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Relation between intake of vitamins C and E and risk of diabetic retinopathy in the Atherosclerosis Risk in Communities Study^1,2,3

¹ From the Department of Ophthalmology and Visual Sciences (AEM, RK, and JAM) and the Departments of Population Health and Biostatistical Medical Informatics (MP), University of Wisconsin Medical School, Madison; the Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis (ARF); and the Department of Nutrition, University of North Carolina, Chapel Hill (JS)

Background: The potential protective effect of vitamins C and E against the development of diabetic retinopathy has not been thoroughly evaluated in epidemiologic studies.

Objective: The objective was to study the association between prevalent diabetic retinopathy and intake of vitamins C and E in participants of the Atherosclerosis Risk in Communities Study.

Design: A total of 1353 subjects with type 2 diabetes diagnosed between 1993 and 1995 or before were included. Nutrient intake was assessed with a food-frequency and supplement questionnaire administered between 1987–1989 and 1993–1995. Prevalent retinopathy (n = 224) was determined in 1993–1995 from graded fundus photographs.

Results: No association of retinopathy with intake of vitamin C or E from food alone or from food and supplements combined was observed. The odds ratios and 95% CIs for retinopathy for quartile 4 compared with quartile 1 of vitamins C and E intakes from food and supplements combined were 1.1 (0.7, 1.9) and 1.3 (0.8, 2.2), respectively, after adjustment for diabetes treatment and serum glucose. There was a significant interaction of the observed relations with serum glucose concentration (P < 0.05). Additionally, a decreased odds of retinopathy was found among users (reported use 3 y before 1993–1995) of vitamin C or E supplements or multisupplements compared with reported use of no supplements: 0.5 (0.3, 0.8), 0.5 (0.2, 0.8), and 0.4 (0.2, 0.9), respectively.

Conclusion: No significant overall associations were observed between risk of retinopathy and intake of major dietary antioxidants. The observed association between risk of retinopathy and supplement use may reflect nondietary factors or a possible benefit of supplementation.

Key Words: Diabetes mellitus • type 2 diabetes • diabetic retinopathy • antioxidants • epidemiology

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