Abstract
Purpose :
Visceral adipose tissue plays an active role in the pathogenesis of diabetes and vascular dysfunction, while evidence from prospective studies on the association between visceral obesity and diabetic retinopathy (DR) remains scanty. We aimed to assess the longitudinal associations of three validated indices of visceral adiposity, i.e., lipid accumulation product (LAP), visceral adiposity index (VAI), and Chinese VAI (CVAI), with incident DR in adult patients with type 2 diabetes.
Methods :
This was a community-based, longitudinal study which enrolled 1,403 diabetic patients between 2017 and 2020 who were referred to a national-leading tertiary hospital specialised in ophthalmology through a specialist-generalist working alliance consisting of 18 community health centres (CHCs) in Guangzhou, southern China. Subjects included in the analysis were free of DR at baseline and were annually followed until 2022. Anthropometric, biochemical, and clinical parameters were measured onsite at each follow-up visit. The status of DR was determined based on the seven-standard photographic fields using modified Airlie House classification. Time-dependent Cox proportional hazards regression models were constructed to estimate the hazard ratio (HR) with 95% confidence interval (CI).
Results :
The mean age of study participants was 64.5 ± 7.6 years, and 816 (58.2%) were women. We observed 406 DR events during a median of 2.13 years. A one-standard-deviation increment in LAP, VAI, or CVAI was consistently associated with increased risks for DR, with a multivariable-adjusted HR of 1.24 (1.09 to 1.41, p=0.001), 1.22 (1.09 to 1.36, p<0.001), and 1.49 (1.19 to 1.86, p<0.001), respectively. Similar trends were observed across tertiles in LAP (p=0.001), VAI (p=0.001), and CVAI (p=0.007). We did not detect the presence of effect modification by age, sex, duration of diabetes, body mass index, and comorbidity (all p for interaction >0.10).
Conclusions :
Elevated LAP, VAI, and CVAI are all independently associated with increased risks for DR in Chinese patients with type 2 diabetes. Our findings suggest the need for regular monitoring of these indices in clinical practice to enhance the population-based primary prevention for DR. Future investigations with longer follow-up period in a different mix of subjects will help elucidate the long-term effects of increased visceral adiposity on the pathogenesis of DR.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.