Association between abdominal obesity and diabetic retinopathy in patients with diabetes mellitus: A systematic review and meta-analysis

Abstract

Objective Previous studies have reported different opinions regarding the association between abdominal obesity and diabetic retinopathy (DR) in patients with diabetes mellitus (DM). In this study, we aimed to investigate this problem through a systematic review and meta-analysis to provide a basis for clinical interventions. Methods A comprehensive search was conducted in the PubMed, Embase, and Web of Science databases up to May 1, 2022, for all eligible observational studies. Standardized mean differences (SMD) and 95% confidence intervals (CI) were evaluated using a random-effects model in the Stata software. We then conducted, publication bias assessment, heterogeneity, subgroup and sensitivity analyses. Results A total of 5596 DR patients and 17907 non-DR patients were included from 24 studies. The results of the meta-analysis of abdominal obesity parameters showed statistically significant differences between DR and non-DR patients in both type 1 and type 2 diabetes. Waist circumference (WC) was higher in patients with DR than in the non-DR patients. In the waist-hip ratio (WHR) subgroup, the level of WHR was higher in patients with DR than that in non-DR patients. The association between abdominal obesity and mild to moderate nonproliferative DR or vision-threatening DR groups did not show any statistical difference. Subgroup analysis according to ethnicity showed that Caucasians had higher levels of combined abdominal obesity parameters than Asians. Conclusion We found that abdominal obesity measured by WC and WHR is associated with DR in patients with type 1 and type 2 diabetes. This association is stronger in Caucasians than in Asians, where isolated abdominal obesity might be more related to DR. However, no correlation was found between abdominal obesity and varying degrees of diabetic retinopathy. Further prospective cohort studies with larger sample sizes are yet to be conducted to clarify our findings.

Weight loss, bariatric surgery, and novel antidiabetic drugs effects on diabetic retinopathy: a review

“…As the rising burden of type 2 DM is a major concern in worldwide healthcare, the utility of weight loss, bariatric surgery, and novel antidiabetic drugs to improve comorbidities have been increasingly studied. Early worsening of DR is a documented paradoxical phenomenon that follows rapid, intensive correction of HbA1c [2 ▪▪ ,8 ▪ ,9,10]. While intensive glycemic control may exhibit short-term retinopathy progression, it still emerges as a favorable strategy in the long-term.…”

“…In this same study, overweight participants randomized into lifestyle intervention counseling (including increased physical activity, fiber intake >15 g/1000 kcal, and 30% decrease in dietary fat intake) over a mean of 4 years demonstrated significantly decreased retinal microvascular abnormalities [odds ratio (OR) 0.52, P = 0.039] [7]. Other multivariable type 2 DM analyses demonstrate that the distribution of adipose tissue, especially abdominal obesity, was more closely associated with DR prevalence and severity than relative BMI [8 ▪ ]. The U.S. Diabetes Prevention Program Outcomes Study has challenged this association.…”

Investigating the causal association of generalized and abdominal obesity with microvascular complications in patients with type 2 diabetes: A community‐based prospective study

“…17,18,24 Nevertheless, the relationship between WC, the most commonly used parameter of abdominal adiposity, and DMC remains unclear. [24][25][26] Recent pooled analysis, largely of cross-sectional data, showed a positive association of WC with DN and DR. 57,58 This is, however, probably subject to the limitations mentioned above, including the time-varying confounding bias.…”

A Mediterranean Diet May Be Protective in the Development of Diabetic Retinopathy

“…A study conducted in Sweden showed that in T1DM and T2DM patients, the occurrence of DR was correlated with a high BMI [ 142 ]. It was also shown that abdominal obesity measured by waist circumference (WC) and waist-to-hip ratio (WHR) was positively associated with DR in patients with T1DM and T2DM [ 143 , 144 ]. Waist circumference (WC) was higher in patients with DR than in patients without DR.…”

“…Waist circumference (WC) was higher in patients with DR than in patients without DR. Similarly, the waist-to-hip ratio (WHR) was higher in patients with DR than in patients without DR [ 144 ]. However, no correlation was found between abdominal obesity and the severity of diabetic retinopathy [ 144 ].…”