Dietary associations with diabetic retinopathy-A cohort study

Dietary factors and predominant eye diseases in sub-Saharan African populations: A systematic review protocol

Evidence linking diet and ocular diseases is growing, yet variations persist, with a paucity of data in sub-Saharan Africa. The proposed review will systematically synthesize evidence on dietary factors associated with predominant eye disorders (cataracts, refractive error, glaucoma, diabetic retinopathy, age-related macular degeneration, and dry eye disease) in the sub-Saharan African population. The systematic review protocol will follow PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols) for transparency in reporting. All relevant published studies in the English Language will be identified from PubMed, Scopus, Web of Science, Embase, Health Inter-Network Access to Research Initiative (HINARI), Cumulative Index to Nursing and Allied Health Literature (CINAHL), African Journal of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) using medical subject headings (MeSH) and controlled vocabulary without date restrictions. The reference lists of all retrieved studies will be checked and experts will be contacted for additional relevant studies. The risk of bias for observational studies will be assessed using ROBINS-E (Risk of Bias in Non-Randomized Studies - of Exposure) and for non-interventional and randomized studies ROBINS-V2 (Risk of Bias in Non-Randomized Studies version 2) and ROB2 (Cochrane Risk of Bias 2) will be employed respectively. Study quality will be assessed using the National Heart Lung and Blood Institutes Quality Assessment (NHLBI) tool for Observational Cohort and Cross-Sectional Studies and Controlled Interventional Studies. Meta-analysis will not be considered because of the wide range of dietary factors and the susceptibility to high heterogeneity. Patterns of association between dietary factors and the specific eye diseases will be consolidated by Synthesis Without Meta-analysis (SWiM).

Insights into the systemic risk factors associated with diabetic retinopathy in the Indian population: A comprehensive systematic review and meta-analysis

Diabetic retinopathy (DR) is a predominant cause of vision impairment globally. Understanding risk factors is crucial for effective planning. The aim of this study is to comprehensively investigate the risk factors in the Indian population contributing to the increased incidence of DR, which is a potentially sight-threatening complication among diabetic individuals. A comprehensive literature search was done on PubMed, Embase, and Google Scholar databases for epidemiological studies reporting risk factors in the adult Indian population in the English language. Joanna Briggs Institute's (JBI) critical appraisal tools were used to assess the quality of the included studies. Analysis was performed using R studio. I2 statistic was used for the assessment of heterogeneity. Results are expressed as odds ratio (OR) and standardized mean difference (SMD) along with a 95% confidence interval (CI). Overall, 20 studies enrolling 4,12,421 patients with 1,04,104 DR-positive and 3,08,317 DR-negative adults were analyzed. Being male (OR: 1.38, 95% CI: 1.11-1.72), intake of insulin (OR: 2.05, 95% CI: 1.02-4.14), higher HbA1c levels (MD: 0.50, 95% CI: 0.06-0.94), higher random (MD: 0.32, 95% CI: 0.10-0.55), and fasting blood glucose levels (MD: 0.51, 95% CI: 0.10-0.93) were found to be significantly associated with increased risks of DR among diabetic patients, while age, body mass index, hypertension, lipid profile, and smoking status did not indicate any association with DR. Good glycemic control remains the most important modifiable risk factor to reduce the risk of progression of DR and vision loss.

Diabetes Eye Disease Sufferers and Non-Sufferers Are Differentiated by Sleep Hours, Physical Activity, Diet, and Demographic Variables: A CRT Analysis

INTRODUCTION

Diabetic eye disease is the most common microvascular complication of diabetes mellitus. This complication has some direct impact on an individual's well-being and health. Some lifestyle habits have been associated with the incidence of these co-morbidities.

OBJECTIVE

To classify the diabetic population into sufferers or non-sufferers of diabetes eye disease according to lifestyle and demographic variables, and to identify which of these variables are significant for this classification.

METHODS

The present cross-sectional study based on the NHANES 2011-2020 used the Classification and Regression Tree (CRT) analysis for classifying the diabetic population into sufferers and non-sufferers of diabetes eye disease. The odds ratio (OR) and relative risks (RR) of suffering this diabetes complication of the subgroups formed by the model were studied. The final sample formed 2657 individuals (1537 males and 1120 females).

RESULTS

A 79.4% accuracy was found for the CRT model. The independent variables of sleep hours (100.0%), physical activity (PA) group (92.8%), gender (76.2%), age (46.4%), education level (38.4%), sedentary time (38.1%), and diet (10.0%) were found to be significant for the classification of cases. The variable high alcohol consumption was not found significant. The analysis of the OR and RR of the subgroups formed by the model evidenced greater odds of suffering diabetes eye disease for diabetes sufferers from the inactive and walk/bicycle PA group compared to those from the Low, Moderate, and High PA groups (OR: 1.48 and RR: 1.36), for males compared to females (OR: 1.77 and RR: 1.61), for those sleeping less than 6 h or more than 9 compared to those who sleep between 6 and 8 h (OR: 1.61 and RR: 1.43), and for diabetes sufferers aged over 62 compared to younger ones (OR: 1.53 and RR: 1.40).

CONCLUSIONS

sleep hours, PA group, gender, age, education level, sedentary time, and diet are significant variables for classifying the diabetic population into sufferers and non-sufferers of diabetes eye disease. Additionally, being in the inactive or walk/bicycle PA group, being a male, sleeping less than 6 or more than 9 h, and being aged over 62 were identified as risk factors for suffering this diabetes complication.

Inter-Relations between Dietary Patterns and Glycemic Control-Related Biomarkers on Risk of Retinopathy in Type 2 Diabetes

Diabetic retinopathy (DR), which can cause vision loss, may progress faster with poor glycemic control and oxidative stress. This study aims to examine how dietary patterns and glycemic control biomarkers relate to retinopathy risk in type 2 diabetes patients. In this study, we enrolled diabetic patients with retinopathy (DR) (n = 136) and without retinopathy (no DR) (n = 466) from a cohort of participants in the "Blood Pressure Control to Reduce the Risk of Type 2 Diabetic Nephropathy Study". Hemoglobin A1c (HbA1c) and malondialdehyde were defined as elevated when their levels reached ≥8.5% and ≥2/3 (16.2 μm), respectively. Dietary data were collected by a food frequency questionnaire. Dietary patterns were identified by factor analysis. Elevated HbA1c was significantly correlated with increased risk of DR (OR: 2.12, 95% CI: 1.14-3.93, p = 0.017). In subjects with a high animal protein and processed food dietary pattern (≥highest tertile score) or a low vegetable intake pattern ( Collapse

Key Words

• diabetic retinopathy
• glycated hemoglobin A1c
• malondialdehyde

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MESH Headings

• Humans
• Diabetes Mellitus, Type 2/blood
• Diabetes Mellitus, Type 2/complications
• Male
• Diabetic Retinopathy/etiology
• Diabetic Retinopathy/epidemiology
• Diabetic Retinopathy/blood
• Female
• Middle Aged
• Biomarkers/blood
• Glycated Hemoglobin/analysis
• Glycated Hemoglobin/metabolism
• Diet/adverse effects
• Risk Factors
• Aged
• Glycemic Control
• Malondialdehyde/blood
• Blood Glucose/metabolism
• Feeding Behavior

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Grants

• 112-2320-B-037-018 National Science and Technology Council, Taiwan
• KMUH-108-8R78 Kaohsiung Medical University Hospital

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Affiliation(s)

Yu-Ju Wu Department of Nutrition and Dietetics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807378, Taiwan; Graduate Institute of Medicine and Department of Public Health and Environmental Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807378, Taiwan;
Chih-Cheng Hsu Institute of Population Health Sciences, National Health Research Institutes, Miaoli County 350401, Taiwan; (C.-C.H.); (Y.-F.H.) Department of Health Services Administration, China Medical University, Taichung 4064040, Taiwan Department of Family Medicine, Min-Sheng General Hospital, Taoyuan 330056, Taiwan National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin 632007, Taiwan
Shang-Jyh Hwang Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807378, Taiwan; Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807378, Taiwan;
Kun-Der Lin The Lin’s Clinics, Kaohsiung 807057, Taiwan;
Pi-Chen Lin Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807378, Taiwan;
Ya-Fang Huang Institute of Population Health Sciences, National Health Research Institutes, Miaoli County 350401, Taiwan; (C.-C.H.); (Y.-F.H.)
Chien-Hung Lee Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung 807378, Taiwan;
Chiao-I Chang Graduate Institute of Medicine and Department of Public Health and Environmental Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807378, Taiwan;
Meng-Chuan Huang Department of Nutrition and Dietetics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807378, Taiwan; Graduate Institute of Medicine and Department of Public Health and Environmental Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807378, Taiwan;

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Collaborators Collapse

Effect of High-Sucrose Diet on the Occurrence and Progression of Diabetic Retinopathy and Dietary Modification Strategies

As the most serious of the many worse new pathological changes caused by diabetes, there are many risk factors for the occurrence and development of diabetic retinopathy (DR). They mainly include hyperglycemia, hypertension, hyperlipidemia and so on. Among them, hyperglycemia is the most critical cause, and plays a vital role in the pathological changes of DR. High-sucrose diets (HSDs) lead to elevated blood glucose levels in vivo, which, through oxidative stress, inflammation, the production of advanced glycation end products (AGEs) and vascular endothelial growth factor (VEGF), cause plenty of pathological damages to the retina and ultimately bring about loss of vision. The existing therapies for DR primarily target the terminal stage of the disease, when irreversible visual impairment has appeared. Therefore, early prevention is particularly critical. The early prevention of DR-related vision loss requires adjustments to dietary habits, mainly by reducing sugar intake. This article primarily discusses the risk factors, pathophysiological processes and molecular mechanisms associated with the development of DR caused by HSDs. It aims to raise awareness of the crucial role of diet in the occurrence and progression of DR, promote timely changes in dietary habits, prevent vision loss and improve the quality of life. The aim is to make people aware of the importance of diet in the occurrence and progression of DR. According to the dietary modification strategies that we give, patients can change their poor eating habits in a timely manner to avoid theoretically avoidable retinopathy and obtain an excellent prognosis.

Patterns of risk for diabetic retinopathy in the Mumbai slums: The Aditya Jyot Diabetic Retinopathy in Urban Mumbai Slums Study (AJ-DRUMSS) Report 3

Diabetes onset precedes diabetic retinopathy (DR) by 5-10 years, but many people with diabetes remain free of this microvascular complication. Our aim was to identify risk factors for DR progression in a unique and diverse population, the slums of Mumbai. We performed a nested case-control study of 1163 diabetics over 40 years of age from slums in 18 wards of Mumbai. Data was collected on 33 variables and assessed for association with DR using both univariate and multivariate analyses. Stratified analyses were also performed on males and females, separately. Among hypertensive individuals we also assessed whether duration of hypertension associated with DR. Of 31 non-correlated variables analysed as risk factors for DR, 15 showed evidence of significant association. The most prominent included sex, where being a female associated with decreased odds of DR, while longer duration of diabetes and poor glycaemic control associated with increased odds. The duration of diabetes effect was partially, but significantly, mediated by age of diabetes diagnoses (8.6% of variance explained, p = 0.012). Obesity as measured by several measures, including body mass index (BMI) and measures of central obesity had a negative association with DR; increased measures of obesity consistently reduced odds of DR. As in most earlier studies, DR was associated with the duration of diabetes and glycaemic control. However, other factors, especially obesity related measures were associated with DR, in ways that contrast with most prior studies. These results indicated that the overall pattern of association in the Mumbai slums was novel. Thus, in previously uncharacterized populations, such as the slums that we examined, it is important to evaluate all risk factors de novo to appropriately assess patterns of association as the patterns of association with DR can be complex and population specific.

Single-Field Fundus Photography for Screening of Diabetic Retinopathy: The Prevalence and Associated Factors in a Population-Based Study

INTRODUCTION

We aimed to determine the prevalence and risk factors for diabetic retinopathy (DR) in a multi-primary healthcare facilities-based DR screening project by analyzing single-field fundus photographs among patients with diabetes in Rafsanjan City, Iran, based on the Rafsanjan Cohort Study, as a part of the prospective epidemiological research studies in IrAN (PERSIAN).

METHODS

Of all participants in the Rafsanjan Cohort Study (performed in four primary healthcare facilities across Rafsanjan City from August 2015 to December 2017), patients with diabetes were recruited in this study. All participants underwent a standardized interview and clinical and paraclinical examinations for demographic characteristics, and medical conditions according to the PERSIAN's protocols. In addition, digital fovea-centered and single-field fundus photography was performed for DR identification and grading. For assessment of agreement, a subgroup of participants underwent fundus examination, randomly. DR was graded as nonproliferative (NPDR) or proliferative (PDR).

RESULTS

Of 8414 screened participants, 1889 had diabetes. The total prevalence of DR was 6.93% [131 individuals including 110 (5.82%) with NPDR, and 21 (1.11%) with PDR] based on single-field fundus photographs, with almost perfect agreement with fundus examinations (κ = 0.82). On adjusted multivariate analysis, duration of diabetes (OR 1.16, 95% CI 1.13-1.19), positive family history for diabetes (OR 1.73, 95% CI 1.09-2.75), fasting plasma glucose (FPG) ≥ 126 mg/dL (OR 1.98, 95% CI 1.16-3.39), and serum creatinine level (OR 1.79, 95% CI 1.08-2.98) were associated with DR. Factors including age, education level, physical activity, body mass index, hypertension, and cardiovascular and renal diseases did not have association with DR on adjusted multivariate analysis.

CONCLUSIONS

Single-field fundus photography can be used for screening of DR in primary healthcare facilities. In individuals with diabetes, duration of diabetes, positive family history for diabetes, FPG ≥ 126 mg/dL, and serum creatinine level may be associated with DR.

Dietary Intake and Diabetic Retinopathy: A Systematic Review of the Literature

Diabetic retinopathy (DR) is a common microvascular complication of diabetes mellitus. The evidence connecting dietary intake and DR is emerging, but uncertain. We conducted a systematic review to comprehensively summarize the current understanding of the associations between dietary consumption, DR and diabetic macular edema (DME). We systematically searched PubMed, Embase, Medline, and the Cochrane Central Register of Controlled Trials between January 1967 to May 2022 for all studies investigating the effect of diet on DR and DME. Of the 4962 articles initially identified, 54 relevant articles were retained. Our review found that higher intakes of fruits, vegetables, dietary fibers, fish, a Mediterranean diet, oleic acid, and tea were found to have a protective effect against DR. Conversely, high intakes of diet soda, caloric intake, rice, and choline were associated with a higher risk of DR. No association was seen between vitamin C, riboflavin, vitamin D, and milk and DR. Only one study in our review assessed dietary intake and DME and found a risk of high sodium intake for DME progression. Therefore, the general recommendation for nutritional counseling to manage diabetes may be beneficial to prevent DR risk, but prospective studies in diverse diabetic populations are needed to confirm our findings and expand clinical guidelines for DR management.