Body mass index and visual impairment in Israeli adolescents: A nationwide study

Background

Previous research on the association between body mass index (BMI) and visual impairment (VI) in youth has reported inconsistent findings. We aimed to investigate this association in a national cohort of Israeli adolescents.

Methods

This retrospective, population-based, cross-sectional study included 1 697 060 adolescents (56.4% men; mean age 17 years) who underwent mandatory pre-military service assessments from 1993 to 2017. BMI was classified based on the US age- and sex-matched percentiles. Unilateral or bilateral VI was classified as best-corrected visual acuity (BCVA) worse than 6/9 in either or both eyes, respectively. Sex-stratified regression models adjusted for sociodemographic variables were used to analyse the BMI-VI relationship.

Results

Overall, 17 871 (1.05%) and 5148 (0.30%) adolescents had unilateral and bilateral VI, respectively. Compared with high-normal BMI (50th to 85th percentile), adjusted odds ratios (ORs) for unilateral and bilateral VI gradually increased with higher BMI, reaching 1.33 (1.13–1.55) and 1.80 (1.37–2.35) in men with severe obesity, and 1.51 (1.24–1.84) and 1.52 (1.08–2.14) in women with severe obesity, respectively. Men with underweight also had increased ORs for unilateral and bilateral VI (1.23; 1.14–1.33 and 1.59; 1.37–1.84, respectively), a pattern not observed in women (0.96; 0.86–1.07 and 1.02; 0.83–1.25, respectively). Results were maintained when the outcome was restricted to mild VI, as well as in subgroups of adolescents with unimpaired health and those without moderate-to-severe myopia.

Conclusions

Abnormal BMI, and particularly obesity, is associated with increased OR for VI in late adolescence.