Elsevier

Ophthalmology

Volume 117, Issue 8, August 2010, Pages 1521-1529
Ophthalmology

Original article
Anthropometric Measures and their Relation to Incident Primary Open-Angle Glaucoma

Presented in part at: American Glaucoma Society Meeting, March 2008, Washington, DC.
https://doi.org/10.1016/j.ophtha.2009.12.017Get rights and content

Purpose

To assess the relation between anthropometric measures and incident primary open-angle glaucoma (POAG).

Participants

Included were 78 777 women in the Nurses' Health Study and 41 352 men in the Health Professionals Follow-up Study.

Methods

Females and male health professionals were followed prospectively from 1980 through 2004 and 1986 through 2004, respectively. Eligible participants were 40 years of age or older, did not have POAG at baseline, and reported undergoing eye examinations during follow-up. Information regarding anthropometric measures, potential confounders, and ophthalmic status was updated using biennial questionnaires. During follow-up, 980 POAG cases were identified.

Main Outcome Measures

Multivariate rate ratios (MVRR) of POAG and their 95% confidence intervals (CIs).

Results

There was no significant relation between cumulatively averaged body mass index (BMI) in kilograms per meter squared and POAG overall (P = 0.06, for trend). However, in relation to POAG with intraocular pressure (IOP) of 22 mmHg or less at diagnosis, each unit increase in BMI was associated with a 6% reduced risk in women (MVRR, 0.94; 95% CI, 0.91–0.98; P = 0.01), but not for men (MVRR, 1.02; 95% CI, 0.96–1.09; P = 0.57); this gender difference was significant (P = 0.03, for heterogeneity). In multivariate analyses to explore the independent effects of height and weight, weight (as height-adjusted weight residuals; P = 0.002, for trend), but not height (P = 0.10, for trend) seemed to account for most of the inverse association between BMI and POAG with IOP of 21 mmHg or less at diagnosis in women. There was no association between BMI and POAG with IOP of more than 21 mmHg at diagnosis for either gender (P≥0.26, for trend). Among women, analyses found that the relations between anthropometric parameters and both POAG subtypes (POAG with IOP≤21 mmHg vs. POAG with IOP >21 mmHg when diagnosed) were significantly different (P≤0.0001).

Conclusions

Among women, higher BMI was associated with a lower risk of POAG with IOP of 21 mmHg or less at diagnosis. The factors contributing to this tendency may yield insight into the pathogenesis of POAG.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Description of the Cohort at Risk for Primary Open-Angle Glaucoma

The Nurses' Health Study (NHS) is an ongoing, population-based cohort of registered nurses. The NHS was established in 1976, when 121 700 American women were invited to complete a questionnaire regarding lifestyle, health behavior, and chronic diseases. The Health Professionals Follow-Up Study (HPFS) is an ongoing cohort created in 1986 when 51 529 male healthcare providers (dentists, veterinarians, pharmacists, optometrists, osteopaths, and podiatrists) completed a similar health survey. The

Results

During 1 610 334 person-years of follow-up, 980 incident POAG cases were identified. As expected, participants with higher BMI had higher rates of hypertension and DM (Table 1). They also were less likely to be physically active or to consume alcohol or smoke cigarettes. These potential confounders were accounted for in multivariate analyses.

Compared with the reference group of cumulatively averaged BMI in the 24- to 25-kg/m2 range (Table 2), there were no significant associations with very low

Discussion

This prospective study did not show associations between cumulatively averaged BMI and POAG overall. Interestingly, significant inverse relations were found between higher BMI and POAG with IOP of 21 mmHg or less among women, but not among men. Height was not associated with risk of POAG. The trends reported here are consistent with prior cross-sectional data,25, 30 although the gender-specific nature of the trend has not been reported previously. The significant inverse association observed

References (52)

  • M.F. Kuczmarski et al.

    Effects of age on validity of self-reported height, weight, and body mass index: findings from the Third National Health and Nutrition Examination Survey, 1988–1994

    J Am Diet Assoc

    (2001)
  • R. DerSimonian et al.

    Meta-analysis in clinical trials

    Control Clin Trials

    (1986)
  • T. Oshitari et al.

    Effect of chronic hyperglycemia on intraocular pressure in patients with diabetes

    Am J Ophthalmol

    (2007)
  • R.E. Gimeno et al.

    Adipose tissue as an active endocrine organ: recent advances

    Curr Opin Pharmacol

    (2005)
  • C. Samarawickrama et al.

    Birth weight and optic nerve head parameters

    Ophthalmology

    (2009)
  • M.J. Cartwright et al.

    Correlation of asymmetric damage with asymmetric intraocular pressure in normal-tension glaucoma (low-tension glaucoma)

    Arch Ophthalmol

    (1988)
  • A. Sommer et al.

    Relationship between intraocular pressure and primary open angle glaucoma among white and black Americans: the Baltimore Eye Survey

    Arch Ophthalmol

    (1991)
  • R.A. Levine et al.

    Asymmetries and visual field summaries as predictors of glaucoma in the Ocular Hypertension Treatment Study

    Invest Ophthalmol Vis Sci

    (2006)
  • M.C. Leske et al.

    Incidence of open-angle glaucoma: the Barbados Eye Studies

    Arch Ophthalmol

    (2001)
  • G.A. Colditz et al.

    Weight as a risk factor for clinical diabetes in women

    Am J Epidemiol

    (1990)
  • B.E. Klein et al.

    Intraocular pressure in an American community: the Beaver Dam Eye Study

    Invest Ophthalmol Vis Sci

    (1992)
  • S.Y. Wu et al.

    Associations with intraocular pressure in the Barbados Eye Study

    Arch Ophthalmol

    (1997)
  • K. Mori et al.

    Relationship between intraocular pressure and obesity in Japan

    Int J Epidemiol

    (2000)
  • S.W. Oh et al.

    Elevated intraocular pressure is associated with insulin resistance and metabolic syndrome

    Diabetes Metab Res Rev

    (2005)
  • A. Akinci et al.

    Relationship between intraocular pressure and obesity in children

    J Glaucoma

    (2007)
  • R. David et al.

    Epidemiology of intraocular pressure in a population screened for glaucoma

    Br J Ophthalmol

    (1987)
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    Manuscript no. 2009-973.

    Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

    Supported by the National Institutes of Health, Bethesda, Maryland (grant nos.: CA87969, CA55075, EY09611, HL35464, and EY015473).

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