Department of Family Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea.
Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Eye (Lond). 2019 Jun;33(6):980-987. doi: 10.1038/s41433-019-0352-z. Epub 2019 Feb 13.
To evaluate the association of body mass index (BMI), waist circumference, and body fat with diabetic retinopathy (DR) in Korean patients with type 2 diabetes.
Among the 1130 participants 19 years of age or older with type 2 diabetes enrolled in the nationwide survey, a total of 887 participants were included in the analyses after excluding patients with ungradable fundus images. The presence and severity of DR were graded with seven-field fundus photographs. The associations between DR and anthropometric parameters and total body fat, which was assessed by dual-energy X-ray absorptiometry, were analysed using multivariate logistic regression models.
Patients were divided into three groups according to severity of DR: no DR (n = 702, 79.1%), mild/moderate DR (n = 130, 14.7%), and vision-threatening DR (n = 55, 6.2%). In multivariate-adjusted analyses, higher BMI (adjusted odds ratio [aOR], 0.80; 95% confidence interval [CI], 0.70-0.92; P = 0.001), larger waist circumference (aOR, 0.96; 95% CI, 0.91-1.00; P = 0.047), and higher total body fat (aOR, 0.86; 95% CI, 0.79-0.92; P < 0.001) were significantly associated with a lower risk of vision-threatening DR. In sex-stratified analyses, however, only total body fat in women showed a significant inverse association with the presence of DR (aOR, 0.93; 95% CI, 0.88-0.98; P < 0.001) and independently with the severity of DR (P for trend = 0.004).
In Korean patients with type 2 diabetes, obese patients might be less likely to have vision-threatening DR. Total body fat in women appears to be inversely and independently associated with DR prevalence and progression.
评估体重指数（BMI）、腰围和体脂与韩国 2 型糖尿病患者糖尿病视网膜病变（DR）的相关性。
在参加全国性调查的 1130 名年龄在 19 岁及以上的 2 型糖尿病患者中，共有 887 名患者在排除了眼底图像不可评估的患者后被纳入分析。使用 7 个视野眼底照片对 DR 的存在和严重程度进行分级。使用多变量逻辑回归模型分析 DR 与人体测量参数和全身脂肪的关系，全身脂肪通过双能 X 射线吸收法评估。
根据 DR 的严重程度，患者被分为三组：无 DR（n=702，79.1%）、轻度/中度 DR（n=130，14.7%）和威胁视力的 DR（n=55，6.2%）。在多变量调整分析中，较高的 BMI（调整后的优势比[aOR]，0.80；95%置信区间[CI]，0.70-0.92；P=0.001）、较大的腰围（aOR，0.96；95%CI，0.91-1.00；P=0.047）和较高的全身脂肪（aOR，0.86；95%CI，0.79-0.92；P<0.001）与威胁视力的 DR 风险降低显著相关。然而，在性别分层分析中，只有女性的全身脂肪与 DR 的存在（aOR，0.93；95%CI，0.88-0.98；P<0.001）和严重程度（P 趋势=0.004）呈显著负相关。
在韩国 2 型糖尿病患者中，肥胖患者可能不太容易发生威胁视力的 DR。女性的全身脂肪似乎与 DR 的患病率和进展呈负相关且独立相关。
