Yue Yihua, Patel Sangita P, Nie Jing, Andrews Chris A, Wactawski-Wende Jean, Shadyab Aladdin H, Wallace Robert, Millen Amy E
Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, New York, United States.
Department of Ophthalmology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, New York, United States.
Invest Ophthalmol Vis Sci. 2025 Feb 3;66(2):26. doi: 10.1167/iovs.66.2.26.
Both genetic and environmental factors contribute to the development of Fuchs' endothelial corneal dystrophy (FECD), the most common indication for corneal transplantation in the United States. Prior studies have suggested an association of height, weight, or body mass index (BMI) with FECD. We examined the association between anthropometric measures and incident FECD in the Women's Health Initiative Observational Study (WHI-OS) of postmenopausal women (n = 22,983).
Medicare Part B claims data from the WHI-OS baseline visit (1993-1998) to 2019 were used to identify incident cases of FECD. At baseline and follow-up year 3, weight, height, waist circumference (WC), and hip circumference were measured. At baseline, women were asked to recall their historic weight at ages 18, 35, and 50 years. At follow-up years 1 and 4 to 8, the women were asked to self-report their weight. Height and weight were used to calculate BMI at each time point. Adjusted hazard ratios (HRs), 95% confidence intervals (CI), and p for trend for incident FECD were estimated by measures of historic BMI, baseline anthropometrics measures, and anthropometric measures that incorporated more than one baseline visit (time-varying). Anthropometric measures were parameterized as continuous and categorical in analyses.
There were 1399 incident FECD cases with an annualized incidence rate of 5.06 per 1000 person-years (95% CI = 4.80-5.33) over 276,443 person-years of follow-up. No statistically significant associations were observed between baseline height and risk of FECD. Women with baseline BMIs ≥35 (obesity II) compared to <25 kg/m2 (normal weight or underweight) had lower risk of incident FECD (HR = 0.68, 95% CI = 0.53-0.88) with a P value = 0.0373 for an ordinal trend analysis across BMI categories. Significant inverse associations were observed for continuous measures of WC (HR = 0.97, 95% CI = 0.95-0.99 per 5 cm increase) and waist-to-hip ratio (WHR; HR = 0.92, 95% CI = 0.86-0.99 per 0.1 unit increase). No statistically significant associations were observed for time-varying BMI, but time-varying WC and WHR has statistically significant inverse associations with risk for FECD (data not shown).
In this cohort of postmenopausal women, BMI, WC, and WHR were inversely associated with incident FECD. These findings generally support the potential role of anthropometric measures, particularly those indicative of abdominal obesity in FECD susceptibility in women.
遗传和环境因素均促使富克斯角膜内皮营养不良（FECD）的发生，这是美国角膜移植最常见的适应症。先前的研究表明身高、体重或体重指数（BMI）与FECD有关联。我们在绝经后女性的妇女健康倡议观察性研究（WHI-OS，n = 22,983）中研究了人体测量指标与FECD发病之间的关联。
利用来自WHI-OS基线访视（1993 - 1998年）至2019年的医疗保险B部分理赔数据来确定FECD的发病病例。在基线和随访第3年测量体重、身高、腰围（WC）和臀围。在基线时，要求女性回忆她们18岁、35岁和50岁时的历史体重。在随访第1年以及第4至8年，要求女性自行报告体重。在每个时间点利用身高和体重计算BMI。通过历史BMI测量值、基线人体测量指标以及纳入不止一次基线访视的人体测量指标（随时间变化）来估计FECD发病的校正风险比（HRs）、95%置信区间（CI）和趋势p值。在分析中，人体测量指标被参数化为连续变量和分类变量。
在276,443人年的随访期间，有1399例FECD发病病例，年化发病率为每1000人年5.06例（95% CI = 4.80 - 5.33）。未观察到基线身高与FECD风险之间存在统计学显著关联。与BMI < 25 kg/m²（正常体重或体重过轻）的女性相比，基线BMI≥35（肥胖II级）的女性发生FECD的风险较低（HR = 0.68，95% CI = 0.53 - 0.88），对BMI类别进行有序趋势分析的P值 = 0.0373。观察到WC连续测量值（每增加5 cm，HR = 0.97，95% CI = 0.95 - 0.99）和腰臀比（WHR；每增加0.1单位，HR = 0.92，95% CI = 0.86 - 0.99）存在显著的负相关。未观察到随时间变化的BMI存在统计学显著关联，但随时间变化的WC和WHR与FECD风险存在统计学显著的负相关（数据未显示）。
在这一绝经后女性队列中，BMI、WC和WHR与FECD发病呈负相关。这些发现总体上支持人体测量指标，特别是那些表明腹部肥胖的指标在女性FECD易感性中的潜在作用。
