A large-scale population analysis from the National Health and Nutrition Examination Survey (NHANES) has identified a positive association between the weight-adjusted waist index (WWI) — a new measure of obesity that accounts for both body weight and waist circumference — and the risk of diabetic retinopathy (DR) among US adults with type 2 diabetes.
The cross-sectional study, published in Medicine, evaluated 2,001 adults (mean age 59.4 years; 51% male) from NHANES data collected between 2005 and 2018. The researchers, based at the Hunan University of Chinese Medicine, China, used multivariable logistic regression to assess the relationship between WWI and DR, while adjusting for a range of demographic, metabolic, and lifestyle covariates.
The study found that each unit increase in WWI was associated with a 32% higher risk of diabetic retinopathy after controlling for confounders such as age, sex, ethnicity, blood pressure, lipid levels, and HbA1c.
A nonlinear relationship between WWI and DR was identified, with a threshold effect at a WWI of 12.35 — above which the odds of DR rose sharply. Subgroup analyses revealed that this relationship was strongest among women, older adults (≥50 years), and non-Hispanic White participants. Notably, DR participants exhibited higher blood pressure and HbA1c, lower serum albumin, and higher WWI values compared to those without DR.
The authors suggest that WWI may act as a more sensitive indicator of obesity-related metabolic risk than traditional measures such as body mass index (BMI) or waist circumference alone. Unlike BMI, which cannot differentiate between fat and muscle mass, WWI isolates the impact of central adiposity — a key factor in the pathogenesis of diabetic microvascular complications.
Proposed mechanisms linking increased WWI to DR include adipose tissue dysfunction, chronic inflammation, oxidative stress, and insulin resistance. These factors contribute to retinal microvascular injury and may accelerate DR progression.
While the study benefits from nationally representative data and extensive covariate adjustment, its cross-sectional design limits causal inference. The researchers conclude that, while their current findings indicate a positive correlation between WWI and DR, further empirical research is needed to confirm whether this connection exists in other national and regional groups.
If it is confirmed, WWI could indeed become a practical clinical screening tool for identifying patients with diabetes at higher risk of vision-threatening disease — offering ophthalmologists and endocrinologists a simple yet powerful addition to risk stratification models.
The cross-sectional study, published in Medicine, evaluated 2,001 adults (mean age 59.4 years; 51% male) from NHANES data collected between 2005 and 2018. The researchers, based at the Hunan University of Chinese Medicine, China, used multivariable logistic regression to assess the relationship between WWI and DR, while adjusting for a range of demographic, metabolic, and lifestyle covariates.
The study found that each unit increase in WWI was associated with a 32% higher risk of diabetic retinopathy after controlling for confounders such as age, sex, ethnicity, blood pressure, lipid levels, and HbA1c.
A nonlinear relationship between WWI and DR was identified, with a threshold effect at a WWI of 12.35 — above which the odds of DR rose sharply. Subgroup analyses revealed that this relationship was strongest among women, older adults (≥50 years), and non-Hispanic White participants. Notably, DR participants exhibited higher blood pressure and HbA1c, lower serum albumin, and higher WWI values compared to those without DR.
The authors suggest that WWI may act as a more sensitive indicator of obesity-related metabolic risk than traditional measures such as body mass index (BMI) or waist circumference alone. Unlike BMI, which cannot differentiate between fat and muscle mass, WWI isolates the impact of central adiposity — a key factor in the pathogenesis of diabetic microvascular complications.
Proposed mechanisms linking increased WWI to DR include adipose tissue dysfunction, chronic inflammation, oxidative stress, and insulin resistance. These factors contribute to retinal microvascular injury and may accelerate DR progression.
While the study benefits from nationally representative data and extensive covariate adjustment, its cross-sectional design limits causal inference. The researchers conclude that, while their current findings indicate a positive correlation between WWI and DR, further empirical research is needed to confirm whether this connection exists in other national and regional groups.
If it is confirmed, WWI could indeed become a practical clinical screening tool for identifying patients with diabetes at higher risk of vision-threatening disease — offering ophthalmologists and endocrinologists a simple yet powerful addition to risk stratification models.
