Prevalence of Obesity-Related Disease in a Danish Population – The Results of an Algorithm-Based Screening Program

Abstract

Purpose

The prevalence of obesity continues to rise. People with obesity are at increased risk of several diseases. We tested an algorithm-based screening program for people with a BMI above 30 kg/m² and present data on the prevalence of previously undiagnosed obesity-related diseases.

Patients and Methods

Seven hundred and sixty-nine persons with BMI > 30 kg/m² and age 18–60 years were screened for diabetes (assessed by glycosylated hemoglobin and oral glucose tolerance test at HbA1c 43–48 mmol/mol), sleep apnea (screened by questionnaires and assessed by cardiorespiratory monitoring at indication of sleep disorder), liver steatosis or liver fibrosis (assessed by biochemistry and fibroscan) and arterial hypertension (assessed by both office and 24-hour blood pressure measurement). A reference group of people with a BMI of 18.5–29.9 kg/m² was established.

Results

Of those referred, 73.0% were women. We identified new diabetes in 4.2%, prediabetes in 9.1%, moderate-to-severe sleep apnea in 25.1%, increased liver fat and increased liver stiffness in 68.1% and 17.4%, respectively, and hypertension or masked hypertension in 19.0%. The prevalence of diseases was much higher among men and increased with BMI. Except for hypertension, we found few participants with undiagnosed disease in the reference group.

Conclusion

An algorithm-based screening program is feasible and reveals undiagnosed obesity-related disease in a large proportion of the participants. The disproportional referral pattern calls for a tailored approach aiming to include more men with obesity.

Trial Registration

Inclusion of the non-obese group was approved by the Scientific Ethics Committee of The Region of Southern Denmark (project identification number: S-20210091), and the study was reported at clinicaltrials.gov (NCT05176132).

Plain Language Summary

The number of people with obesity is going up, and they are at a higher risk for various diseases. We tested a screening program for people referred with a BMI over 30 kg/m² and presented the prevalence of diseases related to obesity. We screened 769 people aged 18 to 60 years with a BMI over 30 kg/m² for diabetes (biochemistry and glucose tolerance test), sleep apnea (both questionnaires and home monitoring), liver disease (biochemistry and liver scan) and high blood pressure (office and 24-hour readings). We also tested a reference group of people with BMI 18.5-30 kg/m². Among those screened, 73.0% were women. We found new cases of diabetes in 4.2%, prediabetes in 9.1%, sleep apnea in 25.1%, increased liver fat in 68.1%, increased liver stiffness in 17.4%, and hypertension or masked hypertension in 19.0%. The diseases were more common in men and increased with both higher BMI and age. Except for hypertension, we found few cases in the reference groups. The screening program uncovered undiagnosed obesity-related diseases in a large group of individuals. The uneven distribution of referrals suggests we need a customized approach to include more men with obesity.

Keywords:

• diabetes
• pre-diabetes
• sleep apnea
• metabolic dysfunction-associated steatotic liver disease
• hypertension

Abbreviations

T2D, type 2 diabetes; MASLD, metabolic dysfunction-associated steatotic liver disease; SDOI, South Danish Obesity Initiative; Hb1c, glycosylated hemoglobin or hemoglobin a1c; ALT, alanine aminotransferase; AST, aspartate aminotransferase; OGTT, Oral glucose tolerance test; IFG, Impaired fasting glucose; WCH, White coat hypertension; CRM, Cardiorespiratory monitoring; AHI, apnea-hypopnea index; ODI, Oxygen desaturation index.

Data Sharing Statement

De-identified individual participant data can be provided upon specific request to corresponding author (CBJ) and subsequent application and approval from the relevant authority. This will be available for five years from the day of publication.

Acknowledgments

The Hospital Management of University Hospital of Southern Denmark, Esbjerg, Denmark, is thanked for extensive support. The staff of SDOI (Birgitte Nielsen, Pia Hansen, Hanne Slemmings, Trine Ekblad and Martin Skriver Nicolaisen) are thanked for their dedicated attitude to the initiative.

Disclosure

The authors report no conflicts of interest in this work.