Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland.
Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Ophthalmology. 2020 Nov;127(11):1515-1528. doi: 10.1016/j.ophtha.2020.04.030. Epub 2020 Apr 26.
To determine whether closer adherence to a Mediterranean diet (and its individual components) was associated with altered risk of progression to late age-related macular degeneration (AMD) and large drusen. Additional objectives were to assess interactions with AMD genotype.
Retrospective analysis of 2 controlled clinical trial cohorts: Age-Related Eye Disease Study (AREDS) and AREDS2.
Eyes with no late AMD at baseline in AREDS participants (n = 4255) and AREDS2 participants (n = 3611): total of 13 204 eyes (7756 participants). Mean age was 71 years (standard deviation, 6.6); 56.5% were female.
Color fundus photographs were collected at annual study visits and graded centrally for late AMD. The modified Alternative Mediterranean Diet Index (aMedi) score was calculated for each participant from food frequency questionnaires.
Progression to late AMD, geographic atrophy (GA), and neovascular AMD; progression to large drusen.
Over a median follow-up of 10.2 years, of the 13 204 eyes, 34.0% progressed to late AMD. Hazard ratios (HRs) for progression in aMedi tertile 3 versus 1 were 0.78 (95% confidence interval [CI], 0.71-0.85, P < 0.0001) for late AMD, 0.71 (0.63-0.80, P < 0.0001) for GA, and 0.84 (0.75-0.95, P = 0.005) for neovascular AMD. For fish consumption, HRs for late AMD in quartile 4 versus 1 were 0.69 (0.58-0.82, P < 0.0001; AREDS) and 0.92 (0.78-1.07, P = 0.28; AREDS2). In AREDS, both aMedi and its fish component interacted with CFH rs10922109 for late AMD (P = 0.01 and P = 0.0005, respectively); higher aMedi and fish intake were each associated with decreased risk only in participants with protective alleles. In separate analyses (n = 5029 eyes of 3026 AREDS participants), the HR for progression to large drusen in aMedi tertile 3 versus 1 was 0.79 (0.68-0.93, P = 0.004).
Closer adherence to a Mediterranean-type diet was associated with lower risk of progression to late AMD and to large drusen. The signal was greater for GA than neovascular AMD. Fish intake contributed to this protective association. CFH genotype strongly influenced these relationships. These findings may help inform evidence-based dietary recommendations.
确定更严格地遵循地中海饮食（及其各个组成部分）是否与晚期年龄相关性黄斑变性（AMD）和大玻璃膜疣进展风险的改变有关。此外，还评估了与 AMD 基因型的相互作用。
回顾性分析 2 项对照临床试验队列：年龄相关性眼病研究（AREDS）和 AREDS2。
基线时无晚期 AMD 的眼（AREDS 参与者[n=4255]和 AREDS2 参与者[n=3611]）：共 13204 只眼（7756 名参与者）。平均年龄为 71 岁（标准差为 6.6）；56.5%为女性。
每年的研究访问中采集眼底彩色照片，并进行中心分级以确定晚期 AMD。从食物频率问卷中为每位参与者计算改良替代地中海饮食指数（aMedi）评分。
进展为晚期 AMD、地理萎缩（GA）和新生血管性 AMD；进展为大玻璃膜疣。
在中位随访 10.2 年期间，13204 只眼中，34.0%进展为晚期 AMD。与 aMedi 三分位 3 相比，三分位 1 的进展风险比（HR）分别为 0.78（95%置信区间[CI]，0.71-0.85，P<0.0001）、0.71（0.63-0.80，P<0.0001）和 0.84（0.75-0.95，P=0.005）。对于鱼类摄入量，四分位 4 与四分位 1 相比，晚期 AMD 的 HR 分别为 0.69（0.58-0.82，P<0.0001；AREDS）和 0.92（0.78-1.07，P=0.28；AREDS2）。在 AREDS 中，aMedi 及其鱼类成分均与 CFH rs10922109 相互作用（P=0.01 和 P=0.0005）；较高的 aMedi 和鱼类摄入量仅与保护性等位基因的参与者风险降低相关。在单独的分析中（n=3026 名 AREDS 参与者的 5029 只眼），aMedi 三分位 3 与三分位 1 相比，大玻璃膜疣进展的 HR 为 0.79（0.68-0.93，P=0.004）。
更严格地遵循地中海饮食类型与晚期 AMD 和大玻璃膜疣进展风险降低相关。GA 的信号强于新生血管性 AMD。鱼类摄入量有助于这种保护关联。CFH 基因型强烈影响这些关系。这些发现可能有助于为基于证据的饮食建议提供信息。
