Estimated Resting Metabolic Rate and Body Composition Measures Are Strongly Associated With Diabetic Retinopathy in Indonesian Adults With Type 2 Diabetes

Sasongko, Muhammad Bayu; Widyaputri, Felicia; Sulistyoningrum, Dian Caturini; Wardhana, Firman Setya; Widayanti, Tri Wahyu; Supanji, Supanji; Widyaningrum, Rifa; Indrayanti, Sarah Rizqia; Widhasari, Idhayu Anggit; Agni, Angela Nurini

doi:10.2337/dc18-1074

Cited by 22 publications

(22 citation statements)

References 39 publications

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“…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. 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: 99%

“…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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Influence of Diabetic Retinopathy on the Relationship Between Body Mass Index and Mortality in Patients with Poorly Controlled Type 2 Diabetes

Li¹,

Sheu²,

Lee³

2020

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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: 99%

Section: Discussionmentioning

confidence: 99%

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

Li¹,

Sheu²,

Lee³

2020

DMSO

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“…25 Following this line of thinking a recent work performed in a population of Indonesian patients with T2DM reported that body composition and overall estimated REE using BIA were strongly associated with and contributed considerably to the presence and severity of diabetic retinopathy independent of other systemic factors including diabetes duration, blood pressure, diabetes medication, and other diabetes complications. 26 Limitations of the present work are the crosssectional and retrospective nature of the analysis, the assessment of body composition using BIA methodology and the lack of knowledge for food preference. First, the retrospective analysis is the reason why the three groups of subjects resulted to be different in terms of some anthropometric parameters (sex, age and BMI; Table 1) with potential impact on energy metabolism; to minimize this potential bias we applied the appropriate adjustments for these differences in the multivariate analysis confirming the hypothesized association between REE and HOMA-IR (Table 2).…”

Section: Discussionmentioning

confidence: 99%

Resting Whole Body Energy Metabolism in Class 3 Obesity; from Preserved Insulin Sensitivity to Overt Type 2 Diabetes

Manzoni

Oltolini

Perra

et al. 2020

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Context: Insulin resistance and diabetes may influence separately or in combination whole body energy metabolism. Objective: To assess the impact of insulin resistance and/or overt type 2 diabetes on resting energy expenditure (REE) in class 3 obese individuals. Design and Setting: Retrospective, cross-sectional analysis of a set of data about individuals attending the outpatients service of a single center of bariatric surgery between January 2015 and December 2017. Patients: We screened 382 patients in which abnormal thyroid function was excluded, and segregated them in three groups of subjects: patients with type 2 diabetes (T2DM; n=70), nondiabetic insulin-resistant patients with HOMA-IR ≥ 3 (n=236), non-diabetic insulin-sensitive patients with HOMA-IR < 3 (n=75). Main Outcome Measure: Resting energy expenditure (REE), body composition and insulin resistance assessed using indirect calorimetry, bioimpedance and HOMA-IR. Results: Non-diabetic insulin-sensitive patients resulted to be younger, with lower BMI and higher prevalence of female subjects; meanwhile, non-diabetic but insulin-resistant patients and T2DM patients were not different in terms of anthropometric parameters. REE was higher in T2DM than in non-diabetic insulin-resistant and insulin-sensitive individuals when expressed as percent of the predicted REE (based on Harris Benedict equation) (p<0.0001) or when adjusted for kg of free fat mass (p<0.0001) and was found to be higher also in insulinresistant vs insulin-sensitive patients (p<0.001). The respiratory quotient was different between groups (0.87±0.11, 0.86±0.12 and 0.91±0.14 in T2DM, insulin-resistant and insulinsensitive patients, respectively; p<0.03). Regression analysis confirmed that HOMA-IR was independently associated with the REE (R 2 =0.110, p<0.001). Conclusion: Class 3 obese patients with normal insulin sensitivity are characterized by reduced fasting REE in comparison to insulin-resistant obese patients and obese patients with short duration of diabetes supporting the hypothesis that down-regulation of nutrients' oxidative disposal may represent an adaptation of energy metabolism in obese individuals with preserved insulin sensitivity.

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“…BMI is another index to assess the nutritional condition in routine clinical practice. Previous studies revealed that low BMI caused by uncontrolled glycaemia was correlated with an increased risk of DR. 32,33 Other studies discovered that high BMI or overnutrition, accompanied by hypertension and hyperlipidemia, brought about oxidative stress and inflammation, and then resulted in endothelial dysfunction, ultimately leading to the progression of DR. 34,35 Thus, the relationship between BMI and DR remains inconsistent. Abdominal obesity is considered as the risk for DR. 36 However, Muhammad et al discovered that WC was inversely associated with the severity of DR. 32 The current research suggested that there was no relationship between BMI and DR.…”

Section: Discussionmentioning

confidence: 99%

A Clinical Epidemiological Analysis of Prognostic Nutritional Index Associated with Diabetic Retinopathy

Yang¹,

Yu²,

Pan³

et al. 2021

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Purpose Prognostic nutritional index (PNI) is an effective tool to evaluate the nutritional conditions and predict prognosis, but clinical data are limited for the use of PNI in diabetic retinopathy (DR). This study aimed to investigate the relationship of PNI with the prevalence and severity of DR in patients with type 2 diabetes mellitus (T2DM). Patients and Methods This cross-sectional analysis enrolled 1023 individuals with T2DM hospitalized between 2017–2020. PNI was calculated as 10 × serum albumin (g/l) + 0.005 × total lymphocyte count (cells/mL). DR severity was categorized as no, nonproliferative, and vision-threatened DR (VTDR) according to the modified Airlie House classification. Multivariate-adjusted odds ratio (OR) with 95% confidence interval (CI) for the prevalent DR in the top (Q4) compared with the bottom quartile (Q1) of PNI levels were estimated by using logistic regression analyses. Results PNI levels were significantly lower in individuals with VTDR than those with no and nonproliferative DR (both P < 0.001), and the proportions of individuals with DR were significantly decreased in the top quartile compared with the bottom quartile of PNI levels ( P < 0.001). After adjustments for age, gender, DM duration, obesity-related risk factors and clinical biochemical parameters, the higher levels of PNI were significantly associated with a lower prevalence of DR (Q4 vs Q1: OR = 0.402, 95% CI: 0.250–0.649, P < 0.001), with a 5.9% reduction in the prevalence of DR for a per-unit increment in the levels of PNI (OR = 0.941, 95% CI: 0.911–0.972, P < 0.001). The association of PNI and obesity-related indexes (body mass index and waist circumference) with the severity of DR was independent of each other (P<0.001). Conclusion PNI was inversely and independently associated with the severity and prevalence of DR, which suggested that PNI could likely be used to predict DR prognosis in clinical practice.

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Estimated Resting Metabolic Rate and Body Composition Measures Are Strongly Associated With Diabetic Retinopathy in Indonesian Adults With Type 2 Diabetes

Cited by 22 publications

References 39 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>

<p>Resting Whole Body Energy Metabolism in Class 3 Obesity; from Preserved Insulin Sensitivity to Overt Type 2 Diabetes</p>

A Clinical Epidemiological Analysis of Prognostic Nutritional Index Associated with Diabetic Retinopathy

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