Differential Effect of Generalized and Abdominal Obesity on the Development and Progression of Diabetic Retinopathy in Chinese Adults With Type 2 Diabetes

Xiaoyan Han; Huimin Wu; Youjia Li; Meng Yuan; Xia Gong; Xiao Guo; Rongqiang Tan; Ming Xie; Xiaoling Liang; Wenyong Huang; Hua Liu; Lanhua Wang

doi:10.3389/fmed.2022.774216

Differential Effect of Generalized and Abdominal Obesity on the Development and Progression of Diabetic Retinopathy in Chinese Adults With Type 2 Diabetes

Front Med (Lausanne). 2022 May 27:9:774216. doi: 10.3389/fmed.2022.774216. eCollection 2022.

Authors

Xiaoyan Han¹, Huimin Wu², Youjia Li¹, Meng Yuan³, Xia Gong³, Xiao Guo³, Rongqiang Tan¹, Ming Xie¹, Xiaoling Liang³, Wenyong Huang³, Hua Liu⁴, Lanhua Wang³

Affiliations

¹ The First People's Hospital of Zhaoqing, Zhaoqing, China.
² Shenzhen Children's Hospital, Shenzhen, China.
³ State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Disease, Guangzhou, China.
⁴ Department of Ophthalmology, Third Affiliated Hospital of Jinzhou Medical University, Jinzhou, China.

Abstract

Background: 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).

Method: 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.

Results: 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; P < 0.001] and incident VTDR (RR = 0.22; 95%CI, 0.11-0.43; P < 0.001), while WHR was positively associated with incident DR (RR = 1.47; 95% CI, 1.27-1.71; P < 0.001). BMI and WHR level were not significantly associated with 2-year DR progression in multivariate models (all P > 0.05).

Conclusions: 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.

Keywords: abdominal obesity; body mass index; cohort; diabetic retinopathy; generalized obesity; waist to hip ratio.