Association of obesity and risk of diabetic retinopathy in diabetes patients: A meta-analysis of prospective cohort studies

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type 1 diabetes mellitus 1 endocrinologydiseases
type 2 diabetes mellitus 2 endocrinologydiseases
diabetes mellitus 3 endocrinologydiseases
diabetic retinopathy 3 endocrinologydiseases
metabolic syndrome 1 endocrinologydiseases
obesity 46 endocrinologydiseases

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diabetes mellitus 1298 association between obesity and risk of PDR was detected. Significant harmful effect was detected in type 2 diabetes mellitus (T2DM) group (RR, 1.40; 95% CI, 1.05–1.87; I2 = 67.6%) but not mixed group (RR, 1.04; 95% CI,
diabetes mellitus 1761 required to deepen our understanding of the relation between obesity and DR.Introduction1Both type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) were considered as important burdens on public health system.[[1]]
diabetes mellitus 1797 of the relation between obesity and DR.Introduction1Both type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) were considered as important burdens on public health system.[[1]] Diabetic retinopathy (DR),
diabetic retinopathy 50 Title: MedicineAssociation of obesity and risk of diabetic retinopathy in diabetes patientsA meta-analysis of prospective cohort studiesWei ZhuYan WuYi-Fang MengQian XingJian-Jun
diabetic retinopathy 10949 stars) were present in most included studies (12 in 13).Table 1Characteristics of studies of obesity and diabetic retinopathy risk included in the final analysis (n = 13).Obesity and the risk of DR4.3Figure 2 demonstrated
diabetic retinopathy 11395 1.01–1.43; I2 = 59.6%).Figure 2Forest plot for the association between obesity and DR risk. DR = diabetic retinopathy .To deepen the understanding on the relationship between obesity and DR, the subgroup analyses by study
metabolic syndrome 5430 The key word group for obesity was composed by obesity, overweight, adiposity, body mass index, BMI, metabolic syndrome , intra-abdominal fat, waist–hip ratio, and waist circumference. No restrictions of language or publication
obesity 30 Title: MedicineAssociation of obesity and risk of diabetic retinopathy in diabetes patientsA meta-analysis of prospective cohort studiesWei
obesity 651 of diabetes. The purpose of the current study was to investigate the potential association between obesity and DR risk by conducting a meta-analysis of prospective studies.Methods:A consummate literature search
obesity 972 were included in this meta-analysis.Results:On meta-analysis of all the studies assessing DR risk, obesity was associated with a significant increase in DR incidence (relative risk [RR], 1.20; 95% confidence
obesity 1210 I2 = 59.6%). When only proliferative DR (PDR) was considered, no significant association between obesity and risk of PDR was detected. Significant harmful effect was detected in type 2 diabetes mellitus (T2DM)
obesity 1721 well-conducted epidemiologic studies were required to deepen our understanding of the relation between obesity and DR.Introduction1Both type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) were considered
obesity 2969 and intense treatment for patients with higher DR risks would provide better prognoses.The impacts of obesity on carcinomas, cardiovascular, and metabolic systems disorders have been widespread and obese was regarded
obesity 3187 a harmful factor in most diseases.[[5],[6]] Considering that there was significant relation between obesity and diabetes risk, it was natural to consider the potential effect of obesity on the incidence of DR.
obesity 3265 significant relation between obesity and diabetes risk, it was natural to consider the potential effect of obesity on the incidence of DR. Through a population-based study involving 6499 individuals with a follow-up
obesity 3407 population-based study involving 6499 individuals with a follow-up of 11.1 years, it was found that obesity was associated with an increased risk of diabetes.[[7]] Besides, obesity was an established risk factor
obesity 3480 11.1 years, it was found that obesity was associated with an increased risk of diabetes.[[7]] Besides, obesity was an established risk factor for several systemic diseases including hypertension, stroke, dyslipidemia,
obesity 3717 and these diseases were reported as potential risk factors of DR.[[9],[10]] The association between obesity and DR risk was reported in several previous observational studies, however, no accordant conclusions
obesity 3911 accordant conclusions were obtained. Data of a hospital-based study with 156 diabetic persons showed that obesity may be considered as a risk factor for DR in T2DM patients.[[11]] While in a cross-sectional study using
obesity 4134 data in Saudi National Diabetes Registry data with a cohort of 50,464 Saudi patients, overweight and obesity were reported to be associated with an inversed risk of DR after adjustments of age and sex.[[12]] Besides,
obesity 4659 together.[[14]] The purpose of this current meta-analysis was to investigate the relationship between obesity and DR risk of prospective cohorts. Besides, detailed analyses in this study would also provide certain
obesity 5283 study.Search strategy2.1PubMed, EMBASE, and web of science were searched using selected key words regarding obesity and DR (last search update July 206). The key word group for obesity was composed by obesity, overweight,
obesity 5352 using selected key words regarding obesity and DR (last search update July 206). The key word group for obesity was composed by obesity, overweight, adiposity, body mass index, BMI, metabolic syndrome, intra-abdominal
obesity 5376 regarding obesity and DR (last search update July 206). The key word group for obesity was composed by obesity , overweight, adiposity, body mass index, BMI, metabolic syndrome, intra-abdominal fat, waist–hip ratio,
obesity 5977 inclusion, the studies would be included if they met the following criteria: the association between obesity and DR was evaluated; a prospective cohort study design was adopted; the odds ratios (OR), relative
obesity 7955 included studies were prospective cohort study, RR values were used to evaluate the associations between obesity and the risk of DR.The test of heterogeneity in quantitative calculation across studies was carried
obesity 10937 high-quality (>6 stars) were present in most included studies (12 in 13).Table 1Characteristics of studies of obesity and diabetic retinopathy risk included in the final analysis (n = 13).Obesity and the risk of DR4.3Figure
obesity 11084 in the final analysis (n = 13).Obesity and the risk of DR4.3Figure 2 demonstrated the effect of obesity on DR risk through pooling all the included studies in this meta-analysis. The analyses of the 13 included
obesity 11219 all the included studies in this meta-analysis. The analyses of the 13 included studies showed that obesity was a risk factor for the incidence of DR (RR, 1.20; 95% CI, 1.01–1.43; I2 = 59.6%).Figure 2Forest
obesity 11365 DR (RR, 1.20; 95% CI, 1.01–1.43; I2 = 59.6%).Figure 2Forest plot for the association between obesity and DR risk. DR = diabetic retinopathy.To deepen the understanding on the relationship between obesity
obesity 11472 and DR risk. DR = diabetic retinopathy.To deepen the understanding on the relationship between obesity and DR, the subgroup analyses by study characters and adjusting status were conducted (Table 2). When
obesity 11661 conducted (Table 2). When only proliferative DR (PDR) was considered, no significant association between obesity and risk of PDR was detected (RR, 1.15; 95% CI, 0.89–1.48; I2 = 32.5%). Considering that different
obesity 12121 analysis by study sites showed that the studies in Asia demonstrated significant relationship between obesity and DR risk (RR, 1.22; 95% CI, 1.04–1.44; I2 = 33.8%). However, the studies conducted in neither
obesity 13031 methodological quality (<6 stars in NOS). After excluding 1 study from the meta-analysis and it was found that obesity was a significant harmful factor for DR (RR, 1.22; 95% CI, 1.00–1.47; I2 = 62.9%).To assess the
obesity 13522 for assessment of publication bias.Discussion5This meta-analysis of 13 prospective cohort studies on obesity for DR risk demonstrated the existence of a significant harmful effect for DR incidence. In general
obesity 14038 important cause of mortality in the whole world.[[6],[35]] It also indicated that the relation between obesity and diabetes risk was significant.[[36]] However, inconsistent conclusions on the association between
obesity 14148 and diabetes risk was significant.[[36]] However, inconsistent conclusions on the association between obesity and DR were detected in previous epidemiological studies. In a cross-sectional study including 501 adults
obesity 14291 epidemiological studies. In a cross-sectional study including 501 adults with T1DM, it was found that obesity (BMI > 30 kg/m2) was the predominant risk factor for retinopathy.[[37]] While through multinomial
obesity 14843 cross-sectional studies.[[39],[40]] Besides, case control studies were also conducted to detect the effect of obesity on DR. However, previous case-control studies also indicated inconsistent conclusions.[[41],[42]] Cohort
obesity 15303 was gained. Through pooling 13 independent studies together, slight but significant harmful effect of obesity on the DR incidence was detected. Thus, the results in this study provided high level of evidence for
obesity 15455 results in this study provided high level of evidence for the existence of the relationship between obesity and DR.However, no significant association was detected in several advanced subgroup analyses and thus
obesity 15692 were required. When the diabetes types were considered, it was found significant association between obesity and DR in T2DM. While no previous prospective cohort study was conducted to detect the effect of obesity
obesity 15797 obesity and DR in T2DM. While no previous prospective cohort study was conducted to detect the effect of obesity on the incidence of DR in T1DM cases. Even no stratified results on obesity and DR risk were reported,
obesity 15873 to detect the effect of obesity on the incidence of DR in T1DM cases. Even no stratified results on obesity and DR risk were reported, however, the relation between BMI and retinopathy incidence in T1DM cases
obesity 16371 showed that BMI at baseline was not associated with the development of DR.[[44]] When time-dependent obesity along the follow-up duration was considered, BMI was associated with DR incidence. Besides, the occurrence
obesity 16633 cases in a study in Sweden.[[45]] When diabetes of both subtypes were considered, it was found that obesity was associated with high risk of DR incidence in this meta-analysis. However, further advanced cohort
obesity 16806 meta-analysis. However, further advanced cohort analyses were required to gain more knowledge in the effect of obesity on the risk of DR.In this study, the definition of obesity was based on the BMI. A previous cross-sectional
obesity 16865 to gain more knowledge in the effect of obesity on the risk of DR.In this study, the definition of obesity was based on the BMI. A previous cross-sectional clinic-based study showed that BMI was inversely associated
obesity 18967 conclusion in this study. First, the conclusion of this study might be influenced by deficient criteria of obesity or different BMI stratifications among the included studies. In the meta-analysis, we adopted the highest
obesity 19329 the conclusion of this study. Second, we attempted to detect the dose–response relationship between obesity and DR risk. However, even significant association was detected, no sufficient data (including BMI stratification,
obesity 19851 required.Conclusions6In conclusion, the findings in this current meta-analysis of prospective cohort studies suggest that obesity was a risk factor for non-proliferative DR. However, the significance could not be detected in several
obesity 20121 well-conducted epidemiologic studies were required to deepen our understanding of the relation between obesity and DR risk. Advanced studies with more data on T1DM cases and different obesity definitions were urgent
obesity 20202 the relation between obesity and DR risk. Advanced studies with more data on T1DM cases and different obesity definitions were urgent required.AcknowledgmentsThe authors have none to acknowledge in this study.Author
type 1 diabetes mellitus 1754 were required to deepen our understanding of the relation between obesity and DR.Introduction1Both type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) were considered as important burdens on public health system.[[1]]
type 2 diabetes mellitus 1291 association between obesity and risk of PDR was detected. Significant harmful effect was detected in type 2 diabetes mellitus (T2DM) group (RR, 1.40; 95% CI, 1.05–1.87; I2 = 67.6%) but not mixed group (RR, 1.04; 95% CI,
type 2 diabetes mellitus 1790 understanding of the relation between obesity and DR.Introduction1Both type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) were considered as important burdens on public health system.[[1]] Diabetic retinopathy (DR),

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