Serum Ω-6/Ω-3 Polyunsaturated Fatty Acids Ratio and Identification of Diabetic Retinopathy: A Propensity Score Matching Based Case-Control Study in China

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Background: Optimal ω-6/ω-3 polyunsaturated fatty acids ratio (PUFAR) is reported to exert protective effects against chronic diseases. However, data on PUFAR and diabetic retinopathy (DR) are scarce. We aimed to thoroughly quantify how PUFAR was associated with DR as well as its role in DR detection. Methods: This is a two-center case-control study, patients were matched using a propensity score algorithm. Multivariable logistic regression models and restricted cubic spline analyses were used to examine the association of PUFAR with DR after adjusting for confounders, which were screened by directed acyclic graph. Performance of the predictive ability to identify DR with PUFAR was assessed by receiver operating characteristic (ROC) analysis and Hosmer-Lemeshow test. Findings: An apparent negative relationship between PUFAR and DR was observed. Adjusted likelihood of DR decreased by 79% (OR:0.21, 95% CI:0.10-0.40) with per interquartile range of PUFAR elevation. Similar results were also obtained in tertile analysis. As compared to those in the 1st tertile of PUFAR, the adjusted odds of DR decreased by 76% (OR:0.24, 95% CI:0.08-0.66) and 93% (OR:0.07, 95% CI:0.03-0.22) for subjects in the 2nd and 3rd tertiles, respectively. Good calibration and discrimination of the predictive model were detected and consistent in both training and testing sets, and PUFAR=35 would be an ideal cut-off value for DR identification. Interpretation: Our present study shows that serum PUAFR was inversely associated with DR and could serve as an ideal biomarker in distinguishing DR from type 2 diabetes. Funding: This study was funded by Natural Science Foundation of Zhejiang Province, Zhejiang Basic Public Welfare Research Project, the Major Project of the Eye Hospital of Wenzhou Medical University and the academician’s science, and technology innovation program in Zhejiang province. Part of this work was also funded by the National Nature Science Foundation of China and Science and Research Funding Project for College Students in Wenzhou Medical University. Declaration of Interest: We declare no conflicts of interests. Ethical Approval: The protocol had been carefully reviewed and approved by the Ethic committee of the Eye hospital of Wenzhou medical university before the study (Number: KYK [2017] 46).