Abstract. Background Diabetic retinopathy is one of the three major complications of diabetes, and it is the leading cause of visual impairment and blindness among adults (1). A recent epidemiological study found diabetic retinopathy prevalence to be 34.6% for individuals with diabetes (2). In the Wisconsin Epidemiological Study of Diabetic Retinopathy, microalbuminuria, representing nephropathy, was associated with the presence of retinopathy in individuals with diabetes (3). The recent rise in the numbers of diabetes and diabetic retinopathy cases worldwide is likely to be related to lifestyle/life environment rather than genetic factors, as a global genetic diversity has not changed appreciably over this short period of time (4-7). Lifestyle factors, including nutrition, have been altered markedly in recent decades (8, 9). Diabetic nephropathy is aggravated by higher intake of total protein (10, 11). However, the impact of altered nutrition, especially protein content, on the development of diabetic retinopathy is not fully understood (10,11,12).Glycemic control and blood pressure control reduce the progression of diabetic retinopathy, and ophthalmological treatment including laser applications plays a prominent role in the control of diabetic retinopathy. However, currently there are no drugs that inhibit the onset or progression of diabetic retinopathy, except for inhibitors of the renin-angiotensin (RA) system (13-17). Regarding nutritional intervention, patients with diabetic retinopathy have been managed by a low-energy diet of suppressed carbohydrate intake and relatively highprotein intake, but the influence of diet on the pathophysiology of retinopathy is not fully understood. A rodent study of diabetic nephropathy reported an additive effect of RA system inhibitors and a low-protein diet on kidney manifestations (18). A low-protein diet may have additional beneficial effects through suppressed expression of genes involved in the kidney RA system. The effect of dietary protein content diets (12-24% energy), which is the range in regular human diets (4, 8), on glucose levels and renal manifestations in db mice (19,20), an animal model for diabetes with leptin-receptor deficiency. In the experiments using db mice, a high-protein, low-carbohydrate diet increased blood glucose levels and exacerbated renal manifestations, compared with a low-protein, high-carbohydrate diet (21,22). The dietary protein content should be examined for its 265