Body mass index and risk of diabetic retinopathy: A meta-analysis and systematic review

Yue Zhou, Yuezhi Zhang, Ke Shi, Changyun Wang, Yue Zhou, Yuezhi Zhang, Ke Shi, Changyun Wang

Abstract

Diabetic retinopathy (DR) is a frequent cause of acquired blindness worldwide. Various studies have reported the effects of body mass index (BMI) on the risk of DR, but the results remain controversial. Therefore, a meta-analysis was performed to evaluate the relationship between BMI and the risk of DR.A systematic search was performed using the Cochrane Library, PubMed, and Embase databases to obtain articles published through December 2016. Articles regarding the association between BMI and the risk of DR were retrieved. The adjusted odds ratios (ORs) and their 95% confidence intervals (CIs) were included and then pooled with a random effects model.A total of 27 articles were included in this meta-analysis. When BMI was analyzed as a categorical variable, neither being overweight (OR = 0.89, 95% CI 0.75-1.07; P = .21; I = 65%) nor obesity (OR = 0.97, 95% CI 0.73-1.30; P = .86) were associated with an increased risk of DR when compared with normal weight. When BMI was analyzed as a continuous variable, a higher BMI was not associated with an increased risk of DR (OR = 0.99, 95% CI 0.97-1.01; P = .25; I2 = 79%). The pooled results did not significantly change after the sensitivity analysis.Based on the current publications, neither being overweight nor obesity is associated with an increased risk of DR. Further studies should confirm these findings.

Conflict of interest statement

The authors have no funding and no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Overview of the research strategy. BMI = body mass index, OR = odds ratio.
Figure 2
Figure 2
Forest plot for the association between BMI and the risk of DR when BMI was analyzed as a categorical variable. BMI = body mass index, CI = confidence interval, DR = diabetic retinopathy, SE = standard error.
Figure 3
Figure 3
Forest plot for the association between BMI and the risk of DR when BMI was analyzed as a continuous variable. BMI = body mass index, DR = diabetic retinopathy, SE = standard error, CI = confidence interval.
Figure 4
Figure 4
Funnel plot of all the included studies for the bias analysis when BMI was analyzed as a continuous variable. BMI = body mass index, SE = standard error.

References

    1. Yau JW, Rogers SL, Kawasaki R, et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care 2012;35:556–64.
    1. Stratton IM, Kohner EM, Aldington SJ, et al. UKPDS 50: risk factors for incidence and progression of retinopathy in Type II diabetes over 6 years from diagnosis. Diabetologia 2001;44:156–63.
    1. Ismail-Beigi F, Craven T, Banerji MA, et al. Effect of intensive treatment of hyperglycaemia on microvascular outcomes in type 2 diabetes: an analysis of the ACCORD randomised trial. Lancet 2010;376:419–30.
    1. Beulens JW, Patel A, Vingerling JR, et al. Effects of blood pressure lowering and intensive glucose control on the incidence and progression of retinopathy in patients with type 2 diabetes mellitus: a randomised controlled trial. Diabetologia 2009;52:2027–36.
    1. Criqui MH, Klauber MR, Barrett-Connor E, et al. Adjustment for obesity in studies of cardiovascular disease. Am J Epidemiol 1982;116:685–91.
    1. Luczynski W, Szypowska A, Bossowski A, et al. [Overweight, obesity and metabolic syndrome in children with type 1 diabetes melllitus]. Pediatr Endocrinol Diabetes Metab 2010;16:83–8.
    1. Lim LS, Tai ES, Mitchell P, et al. C-reactive protein, body mass index, and diabetic retinopathy. Invest Ophthalmol Vis Sci 2010;51:4458–63.
    1. Maberley DA, King W, Cruess AF, et al. Risk factors for diabetic retinopathy in the Cree of James Bay. Ophthalmic Epidemiol 2002;9:153–67.
    1. Nguyen HT, Luzio SD, Dolben J, et al. Dominant risk factors for retinopathy at clinical diagnosis in patients with type II diabetes mellitus. J Diabetes Complications 1996;10:211–9.
    1. Araki A, Ito H, Hattori A, et al. Risk factors for development of retinopathy in elderly Japanese patients with diabetes mellitus. Diabetes Care 1993;16:1184–6.
    1. Manaviat MR, Rashidi M, Afkhami-Ardekani M. Four years incidence of diabetic retinopathy and effective factors on its progression in type II diabetes. Eur J Ophthalmol 2008;18:572–7.
    1. Bener A, Al-Laftah F, Al-Hamaq AO, et al. A study of diabetes complications in an endogamous population: an emerging public health burden. Diabetes Metab Syndr 2014;8:108–14.
    1. Lima VC, Cavalieri GC, Lima MC, et al. Risk factors for diabetic retinopathy: a case-control study. Int J Retina Vitreous 2016;2:21.
    1. Katusic D, Tomic M, Jukic T, et al. Obesity—a risk factor for diabetic retinopathy in type 2 diabetes? Coll Antropol 2005;29(suppl 1):47–50.
    1. Kastelan S, Tomic M, Gverovic AA, et al. Body mass index: a risk factor for retinopathy in type 2 diabetic patients. Mediators Inflamm 2013;2013:436329.
    1. Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000;283:2008–12.
    1. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 2000;894:1–253.
    1. van Dijk GM, Maneva M, Colpani V, et al. The association between vasomotor symptoms and metabolic health in peri- and postmenopausal women: a systematic review. Maturitas 2015;80:140–7.
    1. G. Wells SBOC. The Newcastle Ottawa Scale (NOS) for assessing the quality if nonrandomized studies in meta-analyses. Available: . Accessed December 20, 2016, 2014.
    1. Kontopantelis E, Reeves D. Performance of statistical methods for meta-analysis when true study effects are non-normally distributed: a simulation study. Stat Methods Med Res 2012;21:409–26.
    1. Pang C, Jia L, Jiang S, et al. Determination of diabetic retinopathy prevalence and associated risk factors in Chinese diabetic and pre-diabetic subjects: Shanghai diabetic complications study. Diabetes Metab Res Rev 2012;28:276–83.
    1. Raman R, Rani PK, Gnanamoorthy P, et al. Association of obesity with diabetic retinopathy: Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetics Study (SN-DREAMS Report no. 8). Acta Diabetol 2010;47:209–15.
    1. Janghorbani M, Amini M, Ghanbari H, et al. Incidence of and risk factors for diabetic retinopathy in Isfahan, Iran. Ophthalmic Epidemiol 2003;10:81–95.
    1. van Leiden HA, Dekker JM, Moll AC, et al. Blood pressure, lipids, and obesity are associated with retinopathy: the hoorn study. Diabetes Care 2002;25:1320–5.
    1. Dowse GK, Humphrey AR, Collins VR, et al. Prevalence and risk factors for diabetic retinopathy in the multiethnic population of Mauritius. Am J Epidemiol 1998;147:448–57.
    1. Man RE, Sabanayagam C, Chiang PP, et al. Differential association of generalized and abdominal obesity with diabetic retinopathy in Asian patients with type 2 diabetes. JAMA Ophthalmol 2016;134:251–7.
    1. Rooney D, Lye WK, Tan G, et al. Body mass index and retinopathy in Asian populations with diabetes mellitus. Acta Diabetol 2015;52:73–80.
    1. Lu J, Hou X, Zhang L, et al. Association between body mass index and diabetic retinopathy in Chinese patients with type 2 diabetes. Acta Diabetol 2015;52:701–8.
    1. Dirani M, Xie J, Fenwick E, et al. Are obesity and anthropometry risk factors for diabetic retinopathy? The diabetes management project. Invest Ophthalmol Vis Sci 2011;52:4416–21.
    1. Ahmed KR, Karim MN, Bukht MS, et al. Risk factors of diabetic retinopathy in Bangladeshi type 2 diabetic patients. Diabetes Metab Syndr 2011;5:196–200.
    1. Martin-Merino E, Fortuny J, Rivero-Ferrer E, et al. Risk factors for diabetic retinopathy in people with Type 2 diabetes: A case-control study in a UK primary care setting. Prim Care Diabetes 2016;10:300–8.
    1. Webb EM, Rheeder P, Roux P. Screening in primary care for diabetic retinopathy, maculopathy and visual loss in South Africa. Ophthalmologica 2016;235:141–9.
    1. Azizi-Soleiman F, Heidari-Beni M, Ambler G, et al. Iranian risk model as a predictive tool for retinopathy in patients with type 2 diabetes. Can J Diabetes 2015;39:358–63.
    1. Kajiwara A, Miyagawa H, Saruwatari J, et al. Gender differences in the incidence and progression of diabetic retinopathy among Japanese patients with type 2 diabetes mellitus: a clinic-based retrospective longitudinal study. Diabetes Res Clin Pract 2014;103:e7–10.
    1. Tomic M, Ljubic S, Kastelan S, et al. Inflammation, haemostatic disturbance, and obesity: possible link to pathogenesis of diabetic retinopathy in type 2 diabetes. Mediators Inflamm 2013;2013:818671.
    1. Lim S, Kim KM, Kim MJ, et al. The association of maximum body weight on the development of type 2 diabetes and microvascular complications: MAXWEL study. PLoS One 2013;8:e80525.
    1. Li X, Wang Z. Prevalence and incidence of retinopathy in elderly diabetic patients receiving early diagnosis and treatment. Exp Ther Med 2013;5:1393–6.
    1. Zheng Y, Lamoureux EL, Lavanya R, et al. Prevalence and risk factors of diabetic retinopathy in migrant Indians in an urbanized society in Asia: the Singapore Indian eye study. Ophthalmology 2012;119:2119–24.
    1. Kawasaki R, Tanaka S, Tanaka S, et al. Incidence and progression of diabetic retinopathy in Japanese adults with type 2 diabetes: 8 year follow-up study of the Japan Diabetes Complications Study (JDCS). Diabetologia 2011;54:2288–94.
    1. Yoshida Y, Hagura R, Hara Y, et al. Risk factors for the development of diabetic retinopathy in Japanese type 2 diabetic patients. Diabetes Res Clin Pract 2001;51:195–203.
    1. Mitchell P, Smith W, Wang JJ, et al. Prevalence of diabetic retinopathy in an older community. The Blue Mountains Eye Study. Ophthalmology 1998;105:406–11.
    1. Collins VR, Dowse GK, Plehwe WE, et al. High prevalence of diabetic retinopathy and nephropathy in Polynesians of Western Samoa. Diabetes Care 1995;18:1140–9.
    1. Okumura A, Unoki-Kubota H, Yoshida-Hata N, et al. Reduced serum level of leukocyte cell-derived chemotaxin 2 is associated with the presence of diabetic retinopathy. Clin Chim Acta 2016;463:145–9.
    1. Sekioka R, Tanaka M, Nishimura T, et al. Serum total bilirubin concentration is negatively associated with increasing severity of retinopathy in patients with type 2 diabetes mellitus. J Diabetes Complications 2015;29:218–21.
    1. Loprinzi PD. Concurrent healthy behavior adoption and diabetic retinopathy in the United States. Prev Med Rep 2015;2:591–4.
    1. Garberg G, Lovestam-Adrian M, Nasic S, et al. The prognosis of diabetic retinopathy in patients with type 2 diabetes since 1996-1998: the Skaraborg Diabetes Register. Int Ophthalmol 2015;35:503–11.
    1. Jee D, Lee WK, Kang S. Prevalence and risk factors for diabetic retinopathy: the Korea National Health and Nutrition Examination Survey 2008–2011. Invest Ophthalmol Vis Sci 2013;54:6827–33.
    1. Xu J, Wei WB, Yuan MX, et al. Prevalence and risk factors for diabetic retinopathy: the Beijing Communities Diabetes Study 6. Retina 2012;32:322–9.
    1. Wong TY, Cheung N, Tay WT, et al. Prevalence and risk factors for diabetic retinopathy: the Singapore Malay Eye Study. Ophthalmology 2008;115:1869–75.
    1. Fujisawa T, Ikegami H, Yamato E, et al. Association of plasma fibrinogen level and blood pressure with diabetic retinopathy, and renal complications associated with proliferative diabetic retinopathy, in Type 2 diabetes mellitus. Diabet Med 1999;16:522–6.
    1. Rema M, Ponnaiya M, Mohan V. Prevalence of retinopathy in non insulin dependent diabetes mellitus at a diabetes centre in southern India. Diabetes Res Clin Pract 1996;34:29–36.
    1. Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014;384:766–81.
    1. Fontaine KR, Redden DT, Wang C, et al. Years of life lost due to obesity. JAMA 2003;289:187–93.
    1. Bengtsson B, Heijl A. A long-term prospective study of risk factors for glaucomatous visual field loss in patients with ocular hypertension. J Glaucoma 2005;14:135–8.
    1. Delcourt C, Michel F, Colvez A, et al. Associations of cardiovascular disease and its risk factors with age-related macular degeneration: the POLA study. Ophthalmic Epidemiol 2001;8:237–49.
    1. Ye J, Lou LX, He JJ, et al. Body mass index and risk of age-related cataract: a meta-analysis of prospective cohort studies. PLoS One 2014;9:e89923.
    1. Wang J, Zhang RY, Chen RP, et al. Prevalence and risk factors for diabetic retinopathy in a high-risk Chinese population. BMC Public Health 2013;13:633.
    1. Ahren J, Ahren B, Wierup N. Increased beta-cell volume in mice fed a high-fat diet: a dynamic study over 12 months. Islets 2010;2:353–6.
    1. Cai X, Han X, Zhang S, et al. Age at diagnosis and C-peptide level are associated with diabetic retinopathy in Chinese. PLoS One 2014;9:e91174.
    1. Considine RV, Sinha MK, Heiman ML, et al. Serum immunoreactive-leptin concentrations in normal-weight and obese humans. N Engl J Med 1996;334:292–5.
    1. Miyazawa-Hoshimoto S, Takahashi K, Bujo H, et al. Elevated serum vascular endothelial growth factor is associated with visceral fat accumulation in human obese subjects. Diabetologia 2003;46:1483–8.
    1. Aiello LP, Avery RL, Arrigg PG, et al. Vascular endothelial growth factor in ocular fluid of patients with diabetic retinopathy and other retinal disorders. N Engl J Med 1994;331:1480–7.
    1. Panagiotakos DB, Pitsavos C, Yannakoulia M, et al. The implication of obesity and central fat on markers of chronic inflammation: The ATTICA study. Atherosclerosis 2005;183:308–15.
    1. Fujimoto WY, Abbate SL, Kahn SE, et al. The visceral adiposity syndrome in Japanese–American men. Obes Res 1994;2:364–71.
    1. Ruderman N, Chisholm D, Pi-Sunyer X, et al. The metabolically obese, normal-weight individual revisited. Diabetes 1998;47:699–713.

Source: PubMed

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