Serum Carotenoids and Risks of Diabetes and Diabetic Retinopathy in a Chinese Population Sample

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.

The Importance of Antioxidant Activity for the Health-Promoting Effect of Lycopene

Lycopene is a compound of colored origin that shows strong antioxidant activity. The positive effect of lycopene is the result of its pleiotropic effect. The ability to neutralize free radicals via lycopene is one of the foundations of its pro-health effect, including the ability to inhibit the development of many civilization diseases. Therefore, this study focuses on the importance of the antioxidant effect of lycopene in inhibiting the development of diseases such as cardiovascular diseases, diseases within the nervous system, diabetes, liver diseases, and ulcerative colitis. According to the research mentioned, lycopene supplementation has significant promise for the treatment of illnesses marked by chronic inflammation and oxidative stress. However, the majority of the supporting data for lycopene's health benefits comes from experimental research, whereas the evidence from clinical studies is both scarcer and less certain of any health benefits. Research on humans is still required to establish its effectiveness.

Micronutrients and Diabetic Retinopathy: Evidence From The National Health and Nutrition Examination Survey and a Meta-analysis

PURPOSE

To investigate the associations between circulating micronutrients (vitamins A, C, D, E, and carotenoids) and risk of diabetic retinopathy (DR).

DESIGN

Cross-sectional study and meta-analysis.

METHODS

The cross-sectional study included 517 diabetic participants aged ≥40 years in the 2005-2006 National Health and Nutrition Examination Survey. Serum vitamin D was converted to liquid chromatography-tandem mass spectrometry-equivalent results, while other micronutrients were measured using high-performance liquid chromatography. Presence of DR was determined based on non-mydriatic fundus photographs. A meta-analysis was subsequently performed, which included relevant studies published from January 01, 1990 to December 31, 2020.

RESULTS

Of the 517 included participants, DR was identified in 159 participants (25.17%). After adjusting for multiple confounders, only serum vitamin C was associated with a lower risk of DR (odds ratio [OR]: 0.60; 95% confidence interval [CI]: 0.38-0.95). A total of 35 studies were included in the subsequent meta-analysis. Comparing 1056 participants with DR to 920 controls, the pooled weighted mean difference (WMD) of vitamin C was -11.01 (95% CI: -19.35 to -2.67). Regarding vitamins D and E, the pooled WMD was -3.06 (95% CI: -5.15 to -0.96) and -3.03 (95% CI: -4.24 to -1.82), respectively. No associations were identified between DR and circulating vitamin A or carotenoids.

CONCLUSIONS

Lower levels of circulating vitamins C, D, and E were found in DR patients than those without. More high-quality studies are required to assess the real effects of micronutrients on DR.

Cardiovascular Disease and Possible Ways in Which Lycopene Acts as an Efficient Cardio-Protectant against Different Cardiovascular Risk Factors

Foods rich in antioxidants such as lycopene have a major role in maintaining cardiac health. Lycopene, 80% of which can be obtained by consuming a common vegetable such as tomato, can prevent the disturbances that contribute to cardiovascular disease (CVD). The present work begins with a brief introduction to CVD and lycopene and its various properties such as bioavailability, pharmacokinetics, etc. In this review, the potential cardio-protective effects of lycopene that reduce the progression of CVD and thrombotic complications are detailed. Further, the protective effects of lycopene including in vitro, in vivo and clinical trials conducted on lycopene for CVD protective effects are explained. Finally, the controversial aspect of lycopene as a protective agent against CVD and toxicity are also mentioned.

Lycopene: A Potent Antioxidant for the Amelioration of Type II Diabetes Mellitus

Nutrition is of utmost importance in chronic disease management and has often been described as the cornerstone of a variety of non-communicable diseases. In particular, type II diabetes mellitus (T2DM) represents a prevalent and global public health crisis. Lycopene, a bright red carotenoid hydrocarbon found in tomatoes and other red fruits and vegetables, has been extensively studied for its biological activities and treatment efficiency in diabetes care. Epidemiological investigations indicate that lycopene has potential antioxidant properties, is capable of scavenging reactive species, and alleviates oxidative stress in T2DM patients. This review aims to summarize the characteristics and mechanisms of action of lycopene as a potent antioxidant for T2DM. In addition, the evidence demonstrating the effects of lycopene on glycemic control and oxidative stress biomarkers in T2DM are also highlighted using animal and human studies as literature approach.

Serum lutein is a promising biomarker for type 2 diabetes mellitus and diabetic kidney disease in the elderly

Objective

To investigate the relationship between serum lutein and type 2 diabetes mellitus (T2DM) and diabetic kidney disease (DKD) in elderly individuals.

Methods

A total of 60 T2DM patients over 60 years were subgrouped into a DKD group and a non‐DKD group according to their urinary microalbumin‐to‐creatinine ratio (UACR), while 30 age‐matched non‐T2DM patients were recruited in the control group. Baseline characteristics, laboratory examination results, and serum lutein levels were compared, and their correlations were analyzed. Receiver operating characteristic (ROC) curves were plotted to identify the diagnostic potential of lutein in T2DM and DKD.

Results

The lutein level in the T2DM group was significantly lower than that in the control group and was also significantly lower in the DKD group than in the non‐DKD group (p < 0.001). Lutein levels were negatively correlated with body mass index, glycosylated hemoglobin, fasting blood glucose, triglyceride, and UACR and positively correlated with high‐density lipoprotein cholesterol (p < 0.05). T2DM patients were divided into four groups according to the quartile of their lutein level. The proportion of T2DM and DKD gradually decreased with increasing lutein levels (p < 0.001). The area under the ROC curve of serum lutein in diagnosing T2DM and DKD was 0.880 and 0.779, respectively, with corresponding cut‐off values of 0.433 μmol/L and 0.197 μmol/L (p < 0.001).

Conclusion

The serum level of lutein is negatively correlated with the incidence of T2DM and DKD in the elderly and can serve as a diagnostic marker for T2DM and DKD.

Reply to the 'Comment on "The association between carotenoids and subjects with overweight or obesity: a systematic review and meta-analysis"' by N. Shokri-mashhadi and S. Saadat, Food Funct., 2021, 12, DOI: 10.1039/D1FO01617B

Here, we re-emphasize the purpose of our meta-analysis of the associations between carotenoids and subjects with excess body weight (Yao et al., 2021) and address some of the points raised in the commentary by Nafiseh Shokri-mashhadi and Saeed Saadat. The commentary focused on the methodological faults of our published meta-analysis research-but the research was rigorously conducted and scientifically sound, following strictly the relevant requirements of the Cochrane guidelines. Therefore, in the current reply, we included an elaboration and thorough discussion of the search strategy, inclusion and exclusion criteria, and tests of heterogeneity for the discussed meta-analysis in light of the comments made in the commentary. In conclusion, we believe that our study has made an essential contribution to the investigation of the significance of carotenoids in people with excess body weight.

Vitamin A and Diabetes

Recently, research data have shown that vitamin A (VA, retinol) as a micronutrient participates in the regulation of glucose and lipid metabolism. Since diabetes is a metabolic disease, it is imperative to reveal the relationship of VA and diabetes. This review was aimed to summarize the current understanding of VA and its metabolites in diabetes. Since April of 2020, the authors have searched the PubMed using key words and retrieved articles that focused on diabetes and VA or its metabolites. Based on the published data, it appears that the development of type 1 diabetes leads to reduction of blood VA level in human and animals, and increase of hepatic VA store in experimental animals. On the other hand, the mutual impacts of type 2 diabetes and VA intake and blood VA level on each other appear to be uncertain. Retinoic acid, the active metabolite of VA, has been studied extensively for the treatment of diabetic complications. The current data appear to indicate that the development of diabetes is associated with changes of VA metabolism. More carefully designed clinical and laboratory experiments are needed to reveal the impacts of diabetes on VA metabolism and the role of VA in the development and treatment of diabetes.

Carotenoid status in type 2 diabetes patients with and without retinopathy

Diabetic retinopathy (DR) is one of the leading causes of blindness. Carotenoids are plant-derived pigments required for general health and particularly for vision. In this study, we evaluated the dietary intake and blood carotenoid levels of type 2 diabetes (T2D) patients with and without DR. A cross-sectional case-control study was conducted among 151 age-matched controls and 344 T2D patients, of which 194 had DR and 150 had no DR (NDR). After a complete ophthalmic examination, the demographic, anthropometric and clinical profiles were obtained. Carotenoids in the plasma were measured by HPLC and dietary intakes were obtained using a food frequency questionnaire. The mean plasma levels of carotenoids (except γ-carotene) were significantly lower in the DR group compared to the Control and NDR groups. The dietary intakes of zeaxanthin, lycopene, α-carotene and β-carotene were significantly lower in the NDR group compared to the Control group, and were further lower in the DR group compared to the NDR group. Plasma carotenoid levels were significantly inversely associated with the duration of diabetes, RBS and HbA1c but positively associated with HDL. This study demonstrated decreased plasma levels and lower dietary intakes of carotenoids in DR subjects.

Whole Alga, Algal Extracts, and Compounds as Ingredients of Functional Foods: Composition and Action Mechanism Relationships in the Prevention and Treatment of Type-2 Diabetes Mellitus

Type-2 diabetes mellitus (T2DM) is a major systemic disease which involves impaired pancreatic function and currently affects half a billion people worldwide. Diet is considered the cornerstone to reduce incidence and prevalence of this disease. Algae contains fiber, polyphenols, ω-3 PUFAs, and bioactive molecules with potential antidiabetic activity. This review delves into the applications of algae and their components in T2DM, as well as to ascertain the mechanism involved (e.g., glucose absorption, lipids metabolism, antioxidant properties, etc.). PubMed, and Google Scholar databases were used. Papers in which whole alga, algal extracts, or their isolated compounds were studied in in vitro conditions, T2DM experimental models, and humans were selected and discussed. This review also focuses on meat matrices or protein concentrate-based products in which different types of alga were included, aimed to modulate carbohydrate digestion and absorption, blood glucose, gastrointestinal neurohormones secretion, glycosylation products, and insulin resistance. As microbiota dysbiosis in T2DM and metabolic alterations in different organs are related, the review also delves on the effects of several bioactive algal compounds on the colon/microbiota-liver-pancreas-brain axis. As the responses to therapeutic diets vary dramatically among individuals due to genetic components, it seems a priority to identify major gene polymorphisms affecting potential positive effects of algal compounds on T2DM treatment.

β-Carotene: Preventive Role for Type 2 Diabetes Mellitus and Obesity: A Review

Carotenoids are vital antioxidants for plants and animals. They protect cells from oxidative events and act against the inflammatory process and carcinogenesis. Among the most abundant carotenoids in human and foods is β-carotene. This carotenoid has the highest level of provitamin A activity, as it splits into two molecules of retinol through the actions of the cytosolic enzymes: β-carotene-15,15′-monooxygenase (β-carotene-15,15′-oxygenase 1) and β-carotene-9′,10′-dioxygenase (β-carotene-9′,10′-oxygenase 2). The literature supports the idea that β-carotene acts against type 2 diabetes mellitus, cardiovascular diseases, obesity, and metabolic syndrome. Due to the many processes involved in β-carotene biosynthesis and metabolic function, little is known about such components, since many mechanisms have not yet been fully elucidated. Therefore, our study concisely described the relationships between the consumption of carotenoids, with emphasis on β-carotene, and obesity and type 2 diabetes mellitus and its associated parameters in order to understand the preventive role of carotenoids better and encourage their consumption.

Anti-stress Effect of β-Cryptoxanthin in Satsuma Mandarin Orange on Females

Beta-cryptoxanthin (β-CRX, (3R)-β, β-caroten-3-ol) is an oxygenated carotenoid and a potent antioxidant that is abundant in Satsuma mandarin orange (Citrus unshiu MARC.), which is the most popular fruit in Japan. Since our preliminary data suggested that the ingestion of β-CRX had an anti-stress effect in female participants, the effect was evaluated in another set of female participants. The study design was a double-blind group comparison and participants (n = 23) were randomly assigned to β-CRX-rich orange juice or placebo (β-CRX was removed from orange juice) groups. β-CRX or placebo juice (125 mL, after breakfast) were consumed from 1 week prior to pharmacy practice and continued for 5 d into the practice period. Salivary α-amylase activity (sAA), a marker of sympathetic nervous system activity, was significantly higher in the evening than in the morning in the placebo-group during pharmacy practice, but not in the β-CRX-group. This result supports the anti-stress effect of β-CRX. The dose-dependency of β-CRX was observed in male mice that were loaded with stress. These results indicate that the ingestion of β-CRX is helpful to reduce stress.

The Therapeutic Role of Carotenoids in Diabetic Retinopathy: A Systematic Review

BACKGROUND

Carotenoids are a large group of natural pigments that occur in many foods, fruits, and vegetables. Several studies have shown a number of biological properties of carotenoids, particularly beneficial impacts on cancer, metabolic, neurodegenerative, and cardiovascular diseases. However, recent evidence has shown that these compounds could prevent, delay, and ameliorate diabetic retinopathy (DR). The aim of current study was to review the therapeutic effects of carotenoids in the treatment of DR and discuss the molecular mechanisms that are behind these pharmacological activities.

METHODS

Six online databases (Medline/PubMed, Scopus, Web of Knowledge, Embase, ScienceDirect, and ProQuest) were searched until September 2019. The systematic review was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist.

RESULTS

A total of 25 studies were included after the final retrieval. A relationship was observed between carotenoids and management of DR. Findings also demonstrated that the underlying mechanism of beneficial effects of these compounds was antioxidant, anti-inflammatory, anti-angiogenic, and neuroprotective properties.

CONCLUSION

Carotenoids potentially delay the initiation and prevent the progression of DR; however, ample preclinical studies are required to confirm their effect, and adequate clinical trials are needed to really understand how well these compounds influence DR among humans.

Transthyretin Upregulates Long Non-Coding RNA MEG3 by Affecting PABPC1 in Diabetic Retinopathy

The aim of the study was to demonstrate how transthyretin (TTR) could affect long non-coding RNA (lncRNA) of maternally expressed gene 3 (MEG3) and play important roles in diabetic retinopathy (DR). A DR model in C57BL/6 mice was established after intraperitoneal injection of streptozotocin (STZ). After intravitreal injection with TTR pAAV vector, MEG3 short hairpin RNA (shRNA), scrambled shRNA, or MEG3, retinal imaging, retinal trypsin digestion, and fundus vascular permeability tests were performed. Cell counting kit-8 (CCK8), transwell, and Matrigel assays were employed to detect the proliferation and migration of human retinal microvascular endothelial cells (hRECs). The binding between long non-coding RNA of maternally expressed gene 3 (lncRNA-MEG3) and microRNA-223-3p (miR-223-3p) was observed by using luciferase reporter assays, while co-immunoprecipitation (co-IP) was employed to confirm the interaction between TTR and the target. In the DR mice model, retinal vascular leakage and angiogenesis were repressed by overexpressing TTR. In vitro, the added TTR promoted the level of lncRNA-MEG3 by interacting with poly (A) binding protein cytoplasmic 1 (PABPC1), and then repressed proliferation and angiogenesis of hRECs. In vivo, silencing or overexpressing lncRNA-MEG3 significantly affected retinal vascular phenotypes. Additionally, the interaction between lncRNA-MEG3 and miR-223-3p was confirmed, and silencing of miR-223-3p revealed similar effects on hRECs as overexpression of lncRNA-MEG3. In summary, in the DR environment, TTR might affect the lncRNA MEG3/miR-223-3p axis by the direct binding with PABPC1, and finally repress retinal vessel proliferation.

The effects of lycopene on alloxan induced diabetic optic neuropathy

AIM

To determine the effects of lycopene treatment in prevention of diabetes associated inflammatory response and oxidative stress in an experimental model. With this aim we investigated the levels of oxidative stress markers including Malondialdehyde (MDA), and total oxidative status (TOS)together with inflammatory markers including nuclear factor- kappa B (NFKB) and tumor necrosis factor α (TNF-α) and antioxidants including total glutathione (TGSH), total oxidative status (TOS) and total anti-oxidative status (TAS) levels on eye tissue.

MATERIAL AND METHODS

Totally 18 albino Wistar male rats (250-280 grams) assigned into three groups, with six rats in each group as follows: healthy group (HG), control group (CG), and lycopene group (LG). The diabetes was induced with alloxan administration in rats of CG and LG. Lycopene (4 mg/kg) was administered to the rats in LG once a day for 3 months. At the end of this period, the animals were sacrificed and their eyes were enucleated for histopathological evaluations. From the tissues, MDA, GSH, TOS, TAS, TNF-α and NF-κB levels were analyzed.

RESULTS

MDA, TOS, OSI, NFKB and TNF-α levels were significantly higher, while TGSH and TAS levels were significantly lower in CG compared with HG (p < 0.001). On the other hand in LG; MDA, TOS, OSI, NFKB and TNF-α levels were significantly lower, while TGSH and TAS levels were significantly higher compared with CG (p < 0.001). Regarding histopathological findings, although there was severe damage on optic nerve of rats in CG; there was only a slight damage in lycopene administered group.

CONCLUSION

For the first time in literature we determined that, lycopene was significantly effective in prevention of augmented inflammation and oxidative stress on eye tissue associated with diabetes, as well as the tissue damage on optic nerve. However, studies investigating the long-term clinical effects of lycopene on diabetic individuals are warranted.