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Obesity-related diseases

Obesity associated with an increased risk of T2DM and CAD

Three of the studies analysed also included stroke as a clinical outcome, but the researchers did not find a significant association between obesity and all-cause stroke

Obesity is associated with an increased risk of T2DM and coronary artery disease (CAD) and should remain a major focus of public health initiatives, according to a genetic analysis by the Cleveland Clinic. Interestingly, the researchers found that obesity itself, not just the adverse health effects associated with it, significantly increases the risk of T2DM and CAD.

In the paper, ‘Association Between Obesity and Cardiovascular Outcomes: A Systematic Review and Meta-analysis of Mendelian Randomization Studies’, published in the Journal of the American Medical Association Network Open, the researchers performed a meta-analysis of five studies with more than 881,692 participants. They examined participants' genetic variations using a method called Mendelian randomisation, which offers insight into the relationships between health risks and health outcomes.

By relying on genetic data, this method removes confounding, or outside, variables that can extraneously influence outcomes, such as smoking, high blood pressure, or elevated cholesterol. Mendelian randomisation cannot prove causality, but it can be suggestive of a causal association, as was the case in this study.

Pooled estimates revealed that obesity was significantly associated with an increased risk of type 2 diabetes (OR, 1.67; 95% CI, 1.30-2.14; p<0.001; I2 = 93%) and coronary artery disease (OR, 1.20; 95% CI, 1.02-1.41; p=0.03; I2 = 87%). No association between obesity and stroke was found (OR, 1.02; 95% CI, 0.95-1.09; p=0.65; I2 = 0%).

The present meta-analysis suggests that obesity is associated with type 2 diabetes and coronary artery disease. Hence, health care practitioners should continue to emphasize weight reduction to combat coronary artery disease.

"This study is important because we can conclude that it is not solely factors like high blood pressure, high cholesterol or lack of exercise that tend to come with obesity that are harmful, the excess fat itself is harmful," said Dr Haitham Ahmed, the senior author of the study and a preventive cardiologist at Cleveland Clinic. "Patients may think their cardiovascular risk is mitigated if their other risk factors are normal or being treated, but this study suggests you cannot ignore the extra weight. Physicians should take heed and make sure they are counselling their patients about weight loss in a comprehensive and collaborative manner."

The study showed that each five-point rise in BMI, for example from BMI25 to BMI30, increased the odds of Type 2 diabetes by 67 percent and coronary artery disease by 20 percent. In light of the Mendelian randomisation, these increases are thought to be independent of traditional risk factors. This means the risks hold true even if the patient has, for example, normal cholesterol, blood pressure and blood sugar. Three of the studies analysed also included stroke as a clinical outcome, but the researchers did not find a significant association between obesity and all-cause stroke.

"It is very important to recognize that while lifestyle factors certainly contribute to obesity, obesity is not simply a lifestyle choice. It is a disease, and there is large genetic influence on your weight," Dr. Ahmed said. "Our data show that nearly 100 genetic variations influence the development of obesity and subsequently increase your risk of heart disease."

To access this paper, please click here

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