Acta Diabetologica

, Volume 52, Issue 1, pp 73–80 | Cite as

Body mass index and retinopathy in Asian populations with diabetes mellitus

  • David Rooney
  • Weng Kit Lye
  • Gavin Tan
  • Ecosse L. Lamoureux
  • Mohammad Kamran Ikram
  • Ching-Yu Cheng
  • Neelam Kumari
  • Ying Feng Zheng
  • Paul Mitchell
  • Jie Jin Wang
  • Tien Y. Wong
  • Charumathi Sabanayagam
Original Article


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 



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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Copyright information

© Springer-Verlag Italia 2014

Authors and Affiliations

  • David Rooney
    • 1
  • Weng Kit Lye
    • 2
  • Gavin Tan
    • 3
    • 4
  • Ecosse L. Lamoureux
    • 3
    • 4
    • 5
  • Mohammad Kamran Ikram
    • 3
    • 4
  • Ching-Yu Cheng
    • 3
    • 4
  • Neelam Kumari
    • 6
  • Ying Feng Zheng
    • 7
  • Paul Mitchell
    • 8
  • Jie Jin Wang
    • 8
  • Tien Y. Wong
    • 3
    • 4
    • 9
  • Charumathi Sabanayagam
    • 3
    • 4
    • 5
  1. 1.University of Alabama School of MedicineBirminghamUSA
  2. 2.Center for Quantitative MedicineDuke-NUS Graduate Medical SchoolSingaporeSingapore
  3. 3.Singapore Eye Research InstituteSingapore National Eye CentreSingaporeSingapore
  4. 4.Department of Ophthalmology, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
  5. 5.Office of Clinical SciencesDuke-NUS Graduate Medical SchoolSingaporeSingapore
  6. 6.Department of Ophthalmology and Visual SciencesKhoo Teck Puat HospitalSingaporeSingapore
  7. 7.State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic CenterSun Yat-sen UniversityGuangzhouChina
  8. 8.Centre for Vision ResearchUniversity of SydneySydneyAustralia
  9. 9.Ophthalmology and Visual Sciences Academic Clinical ProgramDuke-NUS Graduate Medical School, National University of SingaporeSingaporeSingapore

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