Abstract
AIMS: The existing literature indicates that oleic acid (OA) is the most prevalent monounsaturated fatty acid (MUFA) in both diet and plasma, known for its beneficial impact on insulin resistance and inflammation. However, its role in diabetic retinopathy (DR) remains unclear. This study aims to elucidate the association between OA and DR and explore its potential in DR detection. METHODS: We conducted a two-center, propensity score-matched case-control study, including 69 type 2 diabetes (T2D) patients with diagnosed DR (cases) and 69 matched T2D individuals without DR (control), in China from August 2017 to June 2018. Multiple logistic regression models analyzed the association between MUFAs and DR. The impact of 7 distinct MUFAs on DR was examined using elastic net regression (ENET), weighted quantile regression (WQS), and Bayesian kernel machine regression (BKMR), focusing on key lipid biomarkers. The diagnostic utility of these biomarkers was assessed by calculating the AUC. RESULTS: A significant negative correlation was found between MUFAs and DR, with OA identified as pivotal by ENET, WQS, and BKMR. The adjusted OR and 95% CI for DR were 0.25 (0.09, 0.69) for subjects in the 2nd tertile of OA and 0.11 (0.04, 0.30) for the 3rd tertile, compared to the lowest tertile. These results were consistent across subgroup and sensitivity analyses. The AUC (95% CI) for OA alone was 0.72 (0.63, 0.81), increasing to 0.77 (0.69, 0.85) when combined with other covariates. CONCLUSIONS: Our findings reveal a robust inverse relationship between plasma OA levels and DR risk, suggesting that OA could serve as a valuable biomarker for identifying type 2 diabetic patients with DR.