{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T07:26:03Z","timestamp":1787210763739,"version":"build-2736575974"},"reference-count":61,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Finnish state research funding"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Multimorbidity and Comorbidity"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Obesity and multimorbidity are increasing challenges for public health. While obesity is a well-recognized risk factor for multimorbidity, evidence commonly comes from cross-sectional studies using body mass index (BMI). Evidence on the body roundness index (BRI), a novel indicator of central obesity, remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study assessed midlife obesity as a risk factor for multimorbidity in a Finnish population cohort during 23 years of follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 1007 participants born between 1933 and 1956 and living in the Savitaipale municipality were enrolled between 1994 and 1996. Baseline data were collected using questionnaires and clinical examinations. Information on 38 chronic diseases was obtained from health registers. Obesity was assessed using BMI, waist circumference (WC), and BRI. Cox proportional hazards models estimated associations with incident multimorbidity, and receiver operating characteristic (ROC) analysis was used to derive BMI, WC and BRI thresholds with the best sensitivity\u2013specificity balance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Over 23 years, obesity defined by BMI and WC, as well as higher BRI, was associated with increased multimorbidity risk. Hazard ratios ranged from 1.52 (95% CI: 1.21\u20131.92) to 2.17 (95% CI: 1.59\u20132.97) in women and from 2.41 (95% CI: 1.82\u20133.19) to 2.79 (95% CI: 2.00\u20133.90) in men, depending on obesity and multimorbidity definitions. ROC-derived thresholds for multimorbidity prediction were: BMI 26.4 in women and 26.1 in men; WC 76.3 cm and 93.3 cm; and BRI 3.41 and 3.70, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This 23-year study highlights midlife obesity as a risk factor for multimorbidity in later life.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/26335565261478101","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T09:13:41Z","timestamp":1786958021000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Obesity as a risk factor for multimorbidity: a 23-years population-based prospective study"],"prefix":"10.1177","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-7224-9910","authenticated-orcid":false,"given":"Jussa-Pekka","family":"V\u00e4litalo","sequence":"first","affiliation":[{"name":"University of Oulu"},{"name":"Oulu University Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"Pesonen","sequence":"additional","affiliation":[{"name":"University of Oulu"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jouko","family":"Saramies","sequence":"additional","affiliation":[{"name":"South Karelia Wellbeing Services County"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sirkka","family":"Kein\u00e4nen-Kiukaanniemi","sequence":"additional","affiliation":[{"name":"University of Oulu"},{"name":"North Ostrobothnia Wellbeing Services County"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannu","family":"Uusitalo","sequence":"additional","affiliation":[{"name":"Tampere University"},{"name":"Tampere University Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Lybeck","sequence":"additional","affiliation":[{"name":"University of Tartu"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esko","family":"Hussi","sequence":"additional","affiliation":[{"name":"South Karelia Wellbeing Services County"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kadri","family":"Suija","sequence":"additional","affiliation":[{"name":"University of Tartu"},{"name":"University of Eastern Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaakko","family":"Tuomilehto","sequence":"additional","affiliation":[{"name":"University of Helsinki"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juha","family":"Auvinen","sequence":"additional","affiliation":[{"name":"University of Oulu"},{"name":"Oulu University Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,17]]},"reference":[{"key":"e_1_3_8_2_2","doi-asserted-by":"publisher","DOI":"10.3109\/13814789609162146"},{"key":"e_1_3_8_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF03391611"},{"key":"e_1_3_8_4_2","doi-asserted-by":"publisher","DOI":"10.1370\/afm.983"},{"key":"e_1_3_8_5_2","first-page":"i4843","article-title":"Clinical assessment and management of multimorbidity: Summary of NICE guidance","volume":"354","author":"Farmer C","year":"2016","unstructured":"Farmer C, Fenu E, O\u2019Flynn N, et al.. Clinical assessment and management of multimorbidity: Summary of NICE guidance. BMJ (Online) 2016; 354: i4843. https:\/\/doi.org\/10.1136\/bmj.i4843","journal-title":"BMJ (Online)"},{"issue":"1","key":"e_1_3_8_6_2","doi-asserted-by":"crossref","first-page":"e0245053","DOI":"10.1371\/journal.pone.0245053","article-title":"Multimorbidity patterns and their relationship to mortality in the US older adult population","volume":"16","author":"Diane Zheng D","year":"2021","unstructured":"Diane Zheng D, Loewenstein DA, Christ SL, et al. Multimorbidity patterns and their relationship to mortality in the US older adult population. PLoS One 2021; 16(1): e0245053. https:\/\/doi.org\/10.1371\/JOURNAL.PONE.0245053","journal-title":"PLoS One"},{"key":"e_1_3_8_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2015.02.012"},{"key":"e_1_3_8_8_2","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp20X713897"},{"key":"e_1_3_8_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.mad.2020.111383"},{"key":"e_1_3_8_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.maturitas.2017.12.004"},{"key":"e_1_3_8_11_2","article-title":"Multimorbidity and health related quality of life in midlife\u2013a longitudinal study from Northern Finland Birth Cohort 1966","author":"Junttila O","year":"2025","unstructured":"Junttila O, Pesonen P, Timonen M, et al.. Multimorbidity and health related quality of life in midlife\u2013a longitudinal study from Northern Finland Birth Cohort 1966. Scand J Prim Health Care 2025. Published online. https:\/\/doi.org\/10.1080\/02813432.2025.2492296;WGROUP:STRING:PUBLICATION","journal-title":"Scand J Prim Health Care"},{"key":"e_1_3_8_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60240-2"},{"key":"e_1_3_8_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2023.101860"},{"key":"e_1_3_8_14_2","unstructured":"Obesity and overweight. Accessed October 26 2024.https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/obesity-and-overweight"},{"key":"e_1_3_8_15_2","doi-asserted-by":"publisher","DOI":"10.1159\/000511023"},{"key":"e_1_3_8_16_2","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/cmt061"},{"key":"e_1_3_8_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-2667(17)30074-9"},{"key":"e_1_3_8_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmedr.2021.101338"},{"key":"e_1_3_8_19_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0246623"},{"key":"e_1_3_8_20_2","doi-asserted-by":"publisher","DOI":"10.1111\/obr.13562"},{"key":"e_1_3_8_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.maturitas.2020.04.016"},{"key":"e_1_3_8_22_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41366-018-0250-7"},{"key":"e_1_3_8_23_2","doi-asserted-by":"publisher","DOI":"10.1370\/afm.1337"},{"key":"e_1_3_8_24_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-021-11421-4"},{"key":"e_1_3_8_25_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph14030251"},{"key":"e_1_3_8_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.exger.2026.113044"},{"key":"e_1_3_8_27_2","doi-asserted-by":"publisher","DOI":"10.1002\/oby.20408"},{"key":"e_1_3_8_28_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0276216"},{"key":"e_1_3_8_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.numecd.2025.104475"},{"key":"e_1_3_8_30_2","doi-asserted-by":"publisher","DOI":"10.31083\/RCM39048"},{"issue":"1","key":"e_1_3_8_31_2","first-page":"1","article-title":"Obesity: preventing and managing the global epidemic. Report of a WHO Consultation on Obesity","volume":"894","author":"World health organization","year":"2000","unstructured":"World health organization. Obesity: preventing and managing the global epidemic. Report of a WHO Consultation on Obesity. Geneva, 1997 (WHO\/NUT\/NCD\/98.1). World Health Organ Tech Rep Ser 2000;894:(1): 1-8.","journal-title":"World Health Organ Tech Rep Ser"},{"key":"e_1_3_8_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30752-2"},{"key":"e_1_3_8_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcd.2021.09.010"},{"key":"e_1_3_8_34_2","doi-asserted-by":"publisher","DOI":"10.1177\/1403494812456637"},{"key":"e_1_3_8_35_2","doi-asserted-by":"publisher","DOI":"10.2147\/CLEP.S314959"},{"key":"e_1_3_8_36_2","doi-asserted-by":"publisher","DOI":"10.1177\/2235042X18795306"},{"key":"e_1_3_8_37_2","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/glq208"},{"issue":"10","key":"e_1_3_8_38_2","first-page":"1417","article-title":"Assessing and Measuring Chronic Multimorbidity in the Older Population: A Proposal for Its Operationalization","volume":"72","author":"Calder\u00f3n-Larra\u00f1aga A","year":"2017","unstructured":"Calder\u00f3n-Larra\u00f1aga A, Vetrano DL, Onder G, et al. Assessing and Measuring Chronic Multimorbidity in the Older Population: A Proposal for Its Operationalization. Journals of Gerontology - Series A Biological Sciences and Medical Sciences 2017; 72(10): 1417\u20131423. https:\/\/doi.org\/10.1093\/GERONA\/GLW233","journal-title":"Journals of Gerontology - Series A Biological Sciences and Medical Sciences"},{"key":"e_1_3_8_39_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjmed-2022-000247"},{"key":"e_1_3_8_40_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-5491.2006.01858.x"},{"key":"e_1_3_8_41_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-022-01978-x"},{"key":"e_1_3_8_42_2","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwf122"},{"key":"e_1_3_8_43_2","doi-asserted-by":"publisher","DOI":"10.1111\/1753-6405.12762"},{"key":"e_1_3_8_44_2","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.148.3.6878708"},{"key":"e_1_3_8_45_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)67483-1"},{"key":"e_1_3_8_46_2","doi-asserted-by":"publisher","DOI":"10.1111\/dom.15610"},{"key":"e_1_3_8_47_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-025-26060-2"},{"key":"e_1_3_8_48_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2024.1296939"},{"key":"e_1_3_8_49_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/cky098"},{"key":"e_1_3_8_50_2","doi-asserted-by":"publisher","DOI":"10.1370\/afm.1363"},{"key":"e_1_3_8_51_2","doi-asserted-by":"publisher","DOI":"10.1177\/26335565231173845"},{"key":"e_1_3_8_52_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-021-06989-x"},{"key":"e_1_3_8_53_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurjcn\/zvaa038"},{"key":"e_1_3_8_54_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.anzjph.2025.100280"},{"issue":"4","key":"e_1_3_8_55_2","first-page":"528","article-title":"Association Between Lifestyle Factors and the Incidence of Multimorbidity in an Older English Population","volume":"72","author":"Dhalwani NN","year":"2017","unstructured":"Dhalwani NN, Zaccardi F, O\u2019Donovan G, et al. Association Between Lifestyle Factors and the Incidence of Multimorbidity in an Older English Population. J Gerontol A Biol Sci Med Sci 2017; 72(4): 528\u2013534. https:\/\/doi.org\/10.1093\/GERONA\/GLW146","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"e_1_3_8_56_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnesp.2022.07.019"},{"key":"e_1_3_8_57_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmet.2013.03.008"},{"key":"e_1_3_8_58_2","doi-asserted-by":"publisher","DOI":"10.1152\/ajpcell.00379.2020"},{"key":"e_1_3_8_59_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.apsb.2023.01.012"},{"key":"e_1_3_8_60_2","doi-asserted-by":"publisher","DOI":"10.1097\/BOR.0b013e328349c2b1"},{"key":"e_1_3_8_61_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1514009"},{"key":"e_1_3_8_62_2","doi-asserted-by":"publisher","DOI":"10.1089\/wound.2013.0478"}],"container-title":["Journal of Multimorbidity and Comorbidity"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/26335565261478101","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/26335565261478101","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/26335565261478101","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T07:17:07Z","timestamp":1787210227000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/26335565261478101"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":61,"alternative-id":["10.1177\/26335565261478101"],"URL":"https:\/\/doi.org\/10.1177\/26335565261478101","relation":{},"ISSN":["2633-5565","2633-5565"],"issn-type":[{"value":"2633-5565","type":"print"},{"value":"2633-5565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]},"article-number":"26335565261478101"}}