Pan Xue
Department of Ophthalmology, Beijing Shijitan Hospital, Capital Medical University, No. 10 Yangfangdian Tieyi Road, Haidian District, Beijing, 100038, P.R. China.
Nutr Metab (Lond). 2025 Jun 3;22(1):54. doi: 10.1186/s12986-025-00953-w.
Oxidative stress and mitochondrial dysfunction play an important role in diabetic retinopathy (DR), and serum methylmalonic acid (MMA) levels are related to oxidative stress and mitochondrial dysfunction. We aimed to explore the impact of MMA levels and the composite dietary antioxidant index (CDAI) on DR risk in patients with diabetes.
Data on patients with diabetes from the 1999-2004 and 2011-2014 National Health and Nutrition Examination Survey (NHANES) datasets were included in this cross-sectional study. Logistic regression analysis (accounting for NHANES survey weights) was used to explore the association of MMA (< 250, ≥ 250 nmol/L) and CDAI (>-0.5, ≤-0.5) with DR risk, and the association was reported as odds ratio (OR) and 95% confidence interval (CI). The combined effect of MMA and CDAI on DR risk was also explored.
A total of 2,373 patients with diabetes were included and 547 (20.48%) patients had DR. MMA levels ≥ 250 nmol/L (OR = 1.47, 95%CI: 1.01-2.13) (vs. <250 nmol/L) were associated with higher odds of DR in patients with diabetes, whereas there was no significant difference in the effect of CDAI >-0.5 and CDAI ≤-0.5 on DR risk (P > 0.05). There was an interaction between MMA and CDAI that increased the risk of DR (OR = 2.24, 95%CI: 1.15-4.35; P=0.018), and this interaction was only in patients with a CDAI ≤-0.5. Subgroup analysis revealed that the interaction between MMA and CDAI was observed in patients < 65 years of age (OR = 5.43, 95%CI: 1.80-16.36), with a body mass index ≥ 25 kg/m (OR = 2.26, 95%CI: 1.11-4.61), with hypertension (OR = 2.13, 95%CI: 1.04-4.36), and with anti-diabetic drug use (OR = 2.42, 95%CI: 1.13-5.20).
There is an interaction between MMA and CDAI that increases the risk of DR, and CDAI plays a moderating role in this association.
氧化应激和线粒体功能障碍在糖尿病视网膜病变（DR）中起重要作用，血清甲基丙二酸（MMA）水平与氧化应激和线粒体功能障碍相关。我们旨在探讨MMA水平和复合膳食抗氧化指数（CDAI）对糖尿病患者DR风险的影响。
本横断面研究纳入了1999 - 2004年和2011 - 2014年国家健康与营养检查调查（NHANES）数据集中的糖尿病患者数据。采用逻辑回归分析（考虑NHANES调查权重）来探讨MMA（<250、≥250 nmol/L）和CDAI（>-0.5、≤-0.5）与DR风险的关联，并将该关联报告为比值比（OR）和95%置信区间（CI）。还探讨了MMA和CDAI对DR风险的联合作用。
共纳入2373例糖尿病患者，其中547例（20.48%）患有DR。糖尿病患者中，MMA水平≥250 nmol/L（OR = 1.47，95%CI：1.01 - 2.13）（vs.<250 nmol/L）与DR的较高发病几率相关，而CDAI > -0.5和CDAI≤ -0.5对DR风险的影响无显著差异（P>0.05）。MMA和CDAI之间存在相互作用，增加了DR风险（OR = 2.24，95%CI：1.15 - 4.35；P = 0.018），且这种相互作用仅在CDAI≤ -0.5的患者中存在。亚组分析显示，MMA和CDAI之间的相互作用在年龄<65岁（OR = 5.43，95%CI：1.80 - 16.36）、体重指数≥25 kg/m²（OR = 2.26，95%CI：1.11 - 4.61）、患有高血压（OR = 2.13，95%CI：1.04 - 4.36）以及使用抗糖尿病药物的患者中观察到（OR = 2.42，95%CI：1.13 - 5.20）。
MMA和CDAI之间存在相互作用，增加了DR风险，且CDAI在这种关联中起调节作用。
