Worldwide phenotypes and transitions in obesity-related multimorbidity

Lead Research Organisation: Imperial College London
Department Name: School of Public Health

Abstract

Gaining too much weight without getting taller damages different organs and functions of human body and causes many diseases. This means that people with obesity tend to have multiple diseases at the same time. This is called multimorbidity and has negative impacts on a person's overall health and wellbeing. Obesity has gone up for years in most countries, but how much it has increased differs between different regions of the world. In some parts of the world, obesity exists side by side with being undernourished. It is also believed that some people are more likely to gain weight in the form of fat that deposits in the abdomen compared to other parts of the body. Also, by how much those affected by obesity also experience other harmful social and lifestyle factors, like smoking, is different across the world. For these reasons, we expect that multimorbidity in people with obesity is a complex phenomenon that is different in different regions of the world. But there is very limited information on multimorbidity in people affected by obesity in terms of what combination of diseases they have and how common each combination is. This is especially the case in lower income countries.

This research study will use a large collection of data that have measured weight and height in tens of millions of people from different countries. The same data also have information about different diseases that people have or have had in the past, behaviours like smoking and alcohol use, and measures like blood pressure and cholesterol. The data do not have any information that can identify individual persons but can tell us what is happening in whole countries. The data have been brought together by hundreds of researchers, doctors and public health experts from around the world.

Our research team will use advanced methods to identify people who have similar set of diseases and measure how common each group (or cluster) of people is. For example, some people with obesity may have a combination of diabetes and kidney disease, and have had a stroke in the past. Another group may have liver disease, diabetes and back pain, and so on. We will also study how much differences in multimorbidity in people who have similar weight for their height is due factors like their smoking, alcohol use, blood pressure or cholesterol. Through this information, we can better use our budgets for providing optimal health care that will benefit people in each country, and to understand how obesity affects multiple diseases so that we can improve disease prevention. This work involves collaboration between researchers in the UK and in other regions of the world so that by the time it is completed, we will each be able to do studies like this in our own region and compare results to learn about the best ways to prevent and treat disease, and improve people's health.

Technical Summary

Obesity and multimorbidity are key challenges to population health in the UK and around the world. Obesity has increased in most countries but there is significant variation in the prevalence of obesity; distribution among class I, II and II obesity; body fat distribution; and whether obesity occurs alongside undernutrition and other risk factors such as tobacco use and high blood pressure and cholesterol. The overall aim of our interdisciplinary programme is to generate the evidence that will help select and prioritize interventions for prevention and treatment of the health burden of obesity throughout the world. To achieve this aim, in four integrated work packages, we will characterise and quantify key clusters of multimorbidity in those who are obese in comparison with those who are under-, normal- or over-weight in different world regions; estimate changes in the diseases contained in obesity-related multimorbidity clusters and in the prevalence of the clusters since 1990; quantify the role of individual demographic, behavioural, physiological and health care characteristics in variations in obesity-related multimorbidity; and establish an interdisciplinary UK-LMIC network for research on obesity and multimorbidity, and translation into clinical practice and policy. Our data will be from the largest global collection of population-based studies, collated through the NCD Risk Factor Collaboration. We will use statistical machine learning methods for probabilistic clustering of participants based on multiple morbidities, and for understanding the role of individual traits in variations in cluster allocation. Our programme will present a comprehensive view of the phenotypes and transitions in obesity-related multimorbidity in diverse populations, significantly advance global research on obesity from a focus on measurement to characterisation of multifaceted impacts on population health, and guide clinical and public health decisions.

Publications

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NCD Risk Factor Collaboration (NCD-RisC) (2023) Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c. in Nature medicine

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NCD Risk Factor Collaboration (NCD-RisC) (2023) Diminishing benefits of urban living for children and adolescents' growth and development. in Nature

 
Title Front cover of Nature Cardiovascular Research Volume 3 Issue 1, January 2024 
Description For Nature Cardiovascular Research (volume 3, issue 1) our paper on "Cardiometabolic and renal phenotypes and transitions in the United States population" was asked to be on the front cover. The artwork was done by marumaru / iStock / Getty Images Plus, and the cover design by Bethany Vukomanovic. The artwork shows how cardiometabolic and renal traits of the US population have shifted from phenotypes with high blood pressure and high cholesterol towards poor kidney function, hyperglycemia and severe obesity. 
Type Of Art Artwork 
Year Produced 2024 
Impact The impact of this artwork is hard to measure. However having the paper on the front cover will undoubtedly increase the reach of the paper. 
URL https://www.nature.com/natcardiovascres/volumes/3/issues/1
 
Title Front cover of Nature Medicine Volume 29 Issue 11, November 2023 
Description For the Nature Medicine Journal (Volume 29 Issue 11) our publication "Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c" was asked to on the front cover. The artwork was done by Abby Gregg, Savannah College of Art and Design, and University of Colorado, and the cover design by Marina Spence. The icebergs on the cover represent different world regions with varying extents of undiagnosed diabetes submerged below the surface; the colours of the ice illustrate detection with FPG or HbA1c. 
Type Of Art Artwork 
Year Produced 2023 
Impact The impact of this is hard to measure, but being on the front cover will have undoubtedly increased the reach of this paper. 
URL https://www.nature.com/nm/volumes/29/issues/11
 
Description Obesity: Biological, socioCultural, and environment risk Trajectories (OBCT)
Amount £1,584,101 (GBP)
Organisation United Kingdom Research and Innovation 
Sector Public
Country United Kingdom
Start 11/2023 
End 11/2028
 
Title Diminishing benefits of urban living for children and adolescents' growth and development 
Description NCD Risk Factor Collaboration (NCD-RisC) Code and Data Sharing This repository contains code and data for generating estimates of mean height and mean body-mass index (BMI) of children and adolescents aged 5 to 19 years living in rural and urban areas in 200 countries and territories from 1990 to 2020, as reported in the publication "Diminishing benefits of urban living for children and adolescents' growth and development" [1]. Contents Guide data/   The list of data sources used in the study, together with input data used in the model from publicly available sources and contact information for other data sources. model/   R code for the Bayesian hierarchical model used to analyse the data to estimate mean height and mean BMI by country, year, age and rural and urban place of residence. See methods section of publication [1] for details of the statistical methods. figures/   R code to produce figures as appeared in publication [1]. utils/   Essential covariate files; functions for producing figures. Contact For more information about the paper or the NCD Risk Factor Collaboration, please see www.ncdrisc.org or contact ncdrisc@imperial.ac.uk. Codes for producing publication figures are provided for transparency and in the spirit of scientific collaboration. We will not be able to answer questions about the details of these codes. Acknowledgements The shape file of the maps was based on Natural Earth [2]. Population data used in this analysis were obtained from the 2019 revision to the United Nations' World Population Prospects [3]. Data on percent national population living in urbanisation areas were obtained from the 2018 revision to the United Nations' World Urbanization Prospects [4]. References NCD Risk Factor Collaboration (NCD-RisC). Diminishing benefits of urban living for children and adolescents' growth and development. Nature, 2023. https://www.naturalearthdata.com/ United Nations, Department of Economic and Social Affairs, Population Division (2019). World Population Prospects 2019: Highlights (ST/ESA/SER.A/423) United Nations, Department of Economic and Social Affairs, Population Division (2018). World Urbanization Prospects: The 2018 Revision, Online Edition 
Type Of Technology Software 
Year Produced 2023 
Impact The release of the input data and code will have benefit other researchers looking to conduct similar analyses. 
URL https://zenodo.org/doi/10.5281/zenodo.7355602
 
Title Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c 
Description NCD Risk Factor Collaboration (NCD-RisC) Code and Data Sharing This repository will contain code and data used in the paper "Global variation in diabetes diagnosis and prevalence based on fasting glucose and haemoglobin A1c" [1]. Contents Guide NCD_RisC_Nature_Medicine_2023_input_data.xlsx The list of data sources used in the study, together with contact information for data access. multi-bugs-logbin-model.odc BUGS model code for log-binomial regressions to examine what individual and study level factors were associated with whether participants with screen-detected diabetes were identified by elevated FPG, elevated HbA1c or elevated levels of both. See methods section of the publication [1] for details. Contact For more information about the paper or the NCD Risk Factor Collaboration, please see www.ncdrisc.org or contact ncdrisc@imperial.ac.uk. Reference NCD Risk Factor Collaboration (NCD-RisC). Global variation in diabetes diagnosis and prevalence based on fasting glucose and haemoglobin A1c. Nature Medicine. 2023. 
Type Of Technology Software 
Year Produced 2023 
Impact The release of the input data and code will have benefit other researchers looking to conduct similar analyses. 
URL https://zenodo.org/records/8169146
 
Title Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population representative studies with 222 million children, adolescents, and adults 
Description NCD Risk Factor Collaboration (NCD-RisC) Code and Data Sharing This repository contains code and data for generating estimates of prevalence of underweight/thinness and obesity in school-aged children and adolescents aged 5 to 19 years, and adults aged 20+ years, in 200 countries and territories from 1990 to 2022, as reported in the publication "Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents and adults" [1]. Contents Guide data/ The list of data sources used in the study, together with input data used in the model from publicly available sources and contact information for other data sources. model/ R code for the Bayesian hierarchical model used to analyse the data to estimate underweight/thinness and obesity prevalence by country, year, and age, separately for children and adolescents and for adults. See methods section and Appendix Text 3 of publication [1] for details of the statistical methods. These codes were tested in R version 4.2.0, and package versions are given in the renv.lock file; see https://rstudio.github.io/renv/articles/renv.html for details on how to load these. figures/ R code to produce figures as appeared in publication [1]. utils/ Essential covariate files. Contact For more information about the paper or the NCD Risk Factor Collaboration, please see www.ncdrisc.org or contact ncdrisc@imperial.ac.uk. Codes for producing publication figures are provided for transparency and in the spirit of scientific collaboration. We will not be able to answer questions about the details of these codes. Other Materials Most users will prefer to access and use the complete NCD-RisC estimates of prevalence of underweight/thinness and obesity for children and adolescents and for adults, which are available here: www.ncdrisc.org/data-downloads.html. Acknowledgements The shape file of the maps was based on Natural Earth [2]. Population data used in this analysis were obtained from the 2019 revision to the United Nations' World Population Prospects [3]. Data on percent national population living in urbanisation areas were obtained from the 2018 revision to the United Nations' World Urbanization Prospects [4]. References NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents and adults. Lancet, 2024. https://www.naturalearthdata.com/ United Nations, Department of Economic and Social Affairs, Population Division (2019). World Population Prospects 2019: Highlights (ST/ESA/SER.A/423) United Nations, Department of Economic and Social Affairs, Population Division (2018). World Urbanization Prospects: The 2018 Revision, Online Edition 
Type Of Technology Software 
Year Produced 2024 
Impact The release of the input data and code will have benefit other researchers looking to conduct similar analyses. 
URL https://zenodo.org/records/10534961
 
Description American College of Cardiology Scientific Session 2023 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Open panel session at the American College of Cardiology Scientific Session 2023 / World Congress of Cardiology held by the World Heart Federation with discussion of the work at NCD Risk Factor Collaboration and the importance of data and health statistics for informing health policies and research. Increased the visibility of the Collaboration in an international clinical audience. Sparked discussions with the audience on issues and challenges pertinent to international collaborations in global health.
Year(s) Of Engagement Activity 2023
 
Description Joint webinar with the World Health Organization and the Lancet 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact Following the publication of the paper "Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults" (https://doi.org/10.1016/S0140-6736(23)02750-2) we hosted a joint webinar with the World Health Organization and the Lancet. The webinar was held on March 1st at 2pm CET.
The structure of the webinar was as a followed:
- Introduction by R.Horton, the Lancet
- Worldwide trends in underweight and obesity from 1990 to 2022 by Majid Ezzati, Imperial College London
- Accelerating the response to the double burden of malnutrition by F. Branca, World Health Organization
- Q&A moderated by R. Horton, the Lancet
- Concluding remarks A. Li and J. Solomon, World Health Organization

Link to the recording and password can be found here: https://ncdrisc.org/publications.html#2024
Year(s) Of Engagement Activity 2024
 
Description NCD-RisC Regional Collaborators Meeting 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact Imperial College London hosted a workshop to bring together 34 leading non-communicable disease (NCD) experts from different regions around the world. These experts included individuals from academia, clinical practice, government/policy, and international organisations. Those invited attended a day and a half long workshop in London. The workshop included presentations on the need for region-specific and country analyses, examples of previously conducted region-specific analyses, and how Imperial College London researchers can support future region-specific analyses. These presentations were followed by in depth discussions in region-specific breakout groups on what the focus of each region-specific analysis should be, the logistics of each analysis, and how to engage policy makers in these analyses to lead to policy change and impact in the area.
Year(s) Of Engagement Activity 2023