Obesity, BMI show inverse association with diabetic retinopathy
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Obesity and BMI showed an inverse association with diabetic retinopathy among Asian adults, according to study results published in British Journal of Ophthalmology.
Charumathi Sabanayagam, MD, PhD, from the Singapore Eye Research Institute, and colleagues gathered data from 10,010 adults with diabetes from 12 population-based studies conducted among China, India, Japan, Singapore, South Korea and Asian populations in Russia.
When stratified by BMI categories, the prevalence of diabetic retinopathy was significantly lower among patients with obesity compared with those of normal weight. Pooled analysis additionally showed that obesity was not significantly correlated with diabetic retinopathy compared with normal weight, and continuous analysis showed an inverse relation between BMI and diabetic retinopathy.
Similarly, the prevalence for vision-threatening diabetic retinopathy was significantly lower among patients with obesity compared with those of normal weight, with inverse association found in pooled analysis for obesity and continuous analysis for BMI.
“This phenomenon, also known as ‘reverse epidemiology,’ has been observed in several chronic diseases, including diabetes and coronary heart disease,” Sabanayagam and colleagues wrote.
While the exact mechanism underlying the inverse association between diabetic retinopathy and either BMI or obesity is not clear, the researchers suggested three plausible explanations: survival bias, higher prevalence of comorbid conditions leading to diabetic retinopathy or genetic predisposition to type 2 diabetes.
“Our results warrant further research to elucidate the longitudinal association and evaluate the effect of weight reduction on development and progression of [diabetic retinopathy] in obese Asian adults with diabetes,” they wrote.
Perspective
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According to the World Health Organization, over 400 million people worldwide are affected by diabetes. That number is expected to continue to climb, with the greatest increase expected to occur in Asia. This has large implications on a large number of people having ocular complications of the disease, given its various manifestations in the eye.
The exact mechanism underlying the inverse association between BMI, obesity and diabetic retinopathy is unclear in Asian populations. Further research is warranted in order to find the potentially protective characteristics contributing to decreased diabetic retinopathy rates. Understanding the underlying mechanisms can lead to potentially novel therapies to help reverse the ocular and maybe systemic manifestations and complications of diabetes.
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Sabanayagam C, et al. Br J Ophthalmol. 2021;doi:10.1136/bjophthalmol-2020-318208.
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