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Retina
Clinical science
Associations between a healthy lifestyle score and retinal neurovascular health
  1. Xiaomin Zeng1,
  2. Ruiye Chen2,3,
  3. Xiayin Zhang1,
  4. Ting Su1,
  5. Yaxin Wang1,
  6. Yijun Hu1,
  7. Xianwen Shang1,2,3,4,5,
  8. Danli Shi4,5,
  9. Honghua Yu1,6
  1. 1 Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
  2. 2 The Ophthalmic Epidemiology Department, Centre for Eye Research Australia, Melbourne, Victoria, Australia
  3. 3 Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
  4. 4 School of Optometry, The Hong Kong Polytechnic University, Hong Kong, Hong Kong, China
  5. 5 Research Centre for SHARP Vision (RCSV), The Hong Kong Polytechnic University, Hong Kong, Hong Kong, China
  6. 6 Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, Guangdong, China
  1. Correspondence to Prof Honghua Yu; yuhonghua{at}gdph.org.cn; Dr Xianwen Shang; xianwen.shang{at}polyu.edu.hk; Dr Danli Shi; danli.shi{at}polyu.edu.hk

Abstract

Aims To investigate the associations between a healthy lifestyle score and retinal neurovascular health, and explore whether lower inflammation levels mediate these associations.

Methods This study is based on the UK Biobank. The healthy lifestyle score ranged from 0 to 6 and comprised physical activity, diet, sleep duration, smoking status, alcohol consumption and bodyweight. Outcomes included retinal diseases (age-related macular degeneration (AMD) and retinal vascular occlusion (RVO)) from hospital admission records (378 648 participants), retinal vascular metrics from retinal photography (32 226 participants) and retinal neural metrics from optical coherence tomography (42 557 participants). An INFLA-score was used to characterise inflammation levels.

Results Participants with better healthy life score (scored from 5 to 6) were associated with a 29% lower risk of AMD, 25% lower risk of RVO, 2% increase in artery-to-vein ratio (AVR), 0.22 µm increase in central retinal artery equivalent, 0.36 µm decrease in central retinal vein equivalent (CRVE), 0.004 increase in fractal dimension, 0.38 µm increase in retinal nerve fibre layer, 0.69 µm increase in ganglion cell-inner plexiform layer (GCIPL) and 0.35 µm increase in photoreceptor segment (PS) compared with those with worst lifestyle score (scored from 0 to 1) (all ptrend<0.01). In addition, INFLA-score partially mediated the associations between healthy lifestyle score and increased risk of AMD (mediated proportion (MP): 14.8%), higher AVR (MP: 12.76%), narrower CRVE (MP: 24.49%), thicker GCIPL (MP: 4.97%) and thicker PS (MP: 26.86%).

Conclusion Great adherence to a healthier lifestyle was associated with better retinal health in a dose-response manner. Lower inflammation partially mediated the association between a healthy lifestyle score and retinal health.

  • Age-Related Macular Degeneration
  • Epidemiology
  • Inflammation
  • Public health

Data availability statement

Data are available in a public, open access repository. Data are available in a public, open-access repository (https://www.ukbiobank.ac.uk/).

https://doi.org/10.1136/bjo-2024-326184

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    Data availability statement

    Data are available in a public, open access repository. Data are available in a public, open-access repository (https://www.ukbiobank.ac.uk/).

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    Footnotes

    • Contributors Study concept and design, acquisition, analysis or interpretation of data: XMZ, XS, DS, HY. Statistical analysis: XMZ, XS. Drafting of the manuscript: XMZ, RC. Critical revision of the manuscript for important intellectual content: RC, XYZ, YH, XS, DS, HY. Obtained funding: HY, XMZ. Study supervision: XS, DS, HY. Study guarantor: HY. Administrative, technical or material support: XYZ, TS, YW, YH. Final approval of the version to be published: all authors.

    • Funding The present work was supported by the following fundings: National Natural Science Foundation of China (U24A20707, 82171075, 82301260), Science and Technology Program of Guangzhou (20220610092), Basic and Applied Basic Research Foundation of Guangdong Province (2023B1515120028), Brolucizumab Efficacy and Safety Single-Arm Descriptive Trial in Patients with Persistent Diabetic Macular Edema (BEST) (2024–29), the launch fund of Guangdong Provincial People’s Hospital for NSFC (8217040546, 8220040257), and China Scholarship Council (202308440506). The sponsor or funding organisation had no role in the study design, data collection, data analysis, data interpretation or writing the report of this study.

    • Competing interests None declared.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.