight, both through physical measurements and self-reports. We used mixed effects linear regression to correct for bias in self-reports. We obtained data for prevalence of obesity and overweight by age, sex, country, and year (n=19,244) with a spatiotemporal Gaussian process regression model to estimate prevalence with 95% uncertainty intervals (UIs). Worldwide, the proportion of adults with a body-mass index (BMI) of 25 kg/m(2) or greater increased between 1980 and 2013 from 28·8% (95% UI 28·4-29·3) to 36·9% (36·3-37·4) in men, and from 29·8% (29·3-30·2) to 38·0% (37·5-38·5) in women. Prevalence has increased substantially in children and adolescents in developed countries; 23·8% (22·9-24·7) of boys and 22·6% (21·7-23·6) of girls were overweight or obese in 2013. The prevalence of overweight and obesity has also increased in children and adolescents in developing countries, from 8·1% (7·7-8·6) to 12·9% (12·3-13·5) in 2013 for boys and from 8·4% (8·1-8·8) to 13·4% (13·0-13·9) in girls. In adults, estimated prevalence of obesity exceeded 50% in men in Tonga and in women in Kuwait, Kiribati, Federated States of Micronesia, Libya, Qatar, Tonga, and Samoa. Since 2006, the increase in adult obesity in developed countries has slowed down. Because of the established health risks and substantial increases in prevalence, obesity has become a major global health challenge. Not only is obesity increasing, but no national success stories have been reported in the past 33 years. Urgent global action and leadership is needed to help countries to more effectively intervene. Bill & Melinda Gates Foundation. Copyright © 2014 Elsevier Ltd. All rights reserved.
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            Mechanisms linking obesity to insulin resistance and type 2 diabetes.

            Obesity is associated with an increased risk of developing insulin resistance and type 2 diabetes. In obese individuals, adipose tissue releases increased amounts of non-esterified fatty acids, glycerol, hormones, pro-inflammatory cytokines and other factors that are involved in the development of insulin resistance. When insulin resistance is accompanied by dysfunction of pancreatic islet beta-cells - the cells that release insulin - failure to control blood glucose levels results. Abnormalities in beta-cell function are therefore critical in defining the risk and development of type 2 diabetes. This knowledge is fostering exploration of the molecular and genetic basis of the disease and new approaches to its treatment and prevention.
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              2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR).


                Author and article information

                Lancet Public Health
                Lancet Public Health
                The Lancet. Public Health
                Elsevier, Ltd
                01 September 2018
                October 2018
                01 September 2018
                : 3
                : 10
                : e490-e497
                [a ]Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
                [b ]Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
                [c ]Department of Epidemiology and Public Health, University College London, London, UK
                [d ]Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
                [e ]Finnish Institute of Occupational Health, Helsinki, Finland
                [f ]Institute of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
                [g ]Department of Medical Sciences, Uppsala University, Uppsala, Sweden
                [h ]Stress Research Institute, University of Stockholm, Stockholm, Sweden
                [i ]Centre for Occupational and Environmental Medicine, Stockholm County Council, Sweden
                [j ]Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
                [k ]School of Health and Welfare, Jönköping University, Jönköping, Sweden
                [l ]Paris Descartes University, Paris, France
                [m ]Inserm UMS 011, Population-Based Epidemiological Cohorts Unit, Villejuif, France
                [n ]Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
                [o ]Clinical Effectiveness Unit, The Royal College of Surgeons, London, UK
                [p ]Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
                [q ]National Research Centre for the Working Environment, Copenhagen, Denmark
                [r ]Department of Psychology, Umeå University, Umeå, Sweden
                [s ]Department of Public Health and Department of Psychology, University of Copenhagen, Copenhagen, Denmark
                [t ]Faculty of Social Sciences (Health Sciences), University of Tampere, Tampere, Finland
                [u ]University of Skövde, School of Health and Education, Skövde, Sweden
                [v ]National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
                [w ]Inserm U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France
                [x ]MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
                [y ]Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
                Author notes
                [* ]Correspondence to: Dr Solja T Nyberg, Clinicum Department of Public Health, University of Helsinki, FI-00014 Helsinki, Finland solja.nyberg@
                © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

                This is an open access article under the CC BY license (



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