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JAMA Ophthalmol. 2016 Mar;134(3):251-7. doi: 10.1001/jamaophthalmol.2015.5103.

Differential Association of Generalized and Abdominal Obesity With Diabetic Retinopathy in Asian Patients With Type 2 Diabetes.

Author information

1
Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.
2
Singapore Eye Research Institute, Singapore National Eye Centre, Singapore2Duke-National University of Singapore Graduate Medical School, Singapore.
3
Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
4
Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia.
5
Centre for Vision Research, Westmead Millennium Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia.
6
Singapore Eye Research Institute, Singapore National Eye Centre, Singapore2Duke-National University of Singapore Graduate Medical School, Singapore6Singapore National Eye Centre, Singapore.
7
Singapore National Eye Centre, Singapore.
8
Singapore Eye Research Institute, Singapore National Eye Centre, Singapore2Duke-National University of Singapore Graduate Medical School, Singapore4Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia.

Abstract

IMPORTANCE:

The association between obesity and diabetic retinopathy (DR) is equivocal, possibly owing to the strong interrelation between generalized and abdominal obesity leading to a mutually confounding effect. To our knowledge, no study in Asia has investigated the independent associations of these 2 parameters with DR to date.

OBJECTIVE:

To investigate the associations of generalized (defined by body mass index [BMI], calculated as weight in kilograms divided by height in meters squared) and abdominal obesity (assessed by waist to hip ratio [WHR]) with DR in a clinical sample of Asian patients with type 2 diabetes mellitus.

DESIGN, SETTING, AND PARTICIPANTS:

This cross-sectional clinic-based study was conducted at the Singapore National Eye Centre, a tertiary eye care institution in Singapore, from December 2010 to September 2013. We recruited 498 patients with diabetes. After exclusion of participants with ungradable retinal images and type 1 diabetes, 420 patients (mean [SD] age, 57.8 [7.5] years; 32.1% women) were included in the analyses.

EXPOSURES:

Body mass index and WHR as waist/hip circumference (in centimeters).

MAIN OUTCOMES AND MEASURES:

The presence and severity of DR were graded from retinal images using the modified Airlie House Classification into none (n = 189), mild-moderate (Early Treatment Diabetic Retinopathy Study scale score, 20-41; n = 125), and severe DR (Early Treatment Diabetic Retinopathy Study scale score ≥53; n = 118). The associations of BMI and WHR with DR were assessed using multinomial logistic regression models adjusting for age, sex, traditional risk factors, and mutually for BMI and WHR.

RESULTS:

Among the total of 420 patients, the median (interquartile range) for BMI and WHR were 25.7 (5.7) and 0.94 (0.08), respectively. In multivariable models, BMI was inversely associated with mild-moderate and severe DR (odds ratio [OR], 0.90 [95% CI, 0.84-0.97] and OR, 0.92 [95% CI, 0.85-0.99] per 1-unit increase, respectively), while WHR was positively associated with mild-moderate and severe DR (OR, 3.49 [95% CI, 1.50-8.10] and OR, 2.68 [95% CI, 1.28-5.62] per 0.1-unit increase, respectively) in women (P for interaction = .006). No sex-specific associations were found between BMI and DR (P for interaction >.10).

CONCLUSIONS AND RELEVANCE:

In Asian patients with type 2 diabetes, a higher BMI appeared to confer a protective effect on DR, while higher WHR was associated with the presence and severity of DR in women. Our results may inform future clinical trials to determine whether WHR is a more clinically relevant risk marker than BMI for individuals with type 2 diabetes.

[Indexed for MEDLINE]

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