Excess visceral adiposity is associated with diabetic retinopathy in a multiethnic Asian cohort with longstanding type 2 diabetes

Moh, Angela; Neelam, Kumari; Zhou, Xiao; Sum, Chee Fang; Tavintharan, Subramaniam; Ang, Keven; Lee, Simon Biing Ming; Tang, Wern Ee; Lim, Su Chi

doi:10.1080/07435800.2018.1451541

Cited by 32 publications

(32 citation statements)

References 45 publications

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“…In contrast to previously reported positive associations between BMI and DR, other study demonstrated protective effects of higher BMI on DR, predominantly among Asians [35]. Additionally, recent metaanalyses reported no increased risk of DR by elevated BMI [33,34]. Discriminating between obesity and weight gain, the current results demonstrated that weight gain after new-onset diabetes could be a strong and novel independent risk factor of DR.…”

Section: A C C E P T E D a R T I C L Econtrasting

confidence: 99%

Weight change and microvascular outcomes in patients with new-onset diabetes: a nationwide cohort study

Koh

Han

Kim

et al. 2020

Korean J Intern Med

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Section: A C C E P T E D a R T I C L Econtrasting

confidence: 99%

Weight change and microvascular outcomes in patients with new-onset diabetes: a nationwide cohort study

Koh

Han

Kim

et al. 2020

Korean J Intern Med

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“…36 The role of adiposity is ambiguous in patients with DR. 37 DR has been shown to be associated with obesity. 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.…”

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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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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“…Body water was quantified using the tetrapolar multifrequency bioimpedance analysis (BIA) device (InBody‐S10; Biospace, Cerritos, California, USA). This procedure involved attaching electrodes in a tetrapolar configuration, followed by passing of weak alternating electric currents at frequencies of 1, 5, 50, 250, 500, and 1000 kHz through the electrodes 17 . BIA has been extensively used as it is safe, relatively low cost, not invasive, and markedly reproducible 6,18‐20 .…”

Section: Methodsmentioning

confidence: 99%

“…BIA has been extensively used as it is safe, relatively low cost, not invasive, and markedly reproducible 6,18‐20 . It has been used extensively by other investigators to estimate body water status 21‐23 and also in our earlier studies on a similar cohort 17,24,25 . ECW/TBW ratio was categorized as “no edema” (0.30‐0.38), “slight edema” (0.39‐0.40), or “edema” (>0.40), taking reference from InbodyS10 user manual 26 and earlier research using BIA 2,27 …”

Section: Methodsmentioning

confidence: 99%

Higher ratio of extracellular water to total body water was associated with reduced cognitive function in type 2 diabetes

Low

Lim

et al. 2020

Journal of Diabetes

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Background Fluid imbalance is associated with various clinical conditions, but the association between elevated extracellular‐water to total‐body‐water (ECW/TBW) ratio, an indicator of fluid balance, and cognitive impairment is unknown. We aimed to investigate relationship between ECW/TBW ratio and cognitive function in type 2 diabetes mellitus. Methods This study was a cross‐sectional design, comparing 1233 patients aged 61.4 ± 8.0 years from the Singapore Study of Macro‐angiopathy and Micro‐vascular Reactivity in Type 2 Diabetes (SMART2D) cohort. ECW/TBW was measured using bioelectrical impedance method. Cognitive function was assessed with Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Multiple linear regression was used to examine association between ECW/TBW and RBANS scores, adjusting for demographics, education, clinical covariates, and apolipoprotein E allele. Results In unadjusted analyses, there was an inverse dose‐dependent association between ECW/TBW and RBANS total score. The associations persisted in fully adjusted model with β = −1.18 (95% confidence interval [CI] −2.19 to −0.17; P = 0.022) for slight edema and −2.33 (−3.99 to −0.67; P = 0.006) for edema. Slight edema and edema were significantly associated with reduced cognitive function in delayed memory and attention. There was significant association between edema but not slight edema, with reduced cognitive function in language. Pulse pressure accounted for 16.8% of association between ECW/TBW and RBANS total score. Conclusions Our novel finding of an independent association between higher ECW/TBW and poorer cognitive function highlights the potential importance of maintaining body fluid balance in the management of cognitive impairment.

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Excess visceral adiposity is associated with diabetic retinopathy in a multiethnic Asian cohort with longstanding type 2 diabetes

Cited by 32 publications

References 45 publications

Weight change and microvascular outcomes in patients with new-onset diabetes: a nationwide cohort study

Weight change and microvascular outcomes in patients with new-onset diabetes: a nationwide cohort study

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

Higher ratio of extracellular water to total body water was associated with reduced cognitive function in type 2 diabetes

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