第二型糖尿病人, 全身脂肪分佈與發生視網膜病變的相關性

新杉伶

第二型糖尿病人, 全身脂肪分佈與發生視網膜病變的相關性

執筆 林口長庚 眼科部 視網膜科主任 黃奕修


肥胖普遍認為與代謝性疾病的發病有關
但其實至今文獻研究的結論並不一致. 有些認為有關, 有些認為無關

此篇研究是關注體重/脂肪分佈, 與糖尿病視網膜病變的關係
結論來自於僅針對亞洲人做研究, 因此很值得台灣衛生學術參考

研究結論很有趣
發現BMI指數反而具有保護效果, 可以防止發生糖尿病視網膜病變
但是, 腰腹肥胖型身材才是產生視網膜病變的危險因子, 特別是在女性

因此, 如果討論體重與糖尿病, 雖然之前的文獻顯示可能有關
但是在眼科視網膜病變, 要注意的可能反而不是BMI, 全身脂肪分佈才是重點.
特別是腰腹型肥胖是明顯的糖尿病視網膜病變發病因子




長庚醫院 林口醫學中心 眼科部 葡萄膜炎/虹彩炎/視網膜科 黃奕修 主任 執筆

醫學新知/最夯科技/訊息導正/連續照護/防盲責任

更多眼科資訊, 請見:
www.uveitis.tw        葡萄膜炎虹彩炎資訊網
www.dmeye.org        糖尿病眼病變資訊網
www.dreye.net[/url]        醫師的眼科醫師-眼科高端醫療資訊網
www.retina.tw        黃奕修醫師-視網膜病變資訊網



原文如下:

Body Fat Distribution and Diabetic Retinopathy in People With Type 2 Diabetes
Article in JAMA The Journal of the American Medical Association 315(16):1778 · April 2016

Abstract
This commentary discusses a cross-sectional study published in JAMA Ophthalmology that investigated association of body fat distribution with diabetic retinopathy in an Asian population with type 2 diabetes.
The association between obesity and diabetic retinopathy (DR) is equivocal, possibly owing to the strong interrelation between generalized and abdominal obesity leading to a mutually confounding effect. To our knowledge, no study in Asia has investigated the independent associations of these 2 parameters with DR to date.

Objective
To investigate the associations of generalized (defined by body mass index [BMI], calculated as weight in kilograms divided by height in meters squared) and abdominal obesity (assessed by waist to hip ratio [WHR]) with DR in a clinical sample of Asian patients with type 2 diabetes mellitus.

Design, Setting, and Participants
This cross-sectional clinic-based study was conducted at the Singapore National Eye Centre, a tertiary eye care institution in Singapore, from December 2010 to September 2013. We recruited 498 patients with diabetes. After exclusion of participants with ungradable retinal images and type 1 diabetes, 420 patients (mean [SD] age, 57.8 [7.5] years; 32.1% women) were included in the analyses. Exposures Body mass index and WHR as waist/hip circumference (in centimeters).

Main Outcomes and Measures
The presence and severity of DR were graded from retinal images using the modified Airlie House Classification into none (n = 189), mild-moderate (Early Treatment Diabetic Retinopathy Study scale score, 20-41; n = 125), and severe DR (Early Treatment Diabetic Retinopathy Study scale score ≥53; n = 118). The associations of BMI and WHR with DR were assessed using multinomial logistic regression models adjusting for age, sex, traditional risk factors, and mutually for BMI and WHR.Results Among the total of 420 patients, the median (interquartile range) for BMI and WHR were 25.7 (5.7) and 0.94 (0.08), respectively. In multivariable models, BMI was inversely associated with mild-moderate and severe DR (odds ratio [OR], 0.90 [95% CI, 0.84-0.97] and OR, 0.92 [95% CI, 0.85-0.99] per 1-unit increase, respectively), while WHR was positively associated with mild-moderate and severe DR (OR, 3.49 [95% CI, 1.50-8.10] and OR, 2.68 [95% CI, 1.28-5.62] per 0.1-unit increase, respectively) in women (P for interaction = .006). No sex-specific associations were found between BMI and DR (P for interaction >.10).

Conclusions and Relevance
In Asian patients with type 2 diabetes, a higher BMI appeared to confer a protective effect on DR, while higher WHR was associated with the presence and severity of DR in women. Our results may inform future clinical trials to determine whether WHR is a more clinically relevant risk marker than BMI for individuals with type 2 diabetes.

JAMA Ophthalmol. 2016;134(3):251-257. doi:10.1001/jamaophthalmol.2015.5103

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