Department of Ophthalmology, King George Medical University, Lucknow, Uttar Pradesh, 226003, India.
Department of Medicine, King George Medical University, Lucknow, Uttar Pradesh, India.
Eur J Nutr. 2017 Sep;56(6):2013-2027. doi: 10.1007/s00394-017-1406-2. Epub 2017 Mar 3.
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.
糖尿病视网膜病变(DR)是可预防失明的主要原因之一。高血糖、高血压、高血脂和贫血主要导致其发病机制。DR 的当前治疗方法包括激光光凝疗法、眼内皮质类固醇、眼内抗血管内皮生长因子(VEGF)药物和玻璃体视网膜手术,这些方法费用高、侵袭性强、长期使用效果未经证实,并且仅在 DR 的晚期选择使用。到那时,视网膜已经遭受了巨大的损伤。营养素通过其自然的生理、生化和分子作用,可以通过干扰促使 DR 发生的各种病理步骤来保护视网膜结构和功能,从而改变发生这种眼部疾病的风险。营养素还可以在对常规医学治疗有抵抗力的 DR 患者中发挥核心作用。然而,由于营养素与 DR 之间错综复杂的相互作用,营养在遏制这种威胁视力的眼部疾病方面的价值仍然没有得到充分体现。这篇综述强调了营养素如何阻止 DR 的发展。如果在早期采用营养疗法,可以提供比当前治疗方法更好的疗效,并且可以成为预防 DR 的临床未满足需求的补充、廉价、易于获得、无痛的选择。目前,除了 DR 之外,在各种临床情况下,评估营养状况都被认为是相关的。体重指数(BMI)在 DR 患者中得出的结果不一致。营养状况的主观整体评估(SGA)最近与 DR 状况提供了相关关联。通过整合营养策略,可以大大降低发生 DR 的风险。这篇综述总结了关于营养的现有知识,这些知识可能有助于预防 DR 并维持糖尿病患者的良好视力。