Functional and internalizing disorders co-aggregate with cardiometabolic and immune-related diseases within families: a population-based cohort study

Abstract Background Functional disorders share familial risk with internalizing disorders such as generalized anxiety disorder and depression, and are comorbid with cardiometabolic and immune-related diseases. We investigated whether functional and internalizing disorders co-aggregate with these dis...

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Main Authors: Olivier D. Steen, Martje Bos, Sonja L. van Ockenburg, Yiling Zhou, Ilja M. Nolte, Harold Snieder, Kenneth Kendler, Judith G. M. Rosmalen, Hanna M. van Loo
Format: Article
Language:English
Published: BMC 2025-08-01
Series:BMC Medicine
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Online Access:https://doi.org/10.1186/s12916-025-04293-7
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author Olivier D. Steen
Martje Bos
Sonja L. van Ockenburg
Yiling Zhou
Ilja M. Nolte
Harold Snieder
Kenneth Kendler
Judith G. M. Rosmalen
Hanna M. van Loo
author_facet Olivier D. Steen
Martje Bos
Sonja L. van Ockenburg
Yiling Zhou
Ilja M. Nolte
Harold Snieder
Kenneth Kendler
Judith G. M. Rosmalen
Hanna M. van Loo
author_sort Olivier D. Steen
collection DOAJ
description Abstract Background Functional disorders share familial risk with internalizing disorders such as generalized anxiety disorder and depression, and are comorbid with cardiometabolic and immune-related diseases. We investigated whether functional and internalizing disorders co-aggregate with these diseases in families to gain insight into the aetiology of functional and internalizing disorders.  Methods We included 166,774 subjects (aged 3–94), from the population-based Lifelines Cohort Study, a Dutch general population cohort. We defined cases for three functional disorders (myalgic encephalomyelitis/chronic fatigue syndrome; ME/CFS, fibromyalgia, and irritable bowel syndrome; IBS), two internalizing disorders (major depressive disorder; MDD and generalized anxiety disorder; GAD), cardiometabolic diseases (obesity, metabolic associated steatotic liver disease, type 2 diabetes, hypertension and cardiovascular disease) and immune-related diseases (composite measures of auto-immune disease and atopy). We used logistic regression to model the prevalence of these disorders in the general population and in participants with affected relatives. Using these prevalence estimates, we assessed familial co-aggregation with (1) recurrence risk ratios (λ R ), and (2) familial correlations (r f ). Results All functional and internalizing disorders co-aggregated with immune-related diseases (λ R range 1.06–1.24). ME/CFS, FM, and MDD co-aggregated with most cardiometabolic diseases (λ R range 1.00–1.23). MDD, fibromyalgia, and ME/CFS showed similar familial correlation patterns with both disease groups (r f range 0.12–0.44), while patterns of IBS and GAD were more variable. Conclusions Internalizing and functional disorders share familial risk with immune-related and cardiometabolic diseases. This suggests that risk factors relevant to immune-related and cardiometabolic diseases may also be relevant for FDs. Future studies should investigate such risk factors to identify novel treatment targets. 
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spelling doaj-art-b77e659c31444fcab552e450caefb8fc2025-08-20T03:46:09ZengBMCBMC Medicine1741-70152025-08-0123111110.1186/s12916-025-04293-7Functional and internalizing disorders co-aggregate with cardiometabolic and immune-related diseases within families: a population-based cohort studyOlivier D. Steen0Martje Bos1Sonja L. van Ockenburg2Yiling Zhou3Ilja M. Nolte4Harold Snieder5Kenneth Kendler6Judith G. M. Rosmalen7Hanna M. van Loo8Department of Psychiatry, University of Groningen, University Medical Center GroningenDepartment of Psychiatry, University of Groningen, University Medical Center GroningenDepartment of Internal Medicine, University of Groningen, University Medical Center GroningenDepartment of Epidemiology, University of Groningen, University Medical Center GroningenDepartment of Epidemiology, University of Groningen, University Medical Center GroningenDepartment of Epidemiology, University of Groningen, University Medical Center GroningenVirginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth UniversityDepartment of Psychiatry, University of Groningen, University Medical Center GroningenDepartment of Psychiatry, University of Groningen, University Medical Center GroningenAbstract Background Functional disorders share familial risk with internalizing disorders such as generalized anxiety disorder and depression, and are comorbid with cardiometabolic and immune-related diseases. We investigated whether functional and internalizing disorders co-aggregate with these diseases in families to gain insight into the aetiology of functional and internalizing disorders.  Methods We included 166,774 subjects (aged 3–94), from the population-based Lifelines Cohort Study, a Dutch general population cohort. We defined cases for three functional disorders (myalgic encephalomyelitis/chronic fatigue syndrome; ME/CFS, fibromyalgia, and irritable bowel syndrome; IBS), two internalizing disorders (major depressive disorder; MDD and generalized anxiety disorder; GAD), cardiometabolic diseases (obesity, metabolic associated steatotic liver disease, type 2 diabetes, hypertension and cardiovascular disease) and immune-related diseases (composite measures of auto-immune disease and atopy). We used logistic regression to model the prevalence of these disorders in the general population and in participants with affected relatives. Using these prevalence estimates, we assessed familial co-aggregation with (1) recurrence risk ratios (λ R ), and (2) familial correlations (r f ). Results All functional and internalizing disorders co-aggregated with immune-related diseases (λ R range 1.06–1.24). ME/CFS, FM, and MDD co-aggregated with most cardiometabolic diseases (λ R range 1.00–1.23). MDD, fibromyalgia, and ME/CFS showed similar familial correlation patterns with both disease groups (r f range 0.12–0.44), while patterns of IBS and GAD were more variable. Conclusions Internalizing and functional disorders share familial risk with immune-related and cardiometabolic diseases. This suggests that risk factors relevant to immune-related and cardiometabolic diseases may also be relevant for FDs. Future studies should investigate such risk factors to identify novel treatment targets. https://doi.org/10.1186/s12916-025-04293-7FibromyalgiaMyalgic encephalomyelitis/chronic fatigue syndromeIrritable bowel syndromeAetiologyFamilial co-aggregationCardiometabolic
spellingShingle Olivier D. Steen
Martje Bos
Sonja L. van Ockenburg
Yiling Zhou
Ilja M. Nolte
Harold Snieder
Kenneth Kendler
Judith G. M. Rosmalen
Hanna M. van Loo
Functional and internalizing disorders co-aggregate with cardiometabolic and immune-related diseases within families: a population-based cohort study
BMC Medicine
Fibromyalgia
Myalgic encephalomyelitis/chronic fatigue syndrome
Irritable bowel syndrome
Aetiology
Familial co-aggregation
Cardiometabolic
title Functional and internalizing disorders co-aggregate with cardiometabolic and immune-related diseases within families: a population-based cohort study
title_full Functional and internalizing disorders co-aggregate with cardiometabolic and immune-related diseases within families: a population-based cohort study
title_fullStr Functional and internalizing disorders co-aggregate with cardiometabolic and immune-related diseases within families: a population-based cohort study
title_full_unstemmed Functional and internalizing disorders co-aggregate with cardiometabolic and immune-related diseases within families: a population-based cohort study
title_short Functional and internalizing disorders co-aggregate with cardiometabolic and immune-related diseases within families: a population-based cohort study
title_sort functional and internalizing disorders co aggregate with cardiometabolic and immune related diseases within families a population based cohort study
topic Fibromyalgia
Myalgic encephalomyelitis/chronic fatigue syndrome
Irritable bowel syndrome
Aetiology
Familial co-aggregation
Cardiometabolic
url https://doi.org/10.1186/s12916-025-04293-7
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