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Differential associations between body mass index with diabetes and vision-threatening diabetic retinopathy in an adult Chinese population
  1. Xiaotong Han1,
  2. Yu Jiang1,
  3. Yong Niu2,
  4. Yongjuan Zhu3,
  5. Wenyong Huang1,4,
  6. Mingguang He1
  1. 1State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
  2. 2Department of Ophthalmology, Guangzhou No. 11 People's Hospital, Guangzhou, China
  3. 3Department of Clinical Laboratory, Health Management Center, Qilinshan Convalescent Hospital, Shenzhen, China
  4. 4Department of Preventive Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
  1. Correspondence to Dr Mingguang He, Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou 510000, China; mingguanghe{at}


Purpose To investigate the associations between body mass index (BMI) with diabetes mellitus (DM) and vision-threatening diabetic retinopathy (VTDR).

Methods This was a longitudinal study which included DM-free participants aged ≥40 years from the Lingtou Eye Cohort Study at baseline (2008–2010). Physical and ocular examinations were performed at baseline and annual follow-ups under standardised protocol. Two 45° non-mydriatic colour digital retinal photographs were obtained for each eye at all study visits, and presence of VTDR at the 2016 follow-up was graded by a deep-learning algorithm (LableMe) with proved high accuracy for detection of VTDR.

Results A total of 2934 participants were included with a mean (SD) age of 59.5 (7.3) years (58.3% men). Participants with incident DM (441/2934, 15%) were significantly older (p<0.001), had higher obesity levels (p<0.001), higher systolic blood pressure (SBP) (p<0.001), diastolic blood pressure (p<0.001), fasting plasma glucose (FPG) (p<0.001), triglycerides (p=0.002) and high-density lipoprotein cholesterol (p<0.001), as compared with those without. Participants with incident VTDR (48/2934, 1.63%) were also older (p<0.001), had higher SBP (p=0.013) and FPG (p<0.001), but did not differ in baseline BMI, comparing with those without. Regression analysis showed that higher baseline BMI was significantly related to incident DM (p<0.005), but not incident VTDR, during the follow-up. Subgroup analysis among participants with incident DM also revealed no association between BMI and VTDR.

Conclusions Higher baseline BMI increased the risk of incident DM, but was not related to the risk of VTDR in this adult Chinese population.

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  • Contributors MH and XH—conception and design. XH, YJ and WH—analysis and interpretation. XH and MH—writing of the article. YJ, YN, YZ and WH—critical revision of the article. XH, YJ, YN and YZ—data collection. WH and MH—administrative, technical or logistical support.

  • Funding MH receives support from the National Key R&D Program of China (2018YFC0116500), the Fundamental Research Funds of the State Key Laboratory of Ophthalmology, Science and Technology Planning Project of Guangdong Province (2013B20400003). XH receives support from the China Postdoctoral Science Foundation (2019TQ0365). This project is funded by Sun Yat-sen university graduate student innovation and development foundation (19ykyjs44) and Science and Technology Planning Project of Guangzhou City in China (201904010192).

  • Disclaimer The sponsor or funding organisation had no role in the design or conduct of this research.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Ethics Committee of the Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou (2012KYNL048), and conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all participants.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. All data relevant to this study are available upon reasonable request.

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