Non-linear association between serum lipid levels and diabetic retinopathy in a nationally representative Korean population

AJO International Pub Date : 2025-09-26 DOI:10.1016/j.ajoint.2025.100176

Seowoong Jun , Joon Yul Choi , Tae Keun Yoo

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Abstract

Purpose

To investigate the associations between serum lipid levels and diabetic retinopathy (DR) in Korean adults with diabetes.

Design

Cross-sectional analysis of a nationally representative survey.

Methods

We analyzed 1,378 adults with diabetes from the Korea National Health and Nutrition Examination Survey (2008–2011). DR was ascertained from fundus photographs and medical history. Lipids (total cholesterol, HDL, LDL, triglycerides, non-HDL) were modeled by quintiles and with restricted cubic splines. Multivariable logistic regression adjusted for age, sex, systolic blood pressure, hemoglobin A1c, and statin use. Sensitivity analyses used multiple imputation.

Results

DR was present in 301/1,378 participants (21.8%). Adjusted models showed no linear trends for cholesterol measures. In quintile analyses, total cholesterol exhibited higher odds of DR at both extremes versus the middle quintile (Q3): Q1 OR 1.63 (95% CI, 1.04–2.57); Q4 OR 1.64 (1.06–2.57); Q5 OR 1.59 (1.03–2.49); P for U-shape = 0.008 (Q2 OR 1.42 [0.90–2.23]). LDL and non-HDL also demonstrated U-shaped patterns (P for U-shape = 0.029 and 0.038). Spline models supported U-shaped association for total cholesterol (P = 0.031), LDL (P = 0.039), and non-HDL (P = 0.014). No consistent nonlinear associations were observed for HDL or triglycerides. Multiple-imputation results were concordant, reinforcing the U-shape for total cholesterol.

Conclusions

Total cholesterol, LDL, and non-HDL showed U-shaped nonlinear associations with DR, indicating elevated risk at both low and high concentrations. Maintaining lipids within an intermediate range may support retinal vascular health and refine metabolic risk stratification in diabetes.

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在具有全国代表性的韩国人群中，血脂水平与糖尿病视网膜病变之间的非线性关联

目的探讨韩国成人糖尿病患者血脂水平与糖尿病视网膜病变（DR）的关系。设计一项全国代表性调查的横断面分析。方法对韩国国家健康与营养调查（2008-2011）中1378名成人糖尿病患者进行分析。DR是根据眼底照片和病史确定的。脂质（总胆固醇、高密度脂蛋白、低密度脂蛋白、甘油三酯、非高密度脂蛋白）用五分位数和受限三次样条建模。多变量logistic回归校正了年龄、性别、收缩压、糖化血红蛋白和他汀类药物的使用。敏感性分析采用多重输入。结果1378例患者中有301例出现dr（21.8%）。调整后的模型显示胆固醇测量没有线性趋势。在五分位数分析中，与中间五分位数（Q3）相比，总胆固醇在两个极端表现出更高的DR几率：Q1 OR 1.63 (95% CI, 1.04-2.57)；Q4或1.64 (1.06-2.57)；Q5或1.59 (1.03-2.49)；u型P = 0.008 （Q2 OR 1.42[0.90-2.23]）。低密度脂蛋白和非高密度脂蛋白也呈u形分布（u形P = 0.029和0.038）。样条模型支持总胆固醇（P = 0.031）、低密度脂蛋白（P = 0.039）和非高密度脂蛋白（P = 0.014）的u形关联。HDL和甘油三酯之间没有一致的非线性关联。多次代入结果一致，强化了总胆固醇的u形。结论总胆固醇、低密度脂蛋白和非高密度脂蛋白与DR呈u型非线性相关，表明低浓度和高浓度均会增加DR的风险。将血脂维持在中间范围内可能有助于视网膜血管健康并改善糖尿病代谢风险分层。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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AJO International

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