OBESITAS SENTRAL SEBAGAI FAKTOR RISIKO KEJADIAN RETINOPATI DIABETIKA PADA PASIEN DIABETES MELLITUS TIPE 2: JOGJAKARTA EYE DIABETIC STUDY IN THE COMMUNITY (JOGED.COM)
SARAH RIZQIA, Prof. dr. Suhardjo, SU, Sp.M(K); dr. M. Bayu Sasongko, M.Epi., Ph.D.
2015 | Skripsi | PENDIDIKAN DOKTERLatar Belakang: Retinopati Diabetika (RD) merupakan komplikasi mikrovaskular utama dari diabetes dan salah satu penyebab kebutaan terbesar di dunia. Prevalensi RD kian meningkat dan penelitian mengenai faktor risikonya semakin berkembang. Obesitas sentral dikatakan memiliki patogenesis inflamasi derajat rendah yang dapat berhubungan dengan kejadian RD. Tujuan: Mengetahui hubungan obesitas sentral dengan RD. Metode: Penelitian berbasis populasi dengan metode potong lintang melibatkan 270 pasien yang terdiagnosis DM tipe 2 oleh dokter keluarga. Setiap subjek menjalani pemeriksaan fisik, pemeriksaan antropometri (tinggi badan, berat badan, IMT, lingkar pinggang), wawancara, dan fotografi retina (Kowa NM-7, Jepang). Obesitas sentral ditentukan dari besar lingkar pinggang. RD dinilai dengan klasifikasi modified Arlie House. Asosisasi obesitas sentral dan RD dianalisis dengan regresi logistik. Hasil: Terdapat 270 peserta (92 [37.40%] pria). Median usia 58 (52 - 64) tahun. Ada 36.4% (90) orang dengan RD [9.7% (24) dengan RDNP ringan, 17.8% (44) RDNP moderat, dan 8.9% (22) VTDR]. Lingkar pinggang berbanding terbalik dengan kejadian RD (Odds Ratio [OR] 0.97; 95% Confidence Interval [CI] 0.95 - 0.99; P=0.03 untuk setiap cm reduksi lingkar pinggang). Obesitas sentral berhubungan dengan kejadian RD (Odds Ratio [OR] 0.56; 95% CI 0.32 - 0.98; P=0.04). Hubungan ini lebih kuat setelah mengontrol usia, gender, durasi DM, glukosa darah, tekanan darah sistolik, dan merokok. Kesimpulan: Ada hubungan signifikan baik antara obesitas sentral maupun lingkar pinggang dengan kejadian RD. Orang DM dengan lingkar pinggang lebih besar cenderung tidak memiliki RD. Butuh penelitian lebih lanjut untuk memahami peran obesitas dan inflamasi sistemik derajat rendah dalam patogenesis RD.
Background: Diabetic retinopathy (DR) is a major microvascular complication of diabetes and one of the main causes of blindness and vision loss worldwide. The prevalence of DR increases and the researches about DR risk factors are developing. Central obesity is thought to be one of the modifiable risk factors due to its low-grade inflammatory state pathogenesis. Purpose: To investigate the association of central obesity with DR in type 2 diabetes. Methods: A community-based cross-sectional study of persons with type 2 diabetes, confirmed by their family physicians. Each underwent a thorough clinical examination, anthropometric measurement (height; weight; BMI; waist circumferences), behavioral aspects interview and retinal photographs (Kowa NM-7, Japan). Central obesity was determined from person's waist circumference. DR was assessed with modified Arlie House classification. Logistic regression was used to assess the association between central obesity and DR. Results: There were 270 participants (92 [37.40%] males). The median (inter-quartile range) age was 58 (52 - 64) years. Overall, there were 36.4% (90) persons with DR [9.7% (24) with mild, 17.8% (44) moderate NPDR, and 8.9% (22) VTDR]. In the crude model, waist circumference was inversely associated with presence of DR (Odds Ratio [OR] 0.97; 95% Confidence Interval [CI] 0.95 - 0.99; P=0.03 for each cm reduction in waist circumference). This association was stronger after controlling for age, gender, duration of diabetes, blood glucose, systolic blood pressure, and smoking. Conclusions: Persons with diabetes with bigger waist circumference are less likely to have DR. Further investigation is needed to understand the relationship between the role of visceral obesity and systemic inflammatory state in the pathogenesis of DR.
Kata Kunci : obesitas, diabetes melitus, retinopati diabetika
