University of Texas Southwestern Medical Center, Department of Ophthalmology, 5323 Harry Hines Blvd, MC 9057, Dallas, TX 75390, United States.
Mite Bogoevski 2/21, 1000 Skopje, Republic of Macedonia.
Med Hypotheses. 2017 Nov;109:184-198. doi: 10.1016/j.mehy.2017.10.010. Epub 2017 Oct 14.
Age-related macular degeneration (AMD) is the leading cause of irreversible vision loss and blindness in developed nations. AMD is anticipated to affect 196 million people worldwide, by 2020. However, the etiology of this disease remains unknown. Aging, genetic, and environmental influences have generally been implicated as major etiologic factors. We sought to examine the hypothesis that consumption of the 'displacing foods of modern commerce,' which equate to processed, nutrient-deficient and potentially toxic foods, may be the primary and proximate cause of AMD. To evaluate this hypothesis, we ran correlative AMD prevalence data against well-known proxy markers of processed food consumption, namely, sugar and vegetable oils, in 25 nations. In twenty-one nations, published studies provided AMD prevalence data and in four Pacific Island nations, practicing ophthalmologists in the regions completed retrospective chart analyses to estimate AMD prevalence in their respective regions. To estimate AMD prevalence historically, an extensive review of published papers and ophthalmic literature was completed. This review indicates that, between the years 1851 and 1930, AMD was a medical rarity worldwide, which then rose modestly in prevalence in the 1930s in the U.S. and U.K, finally elevating to epidemic proportions by 1975 in the U.S. Numerous developed nations have followed suit in recent decades. Simultaneously, between approximately 1880 and 2009, processed, nutrient-deficient foods gradually supplanted and displaced whole, unprocessed, nutrient-dense foods in developed nations, such that by 2009, 63 percent of the American diet was made up of nutrient-deficient foods in the form of refined white flour, added sugars, vegetable oils, and artificially created trans fats. The correlative data in 25 nations shows that increasing sugar and polyunsaturated vegetable oil consumption is invariably associated with new onset or rising prevalence of AMD, generally within about 30-40years of the beginning of increasing consumption of these proxy marker processed food components. The correlative data also demonstrates that, when consumption of sugar is moderate, but "harmful vegetable oil" consumption remains extremely low or absent, the prevalence of AMD remains rare. This study supports the hypothesis that the 'displacing foods of modern commerce,' which equate to processed, nutrient-deficient, and potentially toxic foods, are the primary and proximate cause of AMD. This study also supports the conclusion that macular degeneration is entirely preventable, through ancestral dietary strategy and avoidance of processed foods. Finally, this research has implications for patients with existing early and intermediate stages of AMD.
年龄相关性黄斑变性(AMD)是发达国家导致不可逆性视力丧失和失明的主要原因。据预测,到 2020 年,全球将有 1.96 亿人受到 AMD 的影响。然而,这种疾病的病因仍然未知。衰老、遗传和环境影响通常被认为是主要的病因因素。我们试图检验这样一种假设,即食用“现代商业的替代食品”,也就是加工、营养缺乏且可能有毒的食品,可能是 AMD 的主要和直接原因。为了评估这一假设,我们将相关性 AMD 患病率数据与众所周知的加工食品消费替代标志物(即糖和植物油)在 25 个国家进行了比较。在 21 个国家,发表的研究提供了 AMD 患病率数据,在 4 个太平洋岛国,该地区的执业眼科医生完成了回顾性图表分析,以估计各自地区 AMD 的患病率。为了从历史上估计 AMD 的患病率,我们完成了对已发表论文和眼科文献的广泛回顾。这一回顾表明,在 1851 年至 1930 年期间,AMD 在全球范围内是一种罕见的疾病,然后在 20 世纪 30 年代在美国和英国的患病率略有上升,最终在 1975 年在美国达到流行程度。许多发达国家在最近几十年也相继出现了这种情况。与此同时,在大约 1880 年至 2009 年期间,加工、营养缺乏的食物逐渐取代了完整的、未加工的、营养丰富的食物,在发达国家,到 2009 年,美国人饮食中 63%的食物是营养缺乏的,形式为精制白面粉、添加糖、植物油和人工合成的反式脂肪。在 25 个国家的相关数据表明,糖和多不饱和植物油消耗的增加总是与 AMD 的新发病例或患病率上升相关,通常在这些替代标志物加工食品成分消耗开始增加后的 30-40 年内。相关数据还表明,当糖的消耗适中,但“有害植物油”的消耗仍然极低或不存在时,AMD 的患病率仍然很低。这项研究支持这样一种假设,即“现代商业的替代食品”,也就是加工、营养缺乏且可能有毒的食物,是 AMD 的主要和直接原因。这项研究还支持这样的结论,即通过祖先的饮食策略和避免加工食品,黄斑变性是完全可以预防的。最后,这项研究对现有早期和中期 AMD 患者具有重要意义。