Body mass index (BMI) is an established risk factor for diabetes. However, the association between BMI and diabetic retinopathy (DR) has been inconclusive. We aimed to assess the association between BMI and DR in a large population-based sample of multi-ethnic Asian adults in Singapore. We examined 2,278 adults aged ≥40 years with diabetes who participated in three population-based studies conducted from 2004 to 2011: the Singapore Malay Eye Study, the Singapore Indian Eye Study, and the Singapore Chinese Eye Study. Retinal photographs taken from both eyes were graded for any and vision-threatening (VTDR) using the modified Airlie House Classification. BMI (kg/m2) was categorized into normal/underweight (<25), overweight (25–29.9), and obese (≥30). The prevalence rates of any and VTDR in the study population were 35.1 % and 9.1 %, respectively. The prevalence of any and VTDR decreased with increasing categories of BMI (P trend <0.001 and 0.005). In multivariable models adjusted for potential confounders, compared to those with normal weight, the odds ratio (95 % confidence interval) of any DR was 0.71 (0.57–0.88) for overweight and 0.70 (0.53–0.92) for obese. Corresponding estimates for VTDR were 0.84 (0.59–1.21) for overweight and 0.58 (0.35–0.94) for obese. The inverse association between BMI and any DR was consistently present when BMI was analyzed as a continuous variable and in analyses stratified by ethnicity and age. In a population-based sample of multi-ethnic Asian adults, BMI levels were inversely associated with any DR and VTDR.
Diabetes mellitus Diabetic retinopathy Body mass index
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Authors acknowledge the staff and participants of the SiMES, SINDI, and SCES Study for their important contributions. This study was funded by Biomedical Research Council (BMRC), 08/1/35/19/550 and National Medical Research Council (NMRC), STaR/0003/2008, Singapore and Singapore Ministry of Health’s National Medical Research Council under its Talent Development Scheme R927/36/2012 (CS).
Conflict of interest
The authors declare they have no conflict of interest.
Human and Animal Rights disclosure
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).
Informed consent disclosure
Informed consent was obtained from all patients for being included in the study.
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