European Journal of Epidemiology

, Volume 33, Issue 2, pp 141–156 | Cite as

Diet and risk of diabetic retinopathy: a systematic review

  • Courtney Dow
  • Francesca Mancini
  • Kalina Rajaobelina
  • Marie-Christine Boutron-Ruault
  • Beverley Balkau
  • Fabrice Bonnet
  • Guy FagherazziEmail author


Diabetic retinopathy is a microvascular complication of diabetes that threatens all individuals with diabetes, leading to vision loss or blindness if left untreated. It is frequently associated with diabetic macular edema, which can occur at any point during the development of diabetic retinopathy. The key factors known to lead to its development include hyperglycemia, hypertension, and the duration of diabetes. Though the diet is important in the development of diabetes, its role in diabetic retinopathy has not been clearly identified. In this systematic review, we aimed to identify, summarize and interpret the literature on the association between the diet and dietary intakes of specific foods, nutrients, and food groups, and the risk of diabetic retinopathy. We searched PubMed and Web of Science for English-language studies evaluating the association between the dietary intake of individual foods, macro or micronutrients, dietary supplements, and dietary patterns and their association with retinopathy or macular edema. After reviewing potentially relevant abstracts and, when necessary, full texts, we identified 27 relevant studies. Identified studies investigated intakes of fruit, vegetables, fish, milk, carbohydrates, fibre, fat, protein, salt, potassium, vitamins C, D, and E, carotenoids, dietary supplements, green tea and alcohol. Studies suggest that adherence to the Mediterranean diet and high fruit, vegetable and fish intake may protect against the development of diabetic retinopathy, although the evidence is limited. Studies concerning other aspects of the diet are not in agreement. The role of the diet in the development of diabetic retinopathy is an area that warrants more attention.


Diet Retinopathy Diabetes Complications 



25-Hydroxyvitamin D


Advanced glycation endproducts


Advanced lipoxidation endproducts


Body mass index


Glycated hemoglobin


Monounsaturated fatty acids

n-3 PUFA

Omega-3 polyunsaturated fatty acids

n-6 PUFA

Omega-6 polyunsaturated fatty acids


Polyunsaturated fatty acids


Reactive oxygen species


Saturated fatty acids


Randomized controlled trial


Vascular endothelial growth factor



Courtney Dow was supported by the CORDDIM – Cardiovasculaire, Obésité, Rein, Diabète Program. CORDDIM had no role in the design, analysis or writing of this article. Guy Fagherazzi was supported by the National Research Agency’s program “Investing in the Future” ANR-10-COHO-0006. The National Research Agency had no role in the design, analysis or writing of this article.

Compliance with ethical standards

Conflict of interest

We have no conflicts of interest to declare.

Supplementary material

10654_2017_338_MOESM1_ESM.docx (12 kb)
Supplementary material 1 (DOCX 12 kb)


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Authors and Affiliations

  • Courtney Dow
    • 1
    • 2
  • Francesca Mancini
    • 1
    • 2
  • Kalina Rajaobelina
    • 1
    • 2
  • Marie-Christine Boutron-Ruault
    • 1
    • 2
  • Beverley Balkau
    • 1
    • 2
    • 3
  • Fabrice Bonnet
    • 1
    • 2
    • 4
  • Guy Fagherazzi
    • 1
    • 2
    Email author return OK on get
  1. 1.Inserm U1018, Institut Gustave Roussy, CESPVillejuif CedexFrance
  2. 2.University Paris-Saclay, University Paris-SudVillejuifFrance
  3. 3.University Versailles, Saint Quentin, University Paris-SudVillejuifFrance
  4. 4.CHU RennesUniversité de Rennes 1RennesFrance

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