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Published on: December 30, 2025
The association between sarcopenia and diabetic retinopathy: a mediation analysis of inflammatory biomarkers
Fentao Zhong1, Hui Cao1, Hangju Chen1
1Department of Endocrinology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China.
Background:
Sarcopenia represents a crucial risk factor for diabetic retinopathy (DR). This study is to investigate the association between sarcopenia and DR in patients with type 2 diabetes mellitus (T2DM) and to examine the mediating role of inflammatory biomarkers.
Methods:
Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019. DR was based on ophthalmologic examination. The inflammatory biomarkers included the neutrophil-percentage-to-albumin ratio (NPAR), advanced lung cancer inflammation index (ALI) and pan-immune-inflammation value (PIV). Logistic regression and mediation analyses were conducted to evaluate the associations among sarcopenia, inflammatory biomarkers, and DR and the mediating effects of the biomarkers.
Results:
749 participants were included in the analysis. The prevalence of DR was 25.0% and sarcopenia was associated with DR (adjusted odds ratio (aOR):1.61, 95% confidence level (CI): 1.14-2.26). NPAR, ALI and PIV statistically accounted for this association, explaining 13.44%, 10.41%, and 10.77% of the effect, respectively.
Conclusions:
Sarcopenia is an independent associated factor for DR in T2DM. NPAR, ALI and PIV play a partial role in this association. These blood-cell-based inflammatory biomarkers are associated with DR, but their role in clinical screening remains to be determined.
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