Differential effect of body mass index on the incidence of diabetes and diabetic retinopathy in two Asian populations

Chan, Joel Chee Yee; Chee, Miao Li; Tan, Nicholas; Cheng, Ching‐Yu; Wong, Tien Yin; Sabanayagam, Charumathi

doi:10.1038/s41387-018-0018-0

Cited by 36 publications

(29 citation statements)

References 45 publications

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“…40 Sasongko et al 41 reported that high BMI was significantly associated with lower risk of DR in Indonesians with type 2 diabetes. Similarly, Chan et al 42 reported an inverse association between BMI and incidence of DR in separate prospective cohorts of Malays and Indians.…”

Section: Discussionmentioning

confidence: 82%

“…38,39 On the contrary, several studies have shown that obesity has the potential to diminish the severity of DR in Asians with type 2 diabetes. [40][41][42] Man et al 40 pointed out that generalized obesity and abdominal obesity may have different effects on DR. Although a high waist-to-hip ratio increased the risk of DR, a high BMI decreased the risk of DR in Asians with type 2 diabetes recruited from the Singapore National Eye Centre.…”

Section: Discussionmentioning

confidence: 99%

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<p>Influence of Diabetic Retinopathy on the Relationship Between Body Mass Index and Mortality in Patients with Poorly Controlled Type 2 Diabetes</p>

Li¹,

Sheu²,

Lee³

2020

DMSO

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Purpose: An "obesity paradox" has been observed in patients with type 2 diabetes. However, the optimal body mass index (BMI) for survival may be influenced by the stage of diabetes. We examined the relationship between BMI and mortality in patients with type 2 diabetes and the influence of diabetic retinopathy (DR). Patients and Methods: This is a retrospective cohort composing patients with type 2 diabetes who were admitted due to poor glucose control. Presence of DR was confirmed by ophthalmologists. The primary outcome was all-cause mortality. The association between BMI and mortality was assessed using a Cox proportional hazards model with adjustment for age, sex, and traditional risk factors. Results: A total of 2053 patients were enrolled. Over median follow-up of 6.7 years, there were 1060 deaths. Patients were classified into five categories based on admission BMI (kg/m 2): <18.5, 18.5-23, 23-25, 25-27 (reference), 25-30 and >30. Mortality risk was significantly higher in the <18.5 kg/m 2 , 18.5-23 kg/m 2 , and 23-25 kg/m 2 categories than in the reference category (P <0.001). The similar obesity paradox was observed in the subgroup of patients without DR. However, in patients with DR, only patients with BMI <18.5 kg/m 2 had significantly increased mortality than those in the reference category. The presence of DR significantly modified the shape of the association between BMI and mortality (P = 0.019). Conclusion: The obesity paradox exists in patients with poorly controlled type 2 diabetes. The presence of DR appears to significantly influence the shape of the association between BMI and mortality.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

<p>Influence of Diabetic Retinopathy on the Relationship Between Body Mass Index and Mortality in Patients with Poorly Controlled Type 2 Diabetes</p>

Li¹,

Sheu²,

Lee³

2020

DMSO

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“…The exact mechanisms underlying the inverse association between BMI and DR are uncertain. 48 It may not be that higher BMI is protective towards DR, but that individuals with lower BMI may have more severe DM (as patients with decompensated disease may undergo a catabolic phase resulting in unintentional weight loss) and thus have a higher risk of developing DR. 48 Lu et al also attributed this inverse relationship to better pancreatic β-cell function in overweight individuals. 46 In contrast to our observation, however, studies in Turkey 23 and Australia 49 found obesity to be an independent risk factor for DR with persons with higher BMI being more likely to have DR and more severe stages of DR.…”

Section: Discussionmentioning

confidence: 99%

“…The observation of a lower prevalence of DR in patients with a higher BMI in this study should therefore, be interpreted with caution as overweight and obesity have been associated with many health risks including DM as well as overall mortality. 48,51,52 A limitation of this study was our inability to do optical coherence tomography and Fundus Fluorescein Angiography (FFA) due to lack of necessary equipment.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and risk factors for diabetic retinopathy in north-central Nigeria

Ewuga¹,

Adenuga²,

Wade³

et al. 2018

Ghana Medical Journal

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Background: To determine the prevalence, pattern and risk factors of Diabetic Retinopathy (DR) among patients with Diabetes Mellitus (DM) in a tertiary hospital in north-central Nigeria. Settings and Design: This was a hospital-based cross-sectional study conducted in Jos, north-central Nigeria. Materials and Methods: Consecutive adult patients with DM attending the endocrinology clinic who consented to the study were examined over a six-month period. Demographic data, duration of diabetes and history of any systemic disorder were obtained for each patient. A detailed ocular examination and fundus photography were performed and results of blood investigations such as Fasting Blood Glucose (FBG), Glycosylated Haemoglobin (HbA1c) and serum lipid profile were analysed. Data analysis was done with Statistical Package for Social Sciences (SPSS) version 16.0 software. Results: Three hundred and fifty-six patients were examined comprising of 120 (33.7%) males and 236 (66.3%) females giving a male to female ratio of 1:2. The mean age of the study population was 56.6 ± 12.3 years. Diabetic retinopathy and macular oedema were present in 66 (18.5%) and 51 (14.3%) patients respectively. Diabetes diagnosis of 10 years and above, FBG and HbA1c all had a statistically significant association with DR with p values <0.001. Conclusion: The prevalence of DR was 18.5% in a hospital cohort of diabetic patients in north-central Nigeria with long duration of diabetes and poor glycaemic control being the major risk factors for retinopathy. These findings highlight the need for regular eye screening and good glycaemic control in individuals with diabetes in our environment.

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“…[28,30,31] Another study shows that higher body mass index was associated with a higher incidence of diabetes but a lower incidence of DR over a 6-year period in Asian Malays and Indians. [32] Among different eye diseases, obesity has been linked with age-related cataract, glaucoma, age-related maculopathy, and DR. However, the nature and strength of these associations remain to be determined.…”

Section: Association With Obesitymentioning

confidence: 99%

Hypertension and Chronic Disease Burden

He¹,

Chua²,

Teo³

2018

johtn

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Introduction Lifestyle-related non-communicable chronic diseases are the major causes of morbidity and mortality in both developed and developing countries. The major interrelated chronic diseases that have an impact on the population include hypertension, obesity, dyslipidemia, diabetes, and the metabolic syndrome. These diseases are more prevalent worldwide. The estimated global age-standardized prevalence of hypertension in adults aged ≥20 years in 2010 was 31.1%. [1] 39% of adults aged ≥18 years were overweight in 2016, and 13% were obese. [2] The prevalence of dyslipidemia was 34.0% in China and 15% in America. [3,4] The total number of diabetics aged 20-79 years worldwide was 425 million in 2017, accounting for 8.8% of the total. [5] Even more intractable is that these diseases do not exist alone, they interact with one another and damage end organs together, such as the heart, brain, kidney, and eye. It leads to coronary artery disease (CAD), cerebrovascular disease (CVD), chronic kidney disease (CKD), and retinopathy and contributes to the overall chronic disease burden. [6] Among these chronic diseases, hypertension is the biggest global health challenge due to its high prevalence and resulting target organs damage. [1] Hypertension affects >1 billion people worldwide, ranking third in terms of the global burden of disease. [7] It is the predominant risk factor for mortality in both industrialized nations and low-or middle-income countries. Hypertension is responsible for more than half of deaths from stroke, and 45% of deaths from CAD, and, alarmingly, for more than one-tenth of all global deaths. [8] Hypertension also accounts for up to one-fifth of end-stage renal disease in developing countries [9,10] and for CKD affecting 7% of the world's population. [9] Therefore, it is necessary to improve the current methods of identification, prevention, and treatment of hypertension and reduce the mortality from its complications. While we can identify these conditions, it is not so clear how we can assess the burden of these chronic diseases (end-organ damage) and its relationship to hypertension. For example, clinical practice guidelines recommend using urine albuminto-creatinine ratio as a means to detect target organ damage by

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Differential effect of body mass index on the incidence of diabetes and diabetic retinopathy in two Asian populations

Cited by 36 publications

References 45 publications

<p>Influence of Diabetic Retinopathy on the Relationship Between Body Mass Index and Mortality in Patients with Poorly Controlled Type 2 Diabetes</p>

<p>Influence of Diabetic Retinopathy on the Relationship Between Body Mass Index and Mortality in Patients with Poorly Controlled Type 2 Diabetes</p>

Prevalence and risk factors for diabetic retinopathy in north-central Nigeria

Hypertension and Chronic Disease Burden

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