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Health News Archive 148 - Age Related Macular Degeneration
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Antioxidants Substantially Lower Macular Degeneration Risk

A report published in the December 28, 2005 issue of the Journal of the American Medical Association concluded that individuals whose diets contain high amounts of the antioxidants beta-carotene, vitamin C, vitamin E and zinc have a significantly lower risk of developing age-related macular degeneration (AMD) than people whose diets contain lower levels of the nutrients. Age-related macular degeneration is the most common cause of permanent blindness in the developed world. The Age-Related Eye Disease study (AREDS) found that supplements containing 5 to 13 times the recommended daily allowance of these nutrients slowed the progression of the disease.

The current study included 4,176 men and women at risk of AMD who were participants in the Rotterdam Study, which enrolled 7,983 men and women aged 55 and older from 1990 to 1993 who resided in a suburb of Rotterdam, the Netherlands. Nutrient intake was determined via food frequency questionnaires completed by all subjects. Participants underwent eye examinations upon enrollment, and three times during the eight year follow-up.

Five hundred-sixty subjects were diagnosed with new macular degeneration during the follow-up period. Dietary levels of beta-carotene, vitamins C and E, and zinc from both food and supplements that were above the median of the total participants' intake were associated with a 35 percent lower risk of age-related macular degeneration.

The authors concluded, "This study suggests that the risk of AMD can be modified by diet; in particular, by dietary vitamin E and zinc . . . Although in need of confirmation, our observational data suggest that a high intake of specific antioxidants from a regular diet may delay the development of AMD."

Context Age-related macular degeneration (AMD) is the most prevalent cause of irreversible blindness in developed countries. Recently, high-dose supplementation with beta carotene, vitamins C and E, and zinc was shown to slow the progression of AMD.

Objective To investigate whether regular dietary intake of antioxidants is associated with a lower risk of incident AMD.

Design Dietary intake was assessed at baseline in the Rotterdam Study (1990-1993) using a semiquantitative food frequency questionnaire. Incident AMD until final follow-up in 2004 was determined by grading fundus color transparencies in a masked way according to the International Classification and Grading System.

Setting Population-based cohort of all inhabitants aged 55 years or older in a middle-class suburb of Rotterdam, the Netherlands.

Participants Of 5836 persons at risk of AMD at baseline, 4765 had reliable dietary data and 4170 participated in the follow-up.

Main Outcome Measure Incident AMD, defined as soft distinct drusen with pigment alterations, indistinct or reticular drusen, geographic atrophy, or choroidal neovascularization.

Results Incident AMD occurred in 560 participants after a mean follow-up of 8.0 years (range, 0.3-13.9 years). Dietary intake of both vitamin E and zinc was inversely associated with incident AMD. The hazard ratio (HR) per standard deviation increase of intake for vitamin E was 0.92 (95% confidence interval [CI], 0.84-1.00) and for zinc was 0.91 (95% CI, 0.83-0.98). An above-median intake of all 4 nutrients, beta carotene, vitamin C, vitamin E, and zinc, was associated with a 35% reduced risk (HR, 0.65; 95% CI, 0.46-0.92) of AMD. Exclusion of supplement users did not affect the results.

Conclusion In this study, a high dietary intake of beta carotene, vitamins C and E, and zinc was associated with a substantially reduced risk of AMD in elderly persons.

Author Affiliations: Departments of Epidemiology and Biostatistics (Drs van Leeuwen, Boekhoorn, Vingerling, Witteman, Klaver, Hofman, and de Jong) and Ophthalmology (Drs van Leeuwen, Vingerling, and Klaver), Erasmus Medical Centre, Rotterdam, the Netherlands; Netherlands Ophthalmic Research Institute, Royal Netherlands Academy of Arts and Sciences (KNAW) (Drs Klaver and de Jong), and Department of Ophthalmology, Academic Medical Centre (Dr de Jong), Amsterdam, the Netherlands.

Source:

Redmer van Leeuwen, MD, PhD; Sharmila Boekhoorn, MD; Johannes R. Vingerling, MD, PhD; Jacqueline C. M. Witteman, PhD; Caroline C. W. Klaver, MD, PhD; Albert Hofman, MD, PhD; Paulus T. V. M. de Jong, MD, PhD. Dietary Intake of Antioxidants and Risk of Age-Related Macular Degeneration. JAMA. 2005;294:3101-3107.