Body mass index and retinopathy in Asian populations with diabetes mellitus

Abstract

Body mass index (BMI) is an established risk factor for diabetes. However, the association between BMI and diabetic retinopathy (DR) has been inconclusive. We aimed to assess the association between BMI and DR in a large population-based sample of multi-ethnic Asian adults in Singapore. We examined 2,278 adults aged ≥40 years with diabetes who participated in three population-based studies conducted from 2004 to 2011: the Singapore Malay Eye Study, the Singapore Indian Eye Study, and the Singapore Chinese Eye Study. Retinal photographs taken from both eyes were graded for any and vision-threatening (VTDR) using the modified Airlie House Classification. BMI (kg/m(2)) was categorized into normal/underweight (<25), overweight (25-29.9), and obese (≥30). The prevalence rates of any and VTDR in the study population were 35.1 % and 9.1 %, respectively. The prevalence of any and VTDR decreased with increasing categories of BMI (P trend <0.001 and 0.005). In multivariable models adjusted for potential confounders, compared to those with normal weight, the odds ratio (95 % confidence interval) of any DR was 0.71 (0.57-0.88) for overweight and 0.70 (0.53-0.92) for obese. Corresponding estimates for VTDR were 0.84 (0.59-1.21) for overweight and 0.58 (0.35-0.94) for obese. The inverse association between BMI and any DR was consistently present when BMI was analyzed as a continuous variable and in analyses stratified by ethnicity and age. In a population-based sample of multi-ethnic Asian adults, BMI levels were inversely associated with any DR and VTDR.

Association between body mass index and diabetic retinopathy in Chinese patients with type 2 diabetes

“…On one hand, higher BMI correlates with elevated BP and worse lipid profile [26,33,34], known DR risk factors [11,13,14,18,21]. On the other hand, elevated BMI may exert beneficial effects: Increased BMI was associated with greater pancreatic b cell mass and higher CP levels [19,35,36].…”

“…Earlier studies suggested that higher BMI increases DR risk [17,18,[21][22][23], and there was higher DR prevalence in obese patients compared with normal weight patients [24]; other studies reported no association [15,19,25]. Recently, lower DR prevalence was reported in patients with higher BMI [26][27][28]. It is not known whether this obesity paradox exists between BMI and DR among Chinese type 2 diabetes patients.…”

“…These studies usually treated BMI as a continuous variable [17,18,[21][22][23], and the influence of overweight on DR presence was seldom investigated. Recently, Rooney et al [26] noted that overweight and obesity exerted a protective effect against the development of any DR compared with normal/underweight in Asian population. In India, Raman et al [27] reported that obesity (BMI C 23 kg/m 2 ) played a protective role against any DR.…”

Body mass index and risk of diabetic retinopathy

“…There may be some differences in the associations between WHR or BMI and DR. A study [27] evaluating the risk of DR in an obese population based on BMI and WHR showed an increased risk in the abdominal obesity group but not in the generalized obesity group. The mechanisms underlying the detrimental WHR-DR association were not defined; however, the high levels of inflammation [63] and insulin resistance [64] in the abdominal area of obese people may be responsible for the development of DR.…”

Retinal neurodegeneration in patients with type 1 diabetes mellitus: the role of glycemic variability

“…Moreover, a single-nucleotide polymorphism Rs2910164 was significantly associated with DR in patients affected by Type 1 and Type 2 diabetes mellitus (Type 1 DM; Type 2 DM) [4]. In Asian populations, BMI levels were inversely associated with DR [5], which may be due to better β cell function in overweight patients [6]. …”