Waist-Height Ratio Linked to Severe Diabetic Eye Disease in Type 1 Diabetes

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The relationship between body composition and severe diabetic eye disease in people with type 1 diabetes is unclear. A group of Finnish and Australian researchers sought to discover if there was a connection.

Waist-height ratio (WHtR) is associated with an increased risk of severe diabetic eye disease (SDED) in adults with type 1 diabetes (T1D), according to a study in the Journal of Clinical Endocrinology and Metabolism.

Researchers sought to assess the association between body composition and SDED in 3468 adults with type 1 diabetes from the Finnish Diabetic Nephropathy (FinnDiane) Study. The longitudinal analysis included 3146 patients with normoalbuminuria and microalbuminuria. A total of 768 patients were included in a sensitivity longitudinal analysis to determine the association between WHtR and SDED.

The composite outcome was SDED, which was defined as proliferative diabetic retinopathy (PDR), with initiation of laser treatment or antivascular endothelial growth factor, diabetic maculopathy, vitreous hemorrhage, and vitrectomy.

In the initial longitudinal dataset of all 3468 patients, the median age was 34.8 years (interquartile range [IQR], 25.7-45.1), 51.2% were female, and the median duration of diabetes was 15.3 years (8.2-23.4). After a median follow-up of 14.5 years (7.8-17.5), 886 incident SDED cases occurred for an incidence rate of 25.6%.

In the analysis that included all patients, WHtR was the anthropometric measure that was most strongly associated with SDED risk (hazard ratio [HR] 1.28 for 0.1 increase, z = 3.73), followed by waist circumference (HR 1.01 for 1-cm increase,      z = 3.03), body mass index (HR per 1-kg/m2 increase 1.03, z = 2.33), and waist-hip ratio (HR 1.15 for 0.1 increase, z = 2.22).

In a sensitivity analysis that included patients with Early Treatment of Diabetic Retinopathy Study grading at baseline, with those having no retinopathy as the reference group, WHtR was associated with increased odds of nonproliferative diabetic retinopathy (odds ratio [OR] 1.91; 95% CI, 1.06-3.47; P = .03) or PDR  (OR 3.24; 95% CI, 1.66-6.31; P = .0006) at baseline.

Among participants with normoalbuminuria and microalbuminuria, the risk of SDED was 28% higher (HR 1.28; 95% CI, 1.08-1.50) in those with a WHtR ≥0.5 compared to those with a WHtR <0.5.

The body composition variables that were most strongly associated with SDED were visceral fat/android fat mass ratio (OR 1.40 per 0.1 increase, z = 3.13), followed by android fat/appendicular lean mass ratio (OR 1.91 per 0.1 increase, z = 2.13), and visceral fat/appendicular lean mass ratio (OR 1.16 per 0.01 increase, z = 2.45).

Among several study limitations, the researchers used the variable “any retinopathy at baseline” to adjust the analysis, but no detailed information was available regarding the grading of retinopathy. Additionally, the study was conducted in a homogenous Caucasian-Finnish population.

“From a clinical perspective, this study not only highlights a new modifiable risk factor for SDED but more importantly, it shows that a simple anthropometric measure related to central obesity is associated with SDED in individuals with type 1 diabetes,” stated the investigators.

Disclosure: This research was funded in part by the Novo Nordisk Foundation and other organizations. Some of the study authors declared affiliations with pharmaceutical companies. Please see the original reference for a full list of disclosures.


Parente EB, Harjutsalo V, Forsblom C, Groop P-H. Waist-height ratio and the risk of severe diabetic eye disease in type 1 diabetes: a 15-year cohort study. J Clin Endocrinol Metab. Published online September 11, 2021. doi: 10.1210/clinem/dgab671