Differential associations of beverage consumption with diabetic retinopathy: a systematic review and dose-response meta-analysis of observational studies

Background: Diabetic retinopathy (DR) is a major blinding microvascular complication of diabetes mellitus. The role of dietary factors in its development has garnered increasing attention. However, the association between the consumption of various common beverages and DR risk remains unclear.

Objective: Systematically evaluate the association and dose-response relationship between the intake of alcohol, wine, spirits, sugary drinks (SSBs), artificially sweetened drinks (ASBs), coffee, tea, natural fruit juice and yogurt with the risk of DR.

Methods: The systematic literature search was conducted across four major electronic databases—PubMed, Embase, Web of Science, and the CochraneCochrane is a global independent network of health practitioners researchers patient advocates and o... Library—from their inception dates through February 15, 2026. Fixed- or random-effects models were used to pool effect sizes. Linear and non-linear dose-response relationships were analyzed using a two-stage dose-response meta-analysis. Study quality was assessed using the Newcastle-Ottawa Scale.

Results: A total of 25 studies (94,119 participants) were included, with 84% being of high quality. Overall, no significant association was found between alcohol consumption and DR. However, heterogeneity across disease stages was observed: alcohol was inversely associated with non-proliferative diabetic retinopathy (NPDR) but positively associated with vision-threatening diabetic retinopathy (VTDR). In type 1 diabetes, alcohol showed a non-linear inverse association (OR = 0.54, 95%CI 0.37–0.80 at 50 g/week). Tea consumption was significantly inversely associated with DR (HR = 0.72, 95%CI 0.58–0.90 at 295 g/week). Coffee exhibited an inverse association only at a high dose of 4,032 g/week (OR = 0.42, 95%CI 0.26–0.68). High consumption of ASBs (1,420 g/week) significantly increased the risk of proliferative diabetic retinopathy (PDR) (OR = 2.62, 95%CI 1.14–6.04). No significant associations were found for SSBs, natural fruit juice, or yogurt.ConclusionThe association between alcohol and DR varies by disease stage and beverage type. Tea and high-dose coffee consumption suggest non-linear inverse associations against DR, while high-dose ASB intake may specifically increase the risk of PDR. Given that several analyses were based on a limited number of observational studies, further prospective studies are needed to refine these assessments and provide evidence for dietary prevention strategies.

Systematic reviewA systematic review is an analysis comparing and summarizing the data from different studies on a ce... registrationRegistration number: CRD420261308253. https://www.crd.york.ac.uk/PROSPERO/view/CRD420261308253.