Department of Clinical Trial Design and Management, Translational Research Center, Kyoto University Hospital, Sakyo-ku, Kyoto, Japan.
Epidemiology. 2013 Mar;24(2):204-11. doi: 10.1097/EDE.0b013e318281725e.
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.
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.
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.
Increased fruit intake in ranges commonly consumed was associated with reduced incident diabetic retinopathy among patients adhering to a low-fat energy-restricted diet.
抗氧化剂和膳食纤维据推测对糖尿病性视网膜病变有预防作用，但目前缺乏相关证据。我们对一个年龄在 40-70 岁之间、糖化血红蛋白（HbA1C）≥6.5%的 2 型糖尿病队列进行了这项研究，该队列最初是日本糖尿病并发症研究的一部分。
在排除了未响应饮食调查以及基线时有糖尿病性视网膜病变或主要眼部疾病的患者后，我们分析了 978 名患者。通过基于食物组和 24 小时饮食记录的食物频率问卷评估基线饮食摄入。主要结局是使用国际严重程度量表确定的新发糖尿病性视网膜病变。
水果摄入量四分位范围从 23 到 253 g/天，摄入量随着四分位的增加而增加，而水果摄入量与维生素 C、维生素 E、类胡萝卜素、视黄醇当量、膳食纤维、钾和钠呈正相关。平均能量摄入量范围从 1644 到 1863 kcal/天，脂肪摄入量约为 25%。HbA1C、体重指数、甘油三酯和收缩压控制良好。在 8 年的随访期间，从水果摄入量第一到第四四分位数的新发糖尿病性视网膜病变病例数分别为 83、74、69 和 59。与第一四分位相比，水果摄入量第二、第三和第四四分位的多变量调整后的危险比分别为 0.66（95%置信区间=0.46-0.92）、0.59（0.41-0.85）和 0.48（0.32-0.71）（趋势检验，P < 0.01）。年龄、性别、HbA1C、糖尿病病程、超重、吸烟和高血压对风险无明显修饰作用。随着水果和蔬菜、维生素 C 和类胡萝卜素摄入量的增加，糖尿病性视网膜病变的风险降低。
在遵循低脂能量限制饮食的患者中，摄入水果的量增加与新发糖尿病性视网膜病变的风险降低相关。
