{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T05:10:32Z","timestamp":1779340232009,"version":"3.51.4"},"reference-count":55,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      749 participants were included in the analysis. The prevalence of DR was 25.0% and sarcopenia was associated with DR (adjusted odds ratio (\n                      <jats:italic>aOR<\/jats:italic>\n                      ):1.61, 95% confidence level (\n                      <jats:italic>CI<\/jats:italic>\n                      ): 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1765051","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T04:42:12Z","timestamp":1779338532000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The association between sarcopenia and diabetic retinopathy: a mediation analysis of inflammatory biomarkers"],"prefix":"10.3389","volume":"17","author":[{"given":"Fentao","family":"Zhong","sequence":"first","affiliation":[{"name":"Department of Endocrinology, Longyan First Affiliated Hospital of Fujian Medical University","place":["Longyan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hui","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Longyan First Affiliated Hospital of Fujian Medical University","place":["Longyan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hangju","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Longyan First Affiliated Hospital of Fujian Medical University","place":["Longyan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Baozhen","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Longyan First Affiliated Hospital of Fujian Medical University","place":["Longyan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mei","family":"Tu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Longyan First Affiliated Hospital of Fujian Medical University","place":["Longyan, China"]},{"name":"The School of Clinical Medicine, Fujian Medical University","place":["Fuzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wen","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Longyan First Affiliated Hospital of Fujian Medical University","place":["Longyan, China"]},{"name":"The School of Clinical Medicine, Fujian Medical University","place":["Fuzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shihai","family":"Li","sequence":"additional","affiliation":[{"name":"The School of Clinical Medicine, Fujian Medical University","place":["Fuzhou, China"]},{"name":"Department of Anesthesia, Longyan First Affiliated Hospital of Fujian Medical University","place":["Longyan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(09)62124-3","article-title":"Diabetic retinopathy","volume":"376","author":"Cheung","year":"2010","journal-title":"Lancet"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/s2214-109x(17)30393-5","article-title":"Global causes of blindness and distance vision impairment 1990-2020: a systematic review and meta-analysis","volume":"5","author":"Flaxman","year":"2017","journal-title":"Lancet Glob Health"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(20)30489-7","article-title":"Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: the Right to Sight: an analysis for the Global Burden of Disease Study","volume":"9","year":"2021","journal-title":"Lancet Glob Health"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1186\/s12933-020-01095-4","article-title":"Associations between abdominal obesity indices and diabetic complications: Chinese visceral adiposity index and neck circumference","volume":"19","author":"Wan","year":"2020","journal-title":"Cardiovasc Diabetol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1136\/bjo.83.9.1083","article-title":"Hypertension and diabetic retinopathy--what\u2019s the story","volume":"83","author":"Gillow","year":"1999","journal-title":"Br J Ophthalmol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1016\/j.tem.2021.10.008","article-title":"Common pathways in dementia and diabetic retinopathy: understanding the mechanisms of diabetes-related cognitive decline","volume":"33","author":"Little","year":"2022","journal-title":"Trends Endocrinol Metab"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2022.1055087","article-title":"The role of inflammation in immune system of diabetic retinopathy: Molecular mechanisms, pathogenetic role and therapeutic implications","volume":"13","author":"Yue","year":"2022","journal-title":"Front Immunol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1186\/s12986-024-00842-8","article-title":"Type 2 diabetes: is obesity for diabetic retinopathy good or bad? 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