Skip to main content

Advertisement

SpringerLink
Log in

Association of body mass index with risk of cardiometabolic disease, multimorbidity and mortality: a multi-state analysis based on the Kailuan cohort

  • Original Article
  • Published:
Endocrine Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the association of body mass index (BMI) with risk of first cardiometabolic disease (FCMD), cardiometabolic multimorbidity (CMM) and death.

Methods

87,512 participants free of CMD were included from the Kailuan cohort, which was established during 2006–2007 and followed up until 2020. BMI was classified as underweight ( < 18.5 kg/m2), healthy weight (18.5–23.9 kg/m2), overweight (24.0–27.9 kg/m2), mildly obese (28.0–31.9 kg/m2), and severely obese ( ≥ 32.0 kg/m2). FCMD was defined as the first onset of diabetes, heart disease, or stroke, and CMM as the coexistence of at least two CMD. The hazard ratio (HR) and 95% confidence interval (95%CI) were estimated with multi-state models.

Results

20,577 participants developed FCMD, 2232 developed CMM afterwards, and 10,191 died. Individuals with higher BMI was more likely to develop FCMD and CMM. Compared with healthy weight, the HR (95%CI) of severe obesity for transition from health to FCMD and from FCMD to CMM was 3.12 (2.91, 3.34) and 1.92 (1.60, 2.31), respectively. On the other hand, underweight was consistently associated with higher mortality risk regardless of initial status, whereas severe obesity was only related to increased risk for transition from health to death (HR: 1.36; 95%CI: 1.17, 1.56) but not for transition from FCMD (HR: 0.70; 95%CI: 0.57, 0.87) or CMM (HR: 0.80; 95%CI: 0.54, 1.19) to death.

Conclusion

Our findings highlighted the importance of maintaining healthy weight for primary and secondary prevention of CMD and reflected the demand for more accurate measurement and comprehensive management of obesity for CMD patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. GBD, 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 396(10258), 1204–1222 (2020)

    Article  Google Scholar 

  2. E. Di Angelantonio, S. Kaptoge, D. Wormser, P. Willeit, A.S. Butterworth, N. Bansal, L.M. O’Keeffe, P. Gao, A.M. Wood, S. Burgess et al. Association of Cardiometabolic Multimorbidity With Mortality. Jama 314(1), 52–60 (2015)

    Article  PubMed  Google Scholar 

  3. L. Busija, K. Lim, C. Szoeke, K.M. Sanders, M.P. McCabe, Do replicable profiles of multimorbidity exist? Systematic review and synthesis. Eur. J. Epidemiol. 34(11), 1025–1053 (2019)

    Article  PubMed  Google Scholar 

  4. Y. Han, Y. Hu, C. Yu, Y. Guo, P. Pei, L. Yang, Y. Chen, H. Du, D. Sun, Y. Pang et al. Lifestyle, cardiometabolic disease, and multimorbidity in a prospective Chinese study. Eur. Heart J. 42(34), 3374–3384 (2021)

    Article  PubMed  PubMed Central  Google Scholar 

  5. S.S. Khan, H. Ning, J.T. Wilkins, N. Allen, M. Carnethon, J.D. Berry, R.N. Sweis, D.M. Lloyd-Jones, Association of Body Mass Index With Lifetime Risk of Cardiovascular Disease and Compression of Morbidity. JAMA Cardiol. 3(4), 280–287 (2018)

    Article  PubMed  PubMed Central  Google Scholar 

  6. S. Kenchaiah, J.M. Gaziano, R.S. Vasan, Impact of obesity on the risk of heart failure and survival after the onset of heart failure. Med Clin. North Am. 88(5), 1273–1294 (2004)

    Article  PubMed  Google Scholar 

  7. V. Vyas, P. Lambiase, Obesity and Atrial Fibrillation: Epidemiology, Pathophysiology and Novel Therapeutic Opportunities. Arrhythm. Electrophysiol. Rev. 8(1), 28–36 (2019)

    Article  PubMed  PubMed Central  Google Scholar 

  8. A. Abdullah, A. Peeters, M. de Courten, J. Stoelwinder, The magnitude of association between overweight and obesity and the risk of diabetes: a meta-analysis of prospective cohort studies. Diabetes Res Clin. Pr. 89(3), 309–319 (2010)

    Article  Google Scholar 

  9. M. Kivimäki, E. Kuosma, J.E. Ferrie, R. Luukkonen, S.T. Nyberg, L. Alfredsson, G.D. Batty, E.J. Brunner, E. Fransson, M. Goldberg et al. 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. Lancet Public Health 2(6), e277–e285 (2017)

    Article  PubMed  PubMed Central  Google Scholar 

  10. S. Wu, S. An, W. Li, A.H. Lichtenstein, J. Gao, P.M. Kris-Etherton, Y. Wu, C. Jin, S. Huang, F.B. Hu et al. Association of Trajectory of Cardiovascular Health Score and Incident Cardiovascular Disease. JAMA Netw. Open 2(5), e194758 (2019)

    Article  PubMed  PubMed Central  Google Scholar 

  11. C. Wang, Y. Yuan, M. Zheng, A. Pan, M. Wang, M. Zhao, Y. Li, S. Yao, S. Chen, S. Wu et al. Association of Age of Onset of Hypertension With Cardiovascular Diseases and Mortality. J. Am. Coll. Cardiol. 75(23), 2921–2930 (2020)

    Article  PubMed  Google Scholar 

  12. Y.F. Zhou, S. Chen, G. Wang, S. Chen, Y.B. Zhang, J.X. Chen, Z.Z. Tu, G. Liu, S. Wu, A. Pan, Effectiveness of a Workplace-Based, Multicomponent Hypertension Management Program in Real-World Practice: A Propensity-Matched Analysis. Hypertension 79(1), 230–240 (2022)

    Article  CAS  PubMed  Google Scholar 

  13. B.F. Zhou, Predictive values of body mass index and waist circumference for risk factors of certain related diseases in Chinese adults-study on optimal cut-off points of body mass index and waist circumference in Chinese adults. Biomed. Environ. Sci. 15(1), 83–96 (2002)

    PubMed  Google Scholar 

  14. Y.H. Wang, J. Wang, S.H. Chen, J.Q. Li, Q.D. Lu, M.V. Vitiello, F. Wang, X.D. Tang, J. Shi, L. Lu et al. Association of Longitudinal Patterns of Habitual Sleep Duration With Risk of Cardiovascular Events and All-Cause Mortality. JAMA Netw. Open 3(5), e205246 (2020)

    Article  PubMed  PubMed Central  Google Scholar 

  15. H. Tunstall-Pedoe, K. Kuulasmaa, P. Amouyel, D. Arveiler, A.M. Rajakangas, A. Pajak, Myocardial infarction and coronary deaths in the World Health Organization MONICA Project. Registration procedures, event rates, and case-fatality rates in 38 populations from 21 countries in four continents. Circulation 90(1), 583–612 (1994)

    Article  CAS  PubMed  Google Scholar 

  16. P. Kirchhof, S. Benussi, D. Kotecha, A. Ahlsson, D. Atar, B. Casadei, M. Castella, H.C. Diener, H. Heidbuchel, J. Hendriks et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur. Heart J. 37(38), 2893–2962 (2016)

    Article  PubMed  Google Scholar 

  17. K. Swedberg, J. Cleland, H. Dargie, H. Drexler, F. Follath, M. Komajda, L. Tavazzi, O.A. Smiseth, A. Gavazzi, A. Haverich et al. Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005): The Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology. Eur. Heart J. 26(11), 1115–1140 (2005)

    Article  PubMed  Google Scholar 

  18. Stroke-1989 Recommendations on stroke prevention, diagnosis, and therapy. Report of the WHO Task Force on Stroke and other Cerebrovascular Disorders. Stroke 20(10), 1407–1431 (1989)

    Article  Google Scholar 

  19. H. Putter, M. Fiocco, R.B. Geskus, Tutorial in biostatistics: competing risks and multi-state models. Stat. Med 26(11), 2389–2430 (2007)

    Article  CAS  PubMed  Google Scholar 

  20. A. Singh-Manoux, A. Fayosse, S. Sabia, A. Tabak, M. Shipley, A. Dugravot, M. Kivimäki, Clinical, socioeconomic, and behavioural factors at age 50 years and risk of cardiometabolic multimorbidity and mortality: A cohort study. PLoS Med 15(5), e1002571 (2018)

    Article  PubMed  PubMed Central  Google Scholar 

  21. H. Luo, Q. Zhang, K. Yu, X. Meng, H. Kan, R. Chen, Long-term exposure to ambient air pollution is a risk factor for trajectory of cardiometabolic multimorbidity: A prospective study in the UK Biobank. EBioMedicine 84, 104282 (2022)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. L.C. de Wreede, M. Fiocco, H. Putter, The mstate package for estimation and prediction in non- and semi-parametric multi-state and competing risks models. Comput Methods Prog. Biomed. 99(3), 261–274 (2010)

    Article  Google Scholar 

  23. M. Kivimäki, T. Strandberg, J. Pentti, S.T. Nyberg, P. Frank, M. Jokela, J. Ervasti, S.B. Suominen, J. Vahtera, P.N. Sipilä et al. Body-mass index and risk of obesity-related complex multimorbidity: an observational multicohort study. Lancet Diabetes Endocrinol. 10(4), 253–263 (2022)

    Article  PubMed  PubMed Central  Google Scholar 

  24. D. Gu, J. He, X. Duan, K. Reynolds, X. Wu, J. Chen, G. Huang, C.S. Chen, P.K. Whelton, Body weight and mortality among men and women in China. Jama 295(7), 776–783 (2006)

    Article  CAS  PubMed  Google Scholar 

  25. K. Bhaskaran, I. Dos-Santos-Silva, D.A. Leon, I.J. Douglas, L. Smeeth, Association of BMI with overall and cause-specific mortality: a population-based cohort study of 3.6 million adults in the UK. Lancet Diabetes Endocrinol. 6(12), 944–953 (2018)

    Article  PubMed  PubMed Central  Google Scholar 

  26. L.F. Van Gaal, I.L. Mertens, C.E. De Block, Mechanisms linking obesity with cardiovascular disease. Nature 444(7121), 875–880 (2006)

    Article  PubMed  Google Scholar 

  27. A.R. Saltiel, J.M. Olefsky, Inflammatory mechanisms linking obesity and metabolic disease. J. Clin. Invest 127(1), 1–4 (2017)

    Article  PubMed  PubMed Central  Google Scholar 

  28. P.L. Valenzuela, P. Carrera-Bastos, A. Castillo-García, D.E. Lieberman, A. Santos-Lozano, A. Lucia, Obesity and the risk of cardiometabolic diseases. Nat. Rev. Cardiol. 20(7), 475–494 (2023)

    Article  PubMed  Google Scholar 

  29. C. Koliaki, S. Liatis, A. Kokkinos, Obesity and cardiovascular disease: revisiting an old relationship. Metabolism 92, 98–107 (2019)

    Article  CAS  PubMed  Google Scholar 

  30. A.W. Tutor, C.J. Lavie, S. Kachur, R.V. Milani, H.O. Ventura, Updates on obesity and the obesity paradox in cardiovascular diseases. Prog. Cardiovasc. Dis. 78, 2–10 (2022)

    Article  PubMed  Google Scholar 

  31. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 396(10258):1223–1249 (2020)

  32. H. Dai, T.A. Alsalhe, N. Chalghaf, M. Riccò, N.L. Bragazzi, J. Wu, The global burden of disease attributable to high body mass index in 195 countries and territories, 1990-2017: An analysis of the Global Burden of Disease Study. PLoS Med. 17(7), e1003198 (2020)

    Article  PubMed  PubMed Central  Google Scholar 

  33. R.K. Akyea, W. Doehner, B. Iyen, S.F. Weng, N. Qureshi, G. Ntaios, Obesity and long-term outcomes after incident stroke: a prospective population-based cohort study. J. Cachexia Sarcopenia Muscle 12(6), 2111–2121 (2021)

    Article  PubMed  PubMed Central  Google Scholar 

  34. R.K. Sandhu, J. Ezekowitz, U. Andersson, J.H. Alexander, C.B. Granger, S. Halvorsen, M. Hanna, Z. Hijazi, P. Jansky, R.D. Lopes et al. The ‘obesity paradox’ in atrial fibrillation: observations from the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) trial. Eur. Heart J. 37(38), 2869–2878 (2016)

    Article  PubMed  Google Scholar 

  35. A. Romero-Corral, V.M. Montori, V.K. Somers, J. Korinek, R.J. Thomas, T.G. Allison, F. Mookadam, F. Lopez-Jimenez, Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies. Lancet 368(9536), 666–678 (2006)

    Article  PubMed  Google Scholar 

  36. T.B. Horwich, G.C. Fonarow, M.A. Hamilton, W.R. MacLellan, M.A. Woo, J.H. Tillisch, The relationship between obesity and mortality in patients with heart failure. J. Am. Coll. Cardiol. 38(3), 789–795 (2001)

    Article  CAS  PubMed  Google Scholar 

  37. K.J. Rothman, BMI-related errors in the measurement of obesity. Int J. Obes. (Lond.) 32, S56–S59 (2008)

    Article  PubMed  Google Scholar 

  38. M.E. Piché, P. Poirier, I. Lemieux, J.P. Després, Overview of Epidemiology and Contribution of Obesity and Body Fat Distribution to Cardiovascular Disease: An Update. Prog. Cardiovasc. Dis. 61(2), 103–113 (2018)

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors acknowledge all staff and participants of the Kailuan study for their important participation and contribution.

Author contributions

S.W. and A.W. had full access to all the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: S.W., A.W.; Acquisition, analysis, or interpretation of data: X.X., S.C., X.T., Q.X.; Drafting of the manuscript: X.X., S.C.; Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: X.X., S.C., Y.Z., X.Z., J.L.; Obtained funding: A.W. Administrative, technical, or material support: P.W., S.W., A.W.; Supervision: S.W., A.W.

Funding

This work was supported by the National Key Research and Development Program of China (2022YFC3600600), Training Fund for Open Projects at Clinical Institutes and Departments of Capital Medical University (CCMU2022ZKYXZ009), and Beijing Natural Science Foundation Haidian original innovation joint fund (L222123).

Author information

Author notes

  1. These authors contributed equally: Xue Xia, Shuohua Chen.

Authors and Affiliations

  1. Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China

    Xue Xia, Xue Tian, Qin Xu, Yijun Zhang, Xiaoli Zhang, Jing Li, Penglian Wang & Anxin Wang

  2. China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China

    Xue Xia, Xue Tian, Qin Xu, Yijun Zhang, Xiaoli Zhang, Jing Li, Penglian Wang & Anxin Wang

  3. Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, Tangshan, 063000, Hebei, China

    Shuohua Chen & Shouling Wu

  4. Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, 100069, China

    Xue Tian & Yijun Zhang

  5. Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China

    Xue Tian & Yijun Zhang

Authors
  1. Xue Xia
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shuohua Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xue Tian
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Qin Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yijun Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xiaoli Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jing Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Penglian Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Shouling Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Anxin Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Shouling Wu or Anxin Wang.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Consent to participate

Written informed consent was obtained from all participants before data collection.

Ethical approval

The whole study complies with the Declaration of Helsinki and has been approved by the Ethics Committees of both Kailuan General Hospital and Beijing Tiantan Hospital.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Xia, X., Chen, S., Tian, X. et al. Association of body mass index with risk of cardiometabolic disease, multimorbidity and mortality: a multi-state analysis based on the Kailuan cohort. Endocrine 84, 355–364 (2024). https://doi.org/10.1007/s12020-023-03570-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12020-023-03570-w

Keywords

Search

Navigation