Relation between intake of vitamins C and E and risk of diabetic retinopathy in the Atherosclerosis Risk in Communities Study

Am J Clin Nutr. 2004 May;79(5):865-73. doi: 10.1093/ajcn/79.5.865.


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 > or =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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Antioxidants / administration & dosage*
  • Antioxidants / metabolism
  • Arteriosclerosis / epidemiology*
  • Arteriosclerosis / prevention & control
  • Ascorbic Acid / administration & dosage*
  • Ascorbic Acid / blood
  • Diabetes Mellitus, Type 2 / complications*
  • Diabetic Retinopathy / epidemiology*
  • Diabetic Retinopathy / prevention & control
  • Diet
  • Dietary Supplements
  • Epidemiologic Studies
  • Female
  • Health Surveys
  • Humans
  • Male
  • Middle Aged
  • Nutrition Surveys
  • Odds Ratio
  • Prevalence
  • Risk Factors
  • Surveys and Questionnaires
  • Vitamin E / administration & dosage*
  • Vitamin E / blood


  • Antioxidants
  • Vitamin E
  • Ascorbic Acid