Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland.
Emmes Corporation, Rockville, Maryland.
JAMA Ophthalmol. 2019 May 1;137(5):543-550. doi: 10.1001/jamaophthalmol.2019.0292.
Previous studies of the role of dietary and supplementary calcium in age-related macular degeneration (AMD) have produced mixed results, suggesting that supplementation and decreased dietary intake are both harmful.
To evaluate the association of baseline dietary and supplementary calcium intake with progression of AMD.
DESIGN, SETTING, AND PARTICIPANTS: This study involved secondary analyses of participants enrolled in the Age-Related Eye Disease Study (AREDS). The AREDS study (1992-2001) enrolled patients from academic and community-based retinal practices in the United States. Men and women with varying severity of AMD were included. Data analysis for this article occurred from September 2015 to December 2018.
Baseline self-reported dietary or supplementary calcium intake.
Development of late AMD, geographic atrophy (central or noncentral), or neovascular AMD detected on centrally graded baseline and annual fundus photographs.
A total of 4751 participants were included (mean [SD] age, 69.4 [5.1] years); 4543 (95.6%) were white, and 2655 (55.9%) were female. Compared with those who were in the lowest quintile, the participants in the highest quintile of dietary calcium intake had a lower risk of developing late AMD (hazard ratio [HR], 0.73 [95% CI, 0.59-0.90]), central geographic atrophy (HR, 0.64 [95% CI, 0.48-0.86]), and any geographic atrophy (HR, 0.80 [95% CI, 0.64-1.00]). The participants in the highest tertile of supplementary calcium intake had a lower risk of developing neovascular AMD (HR, 0.70 [95% CI, 0.50-0.97]) compared with those who did not take calcium supplements. When stratified by sex, women in the highest quintile of dietary calcium intake had a lower risk of developing late AMD (HR, 0.73 [95% CI, 0.56-0.97]) compared with those in the lowest quintile. Women in the highest tertile of calcium supplementation had a lower risk of progression to neovascular AMD (HR, 0.67 [95% CI, 0.48-0.94]) compared with those who did not take calcium supplements. Similar findings were found in men for dietary calcium. Too few men took calcium supplements to allow for analyses.
In this secondary analysis, higher levels of dietary and supplementary calcium intake were associated with lower incidence of progression to late AMD in AREDS participants. The results may be owing to uncontrolled confounding or chance and should be considered hypothesis development requiring additional study.
先前关于饮食和补充钙在年龄相关性黄斑变性（AMD）中的作用的研究结果不一，这表明补充和减少饮食摄入都可能有害。
评估基线饮食和补充钙摄入量与 AMD 进展的关系。
设计、地点和参与者： 本研究是对美国年龄相关性眼病研究（AREDS）参与者进行的二次分析。AREDS 研究（1992-2001 年）纳入了来自美国学术和社区视网膜实践的患者。包括了不同严重程度的 AMD 患者。本文的数据分析于 2015 年 9 月至 2018 年 12 月进行。
基线自我报告的饮食或补充钙摄入量。
在中央分级基线和年度眼底照片上检测到晚期 AMD、地理萎缩（中央或非中央）或新生血管性 AMD。
共纳入 4751 名参与者（平均[SD]年龄 69.4[5.1]岁）；4543 名（95.6%）为白人，2655 名（55.9%）为女性。与最低五分位组相比，饮食钙摄入量最高五分位组发生晚期 AMD 的风险较低（风险比[HR]，0.73[95%CI，0.59-0.90]）、中央性地理萎缩（HR，0.64[95%CI，0.48-0.86]）和任何地理萎缩（HR，0.80[95%CI，0.64-1.00]）。与未服用钙补充剂的参与者相比，补充钙摄入量最高三分位组发生新生血管性 AMD 的风险较低（HR，0.70[95%CI，0.50-0.97]）。按性别分层后，与最低五分位组相比，饮食钙摄入量最高五分位组的女性发生晚期 AMD 的风险较低（HR，0.73[95%CI，0.56-0.97]）。补充钙最高三分位组的女性进展为新生血管性 AMD 的风险较低（HR，0.67[95%CI，0.48-0.94]），与未服用钙补充剂的女性相比。在男性中也发现了类似的饮食钙结果。服用钙补充剂的男性太少，无法进行分析。
在这项二次分析中，较高水平的饮食和补充钙摄入与 AREDS 参与者中晚期 AMD 进展发生率较低相关。结果可能归因于无法控制的混杂因素或偶然性，应被视为需要进一步研究的假说发展。
