The global syndemic of metabolic diseases in the young adult population: A consortium of trends and projections from the Global Burden of Disease 2000-2019

Bryan Chong; Gwyneth Kong; Kannan Shankar; H S Jocelyn Chew; Chaoxing Lin; Rachel Goh; Yip Han Chin; Darren Jun Hao Tan; Kai En Chan; Wen Hui Lim; Nicholas Syn; Siew Pang Chan; Jiong-Wei Wang; Chin Meng Khoo; Georgios K Dimitriadis; Karn Wijarnpreecha; Arun Sanyal; Mazen Noureddin; Mohammad Shadab Siddiqui; Roger Foo; Anurag Mehta; Gemma A Figtree; Derek J Hausenloy; Mark Y Chan; Cheng Han Ng; Mark Muthiah; Mamas A Mamas; Nicholas W S Chew

doi:10.1016/j.metabol.2023.155402

The global syndemic of metabolic diseases in the young adult population: A consortium of trends and projections from the Global Burden of Disease 2000-2019

Metabolism. 2023 Apr:141:155402. doi: 10.1016/j.metabol.2023.155402. Epub 2023 Jan 28.

Authors

Bryan Chong¹, Gwyneth Kong¹, Kannan Shankar¹, H S Jocelyn Chew², Chaoxing Lin¹, Rachel Goh¹, Yip Han Chin¹, Darren Jun Hao Tan¹, Kai En Chan¹, Wen Hui Lim¹, Nicholas Syn³, Siew Pang Chan⁴, Jiong-Wei Wang⁵, Chin Meng Khoo⁶, Georgios K Dimitriadis⁷, Karn Wijarnpreecha⁸, Arun Sanyal⁹, Mazen Noureddin¹⁰, Mohammad Shadab Siddiqui⁹, Roger Foo¹¹, Anurag Mehta¹², Gemma A Figtree¹³, Derek J Hausenloy¹⁴, Mark Y Chan¹¹, Cheng Han Ng¹, Mark Muthiah¹⁵, Mamas A Mamas¹⁶, Nicholas W S Chew¹⁷

Affiliations

¹ Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
² Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
³ Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of General Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore.
⁴ Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Biostatistics, Cardiovascular Research Institute, National University Heart Centre, NUHS, Singapore; Department of Cardiology, National University Heart Centre, National University Health System, Singapore.
⁵ Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Surgery, Cardiovascular Research Institute (CVRI), National University Heart Centre, Singapore; Nanomedicine Translational Research Programme, Centre for NanoMedicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
⁶ Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Endocrinology, Department of Medicine, National University Hospital, Singapore.
⁷ Department of Endocrinology ASO/EASO COM, King's College Hospital NHS Foundation Trust, Denmark Hill, London, United Kingdom; Obesity, Type 2 Diabetes and Immunometabolism Research Group, Department of Diabetes, Faculty of Cardiovascular Medicine & Sciences, School of Life Course Sciences, King's College London, London, United Kingdom.
⁸ Division of Gastroenterology and Hepatology, University of Arizona College of Medicine Phoenix, USA.
⁹ Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA.
¹⁰ Houston Research Institute, Houston, TX, USA.
¹¹ Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre, National University Health System, Singapore.
¹² Division of Cardiology, Virginia Commonwealth University, Richmond, VA, USA.
¹³ Northern Clinical School, Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia; Department of Cardiology, Royal North Shore Hospital, Sydney, New South Wales, Australia.
¹⁴ Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore; National Heart Research Institute Singapore, National Heart Centre, Singapore; The Hatter Cardiovascular Institute, University College London, London, UK; Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan.
¹⁵ Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore.
¹⁶ Institute of Population Health, University of Manchester, Manchester, UK; Keele Cardiac Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK.
¹⁷ Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre, National University Health System, Singapore. Electronic address: nicholas_ws_chew@nuhs.edu.sg.

PMID: 36717058
DOI: 10.1016/j.metabol.2023.155402

Abstract

Background: A significant proportion of premature deaths globally are related to metabolic diseases in young adults. We examined the global trends and mortality of metabolic diseases in individuals aged below 40 years using data from the Global Burden of Diseases, Injuries and Risk Factors Study (GBD) 2019.

Methods: From 2000 to 2019, global estimates of deaths and disability-adjusted life years (DALYs) were described for metabolic diseases (type 2 diabetes mellitus [T2DM], hyperlipidemia, hypertension, obesity, non-alcoholic fatty liver disease [NAFLD]). Subgroup analyses were performed based on sex, geographical regions and Socio-Demographic Index (SDI). Age-standardised death and DALYs were presented per 100,000 population with 95 % uncertainty intervals (UI). Projections of mortality and DALYs were estimated using regression models based on the GBD 2019 data and combining them with Institute for Health Metrics and Evaluation projection counts for years up to 2050.

Results: In 2019, the highest age-standardised death rates were observed in hypertension (133·88 [121·25-155·73]), followed by obesity (62·59 [39·92-89·13]), hyperlipidemia (56·51 [41·83-73·62]), T2DM (18·49 [17·18-19·66]) and NAFLD (2·09 [1·61-2·60]). Similarly, obesity (1932·54 [1276·61-2639·74]) had the highest age-standardised DALYs, followed by hypertension (2885·57 [2580·75-3201·05]), hyperlipidemia (1207·15 [975·07-1461·11]), T2DM (801·55 [670·58-954·43]) and NAFLD (53·33 [40·73-68·29]). Mortality rates decreased over time in hyperlipidemia (-0·6 %), hypertension (-0·47 %), NAFLD (-0·31 %) and T2DM (-0·20 %), but not in obesity (1·07 % increase). The highest metabolic-related mortality was observed in Eastern Mediterranean and low SDI countries. By 2050, obesity is projected to contribute to the largest number of deaths (102·8 % increase from 2019), followed by hypertension (61·4 % increase), hyperlipidemia (60·8 % increase), T2DM (158·6 % increase) and NAFLD (158·4 % increase), with males continuing to bear the greatest burden across all metabolic diseases.

Conclusion: The growing burden of metabolic diseases, increasing obesity-related mortality trends, and the sex-regional-socioeconomic disparities evident in young adulthood, underlie the concerning growing global burden of metabolic diseases now and in future.

Keywords: Diabetes mellitus; Global burden; Hypertension; Metabolic disease; Non-alcoholic fatty liver disease.

MeSH terms

Adult
Aged
Diabetes Mellitus, Type 2*
Global Burden of Disease
Humans
Hypertension*
Male
Metabolic Diseases*
Non-alcoholic Fatty Liver Disease*
Obesity
Quality-Adjusted Life Years
Risk Factors
Syndemic
Young Adult