Exploring the diabesity characteristics and associated all‑cause mortality at a population level : results from a small European island state

Abstract

Aim: Diabesity, the co-occurrence of diabetes and obesity, presents a global health crisis. Understanding its prevalence, associated risk factors, and mortality outcomes is crucial for effective public health interventions. This study aims to investigate the prevalence of diabesity and diabetes, assess associated risk factors, and analyze mortality outcomes over a 7-year period in the diabetogenic country of Malta. Subject and methods: A nationwide health examination survey (2014–16) was conducted involving 3947 adults aged 18–70 years. Sociodemographic data, anthropometric measurements, and blood samples were collected. Relationships between different adiposity indices were explored. Mortality data was obtained by cross-referencing with the national mortality register. Statistical analyses included chi-square tests, logistic regression, and Cox proportional hazard models. Results: Prevalence of obesity was 34.08%, diabetes 10.31%, and diabesity 5.78%. Sociodemographic characteristics were similar across all three cohorts. Multivariable regression identified increasing age (OR 1.10 CI95% 1.07–1.12; p≤ 0.001), male gender (OR 0.53 CI95% 0.30–0.93; p = 0.03), and low educational level (OR 2.19 CI95% 1.39–3.45; p = 0.001) as significant predictors of diabesity. Only diabetes showed a significant increase in mortality risk (HR 3.15 CI95% 1.31–7.62; p = 0.02) after adjustment, with gender (HR 3.17 CI95% 1.20–8.37) and body adiposity index (HR 1.08 CI95% 1.01–1.16) also significant (p ≤ 0.05). Conclusion: Diabesity represents a substantial public health challenge in Malta, with implications for mortality outcomes. Targeted interventions addressing sociodemographic disparities and promoting healthy lifestyles are essential to mitigate its impact. The findings underscore the need for comprehensive healthcare strategies and policy initiatives to combat diabesity and reduce associated mortality rates.