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Yang C, Yu Y, An J. Effect of High-Sucrose Diet on the Occurrence and Progression of Diabetic Retinopathy and Dietary Modification Strategies. Nutrients 2024; 16:1393. [PMID: 38732638 PMCID: PMC11085904 DOI: 10.3390/nu16091393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 04/29/2024] [Accepted: 05/02/2024] [Indexed: 05/13/2024] Open
Abstract
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.
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Affiliation(s)
- Chen Yang
- State Key Laboratory of Ophthalmology, Optometry and Vision Science, Wenzhou Medical University, Wenzhou 325027, China;
- Oujiang Laboratory, Zhejiang Lab for Regenerative Medicine, Vision and Brain Health, Wenzhou 325101, China
| | - Yifei Yu
- Key Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, China Agricultural University, Beijing 100193, China
| | - Jianhong An
- State Key Laboratory of Ophthalmology, Optometry and Vision Science, Wenzhou Medical University, Wenzhou 325027, China;
- Oujiang Laboratory, Zhejiang Lab for Regenerative Medicine, Vision and Brain Health, Wenzhou 325101, China
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Zheng G, Ran S, Zhang J, Qian AM, Hua J, Wang C, Vaughn MG, Tabet M, Lin H. Fresh fruit, dried fruit, raw vegetables, and cooked vegetables consumption associated with progression trajectory of type 2 diabetes: a multi-state analysis of a prospective cohort. Eur J Nutr 2024:10.1007/s00394-024-03362-6. [PMID: 38520525 DOI: 10.1007/s00394-024-03362-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 03/10/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE To examine the effects of fresh fruit, dried fruit, raw vegetables, and cooked vegetables on type 2 diabetes (T2D) progression trajectory. METHODS We included 429,886 participants in the UK Biobank who were free of diabetes and diabetes complications at baseline. Food groups were determined using a validated food frequency questionnaire. Outcomes were T2D incidence, complications, and mortality. Multi-state model was used to analyze the effects of food groups on T2D progression. RESULTS During a follow-up of 12.6 years, 10,333 incident T2D cases were identified, of whom, 3961 (38.3%) developed T2D complications and 1169 (29.5%) died. We found that impacts of four food groups on T2D progression varied depending on disease stage. For example, compared to participants who ate less than one piece of dried fruit per day, the hazard ratios and 95% confidence intervals for those who ate ≥ 2 pieces of dried fruit per day were 0.82 (0.77, 0.87), 0.88 (0.85, 0.92), and 0.86 (0.78, 0.95) for transitions from diabetes-free state to incident T2D, from diabetes-free state to total death, and from incident T2D to T2D complications, respectively. Higher intake of fresh fruit was significantly associated with lower risk of disease progression from diabetes-free state to all-cause death. Higher intake of raw and cooked vegetables was significantly associated with lower risks of disease progression from diabetes-free state to incident T2D and to total death. CONCLUSIONS These findings indicate that higher intake of fresh fruit, dried fruit, raw vegetables, and cooked vegetables could be beneficial for primary and secondary prevention of T2D.
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Affiliation(s)
- Guzhengyue Zheng
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, No. 74, 2nd Yat-sen Road, Yuexiu District, Guangzhou, Guangdong, 510080, P. R. China
| | - Shanshan Ran
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, No. 74, 2nd Yat-sen Road, Yuexiu District, Guangzhou, Guangdong, 510080, P. R. China
| | - Jingyi Zhang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, No. 74, 2nd Yat-sen Road, Yuexiu District, Guangzhou, Guangdong, 510080, P. R. China
| | - Aaron M Qian
- Department of Psychology, College of Arts and Sciences, Saint Louis University, United States of America, Tegeler Hall, 3700 Lindell Boulevard, Saint Louis, MO, 63103, USA
| | - Junjie Hua
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, No. 74, 2nd Yat-sen Road, Yuexiu District, Guangzhou, Guangdong, 510080, P. R. China
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, 450001, P. R. China
| | - Michael G Vaughn
- School of Social Work, Saint Louis University, Tegeler Hall, 3550 Lindell Boulevard, Saint Louis, MO, 63103, USA
| | - Maya Tabet
- College of Global Population Health, University of Health Sciences and Pharmacy in Saint Louis, United States of America, 1 Pharmacy Place, Saint Louis, MO, 63110, USA
| | - Hualiang Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, No. 74, 2nd Yat-sen Road, Yuexiu District, Guangzhou, Guangdong, 510080, P. R. China.
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Zhou C, Li S, Ye L, Chen C, Liu S, Yang H, Zhuang P, Liu Z, Jiang H, Han J, Jiang Y, Zhou L, Zhou X, Xiao J, Zhang C, Wen L, Lan C, Wang Y, Sun T, Jiang L, Xie P, Chen F, Liang G, Fu D, Zhang T, Shi X, Song Z, Liu X, Li S, Li P, Xu X, Wei Q, Wang W, Huang X, De Z, Deng A, Ding L, Pan X, Wen H, Zhang Z, Lv H, Zhang J, Tian X, Deng Z, Wang H, Wang F, Wang Y, Zhao H, Fang Y, Wu Y, Wu Y, Shen N, Li B, Li X, Dai H, Zhao N, Sun X, Zheng Z, Liu K, Xu X. Visual impairment and blindness caused by retinal diseases: A nationwide register-based study. J Glob Health 2023; 13:04126. [PMID: 37921040 PMCID: PMC10623496 DOI: 10.7189/jogh.13.04126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023] Open
Abstract
Background Retinal disorders cause substantial visual burden globally. Accurate estimates of the vision loss due to retinal diseases are pivotal to inform optimal eye health care planning and allocation of medical resources. The purpose of this study is to describe the proportion of visual impairment and blindness caused by major retinal diseases in China. Methods A nationwide register-based study of vitreoretinal disease covering all 31 provinces (51 treating centres) of mainland China. A total of 28 320 adults diagnosed with retinal diseases were included. Participants underwent standardised ocular examinations, which included best-corrected visual acuity (BCVA), dilated-fundus assessments, and optical coherence tomography. Visual impairment and blindness are defined using BCVA according to the World Health Organization (WHO) (visual impairment: <20/63-≥20/400; blindness: <20/400) and the United States (visual impairment: <20/40-≥20/200; blindness: <20/200) definitions. The risk factors of vision loss were explored by logistic regression analyses. Results Based on the WHO definitions, the proportions for unilateral visual impairment and blindness were 46% and 18%, respectively, whereas those for bilateral visual impairment and blindness were 31% and 3.3%, respectively. Diabetic retinopathy (DR) accounts for the largest proportion of patients with visual impairment (unilateral visual impairment: 32%, bilateral visual impairment: 60%) and blindness (unilateral blindness: 35%; bilateral blindness: 64%). Other retinal diseases that contributed significantly to vision loss included age-related macular degeneration, myopic maculopathy, retinal vein occlusion, and rhegmatogenous retinal detachment and other macular diseases. Women (bilateral vision loss: P = 0.011), aged patients (unilateral vision loss: 45-64 years: P < 0.001, ≥65 years: P < 0.001; bilateral vision loss: 45-64 years: P = 0.003, ≥65 years: P < 0.001 (reference: 18-44 years)) and those from Midwest China (unilateral and bilateral vision loss: both P < 0.001) were more likely to suffer from vision loss. Conclusions Retinal disorders cause substantial visual burden among patients with retinal diseases in China. DR, the predominant retinal disease, is accountable for the most prevalent visual disabilities. Better control of diabetes and scaled-up screenings are warranted to prevent DR. Specific attention should be paid to women, aged patients, and less developed regions.
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Affiliation(s)
- Chuandi Zhou
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai engineering center for precise diagnosis and treatment of eye diseases, Shanghai, China
| | - Shu Li
- Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Luyao Ye
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai engineering center for precise diagnosis and treatment of eye diseases, Shanghai, China
| | - Chong Chen
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai engineering center for precise diagnosis and treatment of eye diseases, Shanghai, China
| | - Shu Liu
- Department of Ophthalmology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong Province, China
| | - Hongxia Yang
- Department of Ophthalmology, The First People's Hospital of Jinzhong, Jinzhong, Liaoning Province, China
| | - Peng Zhuang
- Department of Ophthalmology, Zhangzhou Municipal Hospital of Fujian Province, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian Province, China
| | - Zengye Liu
- Department of Ophthalmology, Tianjin First Central Hospital, Tianjin, China
| | - Hongwen Jiang
- Department of Ophthalmology, The First People's Hospital of Kashgar, Kashgar, Xinjiang Uighur Autonomous Region, China
| | - Jing Han
- Department of Ophthalmology, The Second Affiliated Hospital of Air Force Medical University, Xi'an, Shanxi Province, China
| | - Yiping Jiang
- Department of Ophthalmology, The First Affiliated Hospital of Gannan Medical University, Gannan, Jiangxi Province, China
| | - Liqin Zhou
- Department of Ophthalmology, The First Hospital of Jiaxing, Affiliatd Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China
| | - Xiyuan Zhou
- Department of Ophthalmology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Xiao
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Cangxia Zhang
- Department of Ophthalmology, Cangzhou Hospital of Integrated TCM-WM of Hebei, Cangzhou, Hebei Province, China
| | - Lihui Wen
- Department of Ophthalmology, The Second People's Hospital of Guilin, Guilin, Guangxi Province, China
| | - Changjun Lan
- Department of Ophthalmology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province, China
| | - Yuqing Wang
- Department of Ophthalmology, The First Affiliated Hospital of Jiamusi University, Jiamusi, Heilongjiang Province, China
| | - Tao Sun
- Department of Ophthalmology, Yancheng City No. 1 People's Hospital, Yancheng, Jiangsu Province, China
| | - Li Jiang
- Department of Ophthalmology, Benxi Central Hospital, Benxi, Liaoning Province, China
| | - Peipei Xie
- Department of Ophthalmology, The 152th Central Hospital of the People's Liberation Army, Pingdingshan, Henan Province, China
| | - Fan Chen
- Department of Ophthalmology, Anqing Municipal Hospital, Anqing, Anhui Province, China
| | - Ge Liang
- Department of Ophthalmology, PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Dongdong Fu
- Department of Ophthalmology, People's Hospital of Zunyi City Bo Zhou District, Zunyi, Guzhou Province, China
| | - Tianzi Zhang
- Department of Ophthalmology, Affiliated Hospital of Inner Mongolia Minzu University, Tongliao, Inner Mongolia Autonomous Region, China
| | - Xuetao Shi
- Department of Ophthalmology, Pu’er City People's Hospital, Pu’er, Yunnan Province, China
| | - Zhengyu Song
- Department of Ophthalmology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xinghong Liu
- Department of Ophthalmology, The Central Hospital of Shaoyang, Shaoyang, Hunan Province, China
| | - Shanshan Li
- Department of Ophthalmology, Workers' Hospital of Jinchuan Group Co., Ltd, Jinchang, Gansu Province, China
| | - Pengcheng Li
- Department of Ophthalmology, Union Hospital Tongji Medical College Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Xiangzhou Xu
- Department of Ophthalmology, Huizhou First Hospital, Huizhou, Guangdong Province, China
| | - Qinfeng Wei
- Department of Ophthalmology, The Second People's Hospital of Xining, Xining, Qinghai Province, China
| | - Weibang Wang
- Department of Ophthalmology, The First People's Hospital of Yinchuan, The Second Affiliated Hospital of Ningxia Medical School, Yinchuan, Ningxia Hui autonomous region, China
| | - Xionggao Huang
- Department of Ophthalmology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, Hainan Province, China
| | - Zhen De
- Department of Ophthalmology, Shigatse People's Hospital, Shigatse, Tibet Autonomous Region, China
| | - Aijun Deng
- Department of Ophthalmology, Affiliated Hospital of Weifang Medical School, Weifang, Shandong Province, China
| | - Lin Ding
- Department of Ophthalmology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Xiuhong Pan
- Yuncheng Eye Hospital, Yuncheng, Shanxi Province, China
| | - Haiyan Wen
- Department of Ophthalmology, People's Hospital of Jilin City, Jilin, Jilin Province, China
| | - Zhongchen Zhang
- Department of Ophthalmology, Hebei Yanda Hospital, Langfang, Hebei Province, China
| | - Hongbin Lv
- Department of Ophthalmology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Jian Zhang
- Department of Ophthalmology, Shaanxi Provincial People's Hospital, Xi’an, Shanxi Province, China
| | - Xuemin Tian
- Department of Ophthalmology, The 988th Hospital of Joint Logistics Support Force of the Chinese People's Liberation Army, Kaifeng, Henan Province, China
| | - Zhen Deng
- Department of Ophthalmology, The First People's Hospital of Linping District, Hangzhou, Zhejiang Province, China
| | - Hua Wang
- Department of Ophthalmology, The First People's Hospital of Lianyungang, Lianyungang, Jiangsu Province, China
| | - Fang Wang
- Department of Ophthalmology, The Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou Province, China
| | - Yu Wang
- Fushun Ophthalmopathy Hospital, Fushun, Liaoning Province, China
| | - Hongchao Zhao
- Department of Ophthalmology, People's Hospital of Yuxi City, Yuxi, Yunnan Province, China
| | - Yanhong Fang
- Department of Ophthalmology, Jiangjin Central Hospital, Chongqing, China
| | - Yuyu Wu
- Department of Ophthalmology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China
| | - Yufeng Wu
- Department of Ophthalmology, Qingyang People's Hospital, Qingyang, Gansu Province, China
| | - Nian Shen
- Department of Ophthalmology, Liuzhou People's Hospital, Liuzhou, Guangxi Zhuang Autonomous Region, China
| | - Bo Li
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai engineering center for precise diagnosis and treatment of eye diseases, Shanghai, China
| | - Xiaorong Li
- Department of Ophthalmology, Tianjin Medical University Eye Hospital, School of Optometry & Eye Institute, Tianjin, China
| | - Hong Dai
- Department of Ophthalmology, Beijing Hospital, Beijing, China
| | - Naiqing Zhao
- Department of Biostatistics, Fudan University School of Public Health, Shanghai, China
| | - Xiaodong Sun
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai engineering center for precise diagnosis and treatment of eye diseases, Shanghai, China
| | - Zhi Zheng
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai engineering center for precise diagnosis and treatment of eye diseases, Shanghai, China
| | - Kun Liu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai engineering center for precise diagnosis and treatment of eye diseases, Shanghai, China
| | - Xun Xu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai engineering center for precise diagnosis and treatment of eye diseases, Shanghai, China
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Wattanathorn J, Tong-un T, Thukham-mee W, Paholpak P, Rangseekhajee P. A Randomized, Double-Blind, Placebo-Controlled Study of an Anthocyanin-Rich Functional Ingredient on Cognitive Function and Eye Dryness in Late Adulthood Volunteers: Roles of Epigenetic and Gut Microbiome Modulations. Nutrients 2023; 15:3499. [PMID: 37630690 PMCID: PMC10459889 DOI: 10.3390/nu15163499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/02/2023] [Accepted: 08/05/2023] [Indexed: 08/27/2023] Open
Abstract
Due to the rising demand for supplements targeting cognitive enhancement and dry eye together with the health benefits of anthocyanins, we have developed a functional soup containing an anthocyanin-rich functional ingredient, or "Anthaplex," and assessed the effects on cognitive function and eye dryness together with the possible mechanisms. A total of 69 male and female health volunteers were randomized and divided into placebo, D2, and D4 groups. All subjects consumed 120 mL of placebo or functional soup containing "Anthaplex" either at 2 or 4 g per serving per day within 5 min in the morning for eight weeks. The cognitive function, working memory, dry eye, AChE, MAO, MAO-A, MAO-B, and GABA-T activities, BDNF, HAC, HDAC, and DNMT activities, pH, and amount of lactic acid-producing bacteria, particularly Lactobacillus and Bifidobacterium spp. in feces, were determined before intervention and after eight weeks of consumption. Subjects who consumed the "Anthaplex" soup had improved cognitive function, working memory, eye dryness, histone acetylation, ACh E suppression, and BDNF with increased Bifidobacterium spp. but decreased pH in feces. These data suggest that "Anthaplex" improves cognitive function and eye dryness via the modulations of the histone acetylation process, gut microbiome, and cholinergic function.
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Affiliation(s)
- Jintanaporn Wattanathorn
- Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand; (T.T.-u.); (W.T.-m.)
- Research Institute for High Human Performance and Health Promotion, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Terdthai Tong-un
- Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand; (T.T.-u.); (W.T.-m.)
- Research Institute for High Human Performance and Health Promotion, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Wipawee Thukham-mee
- Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand; (T.T.-u.); (W.T.-m.)
- Research Institute for High Human Performance and Health Promotion, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Pongsatorn Paholpak
- Department Psychiatry, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand; (P.P.); (P.R.)
| | - Poonsri Rangseekhajee
- Department Psychiatry, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand; (P.P.); (P.R.)
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Bryl A, Mrugacz M, Falkowski M, Zorena K. A Mediterranean Diet May Be Protective in the Development of Diabetic Retinopathy. Int J Mol Sci 2023; 24:11145. [PMID: 37446322 DOI: 10.3390/ijms241311145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
The Mediterranean diet is recognized as one of the healthiest available dietary patterns. This perception results from its beneficial effects on the cardiovascular system and, also, on hypertension, diabetes, and cancer compared with other diets. Its impact on the course of diabetes is assessed in the available scientific literature; however, little information is available about its impact on diabetic retinopathy. The MD is characterized mainly by the consumption of fish, seafood, foods of plant origin, and fresh fruit and vegetables. It is also recommended to consume legumes, which are a source of folic acid, magnesium, iron, and dietary fiber. High consumption of nuts and unrefined grains is also recommended in the MD. Marine fish provide polyunsaturated acids from the omega-3 group. Olive oil plays a very important role, especially olive oil obtained from mechanical pressing. Additionally, olive oil contains vitamins E, K, and polyphenols. Polyphenols, which are present in a diverse range of vegetables, fruits, and seeds, have the ability to decrease oxidative stress, inflammation, and insulin resistance. Resveratrol is naturally found in grape skins and seeds, as well as in peanuts and berries, and is a constituent of red wine. Resveratrol can inhibit increased vascular leakage and loss of pericytes and regulate the level of VEGF protein in the retina, thus inhibiting the development of DR. Consumption of fruits, vegetables, fish, and olive oil may be correlated with a lower risk of diabetic retinopathy. This paper presents the definition of the Mediterranean diet and its influence on the course of diabetes and diabetic retinopathy.
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Affiliation(s)
- Anna Bryl
- Department of Ophthalmology and Eye Rehabilitation, Medical University of Bialystok, 15-089 Bialystok, Poland
| | - Małgorzata Mrugacz
- Department of Ophthalmology and Eye Rehabilitation, Medical University of Bialystok, 15-089 Bialystok, Poland
| | - Mariusz Falkowski
- PhD Studies, Medical University of Bialystok, 15-089 Bialystok, Poland
| | - Katarzyna Zorena
- Department of Immunobiology and Environmental Microbiology, Medical University of Gdansk, 80-211 Gdansk, Poland
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Shah J, Cheong ZY, Tan B, Wong D, Liu X, Chua J. Dietary Intake and Diabetic Retinopathy: A Systematic Review of the Literature. Nutrients 2022; 14:nu14235021. [PMID: 36501054 PMCID: PMC9735534 DOI: 10.3390/nu14235021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022] Open
Abstract
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.
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Affiliation(s)
- Janika Shah
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore
| | - Zi Yu Cheong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | - Bingyao Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore 639798, Singapore
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore 639798, Singapore
| | - Damon Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore 639798, Singapore
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore 639798, Singapore
| | - Xinyu Liu
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore 639798, Singapore
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore 639798, Singapore
| | - Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore
- Correspondence: ; Tel.: +65-6322-4576; Fax: +65-6225-2568
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Zhang G, Sun X, Yuan T, Guo C, Zhou Z, Wang L, Dou G. Certain Dietary Nutrients Reduce the Risk of Eye Affliction/Retinopathy in Individuals with Diabetes: National Health and Nutrition Examination Survey, 2003-2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12173. [PMID: 36231475 PMCID: PMC9566346 DOI: 10.3390/ijerph191912173] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/19/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
As the global trend of diabetes intensifies, the burden of vision-threatening retinopathy, particularly diabetic retinopathy (DR), is increasing. There is an urgent need to seek strategies for early prevention and control of DR. This study attempted to comprehensively evaluate the relationship between dietary nutrient intake and the risk of DR to provide assistance for doctors in guiding the diet of diabetic patients. Data from eligible participants with diabetes from the US National Health and Nutrition Examination Survey (NHANES) from 2003-2018 were analyzed. Univariate logistic regression was used to assess the association between 58 dietary nutrient intakes and self-reported eye disease risk. Multivariate logistic regression model was used to further evaluate the relationship between the two groups after adjusting relevant confounding factors. A total of 4595 diabetic patients were included. People with self-reported eye affliction/retinopathy had lower dietary fiber, butanoic, octanoic, vitamin A, alpha-carotene, folate, magnesium, copper and caffeine intake compared to those without self-reported eye affliction/retinopathy. The pooled ORs (95% CIs) were 0.78 (0.62-0.98), 0.79 (0.63-0.99), 0.72 (0.58-0.91), 0.74 (0.59-0.93), 0.70 (0.55-0.88), 075 (0.60-0.95), 0.79 (0.64-0.99), 0.67 (0.54-0.84) and 0.80 (0.64-0.99). Dietary cholesterol and hexadecenoic intake were higher, with the pooled ORs (95% CIs) of 1.26 (1.01-1.58) and 1.27 (1.02-1.59), respectively. Our research found that among dietary nutrients, dietary fiber, butanoic, octanoic, vitamin A, alpha-carotene, folate, magnesium, copper and caffeine intake reduced the occurrence of DR. Cholesterol and hexadecenoic intake promoted the occurrence of DR. This suggests that certain dietary nutrients should be paid more attention in the prevention of DR.
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Affiliation(s)
- Guoheng Zhang
- Department of Ophthalmology, Eye Institute of Chinese PLA, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
- Department of Ophthalmology, 942 Hospital of the Joint Logistics Support Force of the Chinese People’s Liberation Army, Yinchuan 750000, China
| | - Xiaojia Sun
- Department of Ophthalmology, Eye Institute of Chinese PLA, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
| | - Tianhao Yuan
- Department of Ophthalmology, Eye Institute of Chinese PLA, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
| | - Changmei Guo
- Department of Ophthalmology, Eye Institute of Chinese PLA, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
| | - Ziyi Zhou
- Department of Ophthalmology, Eye Institute of Chinese PLA, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
| | - Ling Wang
- Department of Health Statistics, Faculty of Preventive Medicine, Fourth Military Medical University, Xi’an 710032, China
| | - Guorui Dou
- Department of Ophthalmology, Eye Institute of Chinese PLA, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
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8
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Abstract
Socioeconomic status (SES) may influence the general health and the health-seeking behavior of an individual. Understanding the disease prevalence in different social strata may lead us to the important linkages that SES might have with diabetic retinopathy (DR). The knowledge on the prevalence of DR in the community based on their SES may help design strategies to provide affordable, last-mile care to the population most at risk of this blinding complication of diabetes mellitus. Our systematic search for population-based Indian studies found three studies in the past three decades that evaluated the effect of socioeconomic factors on the prevalence of diabetic retinopathy. The data on the prevalence in various socioeconomic strata was equivocal and the study settings were mostly urban. The parameters used to assess the SES differed among studies. This underscores the need for further research on SES-related diabetic retinopathy complications in India. Future studies should employ more robust socioeconomic scales to define the divide better.
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Affiliation(s)
- Umesh C Behera
- Department of Vitreo-Retina, L V Prasad Eye Institute (Mithu Tulsi Chanrai Campus), Bhubaneswar, Odisha, India
| | - Anand S Brar
- Department of Vitreo-Retina, L V Prasad Eye Institute (Mithu Tulsi Chanrai Campus), Bhubaneswar, Odisha, India
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9
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Effects of a Mediterranean diet on the development of diabetic complications: A longitudinal study from the nationwide diabetes report of the National Program for Prevention and Control of Diabetes (NPPCD 2016-2020). Maturitas 2021; 153:61-67. [PMID: 34654529 DOI: 10.1016/j.maturitas.2021.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 08/10/2021] [Accepted: 08/18/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of a Mediterranean dietary pattern on the incidence of macrovascular and microvascular complications of diabetes, namely cardiovascular disease (CVD), diabetic foot disorders, diabetic retinopathy, nephropathy, and neuropathy. METHODS This longitudinal study was conducted among 71392 adults with diabetes who attended academic tertiary-care outpatient clinics from February 2016 to March 2020 across Iran using the National Program for Prevention and Control of Diabetes database. Among them, 22187 patients with diabetes (type 1 and type 2) completed 2-11 follow-up visits after baseline registration. The association between adherence to a Mediterranean diet and diabetic complications was assessed using pooled logistic regression models. This association was adjusted for potential confounders. The effect of time was assessed using fractional polynomials. RESULTS A total of 22187 participants were included in the analysis (30.22% men and 69.78% women) with either type 1 (mean age 50.7 years) or type 2 (mean age 59.9 years) diabetes. After adjustment for confounding variables, there was a negative correlation between adherence to a Mediterranean diet and the incidence of CVD among patients with type 1 diabetes (T1D) and 2 diabetes (T2D) (OR= 0.53, 95% CI: 0.37 - 0.75, p-value <0.001 and OR= 0.61, 95% CI: 0.57 - 0.89, p-value <0.001, respectively). Also, the diet had a statistically significant protective effect against incident symptomatic neuropathy (OR= 0.32, 95% CI: 0.23 - 0.43, p-value <0.001, and OR= 0.68, 95% CI: 0.64 - 0.72, p-value <0.001, respectively), nephropathy (OR= 0.42, 95% CI: 0.30 - 0.58, p-value <0.001, and OR= 0.88, 95% CI: 0.80 - 0.96, p-value= 0.007, respectively), and retinopathy (OR= 0.32, 95% CI: 0.24 - 0.44, p-value <0.001, and OR= 0.68, 95% CI: 0.61 - 0.71, p-value <0.001, respectively) in T1D and T2D. CONCLUSION The Mediterranean dietary pattern is associated with a lower incidence of CVD and microvascular complications (i.e. diabetic retinopathy, nephropathy, and neuropathy) among a cohort of patients with T1D and T2D in Iran.
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Raman R, Ramasamy K, Rajalakshmi R, Sivaprasad S, Natarajan S. Diabetic retinopathy screening guidelines in India: All India Ophthalmological Society diabetic retinopathy task force and Vitreoretinal Society of India Consensus Statement. Indian J Ophthalmol 2021; 69:678-688. [PMID: 33269742 PMCID: PMC7942107 DOI: 10.4103/ijo.ijo_667_20] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/13/2020] [Accepted: 07/14/2020] [Indexed: 12/15/2022] Open
Abstract
Diabetic retinopathy (DR) is an emerging preventable cause of blindness in India. All India Ophthalmology Society (AIOS) and Vitreo-Retinal Society of India (VRSI) have initiated several measures to improve of DR screening in India. This article is a consensus statement of the AIOS DR task force and VRSI on practical guidelines of DR screening in India. Although there are regional variations in the prevalence of diabetes in India at present, all the States in India should screen their population for diabetes and its complications. The purpose of DR screening is to identify people with sight-threatening DR (STDR) so that they are treated promptly to prevent blindness. This statement provides strategies for the identification of people with diabetes for DR screening, recommends screening intervals in people with diabetes with and without DR, and describes screening models that are feasible in India. The logistics of DR screening emphasizes the need for dynamic referral pathways with feedback mechanisms. It provides the clinical standards required for DR screening and treatment of STDR and addresses the governance and quality assurance (QA) standards for DR screening in Indian settings. Other aspects incorporate education and training, recommendations on Information technology (IT) infrastructure, potential use of artificial intelligence for grading, data capture, and requirements for maintenance of a DR registry. Finally, the recommendations include public awareness and the need to work with diabetologists to control the risk factors so as to have a long-term impact on prevention of diabetes blindness in India.
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Affiliation(s)
- Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Chennai, Tamil Nadu, India
| | - Kim Ramasamy
- Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Ramachandran Rajalakshmi
- Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | | | - S Natarajan
- Aditya Jyot Eye Hospital Pvt. Ltd., Mumbai, Maharashtra, India
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11
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Broadhead GK, Hong T, Bahrami B, Flood V, Liew G, Chang AA. Diet and risk of visual impairment: a review of dietary factors and risk of common causes of visual impairment. Nutr Rev 2020; 79:636-650. [PMID: 33051676 DOI: 10.1093/nutrit/nuaa100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Age-related macular degeneration, diabetic retinopathy, cataract, and glaucoma remain the leading causes of visual impairment in developed nations, resulting in a substantial treatment burden on sufferers and health care systems. Despite significant advances in diagnostic testing and therapeutics, population-based strategies to reduce the burden of these diseases remain limited. However, there is some evidence that these diseases may share overlapping risk factors, particularly in regard to dietary intake and antioxidant status, and it is thus possible that dietary modification may reduce both the prevalence and severity of these conditions. In particular, dietary intake of green leafy vegetables, hyperglycemia/glycemia index, and omega-3 fatty acid intake, as well as overall dietary patterns, may affect risk of one or more of these conditions. In this review, we analyse the evidence for dietary intake and the association with these conditions, and provide insights into possible modifications that may thus simultaneously reduce the risk of visual impairment from multiple causes, including improving dietary intake of green leafy vegetables and reducing dietary glycemic index, both of which have been associated with a decreased risk of multiple causes of visual impairment.
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Affiliation(s)
- Geoffrey K Broadhead
- Save Sight Institute, University of Sydney, Sydney, NSW, Australia.,Sydney Institute of Vision Science, Sydney, NSW, Australia.,Sydney Institute of Vision Science, Sydney, NSW, Australia
| | - Thomas Hong
- Sydney Institute of Vision Science, Sydney, NSW, Australia
| | - Bobak Bahrami
- Save Sight Institute, University of Sydney, Sydney, NSW, Australia.,Sydney Institute of Vision Science, Sydney, NSW, Australia.,Sydney Institute of Vision Science, Sydney, NSW, Australia
| | - Victoria Flood
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Western Sydney Local Health District, Sydney, NSW, Australia.,Westmead Hospital, Western Sydney Local Health District, Westmead, NSW, Australia
| | - Gerald Liew
- Centre for Vision Research, The Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Andrew A Chang
- Save Sight Institute, University of Sydney, Sydney, NSW, Australia.,Sydney Institute of Vision Science, Sydney, NSW, Australia.,Sydney Institute of Vision Science, Sydney, NSW, Australia
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12
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Wang Y, Wang J. Modelling and prediction of global non-communicable diseases. BMC Public Health 2020; 20:822. [PMID: 32487173 PMCID: PMC7268487 DOI: 10.1186/s12889-020-08890-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/11/2020] [Indexed: 12/28/2022] Open
Abstract
Background Non-communicable diseases (NCDs) are the main health and development challenge facing humankind all over the world. They are inextricably linked to socio-economic development. Deaths caused by NCDs should be different in different socio-economic development stages. The stratified heterogeneity of NCD deaths is currently not fully explored. Methods Countries were classified according to their socio-economic types and development stages, which were illustrated as a tree-like structure called Geotree. NCD deaths were linked to the countries and so were attached to the Geotree, which was modelled by a multilevel model (MLM) approach. Accordingly, the levels of NCD death indexes were predicted for 2030. Results Through the Geotree structure constructed in the study, it can be seen that the NCD death index has obvious stratified heterogeneity; that is, the NCD death index shows different trends in different country types and socio-economic development stages. In the first-level branches (country type), as national income increases, NCD mortality rate decreases and the proportion of NCD deaths to total deaths increases. In the secondary-level trunks (socio-economic development stage), as a country’s development stage rises, the NCD mortality rate decreases and the proportion of NCD deaths to total deaths increases. In addition, combined with the hierarchical nature of the evolution tree model, the MLM was used to predict the global NCD death index for 2030. The result was that by 2030, the global average age-standardized NCD mortality rate would be 510.54 (per 100,000 population) and the global average mortality for NCD deaths of the total number of deaths would be 75.26%. Conclusions This study found that there is a significant association between socio-economic factors and NCD death indicators in the tree-like structure. In the Geotree, countries on the same branch or trunk can learn from countries with higher development stages to formulate more effective NCD response policies and find the right prevention and treatment path.
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Affiliation(s)
- Yang Wang
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, 100101, China.,University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Jinfeng Wang
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, 100101, China. .,University of Chinese Academy of Sciences, Beijing, 100049, China.
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13
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Wong MYZ, Man REK, Fenwick EK, Gupta P, Li LJ, van Dam RM, Chong MF, Lamoureux EL. Dietary intake and diabetic retinopathy: A systematic review. PLoS One 2018; 13:e0186582. [PMID: 29324740 PMCID: PMC5764236 DOI: 10.1371/journal.pone.0186582] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 10/03/2017] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The evidence linking dietary intake with diabetic retinopathy (DR) is growing but unclear. We conducted a systematic review of the association between dietary intake and DR. METHODS We systematically searched PubMed, Embase, Medline, and the Cochrane Central register of controlled trials, for publications between January 1967 and January 2017 using standardized criteria for diet and DR. Interventional and observational studies investigating micro- and macro-nutrient intakes; food and beverage consumptions; and dietary patterns were included. Study quality was evaluated using a modified Newcastle-Ottawa scale for observational studies, and the Cochrane collaboration tool for interventional studies. RESULTS Of 4265 titles initially identified, 31 studies (3 interventional, 28 Observational) were retained. Higher intakes of dietary fibre, oily fish, and greater adherence to a Mediterranean diet were protective of DR. Conversely, high total caloric intake was associated with higher risk of DR. No significant associations of carbohydrate, vitamin D, and sodium intake with DR were found. Associations of antioxidants, fatty acids, proteins and alcohol with DR remain equivocal. CONCLUSIONS Dietary fibre, oily fish, a Mediterranean diet and a reduced caloric intake are associated with lower risk of DR. Longitudinal data and interventional models are warranted to confirm our findings and better inform clinical guidelines.
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Affiliation(s)
- Mark Y. Z. Wong
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
| | - Ryan E. K. Man
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
| | - Eva K. Fenwick
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Duke-NUS Medical School, Office of Clinical Sciences, Singapore
| | - Preeti Gupta
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
| | - Ling-Jun Li
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Duke-NUS Medical School, Office of Clinical Sciences, Singapore
| | - Rob M. van Dam
- Singapore Institute for Clinical Sciences, A*STAR, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mary F. Chong
- Singapore Institute for Clinical Sciences, A*STAR, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Ecosse L. Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Duke-NUS Medical School, Office of Clinical Sciences, Singapore
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14
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Diet and risk of diabetic retinopathy: a systematic review. Eur J Epidemiol 2017; 33:141-156. [DOI: 10.1007/s10654-017-0338-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/27/2017] [Indexed: 12/11/2022]
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15
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el Bilbeisi AH, Hosseini S, Djafarian K. Association of dietary patterns with diabetes complications among type 2 diabetes patients in Gaza Strip, Palestine: a cross sectional study. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2017; 36:37. [PMID: 29141668 PMCID: PMC5688727 DOI: 10.1186/s41043-017-0115-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 11/09/2017] [Indexed: 05/17/2023]
Abstract
BACKGROUND The prevalence of diabetes mellitus is rising worldwide. When diabetes is uncontrolled, it has dire consequences for health and well-being. However, the role of diet in the origin of diabetes complications is not understood well. This study identifies major dietary patterns among type 2 diabetes patients and its association with diabetes complications in Gaza Strip, Palestine. METHODS This cross sectional study was conducted among 1200 previously diagnosed type 2 diabetes mellitus (both genders, aged 20-64 years), patients receiving care in primary healthcare centers in Gaza Strip, Palestine. Dietary patterns were evaluated using a validated semi-quantitative food frequency questionnaire. Additional information regarding demographic and medical history variables was obtained with an interview-based questionnaire. Statistical analysis was performed using SPSS version 20. RESULTS Two major dietary patterns were identified by factor analysis: Asian-like pattern and sweet-soft drinks-snacks pattern. After adjustment for confounding variables, patients in the lowest tertile of the Asian-like pattern characterized by a high intake of whole grains, potatoes, beans, legumes, vegetables, tomatoes and fruit had a lower odds for (High BP, kidney problems, heart problems, extremities problems and neurological problems), (OR 0.710 CI 95% (.506-.997)), (OR 0.834 CI 95% (.700-.994)), (OR 0.730 CI 95% (.596-.895)), (OR 0.763 CI 95% (.667-.871)) and (OR 0.773 CI 95% (.602-.991)) respectively, (P value <0.05 for all). No significant association was found between the sweet-soft drinks snacks pattern with diabetes complications. CONCLUSION The Asian-like pattern may be associated with a lower prevalence of diabetes complications among type 2 diabetes patients.
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Affiliation(s)
- Abdel Hamid el Bilbeisi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, International Campus (TUMS- IC), Tehran, Iran
| | - Saeed Hosseini
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, International Campus (TUMS- IC), Tehran, Iran
| | - Kurosh Djafarian
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, International Campus (TUMS- IC), Tehran, Iran
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16
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Nutrition for diabetic retinopathy: plummeting the inevitable threat of diabetic vision loss. Eur J Nutr 2017; 56:2013-2027. [PMID: 28258307 DOI: 10.1007/s00394-017-1406-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 02/10/2017] [Indexed: 12/14/2022]
Abstract
Diabetic retinopathy (DR) is among the leading causes of preventable blindness. Hyperglycemia, hypertension, hyperlipidemia and anemia majorly predispose its pathogenesis. The current treatment modalities of DR include laser photocoagulation therapy, intravitreal corticosteroids, intravitreal anti-vascular endothelial growth factor (VEGF) agents and vitreo-retinal surgery which are costly, highly invasive, unproven for prolonged use and opted in advanced stages of DR. By then retina already encounters a vast damage. Nutrients by their natural physiological, biochemical and molecular action can preserve retinal structure and functions by interfering with the various pathological steps prompting DR incidence, thereby altering the risk of developing this ocular morbidity. Nutrients can also play a central role in DR patients resistant towards the conventional medical treatments. However due to the byzantine interplay existing between nutrients and DR, the worth of nutrition in curbing this vision-threatening ocular morbidity remains silent. This review highlights how nutrients can halt DR development. A nutritional therapy, if adopted in the initial stages, can provide superior-efficacy over the current treatment modalities and can be a complementary, inexpensive, readily available, anodyne option to the clinically unmet requirement for preventing DR. Assessment of nutritional status is presently considered relevant in various clinical conditions except DR. Body Mass Index (BMI) conferred inconclusive results in DR subjects. Subjective Global Assessment (SGA) of nutritional status has recently furnished relevant association with DR status. By integrating nutritional strategies, the risk of developing DR can be reduced substantially. This review summarizes the subsisting knowledge on nutrition, potentially beneficial for preventing DR and sustaining good vision among diabetic subjects.
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Allen L, Williams J, Townsend N, Mikkelsen B, Roberts N, Foster C, Wickramasinghe K. Socioeconomic status and non-communicable disease behavioural risk factors in low-income and lower-middle-income countries: a systematic review. Lancet Glob Health 2017; 5:e277-e289. [PMID: 28193397 PMCID: PMC5673683 DOI: 10.1016/s2214-109x(17)30058-x] [Citation(s) in RCA: 348] [Impact Index Per Article: 49.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 11/24/2016] [Accepted: 12/12/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Non-communicable diseases are the leading global cause of death and disproportionately afflict those living in low-income and lower-middle-income countries (LLMICs). The association between socioeconomic status and non-communicable disease behavioural risk factors is well established in high-income countries, but it is not clear how behavioural risk factors are distributed within LLMICs. We aimed to systematically review evidence on the association between socioeconomic status and harmful use of alcohol, tobacco use, unhealthy diets, and physical inactivity within LLMICs. METHODS We searched 13 electronic databases, including Embase and MEDLINE, grey literature, and reference lists for primary research published between Jan 1, 1990, and June 30, 2015. We included studies from LLMICs presenting data on multiple measures of socioeconomic status and tobacco use, alcohol use, diet, and physical activity. No age or language restrictions were applied. We excluded studies that did not allow comparison between more or less advantaged groups. We used a piloted version of the Cochrane Effective Practice and Organisation of Care Group data collection checklist to extract relevant data at the household and individual level from the included full text studies including study type, methods, outcomes, and results. Due to high heterogeneity, we used a narrative approach for data synthesis. We used descriptive statistics to assess whether the prevalence of each risk factor varied significantly between members of different socioeconomic groups. The study protocol is registered with PROSPERO, number CRD42015026604. FINDINGS After reviewing 4242 records, 75 studies met our inclusion criteria, representing 2 135 314 individuals older than 10 years from 39 LLMICs. Low socioeconomic groups were found to have a significantly higher prevalence of tobacco and alcohol use than did high socioeconomic groups. These groups also consumed less fruit, vegetables, fish, and fibre than those of high socioeconomic status. High socioeconomic groups were found to be less physically active and consume more fats, salt, and processed food than individuals of low socioeconomic status. While the included studies presented clear patterns for tobacco use and physical activity, heterogeneity between dietary outcome measures and a paucity of evidence around harmful alcohol use limit the certainty of these findings. INTERPRETATION Despite significant heterogeneity in exposure and outcome measures, clear evidence shows that the burden of behavioural risk factors is affected by socioeconomic position within LLMICs. Governments seeking to meet Sustainable Development Goal (SDG) 3.4-reducing premature non-communicable disease mortality by a third by 2030-should leverage their development budgets to address the poverty-health nexus in these settings. Our findings also have significance for health workers serving these populations and policy makers tasked with preventing and controlling the rise of non-communicable diseases. FUNDING WHO.
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Affiliation(s)
- Luke Allen
- British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Julianne Williams
- British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Nick Townsend
- British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Bente Mikkelsen
- WHO Global Coordination Mechanisms on the Prevention and Control of Non-communicable diseases, WHO, Geneva, Switzerland
| | - Nia Roberts
- Health Care Libraries, Bodleian Libraries, University of Oxford, Oxford, UK
| | - Charlie Foster
- British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kremlin Wickramasinghe
- British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Raman R, Gella L, Srinivasan S, Sharma T. Diabetic retinopathy: An epidemic at home and around the world. Indian J Ophthalmol 2016; 64:69-75. [PMID: 26953027 PMCID: PMC4821125 DOI: 10.4103/0301-4738.178150] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Prevention of blindness due to diabetic retinopathy (DR) requires effective screening strategies, for which eye care providers need to know the magnitude of the burden and the risk factors pertinent in their geographical location. It is estimated that around 72 million of the global adult population (around 8.2%) has diabetes and about one-fifth of all adults with diabetes lives in the South-East Asia. In India, around 65 million people have diabetes. As the global prevalence of diabetes increases, so will the number of people with diabetes-related complications, such as DR; nearly one-third of them are likely to develop this complication. This article reviews the present status of diabetes and DR in India, the current situation of DR services and the projections on the load of morbidity associated with retinopathy. The article compiles the Indian studies elucidating the risk factors for DR.
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Affiliation(s)
- Rajiv Raman
- Department of Vitreoretinal Services, Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
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19
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Abstract
For individuals at risk for type 2 diabetes mellitus or the metabolic syndrome, adherence to an idealized dietary pattern can drastically alter the risk and course of these chronic conditions. Target levels of carbohydrate intake should approximate 30% of consumed calories. Healthy food choices should include copious fruits, vegetables, and nuts while minimizing foods with high glycemic indices, especially processed foods.
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Affiliation(s)
- Michael A Via
- Division of Endocrinology and Metabolism, Mount Sinai Beth Israel Medical Center, Icahn School of Medicine at Mount Sinai, 317 East 17th Street, 8th Floor, New York, NY 10003, USA.
| | - Jeffrey I Mechanick
- Metabolic Support, Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, 1192 Park Ave, New York, NY 10128, USA
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Alcubierre N, Navarrete-Muñoz EM, Rubinat E, Falguera M, Valls J, Traveset A, Vilanova MB, Marsal JR, Hernandez M, Granado-Casas M, Martinez-Gonzalez D, Jurjo C, Franch-Nadal J, Vioque J, Mauricio D. Association of low oleic acid intake with diabetic retinopathy in type 2 diabetic patients: a case-control study. Nutr Metab (Lond) 2016; 13:40. [PMID: 27274760 PMCID: PMC4893240 DOI: 10.1186/s12986-016-0099-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 05/23/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The objective of this study was to describe the intake of macronutrient, especially fatty acids, and explore their possible effect on diabetic retinopathy (DR) in patients with type 2 diabetes mellitus. METHODS In this case-control study, we included a total of 146 patients with DR and 148 without DR. The intake of macronutrient was evaluated using a validated food frequency questionnaire. We used logistic regression adjusted for sex, age, diabetes duration, energy intake, educational level, physical activity, waist circumference, systolic blood pressure, high-density lipoprotein cholesterol and diabetes treatment, to estimate odds ratio (ORs) of DR. RESULTS Patients with DR had significantly lower intake of fibre, monounsaturated fatty acids (MUFA), and palmitic and oleic acid. Inverse associations were observed between MUFA and oleic acid intake in DR. Subjects with intermediate and high MUFA intake were less likely to have DR than those with lower MUFA intake, with ORs of 0.46 (95 % CI: 0.22-0.93) and 0.42 (95 % CI: 0.18-0.97), respectively. Similarly, intermediate and high oleic acid intake were associated with reduced DR frequency compared with low oleic acid intake, with OR values of 0.48 (95 % CI: 0.23-0.97) and 0.37 (95 % CI: 0.16-0.85), respectively. These associations were stronger in patients with a longer diabetes duration. CONCLUSION In type 2 diabetes mellitus, MUFA and oleic acid intake were inversely associated with DR.
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Affiliation(s)
- Nuria Alcubierre
- Institut de Recerca Biomèdica de Lleida, University of Lleida, Lleida, 25198 Spain
| | - Eva M Navarrete-Muñoz
- Consortium for Biomedical Research in Epidemilogy and Public Health (CIBER en Epidemiología y Salud Pública CIBERESP), Madrid, 28029 Spain.,Public Health Department, Miguel Hernandez University, Alicante, Spain
| | - Esther Rubinat
- Unitat de Suport a la Recerca de Barcelona, Institut Universitari d'Investigació en Atenció. Primària Jordi Gol (IDIAP Jordi Gol), CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Barcelona, 08007 Spain
| | - Mireia Falguera
- Institut de Recerca Biomèdica de Lleida, University of Lleida, Lleida, 25198 Spain.,Primary Health Care Center Igualada Nord, Igualada, 08700 Spain
| | - Joan Valls
- Biostatistics Unit, Institut de Recerca Biomèdica de Lleida, University of Lleida, Lleida, 25198 Spain
| | - Alicia Traveset
- Institut de Recerca Biomèdica de Lleida, University of Lleida, Lleida, 25198 Spain.,Department of Ophthalmology, University Hospital Arnau de Vilanova, Lleida, 25198 Spain
| | | | - Josep Ramon Marsal
- Unitat de Suport a la Recerca de Lleida, Institut Universitari d'Investigació en AtencióPrimària Jordi Gol (IDIAP Jordi Gol), Lleida, 25007 Spain.,Unitat de Epidemiologia, Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Barcelona, 08035 Spain
| | - Marta Hernandez
- Institut de Recerca Biomèdica de Lleida, University of Lleida, Lleida, 25198 Spain.,Department of Endocrinology and Nutrition, University Hospital Arnau de Vilanova, Lleida, 25198 Spain
| | | | | | - Carmen Jurjo
- Institut de Recerca Biomèdica de Lleida, University of Lleida, Lleida, 25198 Spain.,Department of Ophthalmology, University Hospital Arnau de Vilanova, Lleida, 25198 Spain
| | - Josep Franch-Nadal
- Unitat de Suport a la Recerca de Barcelona, Institut Universitari d'Investigació en Atenció. Primària Jordi Gol (IDIAP Jordi Gol), CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Barcelona, 08007 Spain.,Primary Health Care Center Raval Sud, Barcelona, 08001 Spain
| | - Jesús Vioque
- Consortium for Biomedical Research in Epidemilogy and Public Health (CIBER en Epidemiología y Salud Pública CIBERESP), Madrid, 28029 Spain.,Public Health Department, Miguel Hernandez University, Alicante, Spain
| | - Didac Mauricio
- Institut de Recerca Biomèdica de Lleida, University of Lleida, Lleida, 25198 Spain.,Unitat de Suport a la Recerca de Barcelona, Institut Universitari d'Investigació en Atenció. Primària Jordi Gol (IDIAP Jordi Gol), CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Barcelona, 08007 Spain.,Department of Endocrinology and Nutrition, University Hospital and Health Sciences Research Institute Germans Trias Pujol, CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Badalona, 08916 Spain
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Díaz-López A, Babio N, Martínez-González MA, Corella D, Amor AJ, Fitó M, Estruch R, Arós F, Gómez-Gracia E, Fiol M, Lapetra J, Serra-Majem L, Basora J, Basterra-Gortari FJ, Zanon-Moreno V, Muñoz MÁ, Salas-Salvadó J. Mediterranean Diet, Retinopathy, Nephropathy, and Microvascular Diabetes Complications: A Post Hoc Analysis of a Randomized Trial. Diabetes Care 2015; 38:2134-41. [PMID: 26370380 DOI: 10.2337/dc15-1117] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 08/06/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To date no clinical trials have evaluated the role of dietary patterns on the incidence of microvascular diabetes complications. We hypothesized that a nutritional intervention based on the Mediterranean diet (MedDiet) would have greater protective effect on diabetic retinopathy and nephropathy than a low-fat control diet. RESEARCH DESIGN AND METHODS This was a post hoc analysis of a cohort of patients with type 2 diabetes participating in the PREvención con DIeta MEDiterránea (PREDIMED) study, a multicenter randomized nutritional intervention trial conducted in a population at high cardiovascular risk. Individuals with type 2 diabetes who were free of microvascular complications at enrollment (n = 3,614, aged 55-80 years) were randomly assigned to one of three dietary interventions: MedDiet supplemented with extravirgin olive oil (MedDiet+EVOO), MedDiet supplemented with mixed nuts (MedDiet+Nuts), or a low-fat control diet. Two independent outcomes were considered: new onset of diabetic retinopathy and nephropathy. Hazard ratios (HRs) were calculated using multivariable-adjusted Cox regression. RESULTS During a median follow-up of 6.0 years, we identified 74 new cases of retinopathy and 168 of nephropathy. Compared with the control diet, multivariable-adjusted HRs for diabetic retinopathy were 0.56 (95% CI 0.32-0.97) for the MedDiet+EVOO and 0.63 (0.35-1.11) for the MedDiet+Nuts. No between-group differences were found for nephropathy. When the yearly updated information on adherence to the MedDiet was considered, the HR for retinopathy in the highest versus the lowest quintile was 0.34 (0.13-0.89; P = 0.001 for trend). No significant associations were found for nephropathy. CONCLUSIONS A MedDiet enriched with EVOO may protect against diabetic retinopathy but not diabetic nephropathy.
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Affiliation(s)
- Andrés Díaz-López
- Human Nutrition Unit, Biochemistry and Biotechnology Department, Faculty of Medicine and Health Sciences, Institut d'Investigació Sanitària Pere Virgili (IISPV), Rovira i Virgili University, Reus, Spain Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Nancy Babio
- Human Nutrition Unit, Biochemistry and Biotechnology Department, Faculty of Medicine and Health Sciences, Institut d'Investigació Sanitària Pere Virgili (IISPV), Rovira i Virgili University, Reus, Spain Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Miguel A Martínez-González
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain Department of Preventive Medicine and Public Health, University of Navarra, Osasunbidea-Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Dolores Corella
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain Department of Preventive Medicine, University of Valencia, Valencia, Spain
| | - Antonio J Amor
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain Lipid Clinic, Endocrinology and Nutrition Service, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Montse Fitó
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain Cardiovascular Risk and Nutrition (Regicor Study Group), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Ramon Estruch
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain Department of Internal Medicine, IDIBAPS, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Fernando Arós
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain Department of Cardiology, University Hospital Araba, Vitoria, Spain
| | - Enrique Gómez-Gracia
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain Department of Preventive Medicine, University of Malaga, Malaga, Spain
| | - Miquel Fiol
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain Institute of Health Sciences, University of Balearic Islands and Son Espases Hospital, Palma de Mallorca, Spain
| | - José Lapetra
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain Department of Family Medicine, Distrito Sanitario Atencion Primaria Sevilla, Centro de Salud San Pablo, Sevilla, Spain
| | - Lluís Serra-Majem
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain Department of Clinical Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Josep Basora
- Human Nutrition Unit, Biochemistry and Biotechnology Department, Faculty of Medicine and Health Sciences, Institut d'Investigació Sanitària Pere Virgili (IISPV), Rovira i Virgili University, Reus, Spain Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain Primary Care Division, Catalan Institute of Health, Institut d'Investigació i Recerca en Atenció Primària (IDIAP)-Jordi Gol, Barcelona, Spain
| | - F Javier Basterra-Gortari
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain Department of Preventive Medicine and Public Health, University of Navarra, Osasunbidea-Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Vicente Zanon-Moreno
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain Department of Preventive Medicine, University of Valencia, Valencia, Spain
| | - Miguel Ángel Muñoz
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain Primary Care Division, Catalan Institute of Health, Institut d'Investigació i Recerca en Atenció Primària (IDIAP)-Jordi Gol, Barcelona, Spain
| | - Jordi Salas-Salvadó
- Human Nutrition Unit, Biochemistry and Biotechnology Department, Faculty of Medicine and Health Sciences, Institut d'Investigació Sanitària Pere Virgili (IISPV), Rovira i Virgili University, Reus, Spain Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
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Abstract
BACKGROUND Antioxidants and dietary fiber are postulated to have preventive effects on diabetic retinopathy, but evidence is lacking. We investigated this association in a cohort with type 2 diabetes 40-70 years of age with hemoglobin (Hb)A1C ≥6.5%, originally part of the Japan Diabetes Complications Study. METHODS After excluding people who did not respond to a dietary survey and patients with diabetic retinopathy or a major ocular disease at baseline, we analyzed 978 patients. Baseline dietary intake was assessed by a food frequency questionnaire based on food groups and 24-hour dietary records. Primary outcome was incident diabetic retinopathy determined using international severity scales. RESULTS Mean fruit intake in quartiles ranged from 23 to 253 g/day, with increasing trends across quartiles of fruit intake for vitamin C, vitamin E, carotene, retinol equivalent, dietary fiber, potassium, and sodium. Mean energy intake ranged from 1644 to 1863 kcal/day, and fat intake was approximately 25%. HbA1C, body mass index, triglycerides, and systolic blood pressure were well controlled. During the 8-year follow-up, the numbers of incident cases of diabetic retinopathy from the first through the fourth quartiles of fruit intake were 83, 74, 69, and 59. Multivariate-adjusted hazard ratios for the second, third, and fourth quartiles of fruit intake compared with the first quartile were 0.66 (95% confidence interval = 0.46-0.92), 0.59 (0.41-0.85), and 0.48 (0.32-0.71) (test for trend, P < 0.01). There was no substantial effect modification by age, sex, HbA1C, diabetes duration, overweight, smoking, and hypertension. Risk for diabetic retinopathy declined with increased intake of fruits and vegetables, vitamin C, and carotene. CONCLUSION Increased fruit intake in ranges commonly consumed was associated with reduced incident diabetic retinopathy among patients adhering to a low-fat energy-restricted diet.
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