Serum ω-6/ω-3 polyunsaturated fatty acids ratio and diabetic retinopathy: A propensity score matching based case-control study in China

Shuzhen Zhao; Dongzhen Jin; Shengyao Wang; Yanping Xu; Huihui Li; Yujie Chang; Yange Ma; Yixi Xu; Chengnan Guo; Fang Peng; Ruogu Huang; Mengyuan Lai; Zhezheng Xia; Mingzhu Che; Jingjing Zuo; Depeng Jiang; Chao Zheng; Guangyun Mao

doi:10.1016/j.eclinm.2021.101089

Serum ω-6/ω-3 polyunsaturated fatty acids ratio and diabetic retinopathy: A propensity score matching based case-control study in China

EClinicalMedicine. 2021 Aug 16:39:101089. doi: 10.1016/j.eclinm.2021.101089. eCollection 2021 Sep.

Authors

Shuzhen Zhao^{1

2}, Dongzhen Jin^{1

2}, Shengyao Wang³, Yanping Xu³, Huihui Li^{1

2}, Yujie Chang¹, Yange Ma^{1

2}, Yixi Xu^{1

2}, Chengnan Guo^{1

2}, Fang Peng^{1

2}, Ruogu Huang^{1

2}, Mengyuan Lai^{1

2}, Zhezheng Xia^{1

2}, Mingzhu Che^{1

2}, Jingjing Zuo^{4

5}, Depeng Jiang⁶, Chao Zheng^{3

7}, Guangyun Mao^{1

2

4

5}

Affiliations

¹ Division of Epidemiology and Health Statistics, Department of Preventive Medicine, School of Public Health & Management, Wenzhou Medical University, Wenzhou, Zhejiang, China.
² Centre on Evidence-Based Medicine & Clinical Epidemiological Research, School of Public Health & Management, Wenzhou Medical University, Wenzhou, Zhejiang, China.
³ The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
⁴ Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.
⁵ National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China.
⁶ Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Canada.
⁷ The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.

Abstract

Background: Optimal ω-6/ω-3 polyunsaturated fatty acids ratio (PUFAR) is reported to exert protective effects against chronic diseases. However, data on PUFAR and diabetic retinopathy (DR) remains scarce. We aimed to thoroughly quantify whether and how PUFAR was related to DR as well as its role in DR detection.

Methods: This two-centre case-control study was conducted from August 2017 to June 2018 in China, participants were matched using a propensity score matching algorithm. We adopted multivariable logistic regression models and restricted cubic spline analyses to estimate the independent association of PUFAR with DR, adjusting for confounders identified using a directed acyclic graph. The value of PUFAR as a biomarker for DR identification was further evaluated by receiver operating characteristic analyses and Hosmer-Lemeshow tests.

Findings: An apparent negative relationship between PUFAR and DR was observed. Adjusted odds of DR decreased by 79% (OR: 0·21, 95% CI: 0·10-0·40) with an interquartile range increase in PUFAR. Similar results were also obtained in tertile analysis. As compared to those in the 1st tertile of PUFAR, the adjusted odds of DR decreased by 76% (OR: 0·24, 95% CI: 0·08-0·66) and 93% (OR: 0·07, 95% CI: 0·03-0·22) for subjects in the 2nd and 3rd tertiles, respectively. Good calibration and discrimination of the PUFAR associated predictive model were detected and PUFAR = 35 would be an ideal cut-off value for DR identification.

Interpretation: Our results suggest that serum PUAFR is inversely associated with DR. Although PUFAR-alteration is not observed amongst different stages of DR, it can serve as an ideal biomarker in distinguishing patients with DR from those without DR.

Funding: This study was funded by Natural Science Foundation of Zhejiang Province, Zhejiang Basic Public Welfare Research Project, the Major Project of the Eye Hospital of Wenzhou Medical University, and the Academician's Science and Technology Innovation Program in Zhejiang province. Part of this work was also funded by the National Nature Science Foundation of China, and Research Project for College Students in Wenzhou Medical University.

Keywords: Case control study; Diabetic retinopathy; Propensity score matching; ω-6 /ω-3 PUFAs ratio.