Sala-Vila, AleixDíaz-López, AndrésValls-Pedret, CintaCofán, MontserratGarcía-Layana, AlfredoLamuela-Raventós, Rosa-MaríaCastañer, OlgaZanon-Moreno, VicenteMartinez-Gonzalez, Miguel AToledo, EstefaníaBasora, JosepSalas-Salvadó, JordiCorella, DoloresGómez-Gracia, EnriqueFiol, MiquelEstruch, RamónLapetra, JoséFitó, MontserratArós, FernandoSerra-Majem, LuisPintó, XavierRos, EmilioPrevención con Dieta Mediterránea (PREDIMED) Investigators2023-01-252023-01-252016http://hdl.handle.net/10668/10370Diabetic retinopathy (DR) is a devastating complication of individuals with type 2 diabetes mellitus. The retina is rich in long-chain ω-3 polyunsaturated fatty acids (LCω3PUFAs), which are substrate for oxylipins with anti-inflammatory and antiangiogenic properties. Experimental models support dietary LCω3PUFA protection against DR, but clinical data are lacking. To determine whether LCω3PUFA intake relates to a decreased incidence of sight-threatening DR in individuals with type 2 diabetes older than 55 years. In late 2015, we conceived a prospective study within the randomized clinical trial Prevención con Dieta Mediterránea (PREDIMED), testing Mediterranean diets supplemented with extra virgin olive oil or nuts vs a control diet for primary cardiovascular prevention. The trial was conducted in primary health care centers in Spain. From 2003 to 2009, 3614 individuals aged 55 to 80 years with a previous diagnosis of type 2 diabetes were recruited. Full data were available for 3482 participants (48% men; mean age 67 years). Meeting the dietary LCω3PUFA recommendation of at least 500 mg/d for primary cardiovascular prevention, as assessed by a validated food-frequency questionnaire. The main outcome was incident DR requiring laser photocoagulation, vitrectomy, and/or antiangiogenic therapy confirmed by an external adjudication committee. Of the 3482 participants, 48% were men and the mean age was 67 years. A total of 2611 participants (75%) met target LCω3PUFA recommendation. During a median follow-up of 6 years, we documented 69 new events. After adjusting for age, sex, intervention group, and lifestyle and clinical variables, participants meeting the LCω3PUFA recommendation at baseline (≥500 mg/d) compared with those not fulfilling this recommendation ( In middle-aged and older individuals with type 2 diabetes, intake of at least 500 mg/d of dietary LCω3PUFA, easily achievable with 2 weekly servings of oily fish, is associated with a decreased risk of sight-threatening DR. Our results concur with findings from experimental models and the current model of DR pathogenesis. clinicaltrials.gov Identifier: http://www.controlled-trials.com/ISRCTN35739639.enAgedAged, 80 and overDiabetes Mellitus, Type 2Diabetic RetinopathyDietary SupplementsFatty Acids, Omega-3FemaleFollow-Up StudiesHumansIncidenceMaleMiddle AgedProspective StudiesRisk AssessmentRisk FactorsSeafoodSpainTime FactorsTreatment Outcomeresearch article27541690open access10.1001/jamaophthalmol.2016.29062168-6173https://jamanetwork.com/journals/jamaophthalmology/articlepdf/2543478/eoi160065.pdf