The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis

Abstract

Background: Overweight and obese persons are at risk of a number of medical conditions which can lead to further morbidity and mortality. The primary objective of this study is to provide an estimate of the incidence of each co-morbidity related to obesity and overweight using a meta-analysis.

Methods: A literature search for the twenty co-morbidities identified in a preliminary search was conducted in Medline and Embase (Jan 2007). Studies meeting the inclusion criteria (prospective cohort studies of sufficient size reporting risk estimate based on the incidence of disease) were extracted. Study-specific unadjusted relative risks (RRs) on the log scale comparing overweight with normal and obese with normal were weighted by the inverse of their corresponding variances to obtain a pooled RR with 95% confidence intervals (CI).

Results: A total of 89 relevant studies were identified. The review found evidence for 18 co-morbidities which met the inclusion criteria. The meta-analysis determined statistically significant associations for overweight with the incidence of type II diabetes, all cancers except esophageal (female), pancreatic and prostate cancer, all cardiovascular diseases (except congestive heart failure), asthma, gallbladder disease, osteoarthritis and chronic back pain. We noted the strongest association between overweight defined by body mass index (BMI) and the incidence of type II diabetes in females (RR = 3.92 (95% CI: 3.10-4.97)). Statistically significant associations with obesity were found with the incidence of type II diabetes, all cancers except esophageal and prostate cancer, all cardiovascular diseases, asthma, gallbladder disease, osteoarthritis and chronic back pain. Obesity defined by BMI was also most strongly associated with the incidence of type II diabetes in females (12.41 (9.03-17.06)).

Conclusion: Both overweight and obesity are associated with the incidence of multiple co-morbidities including type II diabetes, cancer and cardiovascular diseases. Maintenance of a healthy weight could be important in the prevention of the large disease burden in the future. Further studies are needed to explore the biological mechanisms that link overweight and obesity with these co-morbidities.

Figure 1

Flowchart of article distribution for all diseases.

Figure 2

Meta-analysis of studies for post menopausal breast cancer. *Q-statistic(p-value); F-up is follow-up in years; square shape: study- and gender- specific risk estimates; diamond shape: pooled risk estimates.

Figure 3

Meta-analysis of studies for endometrial cancer. *Q-statistic(p-value); **pre-menopause, square shape: study- and gender- specific risk estimates; diamond shape: pooled risk estimates.

Figure 4

Meta-analysis of studies for ovarian cancer. *Q-statistic(p-value); F-up is follow-up in years; square shape: study- and gender- specific risk estimates; diamond shape: pooled risk estimates.

Figure 5

Meta-analysis of studies for colorectal cancer-females. *Q-statistic(p-value); F-up is follow-up in years; square shape: study- and gender- specific risk estimates; diamond shape: pooled risk estimates.

Figure 6

Meta-analysis of studies for colorectal cancer-males. *Q-statistic(p-value); F-up is follow-up in years; square shape: study- and gender- specific risk estimates; diamond shape: pooled risk estimates.

Figure 7

Meta-analysis of studies for kidney cancer. *Q-statistic(p-value); F-up is follow-up in years; square shape: study- and gender- specific risk estimates; diamond shape: pooled risk estimates.

Figure 8

Meta-analysis of studies for pancreatic cancer. *Q-statistic(p-value); F-up is follow-up in years; square shape: study- and gender- specific risk estimates; diamond shape: pooled risk estimates.

Figure 9

Meta-analysis of studies for prostate cancer. *Q-statistic(p-value); F-up is follow-up in years; square shape: study- and gender- specific risk estimates; diamond shape: pooled risk estimates.

Figure 10

Meta-analysis of studies for type II diabetes. *Q-statistic(p-value); F-up is follow-up in years; square shape: study- and gender- specific risk estimates; diamond shape: pooled risk estimates.

Figure 11

Meta-analysis of studies for hypertension. *Q-statistic(p-value); F-up is follow-up in years; square shape: study- and gender- specific risk estimates; diamond shape: pooled risk estimates.

Figure 12

Meta-analysis of studies for stroke. *Q-statistic(p-value); F-up is follow-up in years; square shape: study- and gender- specific risk estimates; diamond shape: pooled risk estimates.

Figure 13

Meta-analysis of studies for coronary artery disease-females. *Q-statistic(p-value); F-up is follow-up in years; square shape: study- and gender- specific risk estimates; diamond shape: pooled risk estimates.

Figure 14

Meta-analysis of studies for coronary artery disease-males. *Q-statistic(p-value); F-up is follow-up in years; square shape: study- and gender- specific risk estimates; diamond shape: pooled risk estimates.

Figure 15

Meta-analysis of studies for congestive heart failure. *Q-statistic(p-value); **post-menopause; square shape: study- and gender- specific risk estimates; diamond shape: pooled risk estimates.

Figure 16

Meta-analysis of studies for asthma. *Q-statistic(p-value); F-up is follow-up in years; square shape: study- and gender- specific risk estimates; diamond shape: pooled risk estimates.

Figure 17

Meta-analysis of studies for osteoarthritis. *Q-statistic(p-value); F-up is follow-up in years; square shape: study- and gender- specific risk estimates; diamond shape: pooled risk estimates.

Figure 18

Meta-analysis of studies for gallbladder disease. *Q-statistic(p-value); F-up is follow-up in years; square shape: study- and gender- specific risk estimates; diamond shape: pooled risk estimates.