{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T17:27:21Z","timestamp":1790616441148,"version":"4.1.0"},"reference-count":21,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,7,22]],"date-time":"2025-07-22T00:00:00Z","timestamp":1753142400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,7,22]],"date-time":"2025-07-22T00:00:00Z","timestamp":1753142400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["dom-pubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Obesity Metabolism"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Obesity is a well\u2010established risk factor for atrial fibrillation (AF). However, the extent to which this association is driven by obesity\u2010related comorbidities such as hypertension, diabetes and heart failure versus a potential direct effect of obesity itself remains unclear. Differentiating between these pathways is important for developing effective and targeted prevention strategies. To investigate the association between body mass index (BMI) and incident AF using both multivariable Cox regression and causal mediation analysis (CMA), quantifying the extent to which this risk is mediated by obesity\u2010related comorbidities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective cohort study used the Disease Analyzer database (IQVIA) to identify patients aged \u226540\u2009years with documented BMI in German general practices between 2005 and 2023. Patients were categorised as normal weight (18.5\u201324.9\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ), overweight (25.0\u201329.9\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ) or obese (\u226530\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ). The primary outcome was a new diagnosis of AF within 10\u2009years. Multivariable Cox regression models were used and adjusted for age, sex and cardiometabolic comorbidities. CMA was used to estimate the proportion of AF risk mediated through diabetes, hypertension, dyslipidaemia, coronary artery disease and heart failure.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 392\u2009146 patients included in the study, AF incidence was 7.2% in normal weight, 10.1% in overweight and 13.2% in obese individuals over 10\u2009years. Obesity was associated with a significant increase in AF risk (HR 1.43; 95% CI 1.38\u20131.48), with a higher risk observed in men. CMA showed that 27% of the obesity\u2010related AF risk (106% excess total risk) was mediated through comorbidities, while 79% represented a direct effect. In women, the proportion of mediated effects was higher (up to 30.1%), suggesting sex\u2010specific differences in disease pathways.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Obesity significantly increases the risk of AF through both comorbidity\u2010related and potentially independent pathways. While nearly one\u2010third of the excess risk may be preventable through the management of cardiometabolic conditions, a notable proportion of the association remains unexplained by these mediators. These findings highlight the need for comprehensive strategies that address both obesity itself and its associated diseases to reduce the burden of AF.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dom.16637","type":"journal-article","created":{"date-parts":[[2025,7,22]],"date-time":"2025-07-22T08:54:26Z","timestamp":1753174466000},"page":"5822-5830","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Overweight, obesity and incident atrial fibrillation: Real\u2010world evidence from 400\u2009000 patients in Germany"],"prefix":"10.1111","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-9107-8063","authenticated-orcid":false,"given":"Jamschid","family":"Sedighi","sequence":"first","affiliation":[{"name":"Medical Clinic I, Cardiology and Angiology Justus\u2010Liebig\u2010University  Giessen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8149-8087","authenticated-orcid":false,"given":"Mark","family":"Luedde","sequence":"additional","affiliation":[{"name":"Medical Clinic I, Cardiology and Angiology Justus\u2010Liebig\u2010University  Giessen Germany"},{"name":"Christian\u2010Albrechts\u2010University of Kiel  Kiel Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priyanka","family":"Boettger","sequence":"additional","affiliation":[{"name":"Medical Clinic I, Cardiology and Angiology Justus\u2010Liebig\u2010University  Giessen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Bengel","sequence":"additional","affiliation":[{"name":"Medical Clinic I, Cardiology and Angiology Justus\u2010Liebig\u2010University  Giessen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascal","family":"Bauer","sequence":"additional","affiliation":[{"name":"Medical Clinic I, Cardiology and Angiology Justus\u2010Liebig\u2010University  Giessen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Sossalla","sequence":"additional","affiliation":[{"name":"Medical Clinic I, Cardiology and Angiology Justus\u2010Liebig\u2010University  Giessen Germany"},{"name":"Department of Cardiology Kerckhoff\u2010Clinic  Bad Nauheim Germany"},{"name":"German Center for Cardiovascular Research (DZHK)  Partner Site Rhine\u2010Main Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel Eduardo","family":"Rozo S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Epidemiology, IQVIA  Frankfurt Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karel","family":"Kostev","sequence":"additional","affiliation":[{"name":"Epidemiology, IQVIA  Frankfurt Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,7,22]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.123.032277"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.105.595140"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.292.20.2471"},{"key":"e_1_2_11_5_1","unstructured":"World Health Organization.Obesity and Overweight. 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