University of Oulu

Aro, A.; Kauppinen, A.; Kivinen, N.; Selander, T.; Kinnunen, K.; Tuomilehto, J.; Keinänen-Kiukaanniemi, S.; Lindström, J.; Uusitupa, M.; Kaarniranta, K. Life Style Intervention Improves Retinopathy Status—The Finnish Diabetes Prevention Study. Nutrients 2019, 11, 1691.

Life style intevention improves retinopathy status : the Finnish Diabetes Prevention Study

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Author: Aro, A.1; Kauppinen, A.2; Kivinen, N.3;
Organizations: 1Department of Ophthalmology, Karelia Central Hospital, 80210 Joensuu, Finland
2School of Pharmacy, University of Eastern Finland, 70211 Kuopio, Finland
3Department of Ophthalmology, Kuopio University Hospital, 70029 Kuopio, Finland
4Research Service Unit, Kuopio University Hospital, 70029 Kuopio, Finland
5Dasman Diabetes Institute, 15462 Dasman, Kuwai
6Center for Life Course Health Research, University of Oulu, 90014 Oulu, Finland
7Department of Chronic Disease Prevention, National Institute for Health and Welfare, 00271 Helsinki, Finland
8Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211 Kuopio, Finland
9Department of Ophthalmology, University of Eastern Finland and Kuopio University Hospital, 70029 Kuopio, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.1 MB)
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Language: English
Published: Multidisciplinary Digital Publishing Institute, 2019
Publish Date: 2020-04-20


The aim of the study was to find out whether participation in earlier intervention had an effect on the occurrence of retinopathy in study participants. We also examined risk factors (age, sex, weight, fasting and 2 h glucose, fasting insulin, blood pressure, serum lipids) for early retinal changes. The study included 522 individuals (mean 55 years old, range 40–64 years) with impaired glucose tolerance who were randomized into intervention (weight loss, healthy diet, and physical activity, N = 265) and control groups (N = 257). Intervention lasted for median of four years in 1993–2000, after which annual follow-up visits at study clinics were conducted. In the years 2002–2006 (at least five years after stopping intervention), fundus photography was offered for all study participants in four of five study clinics. Photographs were assessed by two experienced ophthalmologists (A.A. and K.K.), masked for the group assignment. After exclusion of poor quality photographs, the data of 211 individuals (N = 113 for intervention and N = 98 for control group) were included in the present study. The occurrence of microaneurysms was significantly higher in the control (37/98, 38%) than in the intervention group (27/113, 24%; p = 0.029). In the model, including age, sex, diabetes diagnosis before the retinal assessment, body mass index (BMI), and treatment group, the odds ratio for microaneurysms was markedly lower in intervention group (OR 0.52; 0.28–0.97, p = 0.039). The only risk factor that predicted the occurrence of microaneurysms was serum triglycerides at baseline (mean ± SD 1.9 ± 0.9 vs. 1.6 ± 0.7, mmol/L, with and without microaneurysms, respectively, p = 0.003). Triglycerides associated with decreased microaneurysms in regression analysis for age, sex, fasting glucose, and intervention group (OR 1.92, p = 0.018). Lifestyle intervention in overweight and obese individuals with impaired glucose tolerance showed decreased occurrence of retinal microaneurysms. Elevated serum triglycerides were associated to the development of early diabetic microangiopathy.

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Series: Nutrients
ISSN: 2072-6643
ISSN-E: 2072-6643
ISSN-L: 2072-6643
Volume: 11
Issue: 7
Article number: 1691
DOI: 10.3390/nu11071691
Type of Publication: A1 Journal article – refereed
Field of Science: 3142 Public health care science, environmental and occupational health
3121 General medicine, internal medicine and other clinical medicine
3141 Health care science
Copyright information: © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (