Abstract
PURPOSE: Primary open-angle glaucoma (POAG) is a leading cause of permanent blindness. Although body mass index (BMI) has been proposed as a factor associated with POAG, existing findings are inconsistent. Systematic investigations into early life body size trajectories and their association with POAG remain limited.
DESIGN: Retrospective cohort study.
PARTICIPANTS: A total of 467,768 participants from the UK Biobank.
METHODS: Body size in childhood was constructed in comparison with peers and categorized as low, average, or high. Adult body size was classified based on residuals from sex-stratified regression models of BMI on age and age squared. Nine distinct early life body size trajectories were defined. Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for body size and trajectories.
MAIN OUTCOME MEASURES: POAG incidence.
RESULTS: Among 467,768 participants, individuals whose trajectories ended in low adult body size had an elevated POAG risk compared to the average-average trajectory after adjusting for all covariates (low-low: HR = 1.35, 95% CI: 1.17-1.55, P < .001; average-low: HR = 1.35, 95% CI: 1.18-1.53, P < .001; high-low: HR = 1.49, 95% CI: 1.17-1.91, P = .001). Individuals with a low body size in adulthood demonstrated an elevated risk of POAG compared to those with an average body size (HR = 1.30; 95% CI: 1.19-1.43; P < .001). In contrast, a high body size was associated with varying effects in childhood (HR = 1.14; 95% CI: 1.00-1.29; P = .046) and adulthood (HR = 0.86; 95% CI, 0.75-0.99; P = .037). In the stratified analyses based on child body sizes, participants with a low child body size who attained an average (HR = 0.79, 95% CI: 0.68-0.93, P = .004) or high (HR = 0.58, 95% CI: 0.44-0.77, P < .001) in adulthood had reduced POAG risk. Among those with high child body size, substantial weight loss to low body size in adulthood increased the risk of POAG (HR = 1.66, 95% CI: 1.19-2.32, P = .003), while moderate weight loss showed no significant risk.
CONCLUSIONS: Low adult body size was consistently associated with an increased risk of POAG, emphasizing the importance of avoiding excessive weight loss in early life, which may be critical for reducing the POAG burden.