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Association of alcohol intake with incidence and progression of diabetic retinopathy
  1. Preeti Gupta1,
  2. Eva K Fenwick2,
  3. Charumathi Sabanayagam1,3,
  4. Alfred Tau Liang Gan2,
  5. Yih-Chung Tham4,
  6. Sahil Thakur5,
  7. Ryan Eyn Kidd Man2,
  8. Paul Mitchell6,
  9. Tien Yin Wong7,
  10. Ching-Yu Cheng1,
  11. Ecosse Luc Lamoureux8,9
  1. 1 Ocular Epidemiology Research Group, Singapore Eye Research Institute, Singapore
  2. 2 Singapore Eye Research Institute, Singapore
  3. 3 Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
  4. 4 Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
  5. 5 Ophthalmology, Singapore Eye Research Institute, Singapore
  6. 6 Centre for Vision Research, The University of Sydney, Sydney, New South Wales, Australia
  7. 7 Academic Medicine Research Institute, National University of Singapore, Singapore
  8. 8 Ophthalmology, University of Melbourne, Melbourne, Victoria, Australia
  9. 9 The Academia, Singapore Eye Research Institute, Singapore
  1. Correspondence to Dr Ecosse Luc Lamoureux, Ophthalmology, University of Melbourne, Victoria, Victoria, Australia; ecosse{at}


Purpose We examined the longitudinal association of baseline alcohol intake and frequency with the 6-year incidence and progression of diabetic retinopathy (DR) in a population-based cohort of Singaporean Indians.

Methods We included 656 participants with diabetes mellitus, gradable retinal photographs from baseline (2007–2009) and follow-up (2013–2015) examinations, information on alcohol intake and other relevant data from the Singapore Indian Eye Study were included. Incident DR was defined using the Modified Airlie House Classification as no DR at baseline and at least minimal non-proliferative DR at follow-up; and DR progression as at least a one-step worsening in DR at follow-up from minimal or worse status at baseline, excluding those with proliferative DR.

Results The mean age (SD) of our participants (n=656) was 58.8 (9.2) years, and 54.4% were male. At follow-up, 82 of 510 (16%) participants developed DR, and 45 of 146 (30.8%) had DR progression. 65 (12.7%) and 28 (19.1%) participants consumed alcohol in incident DR and progression categories, respectively. In multivariable analyses, those who consumed alcohol had nearly two-thirds reduced odds of incident DR (OR (95% CI): 0.36 (0.13 to 0.98)) compared with those who did not. Participants with infrequent consumption of alcohol also had a reduction in odds of incident DR (0.17 (0.04 to 0.69)), compared with non-drinkers. No association was found between alcohol consumption and DR progression.

Conclusions and relevance In our longitudinal population of Singapore Indians, baseline alcohol intake, particularly infrequent consumption, was associated with lower risk of developing DR, compared with non-drinkers, in line with previous cross-sectional findings.

  • epidemiology
  • retina
  • eye (globe)
  • public health

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  • Contributors PG and ELL had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: PG, CS, C-YC, TYW and ELL. Acquisition, analysis or interpretation of data: PG, REKM, EKF, ATLG, YCT, ST, PM, C-YC, TYW and ELL. Drafting of manuscript: PG, REKM, EKF, ATLG and ELL. Critical revision of the manuscript for important intellectual content: PG, REKM, EKF, ATLG, CS, YCT, ST, PM, TYW, C-YC and ELL. Obtained funding: CS. Statistical analysis: PG and ATLG. Administrative, technical or material support: PG, ST and CS. Study supervision: PG, CS, TYW, C-YC and ELL.

  • Funding The Singapore Indian Eye Study was funded by the National Medical Research Council (Singapore), Grant No. NMRC/1371/2013.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval All protocols followed the principles of the Declaration of Helsinki and received approval by the SingHealth Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. However, additional data can be made available on reasonable request.

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