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

Figures & data

Figure 1 Outlines the stepwise diagnostic procedures used to establish the diagnoses of diabetes and related conditions, sleep apnea, increased liver stiffness or increased liver fat, and arterial hypertension.

Table 1 Participants as Stratified by Sex, BMI and Age Group

		Sex		Age (years)
	All	Female	Male	18–29.9	30–39.9	40–49.9	≥50
Obese groups
Number BMI 30–34.9	132	94	38	17	32	28	55
Number BMI 35–39.9	216	162	54	31	48	59	78
Number BMI 40–44.9	207	153	54	34	52	56	65
Number BMI 45–49.9	118	84	34	22	26	30	40
Number BMI >50	96	68	28	15	32	25	24
Total BMI > 30	769	561	208	119	190	198	262
Reference group
Number BMI 18.5–29.9	161	107	54	13	30	56	62

Notes: Number of participants in the obese group and the reference group in each stratum of BMI, sex, and age. There are no differences in BMI or age distribution between men and women.

Table 2 Diabetes, Pre-Diabetic Conditions, and Metabolic Syndrome

	Obese												Reference Population
		Sex		BMI (kg/m^2)					Age (years)				BMI (kg/m^2)
	All Obese	Female	Male	30–34.9	35–39.9	40–44.9	45–49.9	≥50	18–29.9	30–39.9	40–49.9	≥50	18.5–29.9
New type 2 diabetes (%)	4.2	3.9	4.8	2.3	3.2	7.7	1.7	4.2	0.8	2.1	7.1	5.0	0.0
New prediabetes (%)	9.1	8.9	9.6	9.1	7.9	7.2	13.6	10.4	7.6	4.7	9.6	12.6	4.3
New IFG (%)	29.8	25.0	42.8	24.2	27.3	30.4	31.4	39.6	16.8	21.6	33.8	38.5	6.2
Known type 2 diabetes (%)	9.8	8.4	13.5	9.1	8.8	6.8	16.1	11.5	3.4	5.3	9.1	16.4	2.5
Total type 2 diabetes (%)	13.9	12.3	18.3	11.4	12.0	14.5	17.8	15.6	4.2	7.4	16.2	21.4	2.5
Metabolic syndrome (%)	35.8	32.1	45.7	25.0	36.6	35.7	39.8	43.8	36.1	37.9	38.9	31.7	5.0

Notes: Results from the diagnostic tests for diabetes, pre-diabetic conditions, and metabolic syndrome. Four subjects did not have an HbA1c measure. The diabetes diagnosis is based on two consecutive measures of HbA1c above or equal to 48 mmol/mol or one measure of HbA1c between 43 and 47 mmol/mol (both included) and a 120-minute value during oral glucose tolerance test above or equal to 11.1mmol/l or fasting plasma glucose above or equal to 7.1 mmol/l. The diagnosis of prediabetes includes one HbA1c between 43 and 47 mmol/mol (both included) and a 120-minute value during oral glucose tolerance test below 11.1 mmol/l and fasting plasma glucose below 7.1 mmol/l. The diagnosis of impaired fasting glucose (IFG) is based on FPG above or equal to 6.1 mmol/l and HbA1c below or equal to 47 mmol/mol. The same person may present both prediabetes and impaired fasting glucose. The metabolic syndrome is defined as a minimum of three of the following: Increased waist circumference (above 88 cm for women and above 102 cm for men), fasting triglycerides above or equal to 1.7 mmol/l, HDL lower than 1.295 mmol/l for women and 1.036 mmol/l for men) and high blood pressure defined as consultation blood pressure above 135 mmHg (systolic) or 85 mmHg (diastolic) or current treatment for hypertension. The group diagnosed with the metabolic syndrome did not include people with diabetes, prediabetes, or impaired fasting glucose. Number in bold cursive assigns statistical difference between sex, BMI group, or age group (p<0.05).

Table 3 Obstructive Sleep Apnea

	Obese												Reference Group
		Sex		BMI (kg/m^2)					Age (Years)				BMI (kg/m^2)
	All obese	Female	Male	30–34.9	35–39.9	40–44.9	45–49.9	≥50	18–29.9	30–39.9	40–49.9	≥50	18.5–29.9
New sleep apnea (%)	30.9	29.9	33.7	17.4	29.6	31.9	42.4	36.5	19.3	22.1	33.3	40.8	3.7
Berlin score ≥2.(%)	69.1	71.7	62.0	72.0	72.2	68.1	66.9	62.5	78.2	72.6	68.7	62.6	16.1
Epworth score ≥15 (%)	2.7	2.5	3.4	3.8	2.3	3.4	0.8	3.1	4.2	3.2	2.5	1.9	1.2
Subjected to CRM (%)	69.1	71.7	62.0	72.0	72.2	68.1	66.9	62.5	78.2	72.6	68.7	62.6	16.1
AHI ≥ 5 – <15 (EPH) (%)	23.4	25.5	17.8	30.3	24.1	23.7	16.9	19.8	26.9	27.4	24.7	17.9	8.7
AHI 15–30 (EPH) (%)	15.1	16.4	11.5	6.1	18.1	14.0	22.0	14.6	10.9	8.4	17.2	20.2	2.5
AHI ≥30 (EPH) (%)	10.0	7.0	18.3	3.0	8.3	12.1	14.4	13.5	2.5	8.4	8.1	16.0	1.2
Known sleep apnea (%)	15.0	10.2	27.9	7.6	9.7	16.4	21.2	26.0	6.7	7.9	17.7	21.8	2.5
Total sleep apnea (%)	45.9	40.1	61.5	25.0	39.4	48.3	63.6	62.5	26.1	30.0	51.0	62.6	6.2

Notes: Results of the diagnostic procedure of obstructive sleep apnea. All participants without known obstructive sleep apnea responded to the Epworth sleepiness questionnaire except for three subjects and the Berlin sleepiness scale except for three subjects. People showing signs of sleep apnea were subjected to CRM. Among 91 subjects, CRM data is unavailable because either the examination was unsuccessful or they were unwilling to undergo the test. Mild sleep apnea is defined as AHI ≥ 5 – <15 events per hour (EPH), moderate sleep apnea as AHI 15–30 EPH, and severe sleep apnea as AHI ≥30 EPH. Numbers in bold cursive assign statistical differences between sex, BMI group, or age group (p<0.05).

Table 4 Increased Liver Fat or Liver Fibrosis

	Obese												Reference Group
		Sex		BMI (kg/m^2)					Age (years)				BMI (kg/m^2)
	All Obese	Female	Male	30–34.9	35–39.9	40–44.9	45–49.9	≥50	18–29.9	30–39.9	40–49.9	≥50	18.5–29.9
FIB-4 score 1.45–2.67 (%)	3.9	2.7	7.2	4.5	2.3	4.8	3.4	5.2	0.0	0.0	2.9	9.9	11.2
FIB-4-score > 2.67 (%)	0.3	0.2	0.5	0.0	0.0	0.5	0.8	0.0	0.0	0.0	0.5	0.4	0.6
APRI score 0.5–1.5 (%)	4.2	2.3	6.7	3.0	1.9	7.7	4.2	3.1	5.0	4.2	4.0	3.8	5.6
APRI-score > 1.5 (%)	0.3	0.4	0.0	0.0	0.0	0.5	1.7	0.0	0.8	0.0	0.5	0.0	0.6
Fibro scan 8–12 (%)	11.7	8.6	20.2	3.8	6.0	11.6	19.5	26.0	8.4	14.7	13.1	9.9	0.6
Fibro scan > 12 (%)	5.7	3.7	11.1	0.0	1.4	5.8	12.7	14.6	4.2	4.2	5.1	8.0	0.6
CAP > 270 dB/meter (%)	68.1	61.5	86.1	50.8	62.0	70.0	82.2	84.4	60.5	68.9	66.7	72.1	11.8
Known liver disease (%)	23.1	18.2	36.5	7.6	15.3	21.7	39.0	45.8	15.1	25.8	25.8	22.9	1.9

Notes: Results of the diagnostic procedure of liver disease based on biochemistry and elastography. All subjects had the procedures performed irrespective of known liver disease. The Fib-4 score and APRI score are defined in the method section. A Fib-4 score between 1.45 and 2.67 indicates a moderate risk of fibrosis, while a score > 2.67 indicates a high risk of fibrosis. An APRI score of 0.5–1.5 indicates a moderate risk of fibrosis, while a score > 1.5 indicates a high risk of fibrosis. Known liver disease was based on patient reports supported by information from patient files. Fibroscan data were unavailable in 27 (3%) subjects either because the examination was unsuccessful or they were unwilling to undergo the test. Number in bold cursive assigns statistical difference between sex, BMI group, or age group (p<0.05).

Table 5 Arterial Hypertension

	Obese												Reference Group
		Sex		BMI (kg/m^2)					Age (years)				BMI (kg/m^2)
	All obese	Female	Male	30–34.9	35–39.9	40–44.9	45–49.9	≥50	18–29.9	30–39.9	40–49.9	≥50	18.5–29.9
New hypertension (%)	14.3	11.4	22.1	12.1	12.5	13.5	18.6	17.7	10.9	15.8	16.2	13.4	8.7
New WCH (%)	10.8	10.9	10.6	8.3	10.2	12.6	10.2	12.5	7.6	11.6	12.1	10.7	12.4
New masked hypertension (%)	4.7	3.9	6.7	4.5	4.6	4.3	7.6	2.1	6.7	5.3	5.1	3.1	3.1
Known hypertension (%)	30.2	25.8	41.8	19.7	31.0	34.3	33.1	30.2	11.8	14.7	31.8	48.5	13.0
Total hypertension (%)	49.2	41.2	70.7	36.4	48.1	52.2	59.3	50.0	29.4	35.8	53.0	64.9	24.8

Notes: Results of the diagnostic tests of arterial hypertension. Arterial hypertension is defined as blood pressure > 135 (systolic) or > 85 (diastolic) mmHg measured by both consultation blood pressure and 24-hour blood pressure (hypertension) or by 24-hour blood pressure only (masked hypertension). High consultation blood pressure only (white coat hypertension) was considered a benign condition. Total hypertension accordingly denotes new hypertension, new masked hypertension, and known hypertension, while WHC is omitted. Consultation blood pressure was measured in all subjects, while 24-hour blood pressure was unavailable in 103 subjects (11%) because either the examination was unsuccessful or they were unwilling to undergo the test. Number in bold cursive assigns statistical difference between sex, BMI group, or age group (p<0.05).

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.