Abstract
Diabetic retinopathy (DR) is the most common microvascular complication of diabetes, and retinal microaneurysms (MA) are one of the first detected abnormalities associated with DR. We recently showed elevated serum triglyceride levels to be associated with the development of MA in the Finnish Diabetes Prevention Study (DPS). The purpose of this metabolomics study was to assess whether serum fatty acid (FA) composition, plasmalogens, and low-grade inflammation may enhance or decrease the risk of MA. Originally, the DPS included 522 individuals (mean 55 years old, range 40–64 years) with impaired glucose tolerance who were randomized into an intervention (n = 265) or control group (n = 257). The intervention lasted for a median of four years (active period), after which annual follow-up visits were conducted. At least five years after stopping the intervention phase of DPS, participants classified as MA negative (n = 115) or MA positive (n = 51) were included in the current study. All these participants were free of diabetes at baseline (WHO 1985) and had high-sensitive C-reactive protein (hs-CRP), serum FA composition, and selected lipid metabolites measured during the active study period. Among the markers associated with MA, the serum plasmalogen dm16:0 (p = 0.006), the saturated odd-chain FA 15.0 (pentadecanoic acid; p = 0.015), and omega-3 very long-chain FAs (p < 0.05) were associated with a decreased occurrence of MA. These associations were independent of study group and other risk factors. The association of high serum triglycerides with the MA occurrence was attenuated when these MA-associated serum lipid markers were considered. Our findings suggest that, in addition to n-3 FAs, odd-chain FA 15:0 and plasmalogen dm16:0 may contribute to a lower risk of MA in individuals with impaired glucose tolerance. These putative novel lipid biomarkers have an association with MA independently of triglyceride levels.
Highlights
Diabetic retinopathy (DR) is the most common microvascular complication of diabetes and the leading cause of blindness in working-aged people with diabetes [1,2]
Applying full-adjusted models, the previously observed direct association of serum triglycerides levels with MA, suggesting the harmful effect on the development of MA [11], was either attenuated or completely lost when adjusted for the fatty acid (FA), plasmalogens, or calculated desaturase activities that we found to be associated with the presence of MA
With symbols are the proposed factors we find associated with retinal microaneurysms occurrence in in the present study the present study
Summary
Diabetic retinopathy (DR) is the most common microvascular complication of diabetes and the leading cause of blindness in working-aged people with diabetes [1,2]. Elevated serum cholesterol and triglyceride concentrations have been reported to be a risk factor for DR [5,6], and it has been suggested that permeability changes in the retinal microvasculature result in extravascular accumulations of lipoprotein deposits with a consequent loss of function in the surrounding retinal cells [7]. High serum cholesterol and triglyceride concentrations are associated with leaking MAs in diabetic macular edema that may lead to permanent visual loss [8]. Complexes of lipoproteins and macrophages are visualized in fundus photography as hard exudates suggesting that increased serum lipid levels are a risk factor for this advanced form of exudates and other macular complications in diabetes [8,9]
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