Associations between psycho-behavioral risk factors and diabetic retinopathy: NHANES (2005-2018)

Evaluation of the Effect of Psychological Resilience on Anxiety in Patients with Diabetic Retinopathy Through the Mediating Effect of Perceived Stress: A Moderated Mediation Model

Objective

To investigate the anxiety status of Chinese patients with diabetic retinopathy (DR) and its relationship with psychological resilience and perceived stress.

Methods

A sampling method was used to select 606 DR patients, and the 10-item Connor-Davidson Resilience Scale (CD-RISC-10), Perceived Stress Scale short-form (PSS-10), and General Anxiety Disorder-7 (GAD-7) were used for the survey. We used SPSS 26.0 to analyse the data and employed PROCESS v4.1 for the mediating effect test.

Results

The incidence of anxiety in DR patients was approximately 53.63%, with psychological resilience (CD-RISC-10 average=27.51±8.32) and perceived stress (PSS-10 average=15.97±6.54). Anxiety was negatively correlated with psychological resilience (r=-0.569, P<0.01) and positively correlated with perceived stress (r=0.638, P<0.01). Additionally, psychological resilience was negatively correlated with perceived stress (r=-0.681, P<0.01). Perceived stress had a positive predictive effect on anxiety (total effect = -0.327, 95% bootstrap CI = -0.363 to -0.291), and it played a mediating role in the relationship between psychological resilience and anxiety, with a mediating effect size of 54.13%.

Conclusion

Psychological resilience and perceived stress directly or indirectly affect anxiety, Perceived stress moderates the relationship between psychological resilience and anxiety as a mediating variable. By analyzing this psychological mechanism, this study provides a new perspective for applying psychology to chronic diseases and a scientific basis for medical staff to develop targeted psychological intervention measures.

Multi-omics analysis reveals Angelica sinensis-Carthamus tinctorius herb pair ameliorates diabetic retinopathy comorbid with depressive symptoms via the gut-eye-brain axis

BACKGROUND

Diabetic retinopathy (DR) comorbid with depressive symptoms represents a significant public health challenge. The limitations of monotherapeutic approaches and the complex interplay between DR and depression highlight the need for comprehensive, integrated treatment strategies.

PURPOSE

This study aimed to explore the therapeutic efficacy and underlying mechanisms of the Angelica sinensis-Carthamus tinctorius herb pair (ACHP) in addressing DR comorbid with depressive symptoms, utilizing an integrative multi-omics approach.

METHODS

The chemical composition of ACHP was characterized using UPLC-MS. A DR mouse model exhibiting depressive-like behaviors was established through streptozotocin induction and long-term social isolation. The therapeutic effects and mechanisms of ACHP were evaluated using immunofluorescence, qRT-PCR, ELISA, non-targeted metabolomics, and 16S rRNA sequencing. Correlation analysis was conducted to elucidate the relationships among gut and ocular microbiota, serum metabolites, and clinical indices related to DR and depressive symptoms.

RESULTS

ACHP treatment significantly alleviated hyperglycemia, retinal thinning, and depressive-like behaviors in the model mice. Multi-omics analysis revealed that ACHP restored gut microbiota balance by increasing beneficial Lactobacillus and reducing pathogenic genera such as Dubosiella and Faecalibaculum, while also reshaping ocular microbiota by suppressing pro-inflammatory Achromobacter and Pseudomonas. ACHP enhanced intestinal barrier integrity through upregulation of occludin, ZO-1 and MUC-2 and attenuated systemic and neuroinflammatory responses by reducing levels of LPS, TNF-α, IL-6, and IL-1β. Metabolomic profiling revealed that ACHP normalized glycerophospholipid metabolism-crucial for reducing inflammation and oxidative stress-specifically by inhibiting PLA2 and COX-2 while upregulating PPARγ. Correlation network analysis further emphasized the interactions among gut/ocular microbiota, inflammatory markers, and metabolites, highlighting the central role of the gut-eye-brain axis.

CONCLUSION

These findings demonstrate that ACHP alleviates DR-depression comorbidity by synergistically targeting microbial dysbiosis, metabolic dysregulation, and inflammatory cascades across the gut-eye-brain axis. This study provides a novel, holistic therapeutic strategy rooted in traditional Chinese medicine, offering new insights into treating complex comorbid conditions.

Dietary zinc intake and 10-year atherosclerotic cardiovascular disease risk in diabetes mellitus patients: evidence from NHANES database

OBJECTIVE

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in diabetes mellitus (DM) patients. Oxidative stress and inflammation are important pathological mechanisms affecting the occurrence and development of ASCVD in DM patients. Dietary zinc acts a key role in anti-oxidation, anti-inflammation and blood glucose regulation. This study purposes to explore the relationship between dietary zinc intake and 10-year ASCVD in DM patients.

METHODS

Based on the National Health and Nutrition Examination Survey (NHANES) 2007-2018, the 10-year risk of ASCVD was assessed using the 2018 ACC/AHA guidelines & pooled cohort equations model. The total dietary zinc intake was calculated through 24-h dietary recall. Weighted univariable, multivariate logistic regression and restricted cubic splines (RCS) were performed to evaluate the association between dietary zinc intake and 10-year risk of ASCVD among patients with DM. Stratified analysis based on the history of hypertension, dyslipidemia and hypoglycemic agent's treatment were further evaluated these associations.

RESULTS

Finally, we included 3,053 DM patients, of which 1,245 (40.78%) had high risk of 10-year ASCVD. We found higher dietary zinc intake was related to lower 10-year ASCVD risk among patients with DM (OR = 0.77, 95%CI: 0.61-0.99, P = 0.044), especially in patients with hypertension (OR = 0.53, 95%CI: 0.36-0.80), dyslipidemia (OR = 0.74, 95%CI: 0.58-0.95, P = 0.019), and hypoglycemic agent's treatment (OR = 0.71, 95%CI: 0.54-0.93, P = 0.016).

CONCLUSION

Sufficient dietary zinc intake has potential benefits for cardiovascular health among patients with DM. Further large-scale and well-designed prospective study are needed to further explore these associations.

Construction of a nomogram for predicting the risk of all-cause mortality in patients with diabetic retinopathy

Background

Diabetic retinopathy (DR) not only leads to visual impairment but also increases the risk of death in type 2 diabetes patients. This study aimed to construct a nomogram to assess the risk of all-cause mortality in patients with DR.

Methods

This cross-sectional study included 1004 patients from the National Health and Nutrition Examination Survey database (NHANES) between 1999-2018. Participants were randomized in a 7:3 ratio into a training set and a test set. We selected predictors by LASSO regression and multifactorial Cox proportional risk regression analysis and constructed nomograms, guided by established clinical guidelines and expert consensus as the gold standard. We used the concordance index (C-index), receiver operating characteristic curve (ROC), calibration curve, and decision curve analysis (DCA) to evaluate the nomogram's discriminative power, calibration quality, and clinical use.

Results

The training and test sets consisted of 703 and 301 participants with a median age of 64 and 63 years, respectively. The study identified seven predictors, including age, marital status, congestive heart failure (CHF), coronary heart disease (CHD), stroke, creatinine level, and taking insulin. The C-index of the nomogram model constructed from the training set was 0.738 (95% CI: 0.704-0.771), while the C-index of the test set was 0.716 (95% CI: 0.663-0.768). In the training set, the model's AUC values for predicting all-cause mortality risk at 3 years, 5 years, and 10 years were 0.739, 0.765, and 0.808, respectively. In the test set, these AUC values were 0.737, 0.717, and 0.732, respectively. The ROC curve, calibration curve, and DCA curve all demonstrated excellent predictive performance, confirming the model's effectiveness and reliability in clinical applications.

Conclusions

Our nomogram demonstrates high clinical predictive accuracy, enabling clinicians to effectively predict the overall mortality risk in patients with DR, thereby significantly improving their prognosis.

The differences of metabolic profiles, socioeconomic status and diabetic retinopathy in U.S. working-age and elderly adults with diabetes: results from NHANES 1999-2018

AIMS

Controlled metabolic factors and socioeconomic status (SES) was crucial for prevention of diabetic retinopathy (DR). The study aims to assess the metabolic factors control and SES among working-age adults (18-64 years) with diabetes compared to older adults (65 years and older).

METHODS

Totals of 6738 participants with self-reported diagnosed diabetes from National Health and Nutrition Examination Survey were included, of whom 3482 were working-age and 3256 were elderly. The prevalence of DR, metabolic factors control, and the impact of SES and diabetic duration on DR was estimated. Subgroup analysis among working-age adults was employed across different diabetic duration and SES level.

RESULTS

The prevalence of DR was 20.8% among working-age adults and 20.6% in elderly adults. Further, working-age adults possessed suboptimal control on glycemia (median HbA1c: 7.0% vs. 6.8%, p < 0.001) and lipids (Low-density lipoprotein < 100 mg/dL: 46.4% vs. 63.5%, p < 0.001), but better blood pressure control (< 130/80 mmHg: 53.5% vs. 37.5%, p < 0.001) compared to the elderly, judging based on age-specific control targets. Prolonged diabetic duration didn't improve glycemic and composite factors control. SES like education and income impacted metabolic factors control and adults with higher SES were more likely to control well. Diabetic duration was a significant risk factor (OR = 4.006, 95%CI= (2.752,5.832), p < 0.001) while higher income (OR = 0.590, 95%CI= (0.421,0.826), p = 0.002) and educational level (OR = 0.637, 95%CI= (0.457,0.889), p = 0.008) were protective against DR.

CONCLUSIONS

Working-age adults with diabetes demonstrate suboptimal metabolic profile control, especially glycemia and lipids. Additional efforts are needed to improve metabolic factor control and reduce DR risk, particularly for those with longer diabetes duration, less education, and lower incomes.

Risk factors for diabetic retinopathy in young and middle-aged patients: a retrospective study

AIMS/INTRODUCTION

To investigate the related risk factors of retinopathy in young and middle-aged diabetic patients in order to improve the prognosis of patients.

MATERIALS AND METHODS

Using clinical practice data from a cohort study at our two research centers, we developed a bivariate logistic regression model to investigate the frightening risk factors potentially for retinopathy in young and middle-aged patients with diabetes, including diabetes type, physical activity level, treatment-related characteristics and laboratory tests.

RESULTS

A total of 453 patients with diabetes were investigated, 197 (43.5%) developed retinopathy. The risk of retinopathy was closely related to place of residence (OR: 0.275, 95% CI: 0.093-0.814), education level (OR: 0.522, 95% CI: 0.363-0.749), medical payment method (OR: 2.152, 95% CI: 1.308-3.539), BMI (OR: 1.187, 95% CI: 1.091-1.291), disease course (OR: 1.072, 95% CI: 1.028-1.118), hyperlipidemia (OR: 2.547, 95% CI: 1.260-5.150), physical activity level (OR: 0.312, 95% CI: 0.220-0.443), and dietary compliance (OR 0.871, 95% CI: 0.806-0.940). The area under the receiver operator characteristic curve was 0.915. Goodness of fit (Hosmer-Lemeshow) was 0.658.

CONCLUSIONS

The risk of young and middle-aged patients with increased as a result of certain patient characteristics and complications, especially lower dietary compliance and physical activity level.

Prevalence and risk factors of anxiety and depression in diabetic retinopathy patients: A cross-sectional study using multiple scales

OBJECTIVE

To investigate the prevalence of anxiety and depression, and explore their related factors in all types of diabetic retinopathy (DR) patients more precisely and accurately by multiple scales.

METHODS

Beck anxiety inventory (BAI), self-rating anxiety scale (SAS), beck depression inventory (BDI), and self-rating depression scale (SDS) scores were assessed in 247 DR patients and 250 non-retinopathic diabetes mellitus (NRDM) patients.

RESULTS

In DR patients, there were 32 patients with proliferative DR and 115 patients with impaired visual acuity. The prevalences (95% confidence interval) of anxiety were 38.5% (32.4%-44.6%) and 32.0% (26.2%-37.8%) by BAI and SAS, while those for depression were 31.6% (25.8%-37.4%) and 25.1% (19.7%-30.5%) by BDI and SDS in DR patients. BAI score (P = 0.003), BAI-defined anxiety rate (P = 0.010), SAS score (P = 0.001), SAS-defined anxiety rate (P = 0.006), BDI score (P = 0.005), BDI-defined depression rate (P = 0.028), and SDS score (P = 0.001) were increased in DR patients versus NRDM patients. In DR patients, proliferative DR independently related to BAI-defined anxiety (P < 0.001) and SAS-defined anxiety (P < 0.001). Female (P = 0.016) and proliferative DR (P < 0.001) independently associated with BDI-defined depression; female (P = 0.007), DM duration (P = 0.025), triglyceride (TG) (P = 0.026), and proliferative DR (P = 0.014) independently associated with SDS-defined depression. The combination of these independent factors showed acceptable abilities in predicting BAI-defined anxiety, SAS-defined anxiety, BDI-defined depression, or SDS-defined depression in DR patients, with area under curves of 0.626, 0.656, 0.696, and 0.741, respectively (all P < 0.001).

CONCLUSION

Anxiety and depression are prevalent; meanwhile, proliferative DR, female, DM duration, and TG independently relate to anxiety or depression in DR patients.

Association of Dietary Flavonoids Intake With All-Cause and Cardiovascular Disease Mortality in Diabetic Kidney Disease: A Cohort Study From the NHANES Database

The relationship between dietary flavonoid intake and mortality in the diabetic kidney disease (DKD) population is unknown. So this study is aimed at investigating the association of total dietary flavonoid intake and their subclasses with all-cause and cardiovascular disease (CVD) mortality. Data of this cohort study were extracted from the NHANES (2007-2010 and 2017-2018). The survival status of participants was determined by linking to the National Death Index through the end of 2019. Flavonoid intake was measured using two 24-h dietary recall interviews. The Kaplan-Meier curves and weighted Cox proportional hazard regression models were used to assess the effect of dietary flavonoid intake on CVD and all-cause mortality, with adjustments for multiple covariates. A total of 1155 participants were included for analysis. After a median follow-up of 76.36 (S.E: 3.24) months, 409 participants died of all-cause mortality, of which 138 died of CVD. In the fully adjusted model, higher total dietary flavonoids intake (HR = 0.69, 95% CI: 0.52-0.92) was associated with lower all-cause mortality and subclasses of higher flavones (HR = 0.60, 95% CI: 0.35-0.85) was also with lower all-cause mortality. In subclasses of flavonoids, higher intake of both anthocyanidins (HR = 0.54, 95% CI: 0.28 to 0.87) and flavones (HR = 0.50, 95% CI: 0.28-0.87) were associated with lower odds of CVD mortality. Higher flavonoid intake was associated with a reduced risk of CVD and all-cause mortality in DKD. Higher flavonoid intake provides a potential opportunity to improve the prognosis of DKD. And future research into the mechanisms between flavonoids and mortality is needed.

Association between serum vitamin D concentration and liver fibrosis in diabetes mellitus patients: a cross-sectional study from the NHANES database

AIM

Liver fibrosis (LF) is a common complication of diabetes mellitus (DM). Studies have found that vitamin D (VD), as a modifiable factor has been reported to be associated with LF. The relationship between serum VD concentration and LF in DM patients has rarely been reported. The aim of this study was to assess the association between serum VD concentration and LF in DM patients.

METHODS

In this cross-sectional study, data of DM patients aged ≥ 45 years were extracted from the National Health and Nutrition Examination Survey (NHANES 2017-2018). Serum VD concentration was measured by high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). Vibration controlled transient elastography (VCTE) was used to measure liver stiffness. Covariates included sociodemographic information, lifestyles, laboratory data, diseases history were extracted from the database. The weighted univariable and multivariable logistic regression models were utilized to explore the association between serum VD concentration and LF in DM patients, and were described as odds ratio (ORs) and 95% confidence intervals (CIs). Subgroup analyses based on BMI, liver steatosis, hypertension and dyslipidemia were further assessed the association.

RESULTS

A total of 799 patients were included, of which 188 (23.53%) had LF. Higher serum VD concentration was associated with the lower odds of LF (OR = 0.33, 95% CI 0.19-0.59) and advanced LF (OR = 0.31, 95% CI 0.17-0.55) in DM patients after adjustment for race, liver steatosis, BMI, smoking, drinking, AST, ALT and physical activity, especially in patients with liver steatosis (OR = 0.28, 95% CI 0.13-0.59) and dyslipidemia (OR = 0.31, 95% CI 0.14-0.66), respectively.

CONCLUSIONS

High serum VD concentration may have a potential benefit for maintain the liver health in DM patients.

Bidirectional relationship between diabetes mellitus and depression: Mechanisms and epidemiology

Diabetes mellitus and depression exhibit a complex bidirectional relationship that profoundly impacts patient health and quality of life. This review explores the physiological mechanisms, including inflammation, oxidative stress, and neuroendocrine dysregulation, that link these conditions. Psychosocial factors such as social support and lifestyle choices also contribute significantly. Epidemiological insights reveal a higher prevalence of depression among diabetics and an increased risk of diabetes in depressed individuals, influenced by demographic variables. Integrated management strategies combining mental health assessments and personalized treatments are essential. Future research should focus on longitudinal and multi-omics studies to deepen understanding and improve therapeutic outcomes.

Association between waist circumference and sleep disorder in the elderly: Based on the NHANES 2005-2018

The existing data do not consistently support the link between elderly adults' waist circumferences and sleep disorders. This study aimed to evaluate whether waist circumference was connected with sleep disorder in the elderly. This cross-sectional study utilized data from the 2005-2018 National Health and Nutrition Examination Survey (NHANES) regarding waist circumference, sleep disorders, and confounding factors. Included in the study were participants older than 60 who completed sleep questionnaires and waist circumference measurements. Using a multivariate logistic regression model and subgroup analyses, the relationship between waist circumference and sleep disorder was evaluated. To explore the non-linear relationship, restricted cubic spline (RCS) with three knots coupled with a logistic regression model to assess the dose-response relationship between waist circumference (continuous variables) and sleep disorder. A total of 2,545 (Weighted 14,682,916.3) elderly participants with complete information were included in the analysis and 312 (Weighted 1,777,137.8) subjects met the definition of sleep disorder. Compared with participants without sleep disorder, those with sleep disorder had a higher waist circumference (100.80 cm vs. 108.96 cm, P< 0.001). The results of the multivariable adjusted logistic regression model suggested that those in quartiles 4 (≥ 75th percentile) for their waist circumference had higher odds of sleep disorder [adjusted odds ratio (AOR) = 2.75, 95% confidence interval (CI) = 1.66-4.54, P < 0.001] compared with those in quartile 1. The RCS result showed that the OR of sleep disorder and waist circumference displayed a linear relationship (P <0.001, Non-linear P = 0.642). Age and gender subgroup analysis revealed comparable relationships between waist circumference and sleep disorder among elderly individuals. Waist circumference was associated with sleep disorders in the elderly. There was a dose-response relationship between waist circumference and the likelihood of sleep disorder. Those with a larger waist circumference were more likely to have a sleep disorder than those with a smaller waist circumference.

Imaging-based body fat distribution and diabetic retinopathy in general US population with diabetes: an NHANES analysis (2003-2006 and 2011-2018)

BACKGROUND

Limited studies have investigated the correlation between fat distribution and the risk of diabetic retinopathy (DR) in the general population with diabetes. The relationship between obesity and DR remains inconclusive, possibly due to using simple anthropometric measures to define obesity. This study investigates the relationships between the android-to-gynoid fat ratio (A/G ratio, measured using dual-energy X-ray absorptiometry) and DR within the US population with diabetes.

METHODS

The study used a population-based, cross-sectional approach based on the 2003-2006 and 2011-2018 data of the National Health and Nutrition Examination Survey (NHANES). Multivariable logistic regression analyses were performed on participants with diabetes to evaluate the contribution of body mass index (BMI), waist-to-height ratio (WHtR), and A/G ratio to the prevalence of DR.

RESULTS

The prevalence of DR was 22.2, 21.2, and 17.6% among participants with A/G ratios <1.0, 1.0-1.2, and ≥1.2, respectively. After adjusting sex, age, ethnicity, diabetes duration, hemoglobin A1c level, blood pressure level, and non-high-density lipoprotein cholesterol level, a higher A/G ratio (≥1.2) was independently associated with decreased odds of DR (odds ratio [OR], 0.565; 95% CI: 0.372-0.858) compared with the A/G ratio of 1.0-1.2. Associations between a higher A/G ratio and DR remained statistically significant after adjusting for BMI (OR, 0.567; 95% CI: 0.373-0.861) and WHtR (OR, 0.586; 95% CI: 0.379-0.907). Moreover, these associations remained statistically significant in analyses using the ethnic-specific tertiles for the A/G ratio. In sex-stratified models, these correlations remained in males. There was a significant inverse association between the A/G ratio and diabetes duration in males, which persisted after multivariable adjustments (p < 0.05).

CONCLUSIONS

A novel finding indicates that a higher A/G ratio is associated with a reduced likelihood of DR in males with diabetes. The results from NHANES underscore the importance of considering imaging-based fat distribution as a critical indicator in clinical practice.

Predictors and consequences of visual trajectories in Chinese older population: A growth mixture model

Background

Given the relatively high prevalence of vision impairment and the heterogeneity of visual changes among the elderly population, we aimed to identify the visual trajectories and to examine the predictors and consequences associated with each trajectory class.

Methods

We analysed data from 2235 participants involved in the 5th, 6th, 7th, and 8th waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), where vision impairment was evaluated using an adapted Landolt-C chart during each wave. We employed a growth mixture model (GMM) to identify distinct visual trajectories and logistic regression analysis to examine the predictors associated with each trajectory class. Furthermore, we investigated the effect of visual trajectories on distal consequences, including cognitive function, activities of daily living (ADL), instrumental activities of daily living (IADL), depression, anxiety, and fall risk. Within the CLHLS study, cognitive function was assessed using the Chinese version of the Mini-Mental State Examination (CMMSE), ADL via the Katz index, and IADL through a modified version of Lawton's scale. Lastly, depression was assessed using the 10-item version of the Centre for Epidemiologic Studies (CES-D-10), while anxiety was measured using the Generalized Anxiety Disorder scale (GAD-7). Fall risk was determined by asking the question: 'Have you experienced any falls within the past year?'

Results

We identified two distinct visual trajectories in our analysis. Most older adults (n = 1830, 81.9%) initially had a good vision level that diminished ('high-baseline decline' group). Conversely, the remaining participants (n = 405, 18.1%) initially had a lower vision level that improved over time ('low-baseline improvement' group). The 'high-baseline decline' group was more likely to include older adults with relatively higher body mass index (BMI) (odds ratio (OR) = 1.086; 95% confidence interval (CI) = 1.046, 1.127), individuals with higher formal educational qualifications (OR = 1.411; 95% CI = 1.068, 1.864), those current engaging in exercise (OR = 1.376; 95% CI = 1.046, 1.811), and individuals reporting more frequent consumption of fruit (OR = 1.357; 95% CI = 1.053, 1.749). Conversely, the 'low-baseline improvement' group had a higher likelihood of including older individuals (OR = 0.947; 95% CI = 0.934, 0.961), residents of nursing homes (OR = 0.340; 95% CI = 0.116, 0.993) and those self-reporting cataracts (OR = 0.268; 95% CI = 0.183, 0.391) and glaucoma (OR = 0.157; 95% CI = 0.079, 0.315). Furthermore, the 'high-baseline decline' group showed a positive impact on distal consequences, adjusting for sex, birthplace, residence, main occupation, education, economic status, and marital status. This impact included cognitive function (correlation coefficient (β) = 2.092; 95% CI = 1.272, 2.912), ADL (β  = -0.362; 95% CI = -0.615, -0.108), IADL (β  = -1.712; 95% CI = -2.304, -1.121), and reported lower levels of depression (β  = 0.649; 95% CI = 0.013, 1.285). We observed no significant influence on fall risk and anxiety within the identified visual trajectories in the adjusted model.

Conclusions

Vision in older adults with ocular disease could potentially be improved. Having formal education, maintaining an appropriate BMI, engaging in exercise, and consuming fruit more frequently appear to be beneficial for the visual health of the elderly. Considering the negative impact of visual impairment experience on distal cognition, self-care ability, and depression symptoms, stakeholder should prioritise long-term monitoring and management of vision impairment among older adults.

Analysis of the association between high antioxidant diet and lifestyle habits and diabetic retinopathy based on NHANES cross-sectional study

Oxidative stress plays a crucial role in increasing the risk of developing diabetic retinopathy (DR). The oxidative balance score (OBS) and the composite dietary antioxidant index (CDAI) are two tools for assessing the effects of diet and lifestyle on oxidative stress. The aim of this study was to investigate the association between OBS, CDAI and the occurrence of DR. After controlling for potential confounders, OBS was negatively associated with DR with an odds ratio (OR) of 0.976 and a 95% confidence interval (CI) of 0.956-0.996, suggesting that for every unit increase in OBS, the risk of DR was reduced by 2.4%. In contrast, the relationship between OBS and CDAI was not significant (P > 0.05), suggesting that it was OBS, not CDAI, that contributed to the reduced risk of diabetic retinopathy. After adjusting for potential confounders, OBS was negatively associated with DR (OR: 0.976; 95% CI 0.956-0.996), but this association was not found in CDAI (P > 0.05), suggesting that for every one-unit increase in OBS, there was a 2.4% reduction in the risk of developing DR. This study suggests that a diet and lifestyle high in OBS reduces the risk of developing DR, which provides a rationale for nutritional interventions to prevent DR.

Association between biological aging and diabetic retinopathy

The impact of aging on diabetic retinopathy (DR) remains underestimated. The current study aimed to investigate the association between biological aging and DR, in contrast to chronological age (CA). Using the National Health and Nutrition Survey data from 2005 to 2008. Biological aging was evaluated through the biological age (BA) and phenotypic age (PA), which were calculated from clinical markers. DR was identified in participants with diabetes mellitus (DM) when they exhibited one or more retinal microaneurysms or retinal blot hemorrhages under retinal imaging, with or without the presence of more severe lesions. Survey-weighted multivariable logistic regression was performed, and the regression model was further fitted using restricted cubic splines. The discriminatory capability and clinical utility of the model were evaluated using receiver operating characteristic (ROC) curves and decision curve analysis (DCA). Based on weighted analyses, of the 3100 participants included in this study, of which 162 had DR. In the adjusted model, BA (odds ratio [OR] = 1.12, 95% CI, 1.06-1.18) and PA (OR = 1.11, 95% CI, 1.07-1.14) were associated with DR, while CA was not significantly (OR = 1.01, 95% CI, 0.99-1.03). Narrowing the analysis to DM participants and adjusting for factors like insulin showed similar results. ROC and DCA analyses indicate that BA/PA predicted DR better than CA and offer greater clinical utility. The positive association between BA/PA and DR was consistent across subgroups despite potential interactions. Biological aging heightens DR risk, with BA/PA showing a stronger association than CA. Our findings underscored the importance of timely anti-aging interventions for preventing DR.

Multidimensional sleep health and diabetic retinopathy: Systematic review and meta-analysis

Diabetic retinopathy (DR) is one of the most prevalent microvascular diabetic complications. Poor sleep health and obstructive sleep apnea (OSA) are risk factors for diabetes and poor glycemic control. Recent studies have suggested associations between poor sleep health/OSA and DR. Furthermore, there have been suggestions of melatonin dysregulation in the context of DR. We conducted a systematic review and meta-analysis exploring the associations between multidimensional sleep health (duration, satisfaction, efficiency, timing/regularity and alertness), OSA and melatonin with DR. Forty-two studies were included. Long, but not short sleep, was significantly associated with DR, OR 1.41 (95%CI 1.21, 1.64). Poor sleep satisfaction was also significantly associated with DR, OR 2.04 (1.41, 2.94). Sleep efficiency and alertness were not associated with DR, while the evidence on timing/regularity was scant. Having OSA was significantly associated with having DR, OR 1.34 (1.07, 1.69). Further, those with DR had significantly lower melatonin/melatonin metabolite levels than those without DR, standardized mean difference -0.94 (-1.44, -0.44). We explored whether treating OSA with continuous positive airway pressure (CPAP) led to improvement in DR (five studies). The results were mixed among studies, but potential benefits were observed in some. This review highlights the association between poor multidimensional sleep health and DR.

Association of single nucleotide polymorphisms in ITLN1 gene with ischemic stroke risk in Xi'an population, Shaanxi province

Background

Ischemic stroke (IS) is the main cause of death and adult disability. However, the pathogenesis of this complicated disease is unknown. The present study aimed to assess the relationship between ITLN1 single nucleotide polymorphisms (SNPs) and the susceptibility to IS in Xi'an population, Shaanxi province.

Methods

In this study, we designed polymerase chain reaction (PCR) primers located at -3,308 bp upstream of the transcription initiation site within promoter region of the ITLN1 gene. The target fragment was amplified by PCR and identified by agarose gel electrophoresis. Sanger sequencing was then performed in the samples extracted from a cohort comprising 1,272 participants (636 controls and 636 cases), and the obtained sequences were compared with the reference sequences available on the National Center for Biotechnology Information (NCBI) website to detect SNPs in the ITLN1 gene promoter region. Logistic regression analysis was employed to assess the relationship between ITLN1 polymorphisms and IS risk, with adjustments for age and gender. Significant positive results were tested by false-positive report probability (FPRP) and false discovery rate (FDR). The interaction among noteworthy SNPs and their predictive relationship with IS risk were explored using the Multi-Factor Dimensionality Reduction (MDR) software.

Results

The results of Sanger sequencing were compared with the reference sequences on the NCBI website, and we found 14 SNPs in ITLN1 gene promoter satisfied Hardy-Weinberg equilibrium (HWE). Logistic regression analysis showed that ITLN1 was associated with a decreased risk of IS (rs6427553: Homozygous C/C: adjusted OR: 0.69, 95% CI [0.48-0.97]; Log-additive: adjusted OR: 0.83, 95% CI [0.70-0.98]; rs7411035: Homozygous G/G: adjusted OR: 0.66, 95% CI [0.47-0.94]; Dominant G/T-G/G: adjusted OR: 0.78, 95% CI [0.62-0.98]; Log-additive: adjusted OR: 0.81, 95% CI [0.69-0.96]; rs4656958: Heterozygous G/A: adjusted OR: 0.74, 95% CI [0.59-0.94]; Homozygous A/A: adjusted OR: 0.51, 95% CI [0.31-0.84]; Dominant G/A-A/A: adjusted OR: 0.71, 95% CI [0.57-0.89]; Recessive A/A: adjusted OR: 0.59, 95% CI [0.36-0.96]; Log-additive: adjusted OR: 0.73, 95% CI [0.61-0.88]), especially in people aged less than 60 years and males.

Conclusions

In short, our study revealed a correlation between ITLN1 variants (rs6427553, rs7411035 and rs4656958) and IS risk in Xi'an population, Shaanxi province, laying a foundation for ITLN1 gene as a potential biomarker for predicting susceptibility to IS.

Causal effects of diabetic retinopathy on depression, anxiety and bipolar disorder in the European population: a Mendelian randomization study

PURPOSE

To verify the causal effects of diabetic retinopathy (DR) on depression, anxiety and bipolar disorder (BD).

METHODS

Mendelian randomization (MR) analysis was performed to identify the causal relationships between DR and depression or anxiety or BD via using DR-related GWAS data (14,584 cases and 176,010 controls), depression-related GWAS data (59,851 cases and 113,154 controls), anxiety-related GWAS data (7016 cases and 14,745 controls) and BD-related GWAS data (41,917 cases and 371,549 controls). The inverse-variance weighted (IVW) model was adopted to estimate the causal relationship. The outcome was expressed as odds ratio (OR) with 95% confidence intervals (CI).

RESULTS

The MR analysis results presented that DR was causally associated with a significantly increased risk of BD in the European population (IVW, OR = 1.06, 95%CI [1.03, 1.08], P = 2.44 × 10-6), while DR was unable to causally influence the risk of depression (IVW, OR = 1.01, 95%CI [0.99, 1.04], P = 0.32) and anxiety (IVW, OR = 0.97, 95%CI [0.89, 1.06], P = 0.48) in the European population. Subgroup analysis based on BD identified DR causally increased the risk of bipolar I disorder (BD I) but not bipolar II disorder (BD II). Sensitivity analysis results did not show any pleiotropy and heterogeneity in both groups of analyses, indicating that the results were stable and reliable.

CONCLUSIONS

The results of the current MR analysis indicated a causal relationship between DR and BD in the European population, while there was no causal connection between DR and depression or anxiety. However, further research is needed to confirm these conclusions.

Association of dietary carbohydrate and fiber ratio with postmenopausal bone mineral density and prevalence of osteoporosis: A cross-sectional study

BACKGROUND

This study aimed to investigate the associations of carbohydrate to dietary fiber ratio with bone mineral density (BMD) and the prevalence of osteoporosis in postmenopausal women.

METHODS

This cross-sectional study retrieved the data of 2829 postmenopausal women from the National Health and Nutrition Examination Survey (NHANES) database. Weighted univariable logistic regression models were used to investigate the correlations of carbohydrate, dietary fiber, or carbohydrate to fiber ratio with osteoporosis.

RESULTS

Higher dietary fiber intake was correlated with decreased odds ratio of osteoporosis [odds ratio(OR) = 0.96, 95% confidence interval (CI): 0.93 to 0.99]. The odds ratio of osteoporosis in postmenopausal women was elevated as the increase of carbohydrate to fiber ratio (OR = 1.80, 95%CI: 1.10 to 2.96). Carbohydrate to fiber ratio >17.09 was related to increased odds ratio of osteoporosis (OR = 1.63, 95%CI: 1.04 to 2.56). Compared to the carbohydrate to fiber ratio ≤11.59 group, carbohydrate to fiber ratio >17.09 was associated with decreased total femur BMD (β = -0.015, 95%CI: -0.028 to -0.001) and femur neck BMD (β = -0.020, 95%CI: -0.033 to -0.006) in postmenopausal women. The femur neck BMD in postmenopausal women was decreased with the increase of carbohydrate to fiber ratio (β = -0.015, 95%CI: -0.028 to -0.001).

CONCLUSION

In postmenopausal women, a high carbohydrate/fiber ratio >17.09 is associated with an increased risk of osteoporosis and lower hip BMD and high fiber intake is associated with less osteoporosis and higher hip BMD.

Exposure to volatile organic compounds is a risk factor for diabetes retinopathy: a cross-sectional study

Introduction

A few past experimental studies have indicated that exposure to volatile organic compounds (VOCs) might be a potential risk factor for diabetes retinopathy (DR). However, these findings lack substantial support from extensive epidemiological research. This large-scale cross-sectional study aimed to examine whether exposure to low levels of VOCs in the general population is associated with diabetes mellitus (DM) and DR.

Methods

The analytical data was from the National Health and Nutrition Examination Survey (NHANES) dataset (2011-2018). To minimize the potential impact of gender and age on the findings, propensity score matching was utilized to align the data selection. Relationships between blood VOCs and DM and DR were assessed in a sample of 2,932 adults using the logistic regression models. Additionally, Bayesian kernel machine regression (BKMR) models and Weighted Quantile Sum (WQS) were conducted for mixture exposure analysis.

Results

The result shows VOCs were positive associated with DM and DR in US adults, as assessed by WQS model, and the calculated odd ratios (ORs) [95% confidence interval (C.I)] were 53.91(34.11 ~ 85.22) and 7.38(3.65 ~ 14.92), respectively. Among the components of VOCs, 1,2-Dibromoethane, Carbon Tetrachloride and 2,5-Dimethylfuran were positive related with the DR, and ORs (95%C.I) were 2.91(2.29 ~ 3.70), 2.86(2.25 ~ 3.65) and 2.19(1.79 ~ 2.94), respectively. BKMR model shows that there was a dose-response relationship between combined VOCs and DR, although the relationship was non-linearly.

Conclusion

This study suggested that exposure to VOCs may increase the risk of DR, which had important public health implications.

Modifiable lifestyle, mental health status and diabetic retinopathy in U.S. adults aged 18-64 years with diabetes: a population-based cross-sectional study from NHANES 1999-2018

BACKGROUND

The relationship between integrated lifestyles, mental status and their impact on overall well-being has attracted considerable attention. This study aimed to evaluate the association between lifestyle factors, depression and diabetic retinopathy (DR) in adults aged 18-64 years.

METHODS

A cohort of 3482 participants diagnosed with diabetes was drawn from the National Health and Nutrition Examination Survey (NHANES) spanning the years 1999-2018. DR was defined based on self-reported diabetic retinopathy diagnoses by professional physicians, relying on Diabetes Interview Questionnaires. Subgroup analysis was employed to assess lifestyle and psychological factors between participants with DR and those without, both overall and stratified by diabetic duration. Continuous variables were analyzed using the student's t test, while weighted Rao-Scott χ2 test were employed for categorical variables to compare characteristics among the groups.

RESULTS

Of the 3482 participants, 767 were diagnosed with diabetic retinopathy, yielding a weighted DR prevalence of 20.8%. Patients with DR exhibited a higher prevalence of heavy drinking, depression, sleep deprivation, and insufficient physical activity compared to those without DR. Furthermore, multivariable logistic regression analysis revealed that sleeping less than 5 h (OR = 3.18, 95%CI: 2.04-4.95, p < 0.001) and depression (OR = 1.35, 95%CI:1.06-1.64, p = 0.025) were associated with a higher risk of DR, while moderate drinking (OR = 0.49, 95%CI: 0.32-0.75, p = 0.001) and greater physical activity (OR = 0.64, 95%CI: 0.35-0.92, p = 0.044) were identified as protective factors.

CONCLUSIONS

Adults aged 18-64 years with DR exhibited a higher prevalence of lifestyle-related risk factors and poorer mental health. These findings underscore the need for concerted efforts to promote healthy lifestyles and positive emotional well-being in this population.

Association between depression and endometriosis using data from NHANES 2005-2006

Studies on the association between depression and self-reported endometriosis are limited, and further studies are required to investigate this association. Data were collected from the National Health and Nutrition Examination Survey database (2005-2006). Based on the inclusion and exclusion criteria, 100 participants with self-reported endometriosis and 1295 participants without self-reported endometriosis were included, representing a total population of 64,989,430. Depression severity was assessed using the Patient Health Questionnaire 9 (PHQ9). A survey-weighted logistic regression analysis was performed to explore the association between depression and endometriosis. Subgroup analyses were conducted to explore heterogeneity. The prevalence of endometriosis was 7.17%. A significant positive association was found between the PHQ9 score and endometriosis. After adjusting for all covariates, the PHQ9 score positively correlated with endometriosis. Furthermore, compared with the participants without depression, those with moderate depression were more prone to have endometriosis both in unadjusted and fully adjusted model. However, the relationship between severe depression and endometriosis was not significant in all models (P > 0.05). Our findings highlight the influence of depression on the prevalence of self-reported endometriosis. Further studies are required to elucidate the causal relationship between depression and self-reported endometriosis.

Psycho-Behavioral Characteristics Perceived as Facilitators by Brazilian Adults with Type 1 Diabetes Mellitus in a Public Health Service

Type 1 diabetes imposes a complex and challenging routine on patients and caregivers. Therefore, considering individual experiences and personal facilitators to promote assertive interventions is crucial. However, no studies have addressed these perspectives in the Brazilian adult population. We aimed to identify psycho-behavioral characteristics perceived as facilitators for coping with the condition. We used a biographical method to conduct semi-structured, face-to-face, in-depth interviews for each participant. Transcripts were analyzed using inductive thematic analysis. Participants (n = 22) were aged 18-57 years (mean: 30.2; standard deviation (SD): 8.7), and the duration since diagnosis was approximately 20.6 years (SD: 4.6). A total of 12 (54.4%) were women, 13 (59.1%) used insulin pumps, 14 (63.6%) had at least a college degree, and 13 (59.1%) had HbA1C (glycated hemoglobin) levels above 58 mmol/mol (7.5%). Five major themes emerged: (1) peer learning, (2) ownership, (3) welcoming experiences, (4) equity, and (5) reframing the path (P.O.W.E.R.). All themes appeared in the lived experiences shared by participants with HbA1C levels below 58 mmol/mol (7.5%). Improved glycemic control can be achieved, and the challenges encountered in diabetes care within similar socioeconomic contexts can be addressed by an interdisciplinary care team that takes P.O.W.E.R. into consideration when providing person-centered care strategies.

Validity and Reliability of the Chinese Version of the Diabetes Treatment Burden Questionnaire (DTBQ) Among Patients with Type 2 Diabetes

BACKGROUND

In China, diabetes has become a serious healthcare problem that plagues individuals and the government because of its high mortality rate and social burden, with type 2 diabetes mellitus (T2DM) accounting for the vast majority (about 90%) of cases. T2DM patients face a huge medication burden and it is imperative to find appropriate tools to assess the medication burden for patients. This study aimed to translate the original Diabetes Treatment Burden Questionnaire (DTBQ) into Chinese and assessed the reliability and validity of the DTBQ concerning the burden of medication treatment in patients with type 2 diabetes.

METHODS

A total of 329 T2DM patients were recruited to participate in the survey. The original version scale was first translated into Chinese using the backward and forward translation procedures. The internal consistency reliability of the scale was measured by the Cronbach alpha coefficient, the test-retest reliability, and the item-total correlation. The validity of the scale was assessed by the content validity index, exploratory factor analysis and confirmatory factor analysis.

RESULTS

The content validity index of the scale was 0.920. Cronbach alpha coefficient for the scale was 0.831. Exploratory factor analysis (EFA) supported a 15-item and 3-factor structure of the translated questionnaire. Confirmatory factor analysis (CFA) showed in the model fitness index, the chi-square degree of freedom was 3.575, the incremental fit index (IFI) was 0.917, the comparative fit index(CFI) was 0.916, the Tucker Lewis Index(TLI) was 0.900, all within acceptable limits. The retest reliability was 0.892, and the corrected item-total correlations for the items ranged from 0.293 to 0.729.

CONCLUSION

Verification results showed that the Chinese version of the 15-item DTBQ had reliable reliability and validity. Therefore, it can be considered as an appropriate tool to assess the burden of drug treatment for patients with type 2 diabetes in China.