Association of Serum Zinc and Vitamin A Levels with Severity of Retinopathy in Type 2 Diabetic Patients: a Cross-Sectional Study

Diabetic retinopathy (DR) is a common microvascular disorder which occurs in type 2 diabetes mellitus (T2DM) patients due to chronic hyperglycemia. Previous studies reported that serum zinc (Zn) and vitamin A levels were associated with certain diabetic microvascular complications. However, the relationship between Zn and vitamin A levels with the severity of DR in type 2 diabetic patients is not clear. We aimed to analyze the relationship between serum Zn and vitamin A levels with the severity of DR in T2DM. Sixty T2DM patients were selected from whom attending to the ophthalmology center of hospital from June 2017 and Feb 2018. Patients were categorized as controls, non-proliferative DR (NPDR), and proliferative DR (PDR). Anthropometric, dietary, and physical activity data were gathered. Fasting blood samples were taken to measure biochemical parameters. Serum Zn and vitamin A levels were measured via enzymatic-calorimetric and HPLC methods, respectively. Results showed that serum Zn and vitamin A levels were significantly lower in the PDR group than the controls (p = 0.03 and p = 0.008, respectively). Serum low-density lipoprotein (LDL.C) was significantly higher in the PDR than the control group (p = 0.02). Adjusting for the other variables, increase in serum Zn and vitamin A levels reduced risk of DR by 25.7% and 31.1%, respectively (p = 0.02 and p = 0.007). Higher serum LDL.C increased DR severity by 28.7%, adjusted for the variables (95% CI = 0.002, 0.02; p = 0.01). Lower serum Zn and vitamin A levels, as well as higher LDL.C in the T2DM patients, are related to DR severity.