Cover Image

The Association of Serum Leptin Level and Anthropometric Measures With the Severity of Diabetic Retinopathy in Type 2 Diabetes Mellitus

Mehrdad Afarid, Adel Attarzadeh, Mohsen Farvardin, Hossein Ashraf


This study was performed to determine the association amongst serum leptin level and anthropometric measures with the severity of Diabetic Retinopathy (DR) in subjects with type 2 Diabetes Mellitus (DM). This case-controlled study was conducted within a one-year period, during year 2016, at outpatient retina ophthalmology clinics of Shiraz, southern Iran. Eighty-three patients with type 2 DM, referring for ophthalmoscopy evaluation, were included. Anthropometric measures, serum leptin level, and baseline laboratory assessment was performed for all subjects. Patients were categorized as group 1, consisting of patients with severe Non-Proliferative Diabetic Retinopathy (severe NPDR) and Proliferative Diabetic Retinopathy (PDR) (n = 44), and group 2, consisting of patients without Diabetic Retinopathy (no DR) or mild/moderate NPDR (n = 39). The serum leptin level and anthropometric measures were compared between the two study groups. The correlation between these variables was also assessed. The mean age of the participants was 59.3 ± 6.9 years old. The two study groups were comparable regarding baseline characteristics. Cases of group 1 had significantly higher Erythrocyte Sedimentation Rate (ESR) (P = 0.049) and Systolic Blood Pressure (P = 0.025) when compared with those of group 2. The serum level of leptin was found to be significantly higher in cases of group 1 when compared to those of group 2 (P = 0.003). However, anthropometric measures, including Body Mass Index (BMI) (P = 0.167), Body Adiposity Index (BAI) (P = 0.061), and Waist to Hip Ratio (WHR) (P = 0.220) were comparable between the two study groups. Serum leptin level was positively correlated with BMI (r = 0.819; P < 0.001) and BAI (r = 0.630; P < 0.001) in group 1. Increased serum levels of leptin were associated with advanced stages of DR in subjects with type 2 DM. Serum leptin level might be a better indicator of the effects of obesity on DR, compared to anthropometric measures (BAI or BMI).


Thomas RL, Dunstan FD, Luzio SD, Chowdhury SR, North RV, Hale SL, et al. Prevalence of diabetic retinopathy within a national diabetic retinopathy screening service. Br J Ophthalmol. 2015;99(1):64-8. doi: 10.1136/bjophthalmol-2013-304017 pmid: 25091950

Song SJ, Han K, Choi KS, Ko SH, Rhee EJ, Park CY, et al. Trends in diabetic retinopathy and related medical practices among type 2 diabetes patients: Results from the National Insurance Service Survey 2006-2013. J Diabetes Investig. 2018;9(1):173-8. doi: 10.1111/jdi.12655 pmid: 28294558

Ting DS, Cheung GC, Wong TY. Diabetic retinopathy: global prevalence, major risk factors, screening practices and public health challenges: a review. Clin Exp Ophthalmol. 2016;44(4):260-77. doi: 10.1111/ceo.12696 pmid: 26716602

Javadi MA, Katibeh M, Rafati N, Dehghan MH, Zayeri F, Yaseri M, et al. Prevalence of diabetic retinopathy in Tehran province: a population-based study. BMC Ophthalmol. 2009;9:12. doi: 10.1186/1471-2415-9-12 pmid: 19835608

Kyari F, Tafida A, Sivasubramaniam S, Murthy GV, Peto T, Gilbert CE, et al. Prevalence and risk factors for diabetes and diabetic retinopathy: results from the Nigeria national blindness and visual impairment survey. BMC Public Health. 2014;14:1299. doi: 10.1186/1471-2458-14-1299 pmid: 25523434

Sabanayagam C, Yip W, Ting DS, Tan G, Wong TY. Ten Emerging Trends in the Epidemiology of Diabetic Retinopathy. Ophthalmic Epidemiol. 2016;23(4):209-22. doi: 10.1080/09286586.2016.1193618 pmid: 27355693

Yau JW, Rogers SL, Kawasaki R, Lamoureux EL, Kowalski JW, Bek T, et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care. 2012;35(3):556-64. doi: 10.2337/dc11-1909 pmid: 22301125

Tomic M, Ljubic S, Kastelan S, Gverovic Antunica A, Jazbec A, Poljicanin T. Inflammation, haemostatic disturbance, and obesity: possible link to pathogenesis of diabetic retinopathy in type 2 diabetes. Mediators Inflamm. 2013;2013:818671. doi: 10.1155/2013/818671 pmid: 24363502

Anan F, Masaki T, Ito Y, Eto T, Umeno Y, Eshima N, et al. Diabetic retinopathy is associated with visceral fat accumulation in Japanese type 2 diabetes mellitus patients. Metabolism. 2010;59(3):314-9. doi: 10.1016/j.metabol.2009.06.001 pmid: 20004426

Rooney D, Lye WK, Tan G, Lamoureux EL, Ikram MK, Cheng CY, et al. Body mass index and retinopathy in Asian populations with diabetes mellitus. Acta Diabetol. 2015;52(1):73-80. doi: 10.1007/s00592-014-0602-2 pmid: 24880522

Thivel D, O'Malley G, Pereira B, Duche P, Aucouturier J. Comparison of total body and abdominal adiposity indexes to dual x-ray absorptiometry scan in obese adolescents. Am J Hum Biol. 2015;27(3):334-8. doi: 10.1002/ajhb.22643 pmid: 25327573

Borer KT. Counterregulation of insulin by leptin as key component of autonomic regulation of body weight. World J Diabetes. 2014;5(5):606-29. doi: 10.4239/wjd.v5.i5.606 pmid: 25317239

Considine RV, Sinha MK, Heiman ML, Kriauciunas A, Stephens TW, Nyce MR, et al. Serum immunoreactive-leptin concentrations in normal-weight and obese humans. N Engl J Med. 1996;334(5):292-5. doi: 10.1056/NEJM199602013340503 pmid: 8532024

Pradeepa R, Surendar J, Indulekha K, Chella S, Anjana RM, Mohan V. Association of serum adiponectin with diabetic microvascular complications among south Indian type 2 diabetic subjects - (CURES-133). Clin Biochem. 2015;48(1-2):33-8. doi: 10.1016/j.clinbiochem.2014.10.009 pmid: 25445230

Suganami E, Takagi H, Ohashi H, Suzuma K, Suzuma I, Oh H, et al. Leptin stimulates ischemia-induced retinal neovascularization: possible role of vascular endothelial growth factor expressed in retinal endothelial cells. Diabetes. 2004;53(9):2443-8. pmid: 15331557

Uckaya G, Ozata M, Bayraktar Z, Erten V, Bingol N, Ozdemir IC. Is leptin associated with diabetic retinopathy? Diabetes Care. 2000;23(3):371-6. pmid: 10868868

Er H, Doganay S, Ozerol E, Yurekli M. Adrenomedullin and leptin levels in diabetic retinopathy and retinal diseases. Ophthalmologica. 2005;219(2):107-11. doi: 10.1159/000083270 pmid: 15802936

Maberley D, Cui JZ, Matsubara JA. Vitreous leptin levels in retinal disease. Eye (Lond). 2006;20(7):801-4. doi: 10.1038/sj.eye.6702011 pmid: 16052255

Gariano RF, Nath AK, D'Amico DJ, Lee T, Sierra-Honigmann MR. Elevation of vitreous leptin in diabetic retinopathy and retinal detachment. Invest Ophthalmol Vis Sci. 2000;41(11):3576-81. pmid: 11006255

Dossarps D, Petit JM, Guiu B, Cercueil JP, Duvillard L, Bron AM, et al. Body fat distribution and adipokine secretion are not associated with diabetic retinopathy in patients with type 2 diabetes mellitus. Ophthalmic Res. 2014;51(1):42-5. doi: 10.1159/000355323 pmid: 24217637

Bergman RN, Stefanovski D, Buchanan TA, Sumner AE, Reynolds JC, Sebring NG, et al. A better index of body adiposity. Obesity (Silver Spring). 2011;19(5):1083-9. doi: 10.1038/oby.2011.38 pmid: 21372804

Klein R, Knudtson MD, Lee KE, Gangnon R, Klein BE. The Wisconsin Epidemiologic Study of Diabetic Retinopathy: XXII the twenty-five-year progression of retinopathy in persons with type 1 diabetes. Ophthalmology. 2008;115(11):1859-68. doi: 10.1016/j.ophtha.2008.08.023 pmid: 19068374

Chiu FH, Chuang CH, Li WC, Weng YM, Fann WC, Lo HY, et al. The association of leptin and C-reactive protein with the cardiovascular risk factors and metabolic syndrome score in Taiwanese adults. Cardiovasc Diabetol. 2012;11:40. doi: 10.1186/1475-2840-11-40 pmid: 22533665

Hribal ML, Fiorentino TV, Sesti G. Role of C reactive protein (CRP) in leptin resistance. Curr Pharm Des. 2014;20(4):609-15. pmid: 23688010

Procopio C, Andreozzi F, Laratta E, Cassese A, Beguinot F, Arturi F, et al. Leptin-stimulated endothelial nitric-oxide synthase via an adenosine 5'-monophosphate-activated protein kinase/Akt signaling pathway is attenuated by interaction with C-reactive protein. Endocrinology. 2009;150(8):3584-93. doi: 10.1210/en.2008-0921 pmid: 19359389

Chen K, Li F, Li J, Cai H, Strom S, Bisello A, et al. Induction of leptin resistance through direct interaction of C-reactive protein with leptin. Nat Med. 2006;12(4):425-32. doi: 10.1038/nm1372 pmid: 16582918

Dirani M, Xie J, Fenwick E, Benarous R, Rees G, Wong TY, et al. Are obesity and anthropometry risk factors for diabetic retinopathy? The diabetes management project. Invest Ophthalmol Vis Sci. 2011;52(7):4416-21. doi: 10.1167/iovs.11-7208 pmid: 21482643

Kastelan S, Salopek Rabatic J, Tomic M, Gverovic Antunica A, Ljubic S, Kastelan H, et al. Body mass index and retinopathy in type 1 diabetic patients. Int J Endocrinol. 2014;2014:387919. doi: 10.1155/2014/387919 pmid: 24696683

Raman R, Rani PK, Gnanamoorthy P, Sudhir RR, Kumaramanikavel G, Sharma T. Association of obesity with diabetic retinopathy: Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetics Study (SN-DREAMS Report no. 8). Acta Diabetol. 2010;47(3):209-15. doi: 10.1007/s00592-009-0113-8 pmid: 19326040

Lu J, Hou X, Zhang L, Jiang F, Hu C, Bao Y, et al. Association between body mass index and diabetic retinopathy in Chinese patients with type 2 diabetes. Acta Diabetol. 2015;52(4):701-8. doi: 10.1007/s00592-014-0711-y pmid: 25604042

Kastelan S, Tomic M, Gverovic Antunica A, Ljubic S, Salopek Rabatic J, Karabatic M. Body mass index: a risk factor for retinopathy in type 2 diabetic patients. Mediators Inflamm. 2013;2013:436329. doi: 10.1155/2013/436329 pmid: 24347825

Khan AA, Rahmani AH, Aldebasi YH. Diabetic Retinopathy: Recent Updates on Different Biomarkers and Some Therapeutic Agents. Curr Diabetes Rev. 2017. doi: 10.2174/1573399813666170915133253 pmid: 28914194

Castillo J, Aleman I, Rush SW, Rush RB. Preoperative Bevacizumab Administration in Proliferative Diabetic Retinopathy Patients Undergoing Vitrectomy: A Randomized and Controlled Trial Comparing Interval Variation. Am J Ophthalmol. 2017;183:1-10. doi: 10.1016/j.ajo.2017.08.013 pmid: 28860046

Full Text: Full Text PDF

Creative Commons License
This work is licensed under a Creative Commons Attribution 3.0 License.