Acta Diabetologica

, Volume 52, Issue 4, pp 701–708 | Cite as

Association between body mass index and diabetic retinopathy in Chinese patients with type 2 diabetes

  • Jun Lu
  • Xuhong Hou
  • Lei Zhang
  • Fusong Jiang
  • Cheng Hu
  • Yuqian Bao
  • Weiping Jia
Original Article



To explore the factors mediating the relationship between body mass index (BMI) and diabetic retinopathy (DR) in Chinese type 2 diabetes patients.


This is a cross-sectional study. Data of 2,533 patients with type 2 diabetes were studied from the Shanghai Diabetes Registry Database. DR was assessed using non-mydriatic fundus photography and graded as non-DR, mild–moderate (DR I–II), and sight-threatening (DR III–IV). BMI (kg/m2) was classified as normal weight (18.5 ≤ BMI < 25), overweight (25 ≤ BMI < 30), and obese (BMI ≥ 30). β cell function was evaluated by fasting C-peptide (FCP).


DR was present in 701 (27.7 %) patients. Patients with DR had lower BMI (24.3 vs. 24.9 kg/m2, P = 0.001) and fasting C-peptide (1.46 vs. 1.86 ng/ml, P < 0.001) than those without DR. The association between BMI (2 kg/m2 interval) and DR was U-shaped; patients with BMI 28–29.9 kg/m2 had the lowest DR rate. Compared with normal weight, overweight was associated with reduced risk of any DR [odds ratio (OR) 0.73], DR I–II (OR 0.76), and DR III–IV (OR 0.64) after adjustment for sex, age at diabetes diagnosis, and duration of diabetes. This negative association attenuated after adjustment for other confounders and became nonsignificant after further adjustment for FCP. Patients with different BMI categories had similar DR risk when stratified by FCP tertiles.


Overweight patients have lower DR prevalence than normal weight individuals, which may be attributable to better β cell function in overweight patients.


Type 2 diabetes Diabetic retinopathy Body mass index Fasting C-peptide 


Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

This study was approved by the Institutional Ethics Committee of Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, China.

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.

Supplementary material

592_2014_711_MOESM1_ESM.docx (14 kb)
Supplementary material 1 (DOCX 13 kb)


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Copyright information

© Springer-Verlag Italia 2015

Authors and Affiliations

  • Jun Lu
    • 1
  • Xuhong Hou
    • 1
  • Lei Zhang
    • 1
  • Fusong Jiang
    • 1
  • Cheng Hu
    • 1
  • Yuqian Bao
    • 1
  • Weiping Jia
    • 1
  1. 1.Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, Shanghai Clinical Center for DiabetesShanghai Jiao Tong University Affiliated Sixth People’s HospitalShanghaiChina

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