Table 1 The relationship of obesity with general somatic and ocular parameters in the population of the Southern Urals aged 40 years and older according to the Ural Eye and Medical Study (multivariate analysis)
Таблица 1 Взаимосвязь ожирения с общемедицинскими и глазными параметрами у населения Южного Урала в возрасте 40 лет и старше по данным исследования Ural Eye and Medical Study (результаты многофакторного анализа)
Table 2 Correlation of intraocular pressure with general somaticand ocular parameters in the population of the Southern Urals aged 40 years and older according to the Ural Eye and Medical Study (multivariate analysis)
Таблица 2 Взаимосвязь внутриглазного давления с общемедицинскими и глазными параметрами у населения Южного Урала в возрасте 40 лет и старше по данным исследования Ural Eye and Medical Study (результаты многофакторного анализа)
Relevance
Obesity is a chronic metabolic disease that manifests itself in an excessive increase in body weight mainly due to excessive accumulation of adipose tissue. There are several indicators that allow you to judge the presence of obesity in a person — body mass index (BMI), abdominal circumference and waisttohip ratio. In the scientific literature and in clinical practice, BMI is more often used to assess the presence of obesity, which in obese adults equal to ≥30 (normal 18.5–24.9) [1, 2].
From 1996 to 2016, the number of obese people in the world increased by 59%. At the same time, it is established that currently the incidence of obesity in a civilized society is growing regardless of hereditary factors (there are no changes in the genetic pool).The largest number of overweight or obese people is recorded in China (402 million people), India (180 million people) and the United States (172 million people), while the lowest proportion is in Japan (4.3%). In Russia, as in most European countries, about 20% of the population is obese [3].
Obesity carries a social, medical and economic burden, as it is a risk factor for a huge number of diseases: diabetes mellitus, cardiovascular diseases, metabolic syndrome, etc. In addition, it often causes low selfesteem and depression, early mortality, reduced ability to work, and causes significant economic damage to society [2, 4]. In 2023, the loss in life expectancy among the obese population was about 4 years with grade II obesity and from 5 to 15 years — at the third degree [5].
Obese individuals are also more often suffer from eye diseases: inflammatory diseases (as a consequence of systemic inflammation), diabetic retinopathy (due to impaired carbohydrate metabolism and the development of insulin resistance), agerelated macular degeneration (caused by dyslipidemia and systemic inflammation), etc. According to Waspodo et al., obesity is one of the factors contributing to the development of increased intraocular pressure (IOP) and, as a consequence, primary openangle glaucoma, but the data obtained are contradictory and subject to further study [6–8].
Despite a large number of studies on the prevalence of obesity worldwide, there is only a small amount of data in the literature on the incidence of this condition in the Russian Federation (RF), and there is practically no information on the relationship of obesity with other medical and ophthalmological parameters, and in particular, with high IOP.
Purpose
To determine the relationship between obesity and high IOP in the population of the Southern Urals aged 40 years and older.
Material and methods
In the period from 2015 to 2017, a clinical populationbased study Ural Eye and Medical Study (UEMS) was conducted on the basis of the Ufa Eye Research Institute to determine the prevalence and identify risk factors for ocular and systemic diseases among residents of the Southern Ural aged 40 years and older. The UEMS was conducted in accordance with the Helsinki Declaration and was approved by the Local Ethics Committee of the Ufa Eye Research Institute.
All patients provided written informed consent. All respondents underwent a questionnaire (containing questions about their sociodemographic status, lifestyle, and medical history), as well as a general somatic and ophthalmological examination.
The UEMS study included 5899 participants (3319 women — 56,3%). The mean age was 59.5±10.7 years (median: 58.7 years; range: 40–92.8 years). All participants in the study were measured for anthropometric parameters such as body height and weight. BMI was calculated as the ratio of body mass (measured in kilograms) divided by the square of body height (measured in meters). The diagnosis of «obesity» was made in patients with a BMI of ≥30.0 kg/m2. IOP was measured using noncontact tonometry (Kowa KT800 tonometer; Kowa Company Ltd, Hamamatsu, Japan). Tonometry was repeated if the measurement results exceeded 21 mmHg. The presence of arterial hypertension (AH) was assessed by systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg, as well as by anamnesis (the presence of hypertension in the anamnesis, taking antihypertensive drugs). The presence of diabetes mellitus (DM) was assessed by the blood glucose index ≥7.0 mmol (blood sampling was performed on an empty stomach), as well as by anamnesis (the presence of a diagnosis of diabetes mellitus, oral hypoglycemic agents or the use of insulin).
Statistical software (Statistical Package for Social Science, SPSS, version 29.0; IBMSPSS Inc., Chicago, USA) was used for statistical analysis. Univariate and multivariate binary regression analysis was performed to determine the presence of correlations between obesity, intraocular pressure, and other demographic, social, and medical parameters. All variables that were not significantly related to the result parameter were excluded from the list of independent parameters. During linear regression analysis, variables from the list of independent parameters were checked for collinearity.
We calculated a standardized regression coefficient β and a nonstandardized regression coefficient B and its 95% confidence interval (CI), as well as odds ratios (OR) and their 95% CI. All pvalues were twosided and were considered statistically significant, with a value less than 0.05.
Results
In the study population, BMI averaged 27.9±5.0 kg/m2.
The prevalence of overweight (BMI=25–29.9 kg/m2) was 39.3% (2317/5899; 95% CI: 38.0; 40.5), and the prevalence of obesity (BMI ≥30.0 kg/m2) was 30.3% (1787/5899; 95% CI: 29.1; 31.5). The prevalence of overweight and obesity among men was 42.4% (1094/2580) and 21.5% (554/2580), respectively, among women — 36.8% (1223/3319) and 37.1% (1233/3319), respectively. Thus, in the study population of the Southern Urals, about 2/3 of the total number of women included in the study are overweight or obese, while obese men are 2 times less than overweight.
The results of a multivariate analysis showed that the prevalence of obesity is associated with young age, female sex, low level of education, low height, low prevalence of smoking and alcohol consumption, low concentration of bilirubin, highdensity lipoproteins (HDL) and triglycerides in the blood serum, high number of white blood cells, high prevalence of diabetes mellitus, metabolic syndrome, arterial hypertension and cardiovascular diseases, the presence of pain in the thoracic spine and high IOP (OR 1.03; 95% CI: 1.02; 1.05; p<0.001) (Table 1).
Determination of IOP showed that, in general, in the population, its average value in the right eye was 13.4±6.3 mmHg, in the left — 13.8±6.4 mmHg. The range of intraocular pressure varied from 3.5 to 49.0 mmHg, within standard deviations from 6.0 to 21.2 mmHg. For the regression analysis, we randomly selected one eye for each study participant.
Elevated IOP >21 mmHg was observed in 1.3% (79) of the patients, 37% (29) of whom were obese. Another 1.3% (80) of patients with IOP >21 mmHg had normal blood pressure on the background of antihypertensive therapy, of which almost a third (28%, 22 people) were obese.
A multivariate analysis of the relationship between IOP and other systemic and ocular parameters showed that IOP correlates with female sex, urban residence, high BMI (B: 0.06; 95% CI: 0.04; 0.08; β: 0.08; p<0.001), low physical activity diabetes mellitus, high systolic blood pressure, low amount of fruit per day, low concentration of bilirubin and urea in the blood serum.
The analysis revealed the relationship between IOP and such ophthalmological parameters as low best corrected visual acuity (BCVA), large thickness of the central corneal thickness, high refractive power of the corneal anterior surface, low prevalence of cataract surgery, large axial length (AL), the presence of pseudoexfoliation (Table 2).
Thus, the analysis of the results of a population study of the population of the Southern Urals demonstrated the presence of an inverse correlation of obesity and high IOP.
Discussion
In the study population of the Southern Urals aged 40 years and older, the prevalence of overweight and obesity was 39.3% and 30.3% accordingly. Previously, in the period from 2012 to 2014, Kontseva et al. a crosssectional multicenter study of the number regions population of the Russian Federation aged 25 to 64 years was conducted.
The prevalence of overweight and obesity was 34.3% and 30.3%, respectively. Broken down by regions of the Russian Federation, the prevalence of obesity ranged from 24.4% to 35.5%. These indicators are similar to those found in our study [9].
There are 3 types of obesity: alimentaryexchange, hypothalamic, and endocrine. It is alimentary obesity that causes the greatest damage to the body, since it consists in the accumulation of an excessive amount of visceral fat, which has many functions involved in the regulation of normal metabolism [8, 10].
An excessive amount of visceral fat is caused by hypertrophy of fat cells, which are more susceptible to damage, which, in turn, stimulates systemic inflammation, an increase in the number of macrophages, increased production of adipokines, chemokines, cytokines (TNFalpha, IL1, IL6, etc.), ROS, and an increase in the level of Creactive protein in the blood, which ultimately leads to the development of systemic inflammation.
In addition, excessive consumption of carbohydrates and fats provokes dysbiosis of the microflora, the production of endotoxins by the microbiome, increasing the systemic inflammatory process. Inflammatory cells can clog the trabecular work and lead to disruption of the outflow of intraocular fluid [7].
With an excess of visceral fat, the production of fat cells of renin, angiotensin1, angiotensin2, and angiotensinconverting enzyme by adipocytes increases, and the activation of the reninangiotensin system occurs, which contributes to the development of arterial hypertension. High blood pressure leads to increased production of watery moisture by the ciliary body and increased IOP. At the same time, hypertension leads to mechanical overstrain of the vessel walls, their damage, and thickening, which can lead to a decrease in the ability of the Schlemm channel to produce an outflow of intraocular fluid.
Another hypothesis of the relationship between obesity and ophthalmic hypertension indicates that an increase in orbital fat and increased blood viscosity increase episcleral venous pressure and reduce fluid outflow, which leads to an increase in IOP [11–14].
There is evidence that obese patients are more likely to develop glaucoma. Obesity is directly correlated with increased cerebrospinal fluid pressure, often leading to idiopathic intracranial hypertension. Excess weight, especially abdominal obesity, increases intraabdominal and intrathoracic pressure, which complicates venous outflow from the brain and increases CSF pressure.
Increased intracranial pressure can lead to swelling of the optic disc due to mechanical compression of blood vessels and nerve fibers. Thus, the relationship is not a direct transmission of pressure, but the effect of the translaminar pressure difference (the difference between IOP and intracranial pressure) of the optic nerve. on the optic nerve. However, there is no data in the literature on the direct dependence of IOP on intracranial pressure [15–18].
Conclusion
The results of the Ural Eyeand Medical Study showed that the prevalence of obesity among the population of the Southern Urals aged 40 years and older was 30.3% (1787/5899; 95% CI: 29.1; 31.5). The average value of IOP in the right eye was 13.4±6.3 mmHg, in the left eye — 13.8±6.4 mmHg. Elevated IOP >21 mmHg was observed in 1.3% (79) patients, 37% (29) of them were obese.
The presence of an association between obesity and increased IOP was determined (OR 1.03; 95% CI: 1.02; 1.05; p<0.001).
The data obtained indicate that when examining individuals with high intraocular pressure, ophthalmic hypertension and glaucoma, an ophthalmologist should pay attention not only to the ophthalmological status of patients, but also to the general appearance of the eye, its anthropometric data and BMI. The treatment algorithm for obese patients with high IOP must include recommendations for weight loss.
Information about the authors
Ellina M. Iakupova — Candidate of Medical Sciences, Head of integrative ophthalmology department, Ufa Eye Research Institute of Bashkir State Medical University, rakhimova_ellina@mail.ru, https://orcid.org/0000000296166261
Jost B. Jonas — Professor emer. of Ophthalmology, Medical Faculty Mannheim, of the RuprechtKarlsUniversity Heidelberg, Mannheim, Germany jost.jonas@medma.uniheidelberg.de, https://orcid.org/0000000329725227
Songhomitra Panda-Jonas — doctor, Privatpraxis Prof Jonas und Dr.PandaJonas, Heidelberg, Germany, drsjonas@gmail.com, https://orcid.org/00000300709863X
Информация об авторах
Якупова Эллина Маратовна — к.м.н., зав. отделом интегративной офтальмологии, Уфимский НИИ ГБ ФГБОУ ВО БГМУ Минздрава России, rakhimova_ellina@mail.ru, https://orcid.org/0000000296166261
Йост Бруно Йонас — профессор, Госпиталь Фонда Ротшильда, Французский институт близорукости, Париж, Франция, jost.jonas@ medma.uniheidelberg.de, https://orcid.org/0000000329725227
Панда-Йонас Сонгромитра — доктор Частной клиники профессора Йонаса и Доктора ПандаЙонас, Гейдельберг, Германия, drsjonas@gmail.com, https://orcid.org/00000300709863X
Аuthor’s сontribution:
Iakupova E.M. — data curation, writing original draft, review and editing.
Jonas J.B. — conceptualization, мethodology of investigation, data curation and analysis, review and editing.
Panda-Jonas S. — мethodology of investigation, review and editing.
Вклад авторов:
Якупова Э.М. — сбор и обработка материала, написание текста, рецензирование и редактирование.
Йонас Й.Б. — концепция и дизайн исследования, методология исследования, анализ и обработка данных, рецензирование и редактирование.
Панда-Йонас С. — методология исследования, рецензирование и редактирование.
Financial transparency: Аuthors have no financial interest in the submitted materials or methods.
Финансирование: Авторы не получали конкретный грант на это исследование от какоголибо финансирующего агентства в государственном, коммерческом и некоммерческом секторах.
Conflict of interest: Тhere is no conflict of interest.
Конфликт интересов: Отсутствует.
Поступила: 29.01.2026
Переработана: 20.02.2026
Принята к печати: 24.02.2025
Received: 29.01.2026
Revision: 20.02.2026
Accepted: 24.02.2026
