Study: Higher carotenoid intake reduced risk of advanced AMD over long term

Issue: December 10, 2015

An increased intake of lutein/zeaxanthin reduced the long-term risk of advanced age-related macular degeneration, according to a large study.

Perspective from Emily Y. Chew, MD

The prospective cohort study included 63,443 women and 38,603 men who participated in the Nurses’ Health Study and Health Professionals Follow-up Study between 1984 and 2010. All subjects were older than 50 years and were not diagnosed with AMD, diabetes, cardiovascular disease or cancer at baseline.

Food frequency questionnaires were used to calculate predicted plasma carotenoid scores. Regression models were used to account for bioavailability and reporting validity of different foods and to determine associations between predicted plasma carotenoid scores and AMD.

Over the course of follow-up of the studies, there were 1,361 cases of intermediate AMD and 1,118 cases of advanced AMD, primarily neovascular AMD, with visual acuity of 20/30 or worse.

Median age at onset was 73 years among women and 76 years among men.

A comparison of extreme quintiles of predicted plasma lutein/zeaxanthin scores showed a 40% reduction in the risk of advanced AMD in women and men (P < .001).

“Predicted plasma carotenoid scores for other carotenoids, including beta-cryptoxanthin, alpha-carotene and beta-carotene, were associated with a 25% to 35% lower risk of advanced AMD when comparing extreme quintiles,” the study authors said.

There was no association between predicted plasma scores or calculated intake of carotenoids and intermediate AMD. – by Matt Hasson

Disclosure: The authors report no relevant financial disclosures.

Perspective

Emily Y. Chew, MD

Wu and colleagues reported on the relationship of dietary and serum levels of carotenoids with the development of intermediate and late age-related macular degeneration in two large cohorts (n=~100,000), the Nurses’ Health Study and the Health Professionals Follow-up Study in the United States. There was a 40% reduction in the development of late AMD, especially neovascular AMD associated with higher dietary intake and serum levels of lutein and zeaxanthin.
These observational data support the secondary findings of the Age-Related Eye Disease Study 2 (AREDS2), which showed that in the main effects analyses (all assigned vs. those not assigned to lutein and zeaxanthin) resulted in statistically significant beneficial effects of lutein and zeaxanthin on the progression to late AMD. The beneficial effects were particularly important in those participants with the lowest intake of lutein and zeaxanthin. Wu’s data point to the importance of a diet rich in vegetables, especially those enriched in lutein and zeaxanthin, such as spinach, kale and collard greens. Although AREDS2 supplements, which include lutein and zeaxanthin, are recommended for those who have at least intermediate AMD, it is also prudent to recommend a diet replete with green leafy vegetables and fish to our patients. After all, you are what you eat.

Emily Y. Chew, MD

National Eye Institute

Bethesda, Md.

Disclosures: Chew reports no relevant financial disclosures.

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Sources/Disclosures

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Source:

Wu J, et al. JAMA Ophthalmol. 2015;doi:10.1001/jamaophthalmol.2015.3590.