Han Xiaoyan, Wu Huimin, Li Youjia, Yuan Meng, Gong Xia, Guo Xiao, Tan Rongqiang, Xie Ming, Liang Xiaoling, Huang Wenyong, Liu Hua, Wang Lanhua
The First People's Hospital of Zhaoqing, Zhaoqing, China.
Shenzhen Children's Hospital, Shenzhen, China.
Front Med (Lausanne). 2022 May 27;9:774216. doi: 10.3389/fmed.2022.774216. eCollection 2022.
The relationship between obesity and diabetic retinopathy (DR) remains controversial. The aim of this study was to assess the association of generalized obesity [assessed by body mass index (BMI)] and abdominal obesity [assessed by waist to hip ratio (WHR)] with incident DR, and vision-threatening DR (VTDR), and DR progression among Chinese adults with type 2 diabetic mellitus (T2DM).
This prospective cohort study was conducted at the Zhongshan Ophthalmic Center, from November 2017 to December 2020. DR was assessed based on the 7-filed fundus photographs using the modified Airlie House Classification. Multivariable logistic regression models were used to evaluate the associations of BMI and WHR with the development and progression of DR after adjusting for age, sex, traditional risk factors, and mutually for BMI and WHR.
Among the 1,370 eligible participants, 1,195 (87.2%) had no sign of any DR and 175 (12.8%) had DR at baseline examination. During the 2 years follow-up visit, 342 (28.6%) participants had incident DR, 11 (0.8%) participants developed VTDR, 15 (8.6%) demonstrated DR progression. After adjusting for confounders, the BMI was negatively associated with incident DR [relative risk (RR) =0.31; 95% confidence interval (CI), 0.26-0.38; < 0.001] and incident VTDR (RR = 0.22; 95%CI, 0.11-0.43; < 0.001), while WHR was positively associated with incident DR (RR = 1.47; 95% CI, 1.27-1.71; < 0.001). BMI and WHR level were not significantly associated with 2-year DR progression in multivariate models (all > 0.05).
This study provides longitudinal evidence that generalized obesity confer a protective effect on DR, while abdominal obesity increased the risk of DR onset in Chinese patients, indicating that abdominal obesity is a more clinically relevant risk marker of DR than generalized obesity.
肥胖与糖尿病视网膜病变（DR）之间的关系仍存在争议。本研究旨在评估中国2型糖尿病（T2DM）成年患者中，全身性肥胖[通过体重指数（BMI）评估]和腹部肥胖[通过腰臀比（WHR）评估]与DR发病、威胁视力的DR（VTDR）以及DR进展之间的关联。
本前瞻性队列研究于2017年11月至2020年12月在中山眼科中心进行。基于7视野眼底照片，采用改良的艾利屋分类法评估DR。多变量逻辑回归模型用于评估在调整年龄、性别、传统危险因素以及BMI和WHR相互调整后，BMI和WHR与DR发生和进展的关联。
在1370名符合条件的参与者中，1195名（87.2%）在基线检查时无任何DR迹象，175名（12.8%）有DR。在2年的随访期间，342名（28.6%）参与者发生了DR，11名（0.8%）参与者发展为VTDR，15名（8.6%）出现DR进展。在调整混杂因素后，BMI与DR发病[相对风险（RR）=0.31；95%置信区间（CI），0.26 - 0.38；P < 0.001]和VTDR发病（RR = 0.22；95%CI，0.11 - 0.43；P < 0.001）呈负相关，而WHR与DR发病呈正相关（RR = 1.47；95%CI，1.27 - 1.71；P < 0.001）。在多变量模型中，BMI和WHR水平与2年DR进展无显著关联（均P > 0.05）。
本研究提供了纵向证据，表明全身性肥胖对DR具有保护作用，而腹部肥胖增加了中国患者DR发病的风险，表明腹部肥胖比全身性肥胖是更具临床相关性的DR风险标志物。
