To investigate the association between dietary live microbe intake and diabetic retinopathy (DR), and explore whether accelerated biological aging is linked to this association. Using data from National Health and Nutrition Examination Survey 2005–2018 2279 participants were categorized into low/medium/high live microbe intake groups and MedHi food intake groups (G1/G2/G3). Weighted logistic regression, weighted restricted cubic spline (RCS) and mediation analysis were performed to assess associations with DR. Subgroup analysis and sensitivity analysis were conducted to verify the robustness of the main study results. Higher live microbe intake was associated with lower DR risk: medium (OR = 0.65; 95%CI = 0.45–0.96; p = 0.029) and high (OR = 0.58; 95%CI = 0.38–0.90; p = 0.015) groups vs. low; G2(OR = 0.60; 95%CI = 0.36–0.97; p = 0.039) and G3 (OR = 0.64; 95%CI = 0.43–0.95; p = 0.026) vs. G1. RCS analysis revealed a nonlinear dose-response with an inflection point at 262.86 g/day. PhenoAge (PA) acceleration, Klemera-Doubal Method-Biological Age (KDM-BA) acceleration, and HbA1c were associated with 14.7%, 13.4%, and 8.3% of the relationship for high live microbe intake, and 12.6%, 13.9%, and 8.3% for G3, respectively. Subgroup analysis showed that the association between dietary live microbe intake and DR was generally consistent across subgroups of age, race, BMI, etc. with a significant interaction only in the sex subgroup (P for interaction = 0.02). Sensitivity analysis confirmed the robustness of the main study results. Dietary live microbe intake is inversely associated with DR, with biological aging and glycemic control potentially linked to this relationship. Increasing intake of live microbe-rich foods may be correlated with reduced DR risk.
Zeng et al. (2026) studied this question.