Association between Grapes Intake and Diabetic Retinopathy: Inhibitory Effect of Resveratol on Diabetic Retinopathy

Bo Young Lee; Donghyun Jee

doi:10.3341/jkos.2016.57.2.276

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Lee, Jee, and Epidemiology Survey Committee of the Korean Ophthalmology Society: Association between Grapes Intake and Diabetic Retinopathy: Inhibitory Effect of Resveratol on Diabetic Retinopathy

Original Article

J Korean Ophthalmol Soc 2016;57(2):276-282.

Published online: 7 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.2.276

Association between Grapes Intake and Diabetic Retinopathy: Inhibitory Effect of Resveratol on Diabetic Retinopathy

Bo Young Lee, MD, Donghyun Jee, MD, PhD; Epidemiology Survey Committee of the Korean Ophthalmology Society

Department of Ophthalmology and Visual Science, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea

Address reprint requests to Donghyun Jee, MD, PhD Department of Ophthalmology, The Catholic University of Korea St. Vincent's Hospital, #93 Jungbu-daero, Paldal-gu, Suwon 16247, Korea Tel: 82-31-249-7343, Fax: 82-31-249-6225 E-mail: donghyunjee@catholic.ac.kr

Received 26 November 2015 Revised 16 December 2015 Accepted 19 January 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the association between grape intake and diabetic retinopathy.

Methods

A population-based cross-sectional study using a nation-wide, stratified, multistage, clustered sampling method included 1,555 subjects aged ≥30 years who participated in the Korean National Health and Nutritional Examination Survey 2008-2011. All participants performed standardized interviews, food frequency questionnaires (FFQ), and comprehensive ophthalmic examinations. Grape intake was evaluated by an FFQ using 10 intervals of average frequency of grape intake during the past year. Diabetic retinopathy (DR) was evaluated by 7 standard retinal fundus photographs after pharmacological pupil dilatation. DR was classified as any DR, proliferative DR, or vision-threatening DR by the modified Air House classification system.

Results

The prevalence of diabetes was 16.9 ± 1.2%. As the grape intake frequency increases in FFQ, the odds ratio (OR) for any DR, proliferative DR, and vision-threatening DR were 0.86 (95% confidence interval [CI], 0.75-0.98), 0.65 (95% CI, 0.48-0.88), and 0.77 (95% CI, 0.60-0.99) respectively. Compared to the group with a grape intake of less than once per month, the OR for any DR, proliferative DR, and vision-threatening DR in the group with a grape intake of more than 2-3 times per month were 0.54 (95% CI 0.33-0.89), 0.25 (95% CI 0.07-0.81), 0.36 (95% CI 0.13-0.95), respectively.

Conclusions

The intake of grapes was inversely associated with the prevalence of DR.

Keywords: Diabetic retinopathy, Grape, Korea National Health and Nutritional Examination Survey, Resveratrol

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Figure 1.

Flow diagram presenting the selection of study participants. KNHANES = Korea National Health and Nutritional Examination Survey.

Table 1.

Demographic and clinical characteristics, according to DR status, as reported in the Korean National Health and Nutrition Examination Survey 2008-2011

Characteristic	Without DR (n = 1,286)	With DR (n = 269)	Total (n = 1,555)	p-value
Sex (male, %)	55.7 (1.5)	52.1 (3.6)	55.1 (1.4)	0.361
Age (years)	57.1 (0.4)	59.5 (0.9)	58.3 (0.5)	0.015^*
BMI (kg/m²)	25.2 (0.1)	24.2 (0.1)	24.7 (0.1)	<0.001^*
Hypertension (%)	57.9 (1.7)	54.4 (3.3)	57.3 (1.5)	0.648
Fasting glucose (mg/dL)	140.6 (1.4)	160.8 (3.6)	150.7 (1.9)	<0.001^*
HbA1c (%)	7.2 (0.1)	8.1 (0.1)	7.6 (0.1)	<0.001^*
Diabetes duration (years)	6.9 (0.2)	11.0 (0.5)	9.0 (0.3)	<0.001^*

Data are expressed as weighted means or weighted frequency (%) with standard errors.

DR = diabetic retinopathy; BMI = body mass index.

^* Data were compared by Student's t-test, p < 0.05.

Table 2.

Prevalence of DR according to the frequency of grape intake in a representative Korean population

Grape intake	DR
Grape intake	Prevalence	95% confidence interval	N (unweighted)
0: never	23.5 (3.2)	17.8-30.4	67/314
1: 1-11 times/year	18.9 (3.0)	13.6-25.6	55/285
2: 1 time/month	17.6 (2.6)	13.0-23.4	60/345
3: 2-3 times/month	2.5 (1.8)	9.3-16.5	54/405
4: 1-2 times/week	14.3 (3.6)	8.5-22.9	20/112
5: 3-4 times/week	11.3 (4.1)	5.4-22.0	10/86
6: 5-6 times/week	32.0 (20.6)	6.8-75.1	3/6
7: 1 time/day	0 (0)	0	0/2
8: 2 times/day	0	0	0
9: 3 times/day	0	0	0

Data are expressed as weighted frequency (%) with standard errors.

DR = diabetic retinopathy.

Table 3.

Multiple logistic regression analysis between intake of grapes (continuous variable) and any DR, PDR, and VTDR in a representative Korean population

Characteristics	Grapes intake levels by FFQ as continuous variable
Characteristics	Odds ratio	95% confidence interval	p-value
Any DR
Model 1	0.83	0.74-0.93	0.002^*
Model 2	0.84	0.74-0.95	0.005^*
Model 3	0.86	0.75-0.98	0.024^*
PDR
Model 1	0.61	0.45-0.82	0.001^*
Model 2	0.69	0.52-0.92	0.013^*
Model 3	0.65	0.48-0.88	0.006^*
VTDR
Model 1	0.69	0.56-0.85	0.001^*
Model 2	0.77	0.63-0.95	0.018^*
Model 3	0.77	0.60-0.99	0.041^*

Odds ratio were expressed with 95% confidence intervals. Model 1: Crude, Model 2: adjusted for sex and age, Model 3: adjusted for sex, age, hypertension, fasting glucose level, Hemoglobin A1c, body mass index and diabetes duration.

DR = diabetic retinopathy; PDR = proliferative diabetic retinopathy; VTDR = vision threatening diabetic retinopathy; FFQ = food frequency questionnaires.

^* p < 0.05.

Table 4.

Multiple logistic regression analysis between the quartile intake of grapes and any DR, PDR, and VTDR in a representative Korean population

Characteristics	Quartile grapes intake levels
Characteristics	Quartile 1 (<1/month)	Quartile 2 (1/month)	Quartile 3 (2-3 times/month)	Quartile 4 (≥ 1/week)	P for trend
Any DR
Prevalence	21.0 (2.2)	17.3 (2.6)	12.6 (1.8)	13.2 (2.7)	0.017^*
Model 1	Reference	0.78 (0.50-1.21)	0.54 (0.35-0.82)^*	0.57 (0.33-0.96)^*	0.020^*
Model 2	Reference	0.79 (0.51-1.23)	0.55 (0.36-0.86)^*	0.58 (0.34-0.99)^*	0.042^*
Model 3	Reference	0.82 (0.50-1.35)	0.54 (0.33-0.89)^*	0.65 (0.39-1.10)	0.065
PDR
Prevalence	0.7 (0.2)	0.3 (0.1)	0.1 (0.1)	0.2 (0.1)	0.001^*
Model 1	Reference	0.33 (0.13-0.84)	0.18 (0.07-0.46)^*	0.30 (0.10-0.87)^*	0.001^*
Model 2	Reference	0.42 (0.16-1.06)	0.24 (0.09-0.62)^*	0.42 (0.14-1.29)^*	0.017^*
Model 3	Reference	0.64 (0.23-1.78)	0.25 (0.07-0.81)^*	0.22 (0.05-0.87)^*	0.042^*
VTDR
Prevalence	1.1 (1.7)	0.4 (0.1)	0.4 (0.1)	0.4 (0.2)	0.001^*
Model 1	Reference	0.37 (0.17-0.80)	0.32 (0.16-0.62)^*	0.35 (0.15-0.83)^*	0.003^*
Model 2	Reference	0.46 (0.21-0.99)	0.41 (0.21-0.81)^*	0.50 (0.21-1.22)	0.049^*
Model 3	Reference	0.62 (0.26-1.45)	0.36 (0.13-0.95)^*	0.50 (0.16-1.54)	0.093

Prevalence was expressed with standard error, and odds ratio were expressed with 95% confidence intervals. Model 1: Crude, Model 2: adjusted for sex and age, Model 3: adjusted for sex, age, hypertension, fasting glucose level, Hemoglobin A1c, body mass index, and diabetes duration. DR = diabetic retinopathy; PDR = proliferative diabetic retinopathy; VTDR = vision threatening diabetic retinopathy.

^* p < 0.05.

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