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Life sciences · Journal article
PLOS One · November 4, 2026
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BACKGROUND: Type 2 diabetes (T2D) represents a growing global health challenge, with management increasingly focused on organ protection and mitigating cardiometabolic-renal risk. In sub-Saharan African geriatric populations, the interplay between frailty, hypertension, and obesity presents critical diagnostic and management challenges. This prospective cohort study evaluated the baseline prevalence of T2D and the prospective risk of major adverse clinical outcomes associated with a concomitant high-risk cardiometabolic phenotype among older adults in Añisok, Equatorial Guinea. METHODS: A total of 1,702 older adults (aged 60-100 years) were enrolled and followed prospectively from July 2024 to December 2025 (median follow-up: 18.6 months). Participants were stratified at baseline into a High Cardiometabolic Risk Cohort (n = 1,500; concomitant presence of obesity [BMI ≥ 30 kg/m2] AND hypertension [BP ≥ 140/90 mmHg or active antihypertensive treatment]) and a Low-Risk / Control Cohort (n = 202; normotensive and BMI < 30 kg/m2). Baseline prevalent T2D, prospective incident T2D (among baseline non-diabetics, n = 612), composite Major Adverse Cardiometabolic and Renal Events (MACRE), acute renal function decline, metabolic dysfunction-associated steatotic liver disease (MASLD), and peripheral vascular complications were evaluated using multivariable Poisson regression with robust variance and logistic regression models. RESULTS: The overall baseline prevalence of T2D across the entire cohort was 64.0% (n = 1,090; 95% CI: 61.7%-66.3%). Among baseline non-diabetic participants (n = 612), the prospective 18-month incidence of T2D was 31.4% (n = 192). Over follow-up, composite MACRE occurred in 17.5% (263/1,500) of the high-risk cohort versus 4.5% (9/202) in the control cohort (adjusted Relative Risk [aRR] = 3.41, 95% CI: 1.75-6.66; p < 0.001). The high-risk phenotype was also independently associated with prospective peripheral vascular necrosis (aRR = 5.82, 95% CI: 1.44-23.51; p = 0.013) and baseline target-organ damage (aOR = 2.18, 95% CI: 1.84-2.58; p < 0.001). The prospective absolute risk difference (ARD) for composite MACRE between primary exposure cohorts was 13.0% (95% CI: 9.8%-16.2%), while the overall cumulative target-organ complication ARD was 18.8% (95% CI: 15.2%-22.4%). In secondary subgroup analysis stratified by baseline prevalent diabetes status, diabetic participants (n = 1,090) accumulated 263 composite MACRE events (24.1%) compared to 9 events (1.5%) in non-diabetic participants (n = 612; ARD = 22.6%, 95% CI: 19.8%-25.4%; p < 0.001). CONCLUSIONS: Concomitant obesity and hypertension are independently associated with a significantly higher prevalence of target-organ involvement and prospective risk of cardiorenal and vascular complications in older adults in rural Equatorial Guinea. These findings highlight the need for early multi-organ risk screening in primary care settings across resource-limited central African populations.