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Evans JR, Lawrenson JG. Antioxidant vitamin and mineral supplements for slowing the progression of age-related macular degeneration. Cochrane Database Syst Rev 2023; 9:CD000254. [PMID: 37702300 PMCID: PMC10498493 DOI: 10.1002/14651858.cd000254.pub5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
BACKGROUND Age-related macular degeneration (AMD) is a degenerative condition of the back of the eye that occurs in people over the age of 50 years. Antioxidants may prevent cellular damage in the retina by reacting with free radicals that are produced in the process of light absorption. Higher dietary levels of antioxidant vitamins and minerals may reduce the risk of progression of AMD. This is the third update of the review. OBJECTIVES To assess the effects of antioxidant vitamin and mineral supplements on the progression of AMD in people with AMD. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, one other database, and three trials registers, most recently on 29 November 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared antioxidant vitamin or mineral supplementation to placebo or no intervention, in people with AMD. DATA COLLECTION AND ANALYSIS We used standard methods expected by Cochrane. MAIN RESULTS We included 26 studies conducted in the USA, Europe, China, and Australia. These studies enroled 11,952 people aged 65 to 75 years and included slightly more women (on average 56% women). We judged the studies that contributed data to the review to be at low or unclear risk of bias. Thirteen studies compared multivitamins with control in people with early and intermediate AMD. Most evidence came from the Age-Related Eye Disease Study (AREDS) in the USA. People taking antioxidant vitamins were less likely to progress to late AMD (odds ratio (OR) 0.72, 95% confidence interval (CI) 0.58 to 0.90; 3 studies, 2445 participants; moderate-certainty evidence). In people with early AMD, who are at low risk of progression, this means there would be approximately four fewer cases of progression to late AMD for every 1000 people taking vitamins (one fewer to six fewer cases). In people with intermediate AMD at higher risk of progression, this corresponds to approximately 78 fewer cases of progression for every 1000 people taking vitamins (26 fewer to 126 fewer). AREDS also provided evidence of a lower risk of progression for both neovascular AMD (OR 0.62, 95% CI 0.47 to 0.82; moderate-certainty evidence) and geographic atrophy (OR 0.75, 95% CI 0.51 to 1.10; moderate-certainty evidence), and a lower risk of losing 3 or more lines of visual acuity (OR 0.77, 95% CI 0.62 to 0.96; moderate-certainty evidence). Low-certainty evidence from one study of 110 people suggested higher quality of life scores (measured with the Visual Function Questionnaire) in treated compared with non-treated people after 24 months (mean difference (MD) 12.30, 95% CI 4.24 to 20.36). In exploratory subgroup analyses in the follow-on study to AREDS (AREDS2), replacing beta-carotene with lutein/zeaxanthin gave hazard ratios (HR) of 0.82 (95% CI 0.69 to 0.96), 0.78 (95% CI 0.64 to 0.94), 0.94 (95% CI 0.70 to 1.26), and 0.88 (95% CI 0.75 to 1.03) for progression to late AMD, neovascular AMD, geographic atrophy, and vision loss, respectively. Six studies compared lutein (with or without zeaxanthin) with placebo and one study compared a multivitamin including lutein/zeaxanthin with multivitamin alone. The duration of supplementation and follow-up ranged from six months to five years. Most evidence came from the AREDS2 study in the USA; almost all participants in AREDS2 also took the original AREDS supplementation formula. People taking lutein/zeaxanthin may have similar or slightly reduced risk of progression to late AMD (RR 0.94, 95% CI 0.87 to 1.01), neovascular AMD (RR 0.92, 95% CI 0.84 to 1.02), and geographic atrophy (RR 0.92, 95% CI 0.80 to 1.05) compared with control (1 study, 4176 participants, 6891 eyes; low-certainty evidence). A similar risk of progression to visual loss of 15 or more letters was seen in the lutein/zeaxanthin and control groups (RR 0.98, 95% CI 0.91 to 1.05; 6656 eyes; low-certainty evidence). Quality of life (Visual Function Questionnaire) was similar between groups (MD 1.21, 95% CI -2.59 to 5.01; 2 studies, 308 participants; moderate-certainty evidence). One study in Australia randomised 1204 people to vitamin E or placebo with four years of follow-up; 19% of participants had AMD. The number of late AMD events was low (N = 7) and the estimate of effect was uncertain (RR 1.36, 95% CI 0.31 to 6.05; very low-certainty evidence). There was no evidence of any effect of treatment on visual loss (RR 1.04, 95% CI 0.74 to 1.47; low-certainty evidence). There were no data on neovascular AMD, geographic atrophy, or quality of life. Five studies compared zinc with placebo. Evidence largely drawn from the largest study (AREDS) found a lower progression to late AMD over six years (OR 0.83, 95% CI 0.70 to 0.98; 3 studies, 3790 participants; moderate-certainty evidence), neovascular AMD (OR 0.76, 95% CI 0.62 to 0.93; moderate-certainty evidence), geographic atrophy (OR 0.84, 95% CI 0.64 to 1.10; moderate-certainty evidence), or visual loss (OR 0.87, 95% CI 0.75 to 1.00; 2 studies, 3791 participants; moderate-certainty evidence). There were no data on quality of life. Gastrointestinal symptoms were the main reported adverse effect. In AREDS, zinc was associated with a higher risk of genitourinary problems in men, but no difference was seen between high- and low-dose zinc groups in AREDS2. Most studies were too small to detect rare adverse effects. Data from larger studies (AREDS/AREDS2) suggested there may be little or no effect on mortality with multivitamin (HR 0.87, 95% CI 0.60 to 1.25; low-certainty evidence) or lutein/zeaxanthin supplementation (HR 1.06, 95% CI 0.87 to 1.31; very low-certainty evidence), but confirmed the increased risk of lung cancer with beta-carotene, mostly in former smokers. AUTHORS' CONCLUSIONS Moderate-certainty evidence suggests that antioxidant vitamin and mineral supplementation (AREDS: vitamin C, E, beta-carotene, and zinc) probably slows down progression to late AMD. People with intermediate AMD have a higher chance of benefiting from antioxidant supplements because their risk of progression is higher than people with early AMD. Although low-certainty evidence suggested little effect with lutein/zeaxanthin alone compared with placebo, exploratory subgroup analyses from one large American study support the view that lutein/zeaxanthin may be a suitable replacement for the beta-carotene used in the original AREDS formula.
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Affiliation(s)
- Jennifer R Evans
- Centre for Public Health, International Centre for Eye Health, London School of Hygiene & Tropical Medicine, Belfast, UK
| | - John G Lawrenson
- Centre for Applied Vision Research, School of Health Sciences, City University of London, London, UK
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Dansou DM, Zhang H, Yu Y, Wang H, Tang C, Zhao Q, Qin Y, Zhang J. Carotenoid enrichment in eggs: From biochemistry perspective. ANIMAL NUTRITION (ZHONGGUO XU MU SHOU YI XUE HUI) 2023; 14:315-333. [PMID: 37635928 PMCID: PMC10448277 DOI: 10.1016/j.aninu.2023.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/27/2023] [Accepted: 05/31/2023] [Indexed: 08/29/2023]
Abstract
The emergence of safe and functional eggs for consumer acceptance has gained focus. The production of carotenoid-enriched eggs has received attention due to its multifunctional biological properties. Nutritional modification of laying hens' diet can be a strategy to produce such eggs. This review presents the chemistry of carotenoids in nature and eggs, the accumulation process of carotenoids into eggs, and the functions of carotenoids in eggs. Our findings showed that carotenoids can be deposited into the egg and contribute to improving its nutritive value. The biosynthesis, chemical structure, and metabolism pathways of carotenoids lead to the deposition of carotenoids into eggs in their original or metabolized forms. Also, some factors modulate the efficiency of carotenoids in fowls before accumulation into eggs. Carotenoid-enriched eggs may be promising, ensuring the availability of highly nutritive eggs. However, further studies are still needed to comprehend the full metabolism process and the extensive functions of carotenoids in eggs.
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Affiliation(s)
- Dieudonné M. Dansou
- State Key Laboratory of Animal Nutrition and Feeding, Institute of Animal Sciences, Chinese Academy of Agricultural Sciences, Beijing 100193, China
| | - Huiyan Zhang
- State Key Laboratory of Animal Nutrition and Feeding, Institute of Animal Sciences, Chinese Academy of Agricultural Sciences, Beijing 100193, China
| | - Yanan Yu
- State Key Laboratory of Animal Nutrition and Feeding, Institute of Animal Sciences, Chinese Academy of Agricultural Sciences, Beijing 100193, China
| | - Hao Wang
- State Key Laboratory of Animal Nutrition and Feeding, Institute of Animal Sciences, Chinese Academy of Agricultural Sciences, Beijing 100193, China
| | - Chaohua Tang
- State Key Laboratory of Animal Nutrition and Feeding, Institute of Animal Sciences, Chinese Academy of Agricultural Sciences, Beijing 100193, China
| | - Qingyu Zhao
- State Key Laboratory of Animal Nutrition and Feeding, Institute of Animal Sciences, Chinese Academy of Agricultural Sciences, Beijing 100193, China
| | - Yuchang Qin
- State Key Laboratory of Animal Nutrition and Feeding, Institute of Animal Sciences, Chinese Academy of Agricultural Sciences, Beijing 100193, China
| | - Junmin Zhang
- State Key Laboratory of Animal Nutrition and Feeding, Institute of Animal Sciences, Chinese Academy of Agricultural Sciences, Beijing 100193, China
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Dietary vitamins, carotenoids and their sources in relation to age-related macular degeneration risk in China: a population-based case-control study. Br J Nutr 2022; 129:1804-1811. [PMID: 35894297 DOI: 10.1017/s0007114522002161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Mechanistic studies have suggested that antioxidants have beneficial effects on age-related macular degeneration (AMD). This study aimed to investigate the association between the types and sources of dietary vitamin and carotenoid intakes and AMD risk in China. A matched case-control study of 260 AMD cases and 260 matched controls was performed. The participants were interviewed for dietary information and potential confounders, and comprehensive ophthalmic examinations were performed. Conditional logistic models were used to estimate the odds ratio (OR) and 95 % confidence interval (CI) of specific vitamins and carotenoids and their main sources. When comparing the extreme quartiles, the ORs (95 % CI) were 0·30 (0·10, 0·88) for lutein and 0·28 (0·11, 0·74) for β-cryptoxanthin. The associations for other dietary vitamin and carotenoid intakes were generally weaker and non-significant. Higher intakes of spinach and egg, which are important sources of lutein, were associated with a reduced odds of AMD. ORs (95% CIs) comparing extreme categories were 0·42 (0·20, 0·88) for spinach and 0·52 (95% CI: 0·27, 0·98) for egg. Participants who were in the highest category of both egg intake and spinach intake had a much greater reduced odds of having AMD (OR: 0·23; 95% CI: 0·08, 0·71) than those in the lowest category of egg intake and spinach intake. In conclusion, a higher intake of lutein and lutein-rich foods was associated with a significantly decreased odds of AMD. These findings provide further evidence of the benefits of lutein and lutein-rich foods in the prevention of AMD.
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Schnebelen-Berthier C, Acar N, Simon E, Thabuis C, Bourdillon A, Mathiaud A, Dauchet L, Delcourt C, Benlian P, Crochet M, Defoort S, Tailleux A, Staels B, Bretillon L, Lecerf JM. The ALGOVUE Clinical Trial: Effects of the Daily Consumption of Eggs Enriched with Lutein and Docosahexaenoic Acid on Plasma Composition and Macular Pigment Optical Density. Nutrients 2021; 13:nu13103347. [PMID: 34684356 PMCID: PMC8541434 DOI: 10.3390/nu13103347] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 12/22/2022] Open
Abstract
Background. Carotenoids and docosahexaenoic acid (DHA) were identified as essential components for eye health and are both naturally present in eggs. Objective. We aimed to evaluate the effect of the daily consumption of two eggs enriched with lutein/zeaxanthin and DHA on macular pigment optical density (MPOD) and on circulating xanthophyll and fatty acid concentrations in healthy participants. Methods. Ninety-nine healthy volunteers consumed either two standard eggs or two enriched eggs per day for 4 months. MPOD was measured at baseline (V0) and at follow-up (V4) using a modified confocal scanning laser ophthalmoscope (primary outcome). Blood samples were collected to determine total plasma and lipoprotein fatty acids and lutein/zeaxanthin compositions at V0 and V4 (secondary outcomes). Results. A slight but significant increase in MPOD was observed for all study participants consuming two eggs per day for 4 months at all eccentricities (0.5°, 1°, 2°, and 4°). Plasma and lipoprotein lutein, zeaxanthin, and DHA concentrations significantly increased in both groups but were greater in the enriched group (for the enriched group (V0 vs. V4): lutein, 167 vs. 369 ng/mL; zeaxanthin, 17.7 vs. 29.2 ng/mL; DHA, 1.89 vs. 2.56% of total fatty acids). Interestingly, lutein from high-density lipoprotein (HDL) was strongly correlated with MPOD at 0.5 and 1° eccentricities (rho = 0.385, p = 0.008, and rho = 0.461, p = 0.001, respectively). Conclusions. MPOD was slightly increased in both groups. Lutein, zeaxanthin, and DHA plasma concentrations were strongly enhanced in the enriched group compared with the standard group. A significant correlation was found between MPOD level and lutein concentration in HDL.
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Affiliation(s)
- Coralie Schnebelen-Berthier
- Service Nutrition & Activité Physique, Institut Pasteur de Lille, F-59019 Lille, France; (E.S.); (J.-M.L.)
- Correspondence: ; Tel.: +33-20-87-73-33
| | - Niyazi Acar
- Centre des Sciences du Goût et de l’Alimentation, Agrosup Dijon, CNRS, INRA, Université Bourgogne Franche-Comté, F-21000 Dijon, France; (N.A.); (L.B.)
| | - Emilie Simon
- Service Nutrition & Activité Physique, Institut Pasteur de Lille, F-59019 Lille, France; (E.S.); (J.-M.L.)
| | | | - Anne Bourdillon
- MIXSCIENCE, Centre d’Affaires Odyssée, ZAC Cicé Blossac, F-35172 Bruz, France; (A.B.); (A.M.)
| | - Adeline Mathiaud
- MIXSCIENCE, Centre d’Affaires Odyssée, ZAC Cicé Blossac, F-35172 Bruz, France; (A.B.); (A.M.)
| | - Luc Dauchet
- CNRS, INSERM, CHU de Lille, Institut Pasteur de Lille, UMR 1283-EGID, “Integrative Genomics and Modelling of Metabolic Diseases”, Université de Lille, F-59045 Lille, France; (L.D.); (P.B.); (A.T.); (B.S.)
| | - Cécile Delcourt
- “Bordeaux Population Health Research Center” (BPH), INSERM, UMR1219, “Lifelong Exposures, Health and Ageing” (LEHA) Group, Université de Bordeaux, F-33076 Bordeaux, France;
| | - Pascale Benlian
- CNRS, INSERM, CHU de Lille, Institut Pasteur de Lille, UMR 1283-EGID, “Integrative Genomics and Modelling of Metabolic Diseases”, Université de Lille, F-59045 Lille, France; (L.D.); (P.B.); (A.T.); (B.S.)
| | - Martine Crochet
- CHU Lille, Service d’Exploration de la Vision et Neuro-Ophtalmologie, F-59000 Lille, France; (M.C.); (S.D.)
| | - Sabine Defoort
- CHU Lille, Service d’Exploration de la Vision et Neuro-Ophtalmologie, F-59000 Lille, France; (M.C.); (S.D.)
| | - Anne Tailleux
- CNRS, INSERM, CHU de Lille, Institut Pasteur de Lille, UMR 1283-EGID, “Integrative Genomics and Modelling of Metabolic Diseases”, Université de Lille, F-59045 Lille, France; (L.D.); (P.B.); (A.T.); (B.S.)
| | - Bart Staels
- CNRS, INSERM, CHU de Lille, Institut Pasteur de Lille, UMR 1283-EGID, “Integrative Genomics and Modelling of Metabolic Diseases”, Université de Lille, F-59045 Lille, France; (L.D.); (P.B.); (A.T.); (B.S.)
| | - Lionel Bretillon
- Centre des Sciences du Goût et de l’Alimentation, Agrosup Dijon, CNRS, INRA, Université Bourgogne Franche-Comté, F-21000 Dijon, France; (N.A.); (L.B.)
| | - Jean-Michel Lecerf
- Service Nutrition & Activité Physique, Institut Pasteur de Lille, F-59019 Lille, France; (E.S.); (J.-M.L.)
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Khalighi Sikaroudi M, Saraf-Bank S, Clayton ZS, Soltani S. A positive effect of egg consumption on macular pigment and healthy vision: a systematic review and meta-analysis of clinical trials. JOURNAL OF THE SCIENCE OF FOOD AND AGRICULTURE 2021; 101:4003-4009. [PMID: 33491232 DOI: 10.1002/jsfa.11109] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/25/2020] [Accepted: 01/24/2021] [Indexed: 06/12/2023]
Abstract
Increasing macular pigment optical density (MPOD) as a result of increased macular concentration of lutein and zeaxanthin may reduce the risk of age-related macular degeneration (AMD). The aim of the present study was to determine whether the consumption of eggs, a rich source of dietary lutein and zeaxanthin, influences MPOD and serum lutein. In this systematic review and meta-analysis we searched PubMed, Scopus, and ISI Web of Science up to July 2020, for relevant randomized clinical trials. Using a random-effects model, pooled weighted mean differences, and standard deviations (SDs) for each outcome were obtained. The quality of the eligible studies was assessed by the Cochrane Collaboration's tool. A meta-analysis of five trials (296 participants) revealed that egg consumption significantly increased MPOD (weighted mean differences (WMD): +0.037; 95% CI: 0.004, 0.069; P = 0.027) and serum lutein (WMD: +0.150 μmol L̂-1; 95% CI: 0.037, 0.263; P = 0.009). Subgroup analyses showed that egg consumption: (a) had a larger effect on MPOD in studies with a parallel design; and (b) increased serum lutein to a greater extent in a healthy population. We did not detect any heterogeneity between studies. Daily egg consumption has beneficial effects on MPOD and serum lutein is inversely associated with reduced AMD progression. Further clinical trials are required to confirm the results of this study. © 2021 Society of Chemical Industry.
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Affiliation(s)
| | - Sahar Saraf-Bank
- Food Security Research Center, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zachary S Clayton
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Sepideh Soltani
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Fitzpatrick N, Chachay V, Bowtell J, Jackman S, Capra S, Shore A, Briskey D. An appraisal of trials investigating the effects on macular pigment optical density of lutein and zeaxanthin dietary interventions: a narrative review. Nutr Rev 2021; 80:513-524. [PMID: 34339515 DOI: 10.1093/nutrit/nuab038] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Lutein and zeaxanthin (L/Z), xanthophylls obtained from the diet, are deposited in the macula of the eye. The macular concentration of L/Z is quantifiable as macular pigment optical density (MPOD). The aim of this review was to critically appraise the effect on MPOD of increasing L/Z intake by dietary intervention in adults. Pubmed, Cochrane Library, Web of Science, and Cinahl were searched up to April 2020. Ten studies investigating populations with and without age-related macular degeneration were included. MPOD increased significantly in 2 of the 8 controlled studies. Studies varied largely in the prescribed dietary L/Z dosage, duration, and participant characteristics. No relationships between types of dietary L/Z interventions and MPOD response could be determined. Limited monitoring of habitual dietary L/Z intake was identified as a major limitation of all 10 studies. Habitual dietary L/Z intake should be closely monitored in future studies to account for their effects on MPOD response to dietary L/Z interventions.
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Affiliation(s)
- Naomi Fitzpatrick
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Saint Lucia, Queensland, Australia. J. Bowtell and S. Jackman are with the Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK. A. Shore is with the School of Medicine, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Veronique Chachay
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Saint Lucia, Queensland, Australia. J. Bowtell and S. Jackman are with the Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK. A. Shore is with the School of Medicine, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Joanna Bowtell
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Saint Lucia, Queensland, Australia. J. Bowtell and S. Jackman are with the Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK. A. Shore is with the School of Medicine, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Sarah Jackman
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Saint Lucia, Queensland, Australia. J. Bowtell and S. Jackman are with the Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK. A. Shore is with the School of Medicine, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Sandra Capra
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Saint Lucia, Queensland, Australia. J. Bowtell and S. Jackman are with the Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK. A. Shore is with the School of Medicine, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Angela Shore
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Saint Lucia, Queensland, Australia. J. Bowtell and S. Jackman are with the Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK. A. Shore is with the School of Medicine, College of Medicine and Health, University of Exeter, Exeter, UK
| | - David Briskey
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Saint Lucia, Queensland, Australia. J. Bowtell and S. Jackman are with the Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK. A. Shore is with the School of Medicine, College of Medicine and Health, University of Exeter, Exeter, UK
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[Involvement of egg antioxidant components in macular protection and vision improvement]. NUTR HOSP 2021; 38:9-12. [PMID: 34323086 DOI: 10.20960/nh.03789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Age-related macular degeneration (AMD) is an ocular pathology that occurs with excess free radicals, which damages the photoreceptors of the retina producing a disability in the pigment epithelium, which leads, in the most advanced cases, to severe and irreversible vision loss. Lutein and zeaxanthin (L & Z) intake, which are abundant pigments in the macula and have antioxidant and anti-inflammatory action, as well as a role as blue light filter, seem to have a positive effect on the prevention of AMD. These carotenoids cannot be synthesized in the body and must be ingested with the diet. Green leafy vegetables and eggs are the main sources. The former have a higher L & Z content than the latter, but their bioavailability is lower, due to the lipid matrix of the egg yolk, which improves absorption. In relation to the consumption of eggs and AMD prevention, short-term consumption has been associated with an increase in serum concentrations of L & Z, long-term consumption with an increase in the density of macular pigment, and very long- term consumption with a decrease in the risk of developing advanced and neovascular AMD. These facts highlight the advantages of consuming eggs, which should be incorporated into the usual diet in order to minimize the progression of this ocular disease.
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Wilson LM, Tharmarajah S, Jia Y, Semba RD, Schaumberg DA, Robinson KA. The Effect of Lutein/Zeaxanthin Intake on Human Macular Pigment Optical Density: A Systematic Review and Meta-Analysis. Adv Nutr 2021; 12:2244-2254. [PMID: 34157098 PMCID: PMC8634499 DOI: 10.1093/advances/nmab071] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/15/2021] [Accepted: 05/11/2021] [Indexed: 01/05/2023] Open
Abstract
Lutein, zeaxanthin, and meso-zeaxanthin are the only carotenoids found in the human macula and may have a role in visual function. These carotenoids are reported to protect the retina, and thus vision, as antioxidants and by acting as a blue light filter. Our objective was to determine a minimum concentration of lutein/zeaxanthin intake that is associated with a statistically significant and/or clinically important change in macular pigment optical density (MPOD) among adults with healthy eyes. We searched Ovid MEDLINE, CENTRAL, and the Commonwealth of Agriculture Bureau for English-language studies through to July 2020. Two reviewers screened results to identify studies that evaluated supplements or dietary sources of lutein/zeaxanthin on MPOD among adults with healthy eyes. One reviewer extracted data and assessed strength of evidence, which was confirmed by a second reviewer. Two independent reviewers assessed the risk of bias. Meta-analyses were stratified by total lutein/zeaxanthin dose. We included 46 studies (N = 3189 participants; mean age = 43 y; 42% male). There was no statistically significant change in MPOD among studies evaluating <5 mg/d of total lutein/zeaxanthin intake which primarily assessed dietary interventions for 3-6 mo (pooled mean difference, 0.02; 95% CI: -0.01 to 0.05). The pooled mean increase in MPOD was 0.04 units (95% CI: 0.02 to 0.07) among studies evaluating 5 to <20 mg/d of lutein/zeaxanthin and was 0.11 units (95% CI: 0.06 to 0.16) among studies evaluating ≥20 mg/d of lutein/zeaxanthin for 3-12 mo. MPOD increased with lutein/zeaxanthin intake, particularly at higher doses, among adults with healthy eyes. The effects of lutein/zeaxanthin intake at doses <5 mg/d or from dietary sources is less clear. Increased lutein/zeaxanthin intake can help with maintaining ocular health. Future research is needed to determine the minimum dose and duration of lutein/zeaxanthin intake that is associated with a clinically important change in MPOD or visual function.
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Affiliation(s)
| | - Saraniya Tharmarajah
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yuanxi Jia
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Richard D Semba
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Debra A Schaumberg
- Department of Ophthalmology & Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA,Evidera, Inc., Bethesda, MD, USA
| | - Karen A Robinson
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Böhm V, Lietz G, Olmedilla-Alonso B, Phelan D, Reboul E, Bánati D, Borel P, Corte-Real J, de Lera AR, Desmarchelier C, Dulinska-Litewka J, Landrier JF, Milisav I, Nolan J, Porrini M, Riso P, Roob JM, Valanou E, Wawrzyniak A, Winklhofer-Roob BM, Rühl R, Bohn T. From carotenoid intake to carotenoid blood and tissue concentrations - implications for dietary intake recommendations. Nutr Rev 2021; 79:544-573. [PMID: 32766681 PMCID: PMC8025354 DOI: 10.1093/nutrit/nuaa008] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
There is uncertainty regarding carotenoid intake recommendations, because positive and negative health effects have been found or are correlated with carotenoid intake and tissue levels (including blood, adipose tissue, and the macula), depending on the type of study (epidemiological vs intervention), the dose (physiological vs supraphysiological) and the matrix (foods vs supplements, isolated or used in combination). All these factors, combined with interindividual response variations (eg, depending on age, sex, disease state, genetic makeup), make the relationship between carotenoid intake and their blood/tissue concentrations often unclear and highly variable. Although blood total carotenoid concentrations <1000 nmol/L have been related to increased chronic disease risk, no dietary reference intakes (DRIs) exist. Although high total plasma/serum carotenoid concentrations of up to 7500 nmol/L are achievable after supplementation, a plateauing effect for higher doses and prolonged intake is apparent. In this review and position paper, the current knowledge on carotenoids in serum/plasma and tissues and their relationship to dietary intake and health status is summarized with the aim of proposing suggestions for a "normal," safe, and desirable range of concentrations that presumably are beneficial for health. Existing recommendations are likewise evaluated and practical dietary suggestions are included.
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Affiliation(s)
- Volker Böhm
- Institute of Nutritional Sciences, Friedrich Schiller University Jena, Jena, Germany
| | - Georg Lietz
- Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Begoña Olmedilla-Alonso
- Institute of Food Science, Technology and Nutrition, Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - David Phelan
- Nutrition Research Centre Ireland, School of Health Science, Carriganore House, Waterford Institute of Technology, Waterford, Ireland
| | | | | | - Patrick Borel
- C2VN, INRAE, INSERM, Aix Marseille Univ, Marseille, France
| | - Joana Corte-Real
- Population Health Department, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Angel R de Lera
- Departmento de Química Orgánica, Centro De Investigaciones Biomédicas and Instituto de Investigación Biomédica de Vigo, Universidade de Vigo, Vigo, Spain
| | | | | | | | - Irina Milisav
- University of Ljubljana, Ljubljana, Slovenia
- University of Ljubljana, Faculty of Health Sciences, Ljubljana, Slovenia and with University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
| | - John Nolan
- Nutrition Research Centre Ireland, School of Health Science, Carriganore House, Waterford Institute of Technology, Waterford, Ireland
| | - Marisa Porrini
- Universitàdegli Studi di Milano, Department of Food, Environmental and Nutritional Sciences, Division of Human Nutrition, Milan, Italy
| | - Patrizia Riso
- Universitàdegli Studi di Milano, Department of Food, Environmental and Nutritional Sciences, Division of Human Nutrition, Milan, Italy
| | - Johannes M Roob
- Research Unit Chronic Inflammation in Nephrology, Clinical Division of Nephrology, Department of Internal Medicine, Medical University, Graz, Austria
| | | | - Agata Wawrzyniak
- Institute of Human Nutrition Sciences, Warsaw University of Life Sciences, Warsaw, Poland
| | - Brigitte M Winklhofer-Roob
- Human Nutrition & Metabolism Research and Training Center, Institute of Molecular Biosciences, Karl-Franzens University, Graz, Austria
| | - Ralph Rühl
- Paprika Bioanalytics BT, Debrecen, Hungary and with CISCAREX UG, Berlin, Germany
| | - Torsten Bohn
- Population Health Department, Luxembourg Institute of Health, Strassen, Luxembourg
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Gibson S, Gray J. Evaluating current egg consumption patterns: Associations with diet quality, nutrition and health status in the UK National Diet and Nutrition Survey. NUTR BULL 2020. [DOI: 10.1111/nbu.12462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- S. Gibson
- Registered Nutritionist Sig‐Nurture Ltd. Southampton UK
| | - J. Gray
- Registered Nutritionist London UK
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11
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Green-Gomez M, Prado-Cabrero A, Moran R, Power T, Gómez-Mascaraque LG, Stack J, Nolan JM. The Impact of Formulation on Lutein, Zeaxanthin, and meso-Zeaxanthin Bioavailability: A Randomised Double-Blind Placebo-Controlled Study. Antioxidants (Basel) 2020; 9:E767. [PMID: 32824736 PMCID: PMC7463514 DOI: 10.3390/antiox9080767] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/14/2020] [Accepted: 08/15/2020] [Indexed: 12/31/2022] Open
Abstract
Lutein (L), zeaxanthin (Z), and meso-zeaxanthin (MZ) have been the focus of research and commercial interest for their applications in human health. Research into formulations to enhance their bioavailability is merited. This 6 month randomised placebo-controlled trial involving 81 healthy volunteers compared the bioavailability of different formulations of free L, Z, and MZ in sunflower or omega-3 oil versus L, Z, and MZ diacetates (Ld, Zd, and MZd) in a micromicellar formulation. Fasting serum carotenoids, macular pigment, and skin carotenoid score were analysed at baseline and 6 months. Serum L, Z, and MZ concentrations increased in all active interventions compared to placebo (p < 0.001 to p = 0.008). The diacetate micromicelle formulation exhibited a significantly higher mean response in serum concentrations of Z and MZ compared to the other active interventions (p = 0.002 to 0.019). A micromicellar formulation with solubilised Z and MZ diacetates is a promising technology advancement that enhances the bioavailability of these carotenoids when compared to traditional carotenoid formulations (ISRCTN clinical trial registration number: ISRCTN18206561).
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Affiliation(s)
- Marina Green-Gomez
- Nutrition Research Centre Ireland, School of Health Sciences, Carriganore House, Waterford Institute of Technology West Campus, X91 X236 Waterford, Ireland; (M.G.-G.); (A.P.-C.); (R.M.); (T.P.); (J.S.)
| | - Alfonso Prado-Cabrero
- Nutrition Research Centre Ireland, School of Health Sciences, Carriganore House, Waterford Institute of Technology West Campus, X91 X236 Waterford, Ireland; (M.G.-G.); (A.P.-C.); (R.M.); (T.P.); (J.S.)
| | - Rachel Moran
- Nutrition Research Centre Ireland, School of Health Sciences, Carriganore House, Waterford Institute of Technology West Campus, X91 X236 Waterford, Ireland; (M.G.-G.); (A.P.-C.); (R.M.); (T.P.); (J.S.)
| | - Tommy Power
- Nutrition Research Centre Ireland, School of Health Sciences, Carriganore House, Waterford Institute of Technology West Campus, X91 X236 Waterford, Ireland; (M.G.-G.); (A.P.-C.); (R.M.); (T.P.); (J.S.)
| | | | - Jim Stack
- Nutrition Research Centre Ireland, School of Health Sciences, Carriganore House, Waterford Institute of Technology West Campus, X91 X236 Waterford, Ireland; (M.G.-G.); (A.P.-C.); (R.M.); (T.P.); (J.S.)
| | - John M. Nolan
- Nutrition Research Centre Ireland, School of Health Sciences, Carriganore House, Waterford Institute of Technology West Campus, X91 X236 Waterford, Ireland; (M.G.-G.); (A.P.-C.); (R.M.); (T.P.); (J.S.)
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12
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Waugh N, Loveman E, Colquitt J, Royle P, Yeong JL, Hoad G, Lois N. Treatments for dry age-related macular degeneration and Stargardt disease: a systematic review. Health Technol Assess 2019; 22:1-168. [PMID: 29846169 DOI: 10.3310/hta22270] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Age-related macular degeneration (AMD) is the leading cause of visual loss in older people. Advanced AMD takes two forms, neovascular (wet) and atrophic (dry). Stargardt disease (STGD) is the commonest form of inherited macular dystrophy. OBJECTIVE To carry out a systematic review of treatments for dry AMD and STGD, and to identify emerging treatments where future NIHR research might be commissioned. DESIGN Systematic review. METHODS We searched MEDLINE, EMBASE, Web of Science and The Cochrane Library from 2005 to 13 July 2017 for reviews, journal articles and meeting abstracts. We looked for studies of interventions that aim to preserve or restore vision in people with dry AMD or STGD. The most important outcomes are those that matter to patients: visual acuity (VA), contrast sensitivity, reading speed, ability to drive, adverse effects of treatment, quality of life, progression of disease and patient preference. However, visual loss is a late event and intermediate predictors of future decline were accepted if there was good evidence that they are strong predictors of subsequent visual outcomes. These include changes detectable by investigation, but not necessarily noticed by people with AMD or STGD. ClinicalTrials.gov, the World Health Organization search portal and the UK Clinical Trials gateway were searched for ongoing and recently completed clinical trials. RESULTS The titles and abstracts of 7948 articles were screened for inclusion. The full text of 398 articles were obtained for further screening and checking of references and 112 articles were included in the final report. Overall, there were disappointingly few good-quality studies (including of sufficient size and duration) reporting useful outcomes, particularly in STGD. However we did identify a number of promising research topics, including drug treatments, stem cells, new forms of laser treatment, and implantable intraocular lens telescopes. In many cases, research is already under way, funded by industry or governments. LIMITATIONS In AMD, the main limitation came from the poor quality of much of the evidence. Many studies used VA as their main outcome despite not having sufficient duration to observe changes. The evidence on treatments for STGD is sparse. Most studies tested interventions with no comparison group, were far too short term, and the quality of some studies was poor. FUTURE WORK We think that the topics on which the Health Technology Assessment (HTA) and Efficacy Mechanism and Evaluation (EME) programmes might consider commissioning primary research are in STGD, a HTA trial of fenretinide (ReVision Therapeutics, San Diego, CA, USA), a visual cycle inhibitor, and EME research into the value of lutein and zeaxanthin supplements, using short-term measures of retinal function. In AMD, we suggest trials of fenretinide and of a potent statin. There is epidemiological evidence from the USA that the drug, levodopa, used for treating Parkinson's disease, may reduce the incidence of AMD. We suggest that similar research should be carried out using the large general practice databases in the UK. Ideally, future research should be at earlier stages in both diseases, before vision is impaired, using sensitive measures of macular function. This may require early detection of AMD by screening. STUDY REGISTRATION This study is registered as PROSPERO CRD42016038708. FUNDING The National Institute for Health Research HTA programme.
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Affiliation(s)
- Norman Waugh
- Division of Health Sciences, University of Warwick, Coventry, UK
| | | | | | - Pamela Royle
- Division of Health Sciences, University of Warwick, Coventry, UK
| | | | | | - Noemi Lois
- Ophthalmology, Royal Victoria Hospital, Belfast, UK.,Wellcome-Wolfson Centre for Experimental Medicine, Queens University, Belfast, UK
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13
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Consumption of eggs and the 15-year incidence of age-related macular degeneration. Clin Nutr 2019; 39:580-584. [PMID: 30914217 DOI: 10.1016/j.clnu.2019.03.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 03/04/2019] [Accepted: 03/06/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS A naturally rich source of lutein and zeaxanthin are eggs. There is scarce epidemiological data on the temporal association between total egg consumption and age-related macular degeneration (AMD) incidence. We aimed to establish the prospective and independent association between consumption of eggs with the incidence of AMD over a 15-year follow-up. METHODS In this population-based cohort study of 3,654 participants aged 49 + years examined at baseline, 2034 participants had complete information on baseline egg consumption and AMD signs over 15 years. AMD was determined from retinal photographs. Egg consumption was assessed using a semi-quantitative food-frequency questionnaire. Total egg intake was calculated through summing up intakes in all forms e.g. boiled, poached, fried, scrambled and/or omelette. We summarized total egg consumption into the following categories: ≤1 egg/week; 2-4 eggs/week; 5-6 eggs/week; and ≥1 egg/day. RESULTS At baseline, participants who consumed 2-4 eggs/week compared to those who consumed ≤1 egg/week (reference group) had reduced risk of incident late-stage AMD after 15 years: multivariable-adjusted odds ratio, OR, 0.51 (95% confidence intervals, CI, 0.28-0.92). Participants who consumed 2-4 eggs/week versus ≤1 egg/week at baseline had 62% reduced risk of developing neovascular AMD. Among those whose AMD onset was at or before the 10-year follow-up, consumption of 2-4 and 5-6 eggs/week was associated with 54% and 65% reduced risk of incident late AMD, respectively. When analyzed as a dichotomized variable, participants who consumed >1 egg/week versus ≤1 egg/week at baseline, had 46% reduced risk of developing late-stage AMD 15 years later: multivariable-adjusted OR 0.54 (95% CI 0.3-0.90). Non-significant associations were observed between egg consumption and incident early AMD. CONCLUSIONS Our findings suggest that moderate consumption of eggs significantly reduces the risk of developing incident late-stage AMD over 15 years.
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Biosynthesis and biomedical perspectives of carotenoids with special reference to human health-related applications. BIOCATALYSIS AND AGRICULTURAL BIOTECHNOLOGY 2019. [DOI: 10.1016/j.bcab.2018.11.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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15
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Phelan D, Prado-Cabrero A, Nolan JM. Analysis of Lutein, Zeaxanthin, and Meso-Zeaxanthin in the Organs of Carotenoid-Supplemented Chickens. Foods 2018; 7:E20. [PMID: 29401639 PMCID: PMC5848124 DOI: 10.3390/foods7020020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 01/29/2018] [Accepted: 01/30/2018] [Indexed: 11/18/2022] Open
Abstract
The macular carotenoids (i.e., lutein (L), zeaxanthin (Z) and meso-zeaxanthin (MZ)) exhibit anti-inflammatory, antioxidant and optical properties that are believed to support human health and function. Studying the accumulation and distribution of these nutrients in tissues and organs, in addition to the eye, is an important step in understanding how these nutrients might support global human function and health (e.g., heart and brain). Chicken is an appropriate animal model with which to study the accumulation of these carotenoids in organs, as the relevant transport molecules and carotenoid binding proteins for L, Z and MZ are present in both humans and chickens. In this experiment, a sample of 3 chickens that were supplemented with L and MZ diacetate (active group) and a sample of 3 chickens that received a standard diet (control group) were analysed. Both groups were analysed for L, Z and MZ concentrations in the brain, eyes, heart, lung, duodenum/pancreas, jejunum/ileum, kidney and breast tissue. L, Z and MZ were identified in all the organs/tissues analysed from the active group. L and Z were identified in all of the organs/tissues analysed from the control group; while, MZ was identified in the eyes of these animals only. The discovery that MZ is accumulated in the tissues and organs of chickens supplemented with this carotenoid is important, given that it is known that a combination of L, Z and MZ exhibits superior antioxidant capacity when compared to any of these carotenoids in isolation.
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Affiliation(s)
- David Phelan
- Nutrition Research Centre Ireland, School of Health Science, Carriganore House, Waterford Institute of Technology, West Campus, Waterford X91 K236, Ireland.
| | - Alfonso Prado-Cabrero
- Nutrition Research Centre Ireland, School of Health Science, Carriganore House, Waterford Institute of Technology, West Campus, Waterford X91 K236, Ireland
| | - John M Nolan
- Nutrition Research Centre Ireland, School of Health Science, Carriganore House, Waterford Institute of Technology, West Campus, Waterford X91 K236, Ireland.
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