Prevalence and Clinical Impact of Overweight and Obesity in the Hemophilia Population

Introduction

According to estimates from the World Health Organization (WHO), the prevalence of obesity in the adult population has tripled since 1975. The estimated current prevalence of obesity is 13%, and overweight is even 39%. The obesity epidemic brings with it a number of mechanical and metabolic complications, such as an increased risk of osteoarthritis, cardiovascular and cerebrovascular diseases, type 2 diabetes mellitus, sleep apnea, liver and kidney diseases, psychiatric disorders, and certain types of malignant tumors.

Complications associated with overweight and obesity are also expected in the hemophilia population, where they may worsen the impact of the underlying disease on musculoskeletal function, as well as metabolism and mental health. The aim of the study with a meta-analysis of epidemiological data was to evaluate the prevalence of overweight and obesity and the clinical impact of increased body weight on the hemophilia population.

Prevalence of Obesity in the Hemophilia Population

Most available epidemiological data suggest that the prevalence of overweight and obesity in hemophiliacs is comparable to the general population, both in adults and children. Given that some studies disprove this finding and point to a reduced prevalence of overweight and obesity in hemophiliacs, a meta-analysis of available epidemiological data was conducted to create a more accurate estimate of the global prevalence of overweight and obesity in individuals with hemophilia.

In the global hemophilia population, according to the conclusions of this meta-analysis, the overall pooled prevalence of overweight and obesity was 17% (95% confidence interval [CI] 15.0–19.3). When only the European and North American hemophilia populations were evaluated, the estimated prevalence rose to 31% (95% CI 26.8–36.2%). When stratified by age, a higher prevalence of overweight and obesity was observed in adult hemophiliacs (43.3%) compared to children (26.9%). Interestingly, in comparison with North America, a higher prevalence of overweight and obesity in adult hemophiliacs was observed in Europe, but a lower prevalence in children. Similarly to the general population, an increase in the prevalence of overweight and obesity has been noted in hemophiliacs in recent years, by approximately 20% in adults and approximately 40% in children over a 10-year monitoring period.

Clinical Impact of Overweight and Obesity

In the United States, a reduction in the range of motion of weight-bearing joints with accelerated loss of mobility of these joints due to increased adiposity of soft tissues was observed in adult obese hemophiliacs. In Europe, a similar limitation of active flexion in the elbow and knee joints was documented in children with hemophilia.

In cases of overweight and obesity, a higher number of joint bleeds and limitations in lower limb function, as well as an association between obesity and chronic pain, were noted. Obesity is considered by some authors to be a protective factor against osteoporosis; however, data on the risk of skeletal osteoporosis and BMI value are inconsistent in studies with hemophiliacs.

It is well known that increased weight is one of the risk factors for the development of osteoarthritis of weight-bearing joints of the lower limbs, through complex mechanical and metabolic effects. As mentioned earlier, obesity accelerates the loss of joint function in hemophiliacs compared to hemophiliacs with normal weight. Although further clinical data will be needed for confirmation, obesity in hemophiliacs very likely increases the risk of severe joint damage requiring total joint replacement and simultaneously increases the risk of perioperative complications similarly to obese individuals in the general population.

Overweight and obesity are well-known risk factors for cardiovascular and metabolic diseases. In the hemophilia population, available data in the literature are conflicting. Although some studies have indicated a higher prevalence of arterial hypertension in hemophiliacs, more recent studies point to a rather lower prevalence. The situation is similar in the case of other cardiovascular diseases, and this area will require attention.

Other studies also point to an increased incidence of psychological disorders in obese patients with hemophilia, such as depression, anxiety, or sleep disorders. The development of psychological disorders in this patient group is likely complex, and in addition to obesity, the chronic bleeding disorder itself and numerous other factors will also be involved.

Conclusion

Results from the meta-analysis suggest that the estimated prevalence of overweight and obesity approaches that of the general population, and similarly to the general population, an increase has been observed in recent years in individuals with hemophilia. This is a serious medical problem requiring attention, as overweight and obesity can cause a number of complications. The most studied area in hemophiliacs is the impact of increased weight on the musculoskeletal system and psychological disorders. In contrast, in the case of the risk of cardiovascular diseases, no consistent data currently exist to indicate a clear association between obesity and the risk of cardiovascular diseases.

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Source: Wilding J., Zourikian N., Di Minno M. et al. Obesity in the global haemophilia population: prevalence, implications and expert opinions for weight management. Obes Rev 2018; 19 (11): 1569–1584, doi: 10.1111/obr.12746.