{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T10:16:49Z","timestamp":1783592209904,"version":"3.55.0"},"reference-count":71,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Background. Cardiometabolic diseases are strongly socially patterned, with individuals of lower socioeconomic position experiencing a disproportionate burden of metabolic disorders. Obesity has been proposed as a potential explanatory factor that may partly account for the association between social disadvantage and adverse cardiometabolic profiles. This study aimed to evaluate whether obesity may partly explain the observed associations between socioeconomic position and multiple cardiometabolic outcomes. Methods. A cross-sectional study was conducted in 3108 working-age adults undergoing occupational health examinations in the Balearic Islands, Spain. Socioeconomic position was assessed using educational attainment and occupational category. Cardiometabolic outcomes included obesity, FLI-defined probable steatotic liver disease (FLI \u2265 60), insulin resistance, atherogenic risk, and metabolic syndrome. Multivariable logistic regression models with sequential adjustment were performed. Additional models evaluated attenuation after inclusion of obesity. Mediation analyses were conducted using bootstrapping methods. Results. A clear socioeconomic gradient was observed across all cardiometabolic outcomes, with higher prevalence among individuals with lower educational attainment (p for trend &lt; 0.001). In fully adjusted models, lower educational level remained significantly associated with obesity (OR 1.61; 95% CI 1.18\u20132.21), whereas associations with the remaining cardiometabolic outcomes were substantially attenuated after adjustment. Inclusion of obesity reduced effect estimates for FLI-defined probable steatotic liver disease (FLI \u2265 60), insulin resistance, atherogenic risk, and metabolic syndrome by approximately 53\u201372%. Exploratory mediation analyses suggested that obesity was associated with approximately 28% attenuation of the association with estimated steatotic liver disease risk and 8% attenuation of the association with insulin resistance. Conclusions. Socioeconomic inequalities in cardiometabolic risk were evident across multiple metabolic domains. Obesity was associated with substantial attenuation of several downstream cardiometabolic associations and may represent an important explanatory factor associated with the observed socioeconomic differences in metabolic health, particularly for estimated steatotic liver disease risk. However, the magnitude of these associations varied across outcomes, and the cross-sectional design precludes causal interpretation. These findings support the importance of addressing obesity within its broader social context as a potential strategy to reduce metabolic health inequalities among employed working-age adults.<\/jats:p>","DOI":"10.3390\/medsci14030382","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T08:50:56Z","timestamp":1783587056000},"page":"382","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Obesity as a Potential Explanatory Factor in the Association Between Socioeconomic Position and Multidimensional Cardiometabolic Risk"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3071-5897","authenticated-orcid":false,"given":"Mar\u00eda Te\u00f3fila","family":"Vicente-Herrero","sequence":"first","affiliation":[{"name":"ADEMA University School, University of the Balearic Islands, 07009 Palma, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7439-8117","authenticated-orcid":false,"given":"\u00c1ngel Arturo","family":"L\u00f3pez Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"ADEMA University School, University of the Balearic Islands, 07009 Palma, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5222-5784","authenticated-orcid":false,"given":"Pedro J.","family":"T\u00e1rraga L\u00f3pez","sequence":"additional","affiliation":[{"name":"Faculty of Medicine of Castilla La Mancha, 02008 Albacete, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9367-2137","authenticated-orcid":false,"given":"Carla","family":"Busquets-Cort\u00e9s","sequence":"additional","affiliation":[{"name":"ADEMA University School, University of the Balearic Islands, 07009 Palma, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3848-687X","authenticated-orcid":false,"given":"Lluis","family":"Rodas Ca\u00f1ellas","sequence":"additional","affiliation":[{"name":"ADEMA University School, University of the Balearic Islands, 07009 Palma, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6887-4562","authenticated-orcid":false,"given":"Jos\u00e9 Ignacio","family":"Ram\u00edrez Manent","sequence":"additional","affiliation":[{"name":"ADEMA University School, University of the Balearic Islands, 07009 Palma, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1093\/eurjpc\/zwae281","article-title":"Global burden of cardiovascular diseases: Projections from 2025 to 2050","volume":"32","author":"Chong","year":"2025","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2361","DOI":"10.1016\/j.jacc.2022.11.005","article-title":"The Global Burden of Cardiovascular Diseases and Risk: A Compass for Future Health","volume":"80","author":"Vaduganathan","year":"2022","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_3","unstructured":"World Health Organization (2025). Cardiovascular Diseases (CVDs), WHO. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/cardiovascular-diseases-(cvds)."},{"key":"ref_4","first-page":"54","article-title":"Impact of the Goldberg scale on cardiometabolic health: A study of 119,336 Spanish workers","volume":"40","author":"Garrido","year":"2025","journal-title":"Acad. J. Health Sci."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1555","DOI":"10.1007\/s11886-023-01969-5","article-title":"Body Fat Distribution, Diabetes Mellitus, and Cardiovascular Disease: An Update","volume":"25","author":"Kang","year":"2023","journal-title":"Curr. Cardiol. Rep."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"GBD 2021 Adult BMI Collaborators (2025). Global, regional, and national prevalence of adult overweight and obesity, 1990\u20132021, with forecasts to 2050: A forecasting study for the Global Burden of Disease Study 2021. Lancet, 405, 813\u2013838. Erratum in Lancet\u00a02025, 406, 810. https:\/\/doi.org\/10.1016\/S0140-6736(25)01722-2.","DOI":"10.1016\/S0140-6736(25)01722-2"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1656","DOI":"10.2105\/AJPH.2016.303326","article-title":"Determinants and Consequences of Obesity","volume":"106","author":"Hruby","year":"2016","journal-title":"Am. J. Public Health"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.1016\/S0140-6736(16)32380-7","article-title":"Socioeconomic status and the 25 \u00d7 25 risk factors as determinants of premature mortality: A multicohort study and meta-analysis of 1\u00b77 million men and women","volume":"389","author":"Stringhini","year":"2017","journal-title":"Lancet"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Hao, Z., Wang, M., Zhu, Q., Li, J., Liu, Z., Yuan, L., Zhang, Y., and Zhang, L. (2022). Association Between Socioeconomic Status and Prevalence of Cardio-Metabolic Risk Factors: A Cross-Sectional Study on Residents in North China. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.698895"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1093\/eurpub\/ckaf227","article-title":"Using lifespan variation to better understand long-term trends in health inequalities in Scotland and Europe","volume":"36","author":"Walsh","year":"2026","journal-title":"Eur. J. Public Health"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Zhou, L., Nutakor, J.A., Larnyo, E., Addai-Dansoh, S., Cui, Y., Gavu, A.K., and Kissi, J. (2024). Exploring socioeconomic status, lifestyle factors, and cardiometabolic disease outcomes in the United States: Insights from a population-based cross-sectional study. BMC Public Health, 24.","DOI":"10.1186\/s12889-024-19685-2"},{"key":"ref_12","first-page":"92","article-title":"Influence of tobacco consumption on the values of different cardiometabolic risk scales in 418,343 spanish workers","volume":"39","author":"Paublini","year":"2024","journal-title":"Acad. J. Health Sci."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/j.pop.2023.04.004","article-title":"Social Determinants of Health: An Overview for the Primary Care Provider","volume":"50","author":"Morelli","year":"2023","journal-title":"Prim. Care"},{"key":"ref_14","first-page":"e59497","article-title":"Racial and Socioeconomic Determinants of Cardiovascular Health: A Comprehensive Review","volume":"16","author":"Borkowski","year":"2024","journal-title":"Cureus"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"102420","DOI":"10.1016\/j.arr.2024.102420","article-title":"Frailty and socioeconomic position: A systematic review of observational studies","volume":"100","author":"Hanlon","year":"2024","journal-title":"Ageing Res. Rev."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Nie, P., Ding, L., Sousa-Poza, A., Leon, A.A., Xue, H., Jia, P., Wang, L., S\u00e1nchez, M.E.D., and Wang, Y. (2020). Socioeconomic position and the health gradient in Cuba: Dimensions and mechanisms. BMC Public Health, 20.","DOI":"10.1186\/s12889-020-08980-3"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1093\/her\/cyad026","article-title":"Exploring mechanisms and contexts in a Peer Education Project to improve mental health literacy in schools in England: A qualitative realist evaluation","volume":"39","author":"Curtin","year":"2024","journal-title":"Health Educ. Res."},{"key":"ref_18","first-page":"9","article-title":"Variables associated with overweight and obesity in Spanish healthcare workers","volume":"40","year":"2025","journal-title":"Acad. J. Health Sci."},{"key":"ref_19","first-page":"31","article-title":"Equation C\u00f3rdoba body fat values according to sociodemographic variables and healthy habits in 386,924 Spanish workers","volume":"39","author":"Vallejos","year":"2024","journal-title":"Acad. J. Health Sci."},{"key":"ref_20","first-page":"27","article-title":"Influence of sociodemographic variables and healthy habits on the values of overweight and obesity scales in 386,924 Spanish workers","volume":"39","author":"Paublini","year":"2024","journal-title":"Acad. J. Health Sci."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1093\/abm\/kay006","article-title":"Pathways Linking Childhood SES and Adult Health Behaviors and Psychological Resources in Black and White Men","volume":"52","author":"Boylan","year":"2018","journal-title":"Ann. Behav. Med."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"The Lancet (2024). Health equity in Ireland: Past, present, and future. Lancet, 403, 1205.","DOI":"10.1016\/S0140-6736(24)00628-7"},{"key":"ref_23","first-page":"20","article-title":"Factores de riesgo cardiometab\u00f3lico en 37.936 trabajadores de la salud espa\u00f1oles","volume":"40","author":"Villarroel","year":"2025","journal-title":"Acad. J. Health Sci."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Lin, X., and Li, H. (2021). Obesity: Epidemiology, Pathophysiology, and Therapeutics. Front. Endocrinol., 12.","DOI":"10.3389\/fendo.2021.706978"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1016\/j.cmet.2024.03.002","article-title":"Cardiometabolic characteristics of people with metabolically healthy and unhealthy obesity","volume":"36","author":"Petersen","year":"2024","journal-title":"Cell Metab."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1093\/eurpub\/ckr058","article-title":"Social inequalities in obesity and overweight in 11 OECD countries","volume":"23","author":"Devaux","year":"2013","journal-title":"Eur. J. Public Health"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1955","DOI":"10.1002\/oby.24358","article-title":"Projecting Global Trends and Inequalities in Adult Overweight and Obesity, 2023\u20132040: Findings from the NCD-RisC Database","volume":"33","author":"Liu","year":"2025","journal-title":"Obesity"},{"key":"ref_28","first-page":"53","article-title":"Comparative evolution of metabolic health status in obese individuals using novel and conventional anthropometric indexes: A decade-long analysis in Spanish workers","volume":"40","year":"2025","journal-title":"Acad. J. Health Sci."},{"key":"ref_29","first-page":"59","article-title":"Prevalencia de factores de riesgo cardiometab\u00f3lico. Comparativa sector Comercio vs. Industria y variables asociadas","volume":"39","year":"2024","journal-title":"Acad. J. Health Sci."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1186\/s12933-025-02689-6","article-title":"The prognostic significance of stress hyperglycemia ratio in evaluating all-cause and cardiovascular mortality risk among individuals across stages 0\u20133 of cardiovascular\u2013kidney\u2013metabolic syndrome: Evidence from two cohort studies","volume":"24","author":"Tan","year":"2025","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_31","first-page":"1","article-title":"Metabolic syndrome: A closer look at the growing epidemic and its associated pathologies","volume":"16","year":"2015","journal-title":"Obes. Rev."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e261","DOI":"10.1016\/S2468-2667(24)00018-5","article-title":"Life course epidemiology and public health","volume":"9","author":"Wagner","year":"2024","journal-title":"Lancet Public Health"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1016\/j.ssmph.2017.10.001","article-title":"Life course influences on later life health in China: Childhood health exposure and socioeconomic mediators during adulthood","volume":"3","author":"Kendig","year":"2017","journal-title":"SSM Popul. Health"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1152\/physrev.00002.2020","article-title":"Developmental origins of metabolic diseases","volume":"101","author":"Hoffman","year":"2021","journal-title":"Physiol. Rev."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.jjcc.2020.02.003","article-title":"Developmental origins of health and disease theory in cardiology","volume":"76","author":"Arima","year":"2020","journal-title":"J. Cardiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1161\/HYPERTENSIONAHA.123.21354","article-title":"Social Determinants of Health and Disparities in Hypertension and Cardiovascular Diseases","volume":"81","author":"Chaturvedi","year":"2024","journal-title":"Hypertension"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1177\/00221465221150381","article-title":"Socioeconomic Positions and Midlife Health Trajectories in a Changing Social Context: Evidence from China, 1991\u20132006","volume":"64","author":"Zhao","year":"2023","journal-title":"J. Health Soc. Behav."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies","volume":"370","author":"Altman","year":"2007","journal-title":"Lancet"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"132","DOI":"10.2486\/indhealth.2018-0169","article-title":"The Modified International Standard Classification of Occupations defined by the clustering of occupational characteristics in the Korean Working Conditions Survey","volume":"58","author":"Choi","year":"2020","journal-title":"Ind. Health"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"(1998). Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: Executive summary: Expert Panel on the Identification, Evaluation, and Treatment of Overweight in Adults. Am. J. Clin. Nutr., 68, 899\u2013917.","DOI":"10.1093\/ajcn\/68.4.899"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1038\/ejcn.2009.139","article-title":"Body fat distribution and noncommunicable diseases in populations: Overview of the 2008 WHO Expert Consultation on Waist Circumference and Waist-Hip Ratio","volume":"64","author":"Nishida","year":"2010","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_42","first-page":"65","article-title":"Determination of the risk of fatty liver and hepatic fibrosis in the working population of the Balearic Islands","volume":"39","year":"2024","journal-title":"Acad. J. Health Sci."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.ejim.2024.08.026","article-title":"Triglyceride glucose (TyG) index: A promising biomarker for diagnosis and treatment of different diseases","volume":"131","author":"Sun","year":"2025","journal-title":"Eur. J. Intern Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1186\/s12933-024-02334-8","article-title":"Metabolic score for insulin resistance (METS-IR) predicts all-cause and cardiovascular mortality in the general population: Evidence from NHANES 2001\u20132018","volume":"23","author":"Duan","year":"2024","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s12933-025-02589-9","article-title":"Association between atherogenic index of plasma and future risk of cardiovascular disease in individuals with cardiovascular-kidney-metabolic syndrome stages 0\u20133: A nationwide prospective cohort study","volume":"24","author":"Zheng","year":"2025","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_46","first-page":"59","article-title":"Cardiometabolic risk level in 1136 Spanish professional musicians","volume":"39","author":"Vallejos","year":"2024","journal-title":"Acad. J. Health Sci."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Sember, V., Meh, K., Sori\u0107, M., Starc, G., Rocha, P., and Jurak, G. (2020). Validity and Reliability of International Physical Activity Questionnaires for Adults across EU Countries: Systematic Review and Meta Analysis. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17197161"},{"key":"ref_48","first-page":"509","article-title":"Evaluation of adherence to the Mediterranean diet after a nutritional dietary intervention from primary care","volume":"43","author":"Rider","year":"2025","journal-title":"Nutr. Hosp."},{"key":"ref_49","unstructured":"Hayes, A.F. (2022). Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach, Guilford Press. [3rd ed.]."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"NCD Risk Factor Collaboration (NCD-RisC) (2016). Trends in adult body-mass index in 200 countries from 1975 to 2014: A pooled analysis of 1698 population-based measurement studies with 19\u00b72 million participants. Lancet, 387, 1377\u20131396. Erratum in Lancet\u00a02016, 387, 1998. https:\/\/doi.org\/10.1016\/S0140-6736(16)30472-X.","DOI":"10.1016\/S0140-6736(16)30054-X"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"e140","DOI":"10.1016\/S2468-2667(19)30248-8","article-title":"Association between socioeconomic status and the development of mental and physical health conditions in adulthood: A multi-cohort study","volume":"5","author":"Batty","year":"2020","journal-title":"Lancet Public Health"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1136\/bjsports-2022-105435","article-title":"Do associations of physical activity and sedentary behaviour with cardiovascular disease and mortality differ across socioeconomic groups? A prospective analysis of device-measured and self-reported UK Biobank data","volume":"57","author":"Paudel","year":"2023","journal-title":"Br. J. Sports Med."},{"key":"ref_53","first-page":"1056","article-title":"Socioeconomic Disparities in Women\u2019s Cardiovascular Health in the United States and Canada","volume":"40","author":"Kaur","year":"2024","journal-title":"Can. J. Cardiol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"2166","DOI":"10.1161\/CIRCULATIONAHA.117.029652","article-title":"Socioeconomic Status and Cardiovascular Outcomes: Challenges and Interventions","volume":"137","author":"Schultz","year":"2018","journal-title":"Circulation"},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Edwards, A.C., L\u00f6nn, S.L., Chartier, K.G., Lannoy, S., Sundquist, J., Kendler, K.S., and Sundquist, K. (2024). Socioeconomic position indicators and risk of alcohol-related medical conditions: A national cohort study from Sweden. PLoS Med., 21.","DOI":"10.1371\/journal.pmed.1004359"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1001\/jama.2010.332","article-title":"Health behavior vs the stress of low socioeconomic status and health outcomes","volume":"303","author":"Dunn","year":"2010","journal-title":"JAMA"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1186\/s12963-025-00424-7","article-title":"Life-course socioeconomic status and obesity: Scoping review","volume":"23","author":"Adamou","year":"2025","journal-title":"Popul. Health Metr."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"e70173","DOI":"10.1002\/clc.70173","article-title":"Association Between Educational Inequality and Income Inequality with Metabolic Diseases and Cause-Specific Mortality","volume":"48","author":"Niu","year":"2025","journal-title":"Clin. Cardiol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"2300","DOI":"10.1038\/s41366-021-00898-z","article-title":"Life course socioeconomic position and body composition in adulthood: A systematic review and narrative synthesis","volume":"45","author":"Kelly","year":"2021","journal-title":"Int. J. Obes."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1016\/j.gtc.2023.02.003","article-title":"Disparities in Access and Quality of Obesity Care","volume":"52","author":"Washington","year":"2023","journal-title":"Gastroenterol. Clin. N. Am."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1159\/000528083","article-title":"European Association for the Study of Obesity Position Statement on Medical Nutrition Therapy for the Management of Overweight and Obesity in Adults Developed in Collaboration with the European Federation of the Associations of Dietitians","volume":"16","author":"Hassapidou","year":"2023","journal-title":"Obes. Facts."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1007\/s13679-020-00398-7","article-title":"Socioeconomics of Obesity","volume":"9","author":"Anekwe","year":"2020","journal-title":"Curr. Obes. Rep."},{"key":"ref_63","first-page":"48","article-title":"Cardiometabolic risk level in 43,074 Spanish office workers: Associated variables","volume":"39","author":"Tosoratto","year":"2024","journal-title":"Acad. J. Health Sci."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1038\/s41569-023-00847-5","article-title":"Obesity and the risk of cardiometabolic diseases","volume":"20","author":"Valenzuela","year":"2023","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1007\/s13679-021-00464-8","article-title":"How Can We Act to Mitigate the Global Syndemic of Obesity, Undernutrition, and Climate Change?","volume":"11","author":"Dietz","year":"2022","journal-title":"Curr. Obes. Rep."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"117936","DOI":"10.1016\/j.socscimed.2025.117936","article-title":"Healthy eating in life course context: Asymmetric implications of socioeconomic origins and destinations","volume":"372","author":"Malo","year":"2025","journal-title":"Soc. Sci. Med."},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"M\u0142ynarska, E., Czarnik, W., Dzie\u017ca, N., J\u0119draszak, W., Majchrowicz, G., Prusinowski, F., Stabrawa, M., Rysz, J., and Franczyk, B. (2025). Type 2 Diabetes Mellitus: New Pathogenetic Mechanisms, Treatment and the Most Important Complications. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms26031094"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1038\/s41575-023-00807-x","article-title":"Hepatic inflammatory responses in liver fibrosis","volume":"20","author":"Hammerich","year":"2023","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"1335","DOI":"10.1097\/HEP.0000000000000004","article-title":"The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): A systematic review","volume":"77","author":"Younossi","year":"2023","journal-title":"Hepatology"},{"key":"ref_70","unstructured":"Marmot, M., Allen, J., Goldblatt, P., Boyce, T., McNeish, D., Grady, M., Geddes, I., Der, G., Feeney, C., and Taylor, J. (2010). Fair Society, Healthy Lives, The Marmot Review. Available online: https:\/\/www.instituteofhealthequity.org\/resources-reports\/fair-society-healthy-lives-the-marmot-review."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"e966","DOI":"10.1016\/S2468-2667(22)00223-7","article-title":"COVID-19 mortality and deprivation: Pandemic, syndemic, and endemic health inequalities","volume":"7","author":"McGowan","year":"2022","journal-title":"Lancet Public Health"}],"container-title":["Medical Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3271\/14\/3\/382\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T09:14:04Z","timestamp":1783588444000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3271\/14\/3\/382"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,9]]},"references-count":71,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["medsci14030382"],"URL":"https:\/\/doi.org\/10.3390\/medsci14030382","relation":{},"ISSN":["2076-3271"],"issn-type":[{"value":"2076-3271","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,9]]}}}