Inverse association between high blood 25-hydroxyvitamin D levels and diabetic retinopathy in a representative Korean population

Abstract

Purpose: To investigate the association between 25-hydroxyvitamin D and diabetic retinopathy (DR).

Methods: A population-based cross-sectional study using a nation-wide, systemically stratified, multistage, clustered sampling method included a total of 18,363 subjects aged ≥ 40 years who participated in the Korean National Health and Nutrition Examination Survey during 2008-2012. All participants participated in standardized interviews, blood 25-hydroxyvitamin D level evaluations, and comprehensive ophthalmic examinations. Seven standard retinal fundus photographs were obtained from both eyes after pupil dilatation. DR was graded according to the modified Airlie House classification system.

Results: The blood 25-hydroxyvitamin D levels were 19.2 ng/mL in men and 17.9 ng/mL in women. After adjusting for potential confounders, including age, sex, diabetes duration, hemoglobin A1c levels, and hypertension, the odds ratios (OR) for any DR and proliferative DR among men decreased significantly in the highest blood 25-hydroxyvitamin D level quintile relative to the lowest quintile (OR, 0.37; 95% confidence interval [CI], 0.18-0.76; P for trend = 0.004 and OR, 0.15; 95% CI, 0.03-0.83; P for trend = 0.043).

Conclusions: This study provides the first epidemiologic findings of the inverse relationships of blood 25-hydroxyvitamin D levels with any DR and proliferative DR only in men. Considering anti-angiogenic and anti-fibrotic action of vitamin D, further studies including longitudinal and interventional analysis are warranted.

Figure 1. Flow diagram presenting the selection of study participants.

Figure 2. Prevalence of any diabetic retinopathy (DR), proliferative DR, clinical significant macular edema (CSME), and vision threatening DR (VTDR) according to the blood 25-hydroxyvitamin D level quintiles in a representative Korean population.

Figure 3. 25-hydroxyvitamin D levels according to the severity of diabetic retinopathy (DR) including any DR, proliferative DR, clinical significant macular edema (CSME), and vision threatening DR (VTDR) in a representative Korean population.