Wu Juan, Cho Eunyoung, Willett Walter C, Sastry Srinivas M, Schaumberg Debra A
Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Rhode Island3Department of Epidemiology, Brown School of Public Health, Providence, Rhode Island4Channing Division of Network Medicine, Department of Medicine, Brigham.
JAMA Ophthalmol. 2015 Dec;133(12):1415-24. doi: 10.1001/jamaophthalmol.2015.3590.
Despite strong biological plausibility, evidence from epidemiologic studies and clinical trials on the relations between intakes of lutein and zeaxanthin and age-related macular degeneration (AMD) has been inconsistent. The roles of other carotenoids are less thoroughly investigated.
To investigate the associations between intakes of carotenoids and AMD.
DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study, with cohorts from the Nurses' Health Study and the Health Professionals Follow-up Study in the United States. A total of 63,443 women and 38,603 men were followed up, from 1984 until May 31, 2010, in the Nurses' Health Study and from 1986 until January 31, 2010, in the Health Professionals Follow-up Study. All participants were aged 50 years or older and were free of diagnosed AMD, diabetes mellitus, cardiovascular disease, and cancer at baseline.
Predicted plasma carotenoid scores were computed directly from food intake, assessed by repeated food frequency questionnaires at baseline and follow-up, using validated regression models to account for bioavailability and reporting validity of different foods, and associations between predicted plasma carotenoid scores and AMD were determined.
We confirmed 1361 incident intermediate and 1118 advanced AMD cases (primarily neovascular AMD) with a visual acuity of 20/30 or worse by medical record review. Comparing extreme quintiles of predicted plasma lutein/zeaxanthin score, we found a risk reduction for advanced AMD of about 40% in both women and men (pooled relative risk comparing extreme quintiles = 0.59; 95% CI, 0.48-0.73; P for trend < .001). Predicted plasma carotenoid scores for other carotenoids, including β-cryptoxanthin, α-carotene, and β-carotene, were associated with a 25% to 35% lower risk of advanced AMD when comparing extreme quintiles. The relative risk comparing extreme quintiles for the predicted plasma total carotenoid index was 0.65 (95% CI, 0.53-0.80; P for trend < .001). We did not identify any associations of carotenoids, either as predicted plasma score or calculated intake, with intermediate AMD.
Higher intake of bioavailable lutein/zeaxanthin is associated with a long-term reduced risk of advanced AMD. Given that some other carotenoids are also associated with a lower risk, a public health strategy aimed at increasing dietary consumption of a wide variety of fruits and vegetables rich in carotenoids may reduce the incidence of advanced AMD.
尽管从生物学角度有充分的合理性，但关于叶黄素和玉米黄质摄入量与年龄相关性黄斑变性（AMD）之间关系的流行病学研究和临床试验证据并不一致。对其他类胡萝卜素的作用研究得较少。
研究类胡萝卜素摄入量与AMD之间的关联。
设计、地点和参与者：前瞻性队列研究，队列来自美国护士健康研究和卫生专业人员随访研究。护士健康研究中，共有63443名女性和38603名男性接受随访，时间从1984年至2010年5月31日；卫生专业人员随访研究中，从1986年至2010年1月31日。所有参与者年龄均在50岁及以上，基线时未诊断出患有AMD、糖尿病、心血管疾病和癌症。
根据食物摄入量直接计算预测血浆类胡萝卜素得分，通过在基线和随访时重复进行的食物频率问卷评估，使用经过验证的回归模型来考虑不同食物的生物利用度和报告有效性，并确定预测血浆类胡萝卜素得分与AMD之间的关联。
通过病历审查，我们确认了1361例新发中度和1118例晚期AMD病例（主要是新生血管性AMD），视力为20/30或更差。比较预测血浆叶黄素/玉米黄质得分的极端五分位数，我们发现男性和女性晚期AMD的风险降低约40%（比较极端五分位数的合并相对风险=0.59；95%置信区间，0.48 - 0.73；趋势P值<0.001）。比较极端五分位数时，其他类胡萝卜素（包括β-隐黄质、α-胡萝卜素和β-胡萝卜素）的预测血浆类胡萝卜素得分与晚期AMD风险降低25%至35%相关。预测血浆总类胡萝卜素指数的极端五分位数比较的相对风险为0.65（95%置信区间，0.53 - 0.80；趋势P值<0.001）。我们未发现类胡萝卜素（无论是作为预测血浆得分还是计算摄入量）与中度AMD之间存在任何关联。
较高的生物可利用叶黄素/玉米黄质摄入量与晚期AMD的长期风险降低相关。鉴于其他一些类胡萝卜素也与较低风险相关，旨在增加富含类胡萝卜素的各种水果和蔬菜的饮食消费的公共卫生策略可能会降低晚期AMD的发病率。
