二十碳五烯酸和二十二碳六烯酸的膳食摄入量与年龄相关性黄斑变性的风险
Dietary Intakes of Eicosapentaenoic Acid and Docosahexaenoic Acid and Risk of Age-Related Macular Degeneration.
作者信息
Wu Juan, Cho Eunyoung, Giovannucci Edward L, Rosner Bernard A, Sastry Srinivas M, Willett Walter C, Schaumberg Debra A
机构信息
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Dermatology, the Warren Alpert Medical School of Brown University, Providence, Rhode Island; Department of Epidemiology, Brown School of Public Health, Providence, Rhode Island.
出版信息
Ophthalmology. 2017 May;124(5):634-643. doi: 10.1016/j.ophtha.2016.12.033. Epub 2017 Jan 30.
PURPOSE
To evaluate the associations between intakes of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) and the intermediate and advanced stages of age-related macular degeneration (AMD).
DESIGN
Prospective cohort study.
PARTICIPANTS
We followed 75 889 women from the Nurses' Health Study and 38 961 men from the Health Professionals Follow-Up Study who were at least 50 years old, from 1984 to 2012 and 1986 to 2010, respectively. Cohort participants are mostly white (≥95%).
METHODS
We assessed dietary intake by a validated food frequency questionnaire (FFQ) at baseline and every 4 years. We calculated cumulative average intakes of EPA and DHA from FFQs and also computed predicted erythrocyte and plasma scores directly from food intake using regression models. Cox proportional hazards models were used to compute the associations with AMD outcomes.
MAIN OUTCOME MEASURES
We confirmed 1589 incident intermediate and 1356 advanced AMD cases (primarily neovascular AMD) with a visual acuity of 20/30 or worse, owing primarily to AMD, by medical record review.
RESULTS
For intermediate AMD, the pooled hazard ratio (HR) between the 2 cohorts for DHA comparing the extreme quintiles of intake was 0.78 (95% confidence interval [CI], 0.66-0.92; P trend, 0.008) and for EPA + DHA was 0.83 (95% CI, 0.71-0.98; P trend, 0.03). The pooled HR for fatty fish, comparing ≥5 servings per week to almost never, was 0.61 (95% CI, 0.46-0.81; P trend, <0.001). For advanced AMD, the pooled HR for DHA was 1.01 (95% CI, 0.84-1.21; P trend, 0.75) and for fatty fish was 0.80 (95% CI, 0.59-1.08; P trend, 0.11). Secondary analyses using predicted erythrocyte and plasma scores of EPA and DHA yielded slightly stronger inverse associations for intermediate AMD and similar results for advanced AMD.
CONCLUSIONS
Higher intakes of EPA and DHA may prevent or delay the occurrence of visually significant intermediate AMD. However, the totality of current evidence for EPA and DHA and advanced AMD is discordant, though there was no association with advanced AMD in the present study.
目的
评估二十碳五烯酸（EPA）和二十二碳六烯酸（DHA）的摄入量与年龄相关性黄斑变性（AMD）的中期和晚期阶段之间的关联。
设计
前瞻性队列研究。
参与者
我们分别追踪了护士健康研究中的75889名女性和卫生专业人员随访研究中的38961名男性，他们分别于1984年至2012年以及1986年至2010年期间入组，年龄均在50岁及以上。队列参与者大多为白人（≥95%）。
方法
我们在基线时以及每4年通过一份经过验证的食物频率问卷（FFQ）评估饮食摄入量。我们根据FFQ计算EPA和DHA的累积平均摄入量，并使用回归模型直接从食物摄入量计算预测的红细胞和血浆分数。采用Cox比例风险模型计算与AMD结局的关联。
主要结局指标
通过病历审查，我们确认了1589例新发的中期AMD病例和1356例晚期AMD病例（主要是新生血管性AMD），其视力为20/30或更差，主要归因于AMD。
结果
对于中期AMD，在两个队列中，比较DHA摄入量极端五分位数时的合并风险比（HR）为0.78（95%置信区间[CI]，0.66 - 0.92；P趋势，0.008），EPA + DHA的合并HR为0.83（95% CI，0.71 - 0.98；P趋势，0.03）。比较每周食用≥5份与几乎从不食用的多脂鱼的合并HR为0.61（95% CI，0.46 - 0.81；P趋势，<0.001）。对于晚期AMD，DHA的合并HR为1.01（95% CI，0.84 - 1.21；P趋势，0.75），多脂鱼的合并HR为0.80（95% CI，0.59 - 1.08；P趋势，0.11）。使用EPA和DHA的预测红细胞和血浆分数进行的二次分析对于中期AMD产生了稍强的负相关关联，对于晚期AMD则得到了类似结果。
结论
较高的EPA和DHA摄入量可能预防或延缓具有视觉显著性的中期AMD的发生。然而，目前关于EPA和DHA与晚期AMD的全部证据并不一致，尽管在本研究中未发现与晚期AMD存在关联。
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