Genetics identifies obesity as a shared risk factor for co-occurring multiple long-term conditions

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Multimorbidity, the co-occurrence of multiple long-term conditions (LTCs), is an increasingly important clinical problem, but little is known about the underlying causes. We investigate the role of a critical multimorbidity risk factor, obesity, as measured by body mass index (BMI), in explaining shared genetics amongst 71 common LTCs. In a population of northern Europeans, we estimated genetic correlation, between LTCs and partial genetic correlations after adjustment for the genetics of BMI. We used multiple causal inference methods to confirm that BMI causally affects individual LTCs, and their co-occurrence. Finally, we quantified the population-level impact of intervening and lowering BMI on the prevalence of 15 key common multimorbid LTC pairs. BMI partially explains some of the shared genetics for 740 LTC pairs (30% of all pairs considered). For a further 161 LTC pairs, the genetic similarity between the LTCs was entirely accounted for by BMI genetics. This list included diabetes and osteoarthritis and gout and osteoarthritis: Causal inference methods confirmed that higher BMI acts as a common risk factor for a subset of these pairs, and therefore BMI-lowering interventions would likely reduce their prevalence. For example, we estimated that a 1 standard deviation or 4.5 unit decrease in BMI would result in 17 fewer people with both chronic kidney disease and osteoarthritis per 1000 who currently have both LTCs. Our genetics-centred approach quantifies the contribution of obesity to multi-morbidity. Our method for calculating full and partial genetic correlations is published as an R package {partialLDSC}. More than half of people over 65 have several long-term health conditions at the same time. This is becoming a bigger issue in the UK, but we don’t fully understand why some people develop many conditions. We looked at how body weight, measured by body mass index (BMI), affects the shared genetic risks for 71 common health problems such as diabetes, heart disease, arthritis and depression. Using data from people with northern European ancestry, we studied how much the same genes are linked to different conditions — both before and after taking the genetics of BMI into account. We found that BMI explains some of the shared genetic risks between many health conditions, and all of the shared risk for some, such as diabetes and osteoarthritis. Our results suggest that helping people lower their BMI could reduce the number of long-term health problems they experience, allowing more people to live longer and healthier lives. Mounier et al., analyse whether obesity, measured by body mass index (BMI) affects the shared genetic risk between 71 long-term health conditions including diabetes, heart disease and arthritis. Health interventions that help to lower BMI can reduce multimorbidity and promote longer and healthier lives.

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