Title : Global burden of childhood obesity and future multiple sclerosis incidence: A cross-national lagged correlation analysis using global burden of disease 2023 data Across
Abstract:
Background: Multiple sclerosis (MS) has historically been most common in high-income, high-latitude countries. However, childhood obesity rates are rising rapidly in middle-income and lower-income nations. The Global Burden of Disease (GBD) Study 2023, a comprehensive global health dataset, allows examination of whether countries experiencing obesity epidemics are on track to see rising MS rates in the future.
Objective: To determine whether countries with higher childhood obesity rates in the 1990s and early 2000s subsequently experienced greater MS-related disability burden by 2010-2023, and to identify which countries are most at risk for rising MS burden in the coming decades.
Methods: The GBD 2023 database was used to extract two measures for all 204 listed countries from 1990-2023. First was childhood obesity exposure, measured by the Summary Exposure Value (SEV) for high body-mass index in children and adolescents under 20. SEV is a standardized score measuring a population’s exposure extent from 0-100%. Second was MS disease burden, measured by the Disability-Adjusted Life Year (DALY) rate, a combined measure of healthy life years lost to MS, including premature death and years lived with disability.
To test whether childhood obesity predicts future MS burden, a 20-year time gap was introduced between the two measures comparing obesity rates from 1990-2003 against MS burden from 2010-2023. This lag reflects the link between childhood obesity with early adulthood MS development approximately 15 to 25 years later. Spearman rank correlation, which measures how consistently countries with higher obesity rankings also have higher MS burden rankings, was used without assuming a linear relationship between the two. The analysis was also repeated at 15 and 25 year lags.
Results: Countries with higher childhood obesity rates in 1990-2003 had significantly higher MS burden in 2010-2023 (r = 0.405, p = 1.9×10??), and this relationship held consistently whether a 15, 20, or 25 year lag was applied. Upper-middle income countries, including much of East and Southeast Asia, showed the sharpest rise in childhood obesity alongside MS rates that remain low today, consistent with a current unfolding lag effect. Thailand, Vietnam, Malaysia, China, and Indonesia showed the largest childhood obesity increases since 1990, yet currently have among the lowest MS burden in their regions (1.22 to 1.60 per 100,000) compared to the GBD high-income country mean MS burden of 36.6 per 100,000.
Conclusion: Countries experiencing rapid childhood obesity epidemics today may be on a trajectory toward significantly higher MS rates within the next one to two decades. The nations currently showing the largest gaps between rising obesity and still-low MS burden, particularly in East and Southeast Asia, represent high-priority targets for future MS surveillance and healthcare infrastructure investment. Reducing childhood obesity may carry neurological benefits that extend well beyond metabolic disease.
