**3.1 Macronutrients**

In post-hoc analyses (Cundiff DK& Nigg CR 2005) a positive association between total dietary fat, saturated fat and MUFA with retinopathy progression and retinopathy risk factors (mean arterial pressure, LDL/HDL cholesterol ratio, serum triglycerides, HbA1c, body mass index, and insulin utilization) was found. Furthermore, a negative association between carbohydrates and dietary fiber with retinopathy progression and risk factors was found. In addition to this, another cross-sectional study(Toeller M et al. 1999 1) reported a higher intake of cholesterol, total fat and saturated fat in Eastern Europe compared to Southern or North-Western Europe. They also found more frequent acute and chronic complications (including retinopathy) in Eastern European people. As with nephropathy, they could not conclude if this was due to the high intake of cholesterol, total fat and/or saturated fat.

In conclusion there is limited research on the effect of diet on diabetic retinopathy. The results of the post hoc analyses should be interpreted carefully, since it is a retrospective analysis which can generate hypotheses but not prove them.
