Hanyuda Akiko, Rosner Bernard A, Wiggs Janey L, Negishi Kazuno, Pasquale Louis R, Kang Jae H
Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan; Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.
Department of Biostatistics, 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.
Ophthalmology. 2023 Feb;130(2):187-197. doi: 10.1016/j.ophtha.2022.08.023. Epub 2022 Aug 28.
To assess the association between intakes of total alcohol and individual alcoholic beverages and the incidence of exfoliation glaucoma/glaucoma suspect (XFG/XFGS) status.
Prospective cohort study.
A total of 195 408 participants in the Nurses' Health Study (1980-2018), the Health Professionals Follow-up Study (1986-2018), and the Nurses' Health Study II (1991-2019) were followed biennially. Eligible participants at each 2-year risk period were ≧ 40 years and free of XFG/XFGS status with available data on diet and ophthalmic examination findings.
Cumulatively averaged total (primary exposure) and individual alcoholic beverage (beer, wine, and liquor) intakes from validated dietary information every 2-4 years.
Confirmed incident XFG/XFGS status using medical records. We used per-eye Cox proportional hazards models, accounting for intereye correlations, to estimate multivariate-adjusted relative risks (MVRRs) and 95% confidence intervals (CIs).
During 6 877 823 eye-years of follow-up, 705 eyes with XFG/XFGS status were documented. Greater total alcohol consumption was associated significantly with higher XFG/XFGS status risk: the MVRR for XFG/XFGS status for cumulatively averaged alcohol consumption of ≧15 g/day or more versus nondrinking was 1.55 (95% CI, 1.17-2.07; P = 0.02 for trend). Long- and short-term alcohol intake was associated significantly with XFG/XFGS status risk, with the strongest associations with cumulatively averaged alcohol intake as of 4 years before diagnosis (MVRR ≥ 15 g/day vs. nondrinking, 1.65; 95% CI, 1.25-2.18; P = 0.002 for trend). Compared with nondrinkers, consuming ≧ 3.6 drinks of beer, wine, or liquor per week was associated with the following MVRRs for XFG/XFGS status: 1.26 (95% CI, 0.89-1.77; P = 0.40 for trend), 1.30 (95% CI, 1.00-1.68; P = 0.15 for trend), and 1.46 (95% CI, 1.15-1.85; P = 0.01 for trend), respectively. We did not observe interactions by age, latitude, residential tier, or intakes of folate or vitamin A (P > 0.40 for interaction); however, the association between alcohol and XFG/XFGS status was suggestively stronger for those without a family history of glaucoma (P = 0.10 for interaction).
Long-term alcohol consumption was associated with a higher risk of XFG/XFGS status. Our findings provide further clues regarding the XFG/XFGS etiology.
评估总酒精摄入量及各类酒精饮料摄入量与剥脱性青光眼/青光眼可疑状态（XFG/XFGS）发病之间的关联。
前瞻性队列研究。
护士健康研究（1980 - 2018年）、卫生专业人员随访研究（1986 - 2018年）和护士健康研究II（1991 - 2019年）中共有195408名参与者，每两年进行一次随访。在每个2年风险期符合条件的参与者年龄≧40岁，无XFG/XFGS状态，且有饮食和眼科检查结果的可用数据。
每2 - 4年根据经验证的饮食信息累积平均计算总酒精摄入量（主要暴露因素）及各类酒精饮料（啤酒、葡萄酒和烈酒）摄入量。
使用医疗记录确定XFG/XFGS状态的确诊发病情况。我们采用每只眼睛的Cox比例风险模型，并考虑双眼相关性，以估计多变量调整后的相对风险（MVRRs）和95%置信区间（CIs）。
在6877823眼年的随访期间，记录到705只眼睛处于XFG/XFGS状态。总酒精摄入量越高，XFG/XFGS状态风险越高：累积平均酒精摄入量≧15克/天及以上与不饮酒相比，XFG/XFGS状态的MVRR为1.55（95%CI，1.17 - 2.07；趋势P = 0.02）。长期和短期酒精摄入量均与XFG/XFGS状态风险显著相关，与诊断前4年的累积平均酒精摄入量相关性最强（累积平均摄入量≥15克/天与不饮酒相比，MVRR为1.65；95%CI，1.25 - 2.18；趋势P = 0.002）。与不饮酒者相比，每周饮用≧3.6杯啤酒、葡萄酒或烈酒与XFG/XFGS状态的以下MVRRs相关：分别为1.26（95%CI，0.89 - 1.77；趋势P = 0.40）、1.30（95%CI，1.00 - 1.68；趋势P = 0.15）和1.46（95%CI，1.15 - 1.85；趋势P = 0.01）。我们未观察到年龄、纬度、居住层级或叶酸或维生素A摄入量之间的相互作用（相互作用P>0.40）；然而，对于无青光眼家族史者，酒精与XFG/XFGS状态之间的关联似乎更强（相互作用P = 0.10）。
长期饮酒与XFG/XFGS状态风险较高相关。我们的研究结果为XFG/XFGS的病因提供了进一步线索。
