Abstract
AimsTo examine the association of body mass index (BMI) with the incidence of diabetes mellitus (DM) and diabetic retinopathy (DR) in Asians.MethodsWe analysed data from 4101 adults (Malay, n = 1901 and Indian, n = 2200) who participated in the baseline (2004–2009) and 6-year follow-up (2011–2015) of two independent population-based studies with similar methodology in Singapore. BMI was categorised into normal (<25 kg/m2), overweight (25–29.9 kg/m2) and obese (≥30 kg/m2). DM was diagnosed as random plasma glucose ≥200 mg/dL, HbA1c ≥6.5% or self-reported physician diagnosed DM. DR was assessed from retinal photographs graded using a standard protocol. The associations of baseline BMI with incident DM and DR was examined using multivariable poisson regression models adjusting for potential confounders including duration of DM, family history of DM and HbA1c.ResultsThe incidence of DM was 12.8% and among 1586 participants with DM, the incidence of DR was 17.6% over a median follow-up period of 6.2 years. Compared to those with BMI < 25, the relative risk (95% confidence interval) of incident DM was 1.77 (1.36–2.29) for overweight and 2.01 (1.50–2.71) for obese (p trend < 0.001). Relative risk of DR was 0.80 (0.59–1.09) for overweight and 0.60 (0.39–0.92) for obese (p trend = 0.02). In analyses stratified by ethnicity, similar pattern of associations with DM and DR were observed in both ethnicities.ConclusionOur results suggest that, overweight and obesity increased the 6-year risk of DM but decreased the 6-year risk of DR in these Asian populations.
Highlights
1234567890():,; 1234567890():,; Introduction Diabetes mellitus (DM) is projected to increase to 592 million in 2035, with Asia having the highest number of individuals with DM globally and importantly, with the prevalence increasing at a much faster rate than in Correspondence: Charumathi Sabanayagam 1Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Discovery Tower Level 6, Singapore 169856, Singapore 2Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore Full list of author information is available at the end of the article
In two we examined the relationship of baseline body mass index (BMI) with 6-year risk of DM and the 6-year risk of Diabetic retinopathy (DR) in Asian adults with DM in Singapore
We examined the associations of baseline BMI with the two outcomes using two poisson regression models with robust variance:29 1) an age, gender and ethnicity-adjusted model; 2) a multivariable model adjusting for other covariates as well, such as income and education, current smoking, family history of DM, HbA1c, total cholesterol, HDL cholesterol, systolic BP and diabetes duration
Summary
Diabetes mellitus (DM) is projected to increase to 592 million in 2035, with Asia having the highest number of individuals with DM globally and importantly, with the prevalence increasing at a much faster rate than in Correspondence: Charumathi Sabanayagam (charumathi.sabanayagam@seri. com.sg) 1Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Discovery Tower Level 6, Singapore 169856, Singapore 2Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore Full list of author information is available at the end of the articleWestern countries[1]. (BMI) with DR in previous studies have not shown consistent results. Asians have been shown to have different associations between BMI, percentage body fats and health risks such as cardiovascular disease as compared to Western populations[9,10,11]. Previous research suggests that BMI could influence DR differently in Asian and Western populations[8, 12,13,14,15,16,17,18,19,20]. While Western studies have showed higher BMI and obesity is related to DR8, 11, 12 the majority of studies in Asia have shown that lower BMI is related to DR13–17, 19. Few studies have been prospective in nature[10, 11] and the relationship between baseline BMI and the subsequent risk of DR is unclear
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