ArticleBMC public health2025
Non-linear association between Life's Essential 8 and diabetic retinopathy: mediating role of depression in US adults with diabetes.
Article in BMC public health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundLife's Essential 8 (LE8) is a comprehensive cardiovascular health (CVH) metric that is associated with chronic diseases. This study aimed to investigate the association between LE8 and diabetic retinopathy (DR) and the mediating role of depression in this association.
methodsWe analyzed cross-sectional data from 3,815 adults with diabetes mellitus from the National Health and Nutrition Examination Survey (NHANES) (1999-2020). LE8 scores (0-100) were calculated based on diet, physical activity, nicotine exposure, sleep health, body mass index (BMI), blood lipid levels, blood glucose levels, and blood pressure. DR was diagnosed using retinal imaging or self-reports. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9). Weighted logistic regression and mediation analysis were performed. In addition, machine learning (Shapley additive explanation [SHAP]) was used to explain the importance ranking of variables.
resultsWeighted logistic regression models revealed a significant negative association between LE8 scores and the risk of DR. The LE8 score had strong, dose-dependent protective effects against DR, with each 10-point increase in the score being associated with a 2% reduction in the risk of DR (odds ratio [OR] = 0.98, P < 0.0001) across adjusted models. A threshold effect was observed at the LE8 score of 73.12. The protective effect of the LE8 score was significant below this threshold (OR1 = 0.98, P < 0.0001), whereas it was diminished above this threshold (OR2 = 1.06, P = 0.097). Mediation analysis indicated that PHQ-9 scores mediated 13.66% of the total effect of LE8 (P < 0.0001). SHAP analysis showed that blood glucose levels (35.5% importance) had the greatest impact on risk prediction, followed by modifiable behaviors such as physical activity (18.0%) and sleep health (13.5%).
conclusionsLE8 scores are negatively associated with the risk of DR in US adults with diabetes mellitus, and this association is partially mediated by depressive symptoms. Longitudinal studies are warranted to validate causality and elucidate the underlying mechanisms. Interventions targeting both metabolic and mental health may reduce the disease burden of DR.
Indexed as
Identifiers
What Socratic holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.