Abstract
BACKGROUND AND AIMS: Diabetic retinopathy (DR) is a major cause of vision impairment, and its development is linked to chronic inflammation. Investigating the role of dietary patterns, specifically the standard dietary inflammatory index (DII), may provide insights into modifiable risk factors for DR. OBJECTIVE: To quantify the impact of dietary inflammatory potential (assessed via the standard DII) on both risk of DR and structural alterations across individual retinal layers. METHODS: We conducted a prospective cohort study using data from the UK Biobank. Cox proportional hazards models and restricted cubic splines were used to examine the correlation between the standard DII and DR in three adjusted models. Sensitivity analyses were performed to test the robustness of the outcomes. Linear regression models were employed to explore the associations between the standard DII and retinal structural parameters. RESULTS: Data from 16,224 participants with diabetes from the UK Biobank were analyzed, including 1,257 (7.75%) who developed DR during the follow-up period. Higher standard DII scores were associated with an increased risk of DR in all adjusted models [Model 3: HR = 1.51, 95% CI: (1.15, 1.99), p = 0.003]. A J-shaped association between standard DII scores and DR was observed, and the relationship was significant only when the standard DII score was greater than -2.5 [HR = 1.59, 95% CI: (1.44, 2.04), p = 0.002]. Subgroup analyses revealed consistent results across different stratified groups, indicating increased DR risk. Image analysis revealed that standard DII scores were associated with the thinning of the retinal pigment epithelium layer. CONCLUSIONS: Our findings suggest a J-shaped association between standard DII score and DR risk in a multiracial sample from the UK Biobank. These findings indicate that an anti-inflammatory diet may be promising for mitigating the onset of DR.