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

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.

Beverage consumption and diabetic retinopathy: a two-sample Mendelian randomization study

“…Karatzi K found that caffeine consumption was associated with wider retinal venular calibre, but no association was found between caffeinated drinks (coffee and tea) and retinal vessel calibres [22]. A systematic review revealed the uncertain effect of caffeine on the retina [7]. Because of the complexity and di culty of implementing an observational study in the real world, the conclusion may be disturbed by unknown confounding factors.…”

“…A cross-sectional study found that coffee consumption may be associated with a reduced risk of DR [4], while in another cross-sectional study, no signi cant association between coffee intake and DR was found [5]. In addition, most prospective cohort and case-control studies did not nd a signi cant association between alcohol intake and retinopathy [6,7], but Giuffrè G proved the protective effect of alcohol on DR over a long period. Evidence has shown the protective role of tea for DR, and Horikawa C and Yan X reported no statistically signi cant result between juice or milk intake and the incidence of DR [8][9][10].…”

Association between daily low-quality carbohydrate intake and diabetic retinopathy in NHANES 2005-2008

“…Risk factors for diabetes, such as body mass index, gender, and age, are not necessarily risk factors for DR progression 23 . In addition, patients usually manage their own diets after being diagnosed with diabetes.…”

“…In addition, patients usually manage their own diets after being diagnosed with diabetes. Thus, there may be differences in the effects of diet on diabetes and on DR, and there is a lack of real-world evidence on the effect of different quality of carbohydrate intake on the prevalence of DR among diabetics 24 .…”

Causal relationship between dietary intake and diabetic retinopathy: a two-sample Mendelian randomization study

“…A signi cant amount of data points to the importance of dietary consumption in the etiology of diabetic retinopathy [6,7] . Earlier studies have suggested that the consumption of a Mediterranean diet, increased dietary ber and sh intake, as well as cheese, may contribute to a potential reduction in the risk of diabetic retinopathy [8][9][10] . Nevertheless, the majority of present research on the association between diet and DR is based on observational studies, and the causal relationship between dietary patterns and DR remains to be elucidated.…”