年龄相关性眼病研究1和2中膳食营养素摄入量与晚期年龄相关性黄斑变性进展情况
Dietary Nutrient Intake and Progression to Late Age-Related Macular Degeneration in the Age-Related Eye Disease Studies 1 and 2.
作者信息
Agrón Elvira, Mares Julie, Clemons Traci E, Swaroop Anand, Chew Emily Y, Keenan Tiarnan D L
机构信息
Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland.
Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin.
出版信息
Ophthalmology. 2021 Mar;128(3):425-442. doi: 10.1016/j.ophtha.2020.08.018. Epub 2020 Aug 25.
PURPOSE
To analyze associations between the dietary intake of multiple nutrients and risk of progression to late age-related macular degeneration (AMD), its subtypes, and large drusen.
DESIGN
Post hoc analysis of 2 controlled clinical trial cohorts: Age-Related Eye Disease Study (AREDS) and AREDS2.
PARTICIPANTS
Eyes with no late AMD at baseline among AREDS participants (n = 4504) and AREDS2 participants (n = 3738) totaled 14 135 eyes. Mean age was 71.0 years (standard deviation, 6.7 years), and 56.5% of patients were women.
METHODS
Fundus photographs were collected at annual study visits and graded centrally for late AMD. Dietary intake of multiple nutrients was calculated from food frequency questionnaires.
MAIN OUTCOME MEASURES
Progression to late AMD, geographic atrophy (GA), neovascular AMD, and (separate analyses) large drusen.
RESULTS
Over median follow-up of 10.2 years, of the 14 135 eyes, 32.7% progressed to late AMD. For 9 nutrients, intake quintiles 4 or 5 (vs. 1) were associated significantly (P ≤ 0.0005) with decreased risk of late AMD: vitamin A, vitamin B6, vitamin C, folate, β-carotene, lutein and zeaxanthin, magnesium, copper, and alcohol. For 3 nutrients, quintiles 4 or 5 were associated significantly with increased risk: saturated fatty acid, monounsaturated fatty acid, and oleic acid. Similar results were observed for GA. Regarding neovascular AMD, 9 nutrients were associated nominally with decreased risk-vitamin A, vitamin B6, β-carotene, lutein and zeaxanthin, magnesium, copper, docosahexaenoic acid, omega-3 fatty acid, and alcohol-and 3 nutrients were associated with increased risk-saturated fatty acid, monounsaturated fatty acid, and oleic acid. In separate analyses (n = 5399 eyes of 3164 AREDS participants), 12 nutrients were associated nominally with decreased risk of large drusen.
CONCLUSIONS
Higher dietary intake of multiple nutrients, including minerals, vitamins, and carotenoids, is associated with decreased risk of progression to late AMD. These associations are stronger for GA than for neovascular AMD. The same nutrients also tend to show protective associations against large drusen development. Strong genetic interactions exist for some nutrient-genotype combinations, particularly omega-3 fatty acids and CFH. These data may justify further research into underlying mechanisms and randomized trials of supplementation.
目的
分析多种营养素的饮食摄入量与进展为晚期年龄相关性黄斑变性（AMD）、其亚型以及大的玻璃膜疣风险之间的关联。
设计
对两项对照临床试验队列进行事后分析：年龄相关性眼病研究（AREDS）和AREDS2。
参与者
AREDS参与者（n = 4504）和AREDS2参与者（n = 3738）中基线时无晚期AMD的眼睛共计14135只。平均年龄为71.0岁（标准差6.7岁），56.5%的患者为女性。
方法
在每年的研究访视时收集眼底照片，并集中分级以确定晚期AMD。通过食物频率问卷计算多种营养素的饮食摄入量。
主要观察指标
进展为晚期AMD、地图样萎缩（GA）、新生血管性AMD，以及（单独分析）大的玻璃膜疣。
结果
在10.2年的中位随访期内，14135只眼中有32.7%进展为晚期AMD。对于9种营养素，摄入量处于第4或第5五分位数（相对于第1五分位数）与晚期AMD风险降低显著相关（P≤0.0005）：维生素A、维生素B6、维生素C、叶酸、β-胡萝卜素、叶黄素和玉米黄质、镁、铜和酒精。对于3种营养素，第4或第5五分位数与风险增加显著相关：饱和脂肪酸、单不饱和脂肪酸和油酸。GA也观察到类似结果。关于新生血管性AMD，9种营养素名义上与风险降低相关——维生素A、维生素B6、β-胡萝卜素、叶黄素和玉米黄质、镁、铜、二十二碳六烯酸、ω-3脂肪酸和酒精——3种营养素与风险增加相关——饱和脂肪酸、单不饱和脂肪酸和油酸。在单独分析中（3164名AREDS参与者的5399只眼），12种营养素名义上与大的玻璃膜疣风险降低相关。
结论
包括矿物质、维生素和类胡萝卜素在内的多种营养素的较高饮食摄入量与进展为晚期AMD的风险降低相关。这些关联在GA中比在新生血管性AMD中更强。相同的营养素也倾向于对大的玻璃膜疣形成显示出保护关联。某些营养素-基因型组合存在强烈的基因相互作用，特别是ω-3脂肪酸和CFH。这些数据可能为进一步研究潜在机制和补充剂的随机试验提供依据。
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