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Causes of Polyneuropathy in an Obese Population

JAMA Neurol; ePub 2016 Oct 31; Callaghan, et al

The prevalence of polyneuropathy is high in obese individuals, even those with normal glucose levels, with diabetes, prediabetes, and obesity being the likely metabolic drivers, a recent study found. This cross-sectional study included 102 obese participants (mean age 52.9 years; 45 [44.1%] with normoglycemia, 31 [30.4%] with prediabetes, and 26 [25.5%] with type 2 diabetes), and 53 lean controls. Researchers found:

  • The prevalence of polyneuropathy was 3.8% in lean controls (n=2), 11.1% in the obese participants with normoglycemia (n=5), 29% in the obese participants with prediabetes (n=9), and 34.6% in obese participants with diabetes (n=9).
  • Age (OR, 1.09), diabetes (OR, 4.90), and waist circumferences (OR, 1.24) were significantly associated with neuropathy in multivariable models.
  • Prediabetes (OR, 3.82) was not significantly associated with neuropathy.

Citation:

Callaghan BC, Xia R, Reynolds E, et al. Association between metabolic syndrome components and polyneuropathy in an obese population. [Published online ahead of print October 31, 2016]. JAMA Neurol. doi:10.1001/jamaneurol.2016.3745.

Commentary:

Polyneuropathy can range in severity from bothersome, with intermittent tingling and numbness, to severe and disabling. We are familiar with it as a long-term complication of diabetes as well as occurring sporadically in patients without diabetes. We are beginning to recognize that many of the sporadic cases in patients without diabetes may be due to prediabetes and obesity. A previous paper in Diabetes Care demonstrated that evidence of polyneuropathy was found in 49% of a large cohort of patients with prediabetes and that progression of glucose intolerance over 3 years predicted a higher risk of peripheral neuropathy and nerve dysfunction.1 The lack of relationship to prediabetes reported in the current paper is likely due to the relatively small numbers of patients with prediabetes in the study, since the hazard ratio for polyneuropathy with prediabetes was 3.8. The current paper expands these non-diabetes related risk factors for peripheral neuropathy to include obesity as well as diabetes. —Neil Skolnik, MD

  1. Lee CC, et al. Peripheral neuropathy and nerve dysfunction in individuals at high risk for type 2 diabetes: The PROMISE cohort. Diabetes Care. 2015;38:1-8. doi:10.2337/dc14-2585.