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Lawler T, Mares JA, Liu Z, Thuruthumaly C, Etheridge T, Vajaranant TS, Domalpally A, Hammond BR, Wallace RB, Tinker LF, Nalbandyan M, Klein BEK, Liu Y. Association of macular pigment optical density with retinal layer thicknesses in eyes with and without manifest primary open-angle glaucoma. BMJ Open Ophthalmol 2023; 8:e001331. [PMID: 37890895 PMCID: PMC10619120 DOI: 10.1136/bmjophth-2023-001331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023] Open
Abstract
OBJECTIVE To investigate associations between baseline macular pigment optical density (MPOD) and retinal layer thicknesses in eyes with and without manifest primary open-angle glaucoma (POAG) in the Carotenoids in Age-Related Eye Disease Study 2 (CAREDS2). METHODS AND ANALYSIS MPOD was measured at CAREDS baseline (2001-2004) via heterochromatic flicker photometry (0.5° from foveal centre). Peripapillary retinal nerve fibre layer (RNFL), macular ganglion cell complex (GCC), ganglion cell layer (GCL), inner plexiform layer (IPL), and RNFL thicknesses were measured at CAREDS2 (2016-2019) via spectral-domain optical coherence tomography. Associations between MPOD and retinal thickness were assessed using multivariable linear regression. RESULTS Among 742 eyes (379 participants), manifest POAG was identified in 50 eyes (32 participants). In eyes without manifest POAG, MPOD was positively associated with macular GCC, GCL and IPL thicknesses in the central subfield (P-trend ≤0.01), but not the inner or outer subfields. Among eyes with manifest POAG, MPOD was positively associated with macular GCC, GCL, IPL and RNFL in the central subfield (P-trend ≤0.03), but not the inner or outer subfields, and was positively associated with peripapillary RNFL thickness in the superior and temporal quadrants (P-trend≤0.006). CONCLUSION We observed a positive association between MPOD and central subfield GCC thickness 15 years later. MPOD was positively associated with peripapillary RNFL superior and temporal quadrant thicknesses among eyes with manifest POAG. Our results linking low MPOD to retinal layers that are structural indicators of early glaucoma provide further evidence that carotenoids may be protective against manifest POAG.
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Affiliation(s)
- Thomas Lawler
- Department of Nutritional Sciences, College of Agricultural & Life Sciences, University of Wisconsin, Madison, Wisconsin, USA
| | - J A Mares
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin, USA
| | - Zhe Liu
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin, USA
| | - Catherine Thuruthumaly
- Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Tyler Etheridge
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin, USA
| | - Thasarat S Vajaranant
- Department of Ophthalmology & Visual Sciences, University of Illinois, Chicago, Illinois, USA
| | - Amitha Domalpally
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin, USA
| | - Billy R Hammond
- Department of Psychology, University of Georgia, Athens, Georgia, USA
| | - Robert B Wallace
- Department of Epidemiology, University of Iowa, Iowa City, Iowa, USA
| | - Lesley F Tinker
- Department of Cancer Prevention, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Marine Nalbandyan
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin, USA
| | - Barbara E K Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin, USA
| | - Yao Liu
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin, USA
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Tsujinaka H, Saeki K, Obayashi K, Nishi T, Ueda T, Ogata N. Positive Association between Macular Pigment Optical Density and Glomerular Filtration Rate: A Cross-Sectional Study. J Clin Med 2023; 12:5312. [PMID: 37629352 PMCID: PMC10456087 DOI: 10.3390/jcm12165312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
Although decreased macular pigment density is associated with the development of age-related macular degeneration (AMD), exactly how this decrease may contribute to the development of AMD is still not fully understood. In this study, we investigated the relationship between macular pigment optical density (MPOD) and estimated glomerular filtration rate (eGFR). MPOD was measured using MPS II (Electron Technology, Cambridge, UK) in 137 participants who showed no clinical signs of AMD at 3 months after cataract surgery, and simple and multiple linear regression analyses were performed to determine the associations with age, sex, abdominal circumference, diabetes, hypertension, smoking, intraocular lens color, visual acuity before and after surgery, and eGFR. The participants were divided into two groups based on the median MPOD (0.58): the high-pigment and low-pigment groups. The mean value of eGFR in the high-pigment group was significantly higher than that in the low-pigment group (64.2 vs. 58.1, p = 0.02). The simple linear regression analysis revealed a significant positive association between MPOD and eGFR (β = 0.0034, 95% confidence interval [CI]: 0.0011-0.0056, p = 0.0038), and this association was independent of age, sex, abdominal circumference, diabetes, smoking, hypertension, best-corrected visual acuity (BCVA) before surgery, BCVA after surgery, and intraocular lens color (β = 0.0033, 95% CI: 0.00090-0.0058, p = 0.0076). These results show a strong association of renal dysfunction with the decrease in MPOD.
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Affiliation(s)
- Hiroki Tsujinaka
- Department of Ophthalmology, Nara Medical University, Kashihara 634-8521, Nara, Japan; (H.T.)
| | - Keigo Saeki
- Department of Epidemiology, Nara Medical University, Kashihara 634-8521, Nara, Japan
| | - Kenji Obayashi
- Department of Epidemiology, Nara Medical University, Kashihara 634-8521, Nara, Japan
| | - Tomo Nishi
- Department of Ophthalmology, Nara Medical University, Kashihara 634-8521, Nara, Japan; (H.T.)
| | - Tetsuo Ueda
- Department of Ophthalmology, Nara Medical University, Kashihara 634-8521, Nara, Japan; (H.T.)
| | - Nahoko Ogata
- Department of Ophthalmology, Nara Medical University, Kashihara 634-8521, Nara, Japan; (H.T.)
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3
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Li X, Holt RR, Keen CL, Morse LS, Zivkovic AM, Yiu G, Hackman RM. Potential roles of dietary zeaxanthin and lutein in macular health and function. Nutr Rev 2023; 81:670-683. [PMID: 36094616 DOI: 10.1093/nutrit/nuac076] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Lutein, zeaxanthin, and meso-zeaxanthin are three xanthophyll carotenoid pigments that selectively concentrate in the center of the retina. Humans cannot synthesize lutein and zeaxanthin, so these compounds must be obtained from the diet or supplements, with meso-zeaxanthin being converted from lutein in the macula. Xanthophylls are major components of macular pigments that protect the retina through the provision of oxidant defense and filtering of blue light. The accumulation of these three xanthophylls in the central macula can be quantified with non-invasive methods, such as macular pigment optical density (MPOD). MPOD serves as a useful tool for assessing risk for, and progression of, age-related macular degeneration, the third leading cause of blindness worldwide. Dietary surveys suggest that the dietary intakes of lutein and zeaxanthin are decreasing. In addition to low dietary intake, pregnancy and lactation may compromise the lutein and zeaxanthin status of both the mother and infant. Lutein is found in modest amounts in some orange- and yellow-colored vegetables, yellow corn products, and in egg yolks, but rich sources of zeaxanthin are not commonly consumed. Goji berries contain the highest known levels of zeaxanthin of any food, and regular intake of these bright red berries may help protect against the development of age-related macular degeneration through an increase in MPOD. The purpose of this review is to summarize the protective function of macular xanthophylls in the eye, speculate on the compounds' role in maternal and infant health, suggest the establishment of recommended dietary values for lutein and zeaxanthin, and introduce goji berries as a rich food source of zeaxanthin.
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Affiliation(s)
- Xiang Li
- are with the Department of Nutrition, UC Davis, Davis, California, USA
| | - Roberta R Holt
- are with the Department of Nutrition, UC Davis, Davis, California, USA
| | - Carl L Keen
- are with the Department of Nutrition, UC Davis, Davis, California, USA
- is with the Department of Internal Medicine, UC Davis, Sacramento, California, USA
| | - Lawrence S Morse
- are with the Department of Ophthalmology and Vision Science, UC Davis Medical Center, Sacramento, California, USA
| | - Angela M Zivkovic
- re with the Department of Nutrition, UC Davis, Davis, California, USA
| | - Glenn Yiu
- are with the Department of Ophthalmology and Vision Science, UC Davis Medical Center, Sacramento, California, USA
| | - Robert M Hackman
- are with the Department of Nutrition, UC Davis, Davis, California, USA
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4
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Yoshida T, Takagi Y, Igarashi-Yokoi T, Ohno-Matsui K. Efficacy of lutein supplements on macular pigment optical density in highly myopic individuals: A randomized controlled trial. Medicine (Baltimore) 2023; 102:e33280. [PMID: 36961139 PMCID: PMC10036027 DOI: 10.1097/md.0000000000033280] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 02/23/2023] [Indexed: 03/25/2023] Open
Abstract
INTRODUCTION Lutein supplementation is beneficial in preventing maculae from developing serious ocular diseases. This study aimed to evaluate the efficacy and safety of lutein administration in patients with high myopia (HM). METHODS In a single-center randomized double-blinded placebo-controlled trial conducted over 24 months, 22 eyes were enrolled in lutein and control groups. Among them, 15 eyes in the lutein group and 13 eyes in the control group completed the study. All patients with HM (axial length > 26.00) were administered lutein (20 mg) or placebo once daily for 6 months. The macular pigment optical density (MPOD), rate of change in MPOD, visual acuity, contrast sensitivity, and electroretinogram after administration were examined at baseline, 3 months, and 6 months. RESULTS The baseline MPOD in the control and lutein groups was 0.71 ± 0.21 and 0.70 ± 0.22, respectively. The MPOD in the control and lutein groups at 3 months was 0.70 ± 0.21 and 0.70 ± 0.25, respectively, and at 6 months was 0.66 ± 0.20 and 0.72 ± 0.27, respectively, which was not significantly different from those at baseline or between the groups. The MPOD significantly increased from baseline in the lutein group with less than 28.25 mm of axial length at 6 months (from 0.71 ± 0.20 to 0.78 ± 0.22, P = .02, t test). visual acuity, contrast sensitivity, and electroretinogram values were similar between the groups. CONCLUSION Lutein supplementation showed significant benefits in MPOD augmentation in patients with HM.
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Affiliation(s)
- Takeshi Yoshida
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Advanced Ophthalmic Imaging, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasutaka Takagi
- Japan Medical Affairs, Japan business, Santen Pharmaceutical Co. Ltd., Osaka, Japan
| | - Tae Igarashi-Yokoi
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
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Wang H, Wang G, Billings R, Li D, Haase SR, Wheeler PF, Vance DE, Li W. Can Diet Supplements of Macular Pigment of Lutein, Zeaxanthin, and Meso-zeaxanthin Affect Cognition? J Alzheimers Dis 2022; 87:1079-1087. [DOI: 10.3233/jad-215736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Lutein (L), zeaxanthin (Z), and meso-zeaxanthin (MZ) are collectively called macular pigment. MZ can be converted from L in the macula. In the recent decade, many studies have been performed to investigate the effects for taking carotenoids, especially L and Z or L, Z, and MZ, as diet supplements on human health. Objective: We examined if diet supplements of L + Z or L + Z + MZ have effects on cognitive function in adults. Methods: A systemic literature search was performed in March 2021 with the following keywords: lutein, zeaxanthin, meso-zeaxanthin, cognition, cognitive, and macular pigment. The searched databases included Medline EBSCOhost, Scopus, Elsevier, Cochrane Library, ProQuest, and ClinicalTrials.gov. Findings from eight clinical trials were presented as the strongest evidence on the studied topic. Results: Most studies have found that macular pigments (L + Z) in blood or macula are positively correlated with cognitive performance. As an index of the amount of macular pigments in the brain, macular pigment optical density is related to cognitive performance in adults. In addition, there is an inverse relationship between a higher amount of macular pigment in the blood and lower risk of mild cognitive impairments or Alzheimer’s disease. Based on the findings from the clinical trials, diet supplements of L + Z or L + Z + MZ are associated with improved cognition in adults. Conclusion: The diet supplements of L + Z or L + Z+MZ are associated with better cognitive functioning, which may be via their beneficial effects on the vision.
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Affiliation(s)
- Hongwei Wang
- Department of Physiology, Henan Chinese Medicine University, Zhengzhou, China
| | - Ge Wang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rebecca Billings
- UAB Libraries, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Daniel Li
- University of California at Los Angeles, Los Angeles, CA, USA
| | - Shakaye R. Haase
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pariya F. Wheeler
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David E. Vance
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Wei Li
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
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6
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Hayashi R, Hayashi S, Machida S. Changes in Aqueous Humor Lutein Levels of Patients with Cataracts after a 6-Week Course of Lutein-Containing Antioxidant Supplementation. Curr Eye Res 2022; 47:1016-1023. [PMID: 35392749 DOI: 10.1080/02713683.2022.2059811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Oxidative damage is known to be an important cause of age-related cataracts and it has been suggested that administration of antioxidants, such as lutein, may delay the onset and progression of cataracts. Our previous investigation of human aqueous humor after the intake of a lutein-containing supplement demonstrated decreases in peroxidative products. This study evaluated the transportation of lutein into aqueous humor which is an important factor when measuring the antioxidant effects of lutein on the lens. METHODS This study enrolled 155 patients with binocular cataracts of the same grade. Serum and aqueous humor samples were collected during cataract surgery before (as pre-intake samples) and after 6 weeks of oral intake of Ocuvite + Lutein® (as post-intake samples). Lutein levels were measured with high-performance liquid chromatography. RESULTS Lutein levels in both the serum and aqueous humor were significantly higher in the post-intake than the pre-intake samples. There were significant increases in the lutein levels in patients with lower pre-intake lutein serum levels. There was also a tendency for greater increases in patients with lower pre-intake aqueous humor lutein levels. CONCLUSIONS These results demonstrate that oral lutein supplementation increases lutein levels, which further induce decreases in peroxidation in the aqueous humor. Furthermore, lutein supplementation may be more effective in patients with lower serum lutein levels.
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Affiliation(s)
- Rijo Hayashi
- Department of Ophthalmology, Saitama Medical Center, Dokkyo Medical University, Koshigaya, Japan
| | - Shimmin Hayashi
- Department of Ophthalmology, Saitama Medical Center, Dokkyo Medical University, Koshigaya, Japan.,Lively Eye Clinic, Soka, Japan
| | - Shigeki Machida
- Department of Ophthalmology, Saitama Medical Center, Dokkyo Medical University, Koshigaya, Japan
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7
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Zhang Y, Hao J, Cao K, Qi Y, Wang N, Han S. Macular pigment optical density responses to different levels of zeaxanthin in patients with high myopia. Graefes Arch Clin Exp Ophthalmol 2022; 260:2329-2337. [PMID: 35044504 DOI: 10.1007/s00417-021-05532-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/27/2021] [Accepted: 12/16/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Measurement of macular pigment optical density (MPOD) can be conducted to assist in the diagnosis of multiple fundus diseases. METHODS Fifty-four subjects with high myopia were prospectively recruited for a 3-month clinical trial. Detailed ophthalmologic examinations and MPOD measurements were performed. The subjects in each high myopia category group were randomly subdivided into 5 intervention groups, including a low-dose Lycium barbarum group (10 g Lycium barbarum, containing 10 mg of zeaxanthin and 1 mg of lutein), low-dose control group (1 mg of lutein), high-dose Lycium barbarum group (20 g of Lycium barbarum, containing 20 mg of zeaxanthin and 2 mg lutein), high-dose control group (2 mg of lutein), and a blank control group. Differences in the MPODs among the high myopia groups were calculated with Welch two-sample t tests. A linear mixed-effects model was constructed and Pearson's correlation analysis was performed to determine correlations between MPOD and other factors. The MPOD values at baseline and the 3-month follow-up were compared with the Mann-Whitney test. RESULTS The category 1 group had a significantly higher MPOD than the category 2 (P = 0.02) and category 3 groups (P < 0.001). The category 2 group had a significantly higher MPOD than the category 3 group (P < 0.001). The MPOD significantly decreased with increasing axial length (AL) and decreasing best-corrected visual acuity (BCVA) in the category 1-3 groups and with increasing age and increasing intraocular pressure (IOP) in the category 2-3 groups. The MPOD was significantly higher in the group who received high-dose zeaxanthin from Lycium barbarum than in the group who received high-dose lutein at 3 months (P = 0.0403), while no significant difference was identified between the low-dose zeaxanthin group and low-dose lutein group (P = 0.1117). CONCLUSIONS The MPOD was negatively correlated with the category of high myopia. Supplementation of zeaxanthin from Lycium barbarum is beneficial in preventing the loss of macular pigment of high myopia patients. TRIAL REGISTRATION Trial registration number and date of registration: ChiCTR2100046748.
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Affiliation(s)
- Yue Zhang
- Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China.,Beijing Institute of Ophthalmology, No. 1 Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China
| | - Jie Hao
- Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China.,Beijing Institute of Ophthalmology, No. 1 Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China
| | - Kai Cao
- Beijing Institute of Ophthalmology, No. 1 Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China
| | - Yue Qi
- Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China
| | - Ningli Wang
- Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China.,Beijing Institute of Ophthalmology, No. 1 Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China
| | - Song Han
- Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China.
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Goji Berry Intake Increases Macular Pigment Optical Density in Healthy Adults: A Randomized Pilot Trial. Nutrients 2021; 13:nu13124409. [PMID: 34959963 PMCID: PMC8708314 DOI: 10.3390/nu13124409] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/10/2021] [Accepted: 12/07/2021] [Indexed: 12/28/2022] Open
Abstract
Age-related macular degeneration (AMD) is the third leading cause of blindness worldwide. Macular pigment optical density (MPOD), a biomarker for AMD, is a non-invasive measure to assess risk. The macula xanthophyll pigments lutein (L) and zeaxanthin (Z) protect against blue light and provide oxidant defense, which can be indexed by MPOD. This study examined the effects of Z-rich goji berry intake on MPOD and skin carotenoids in healthy individuals. A randomized, unmasked, parallel-arm study was conducted with 27 participants, aged 45–65, who consumed either 28 g of goji berries or a supplement containing 6 mg L and 4 mg Z (LZ), five times weekly for 90 days. After 90 days, MPOD was significantly increased in the goji berry group at 0.25 and 1.75 retinal eccentricities (p = 0.029 and p = 0.044, respectively), while no changes were noted in the LZ group. Skin carotenoids were significantly increased in the goji berry group at day 45 (p = 0.025) and day 90 (p = 0.006), but not in the LZ group. Regular intake of goji berries in a healthy middle-aged population increases MPOD may help prevent or delay the development of AMD.
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Lem DW, Davey PG, Gierhart DL, Rosen RB. A Systematic Review of Carotenoids in the Management of Age-Related Macular Degeneration. Antioxidants (Basel) 2021; 10:1255. [PMID: 34439503 PMCID: PMC8389280 DOI: 10.3390/antiox10081255] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/30/2021] [Accepted: 08/02/2021] [Indexed: 01/14/2023] Open
Abstract
Age-related macular degeneration (AMD) remains a leading cause of modifiable vision loss in older adults. Chronic oxidative injury and compromised antioxidant defenses represent essential drivers in the development of retinal neurodegeneration. Overwhelming free radical species formation results in mitochondrial dysfunction, as well as cellular and metabolic imbalance, which becomes exacerbated with increasing age. Thus, the depletion of systemic antioxidant capacity further proliferates oxidative stress in AMD-affected eyes, resulting in loss of photoreceptors, neuroinflammation, and ultimately atrophy within the retinal tissue. The aim of this systematic review is to examine the neuroprotective potential of the xanthophyll carotenoids lutein, zeaxanthin, and meso-zeaxanthin on retinal neurodegeneration for the purpose of adjunctive nutraceutical strategy in the management of AMD. A comprehensive literature review was performed to retrieve 55 eligible publications, using four database searches from PubMed, Embase, Cochrane Library, and the Web of Science. Epidemiology studies indicated an enhanced risk reduction against late AMD with greater dietary consumption of carotenoids, meanwhile greater concentrations in macular pigment demonstrated significant improvements in visual function among AMD patients. Collectively, evidence strongly suggests that carotenoid vitamin therapies offer remarkable synergic protection in the neurosensory retina, with the potential to serve as adjunctive nutraceutical therapy in the management of established AMD, albeit these benefits may vary among different stages of disease.
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Affiliation(s)
- Drake W. Lem
- College of Optometry, Western University of Health Sciences, Pomona, CA 91766, USA;
| | | | | | - Richard B. Rosen
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
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10
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Cleland SC, Domalpally A, Liu Z, Pak JW, Blodi BA, Bailey S, Gehrs K, Wallace R, Tinker L, Mares JA. Reticular Pseudodrusen Characteristics and Associations in the Carotenoids in Age-Related Eye Disease Study 2 (CAREDS2), an Ancillary Study of the Women's Health Initiative. Ophthalmol Retina 2021; 5:721-729. [PMID: 33387684 PMCID: PMC8243566 DOI: 10.1016/j.oret.2020.12.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 12/23/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE To determine the prevalence and morphologic features of reticular pseudodrusen (RPD) and their association with participant demographics and age-related macular degeneration (AMD) status in the Carotenoids in Age-Related Eye Disease Study 2 (CAREDS2) sample, an ancillary study of the Women's Health Initiative Observational Study. DESIGN Cross-sectional, multicenter, natural history study. PARTICIPANTS Nine hundred and twenty-seven eyes from 466 postmenopausal women 69 to 101 years of age. METHODS Multimodal imaging, including spectral-domain (SD) OCT and infrared reflectance (IR), were used to identify RPD characteristics, including location (within or outside the 6-mm diameter circle centered at the macula), presence of peripapillary RPD, pattern of RPD, and RPD area. Age-related macular degeneration features from SD OCT, IR, and color photographs also were assessed and AMD severity was categorized. MAIN OUTCOME MEASURES Reticular pseudodrusen prevalence using SD OCT and IR imaging and AMD status. RESULTS Reticular pseudodrusen were present in 130 eyes (14% of eyes, 16% of participants), with increasing prevalence with age: 7% in those younger than 78 years, 14% in those 78 to 83 years of age, and 30% in those older than 83 years. Using clinical classification of AMD with color photography, RPD were seen in 2.4% of eyes with no AMD or aging changes, 11.5% in early AMD, 25.1% in intermediate AMD, and 51.1% in late AMD. Mean RPD area was 17.4 mm2 (standard deviation, 14.7 mm2). Ribbon morphologic RPD (53%) was more common than dot morphologic RPD (36%). Reticular pseudodrusen mostly were located both within and outside the 6-mm circle with primarily superior retinal distribution. Reticular pseudodrusen were visualized with corresponding color fundus photography in only 38 eyes (4% of total eyes). Participants with and without RPD had a visual acuity±standard error of 77.9 ± 1.4 letters and 81.3 ± 0.4 letters, respectively (P = 0.02). CONCLUSIONS The prevalence of RPD in CAREDS2 increased with age and was associated with AMD severity. Reticular pseudodrusen were detected in eyes without other features of AMD and could represent an earlier disease state. Multimodal imaging with SD OCT and IR has significantly greater sensitivity for visualizing RPD than color fundus photography.
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Affiliation(s)
- Spencer C Cleland
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin
| | - Amitha Domalpally
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin.
| | - Zhe Liu
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin
| | - Jeong W Pak
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin
| | - Barbara A Blodi
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin
| | - Steven Bailey
- Department of Ophthalmology, Oregon Health & Science University, Casey Eye Institute, Portland, Oregon
| | - Karen Gehrs
- Department of Ophthalmology & Visual Sciences, University of Iowa Hospital & Clinics, Iowa City, Iowa
| | - Robert Wallace
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa
| | - Lesley Tinker
- Division of Public Health Sciences, Department of Cancer Prevention Research Program, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Julie A Mares
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin
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11
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Lem DW, Gierhart DL, Davey PG. A Systematic Review of Carotenoids in the Management of Diabetic Retinopathy. Nutrients 2021; 13:2441. [PMID: 34371951 PMCID: PMC8308772 DOI: 10.3390/nu13072441] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/08/2021] [Accepted: 07/12/2021] [Indexed: 12/21/2022] Open
Abstract
Diabetic retinopathy, which was primarily regarded as a microvascular disease, is the leading cause of irreversible blindness worldwide. With obesity at epidemic proportions, diabetes-related ocular problems are exponentially increasing in the developed world. Oxidative stress due to hyperglycemic states and its associated inflammation is one of the pathological mechanisms which leads to depletion of endogenous antioxidants in retina in a diabetic patient. This contributes to a cascade of events that finally leads to retinal neurodegeneration and irreversible vision loss. The xanthophylls lutein and zeaxanthin are known to promote retinal health, improve visual function in retinal diseases such as age-related macular degeneration that has oxidative damage central in its etiopathogenesis. Thus, it can be hypothesized that dietary supplements with xanthophylls that are potent antioxidants may regenerate the compromised antioxidant capacity as a consequence of the diabetic state, therefore ultimately promoting retinal health and visual improvement. We performed a comprehensive literature review of the National Library of Medicine and Web of Science databases, resulting in 341 publications meeting search criteria, of which, 18 were found eligible for inclusion in this review. Lutein and zeaxanthin demonstrated significant protection against capillary cell degeneration and hyperglycemia-induced changes in retinal vasculature. Observational studies indicate that depletion of xanthophyll carotenoids in the macula may represent a novel feature of DR, specifically in patients with type 2 or poorly managed type 1 diabetes. Meanwhile, early interventional trials with dietary carotenoid supplementation show promise in improving their levels in serum and macular pigments concomitant with benefits in visual performance. These findings provide a strong molecular basis and a line of evidence that suggests carotenoid vitamin therapy may offer enhanced neuroprotective effects with therapeutic potential to function as an adjunct nutraceutical strategy for management of diabetic retinopathy.
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Affiliation(s)
- Drake W. Lem
- College of Optometry, Western University of Health Sciences, 309 E Second St, Pomona, CA 91766, USA;
| | | | - Pinakin Gunvant Davey
- College of Optometry, Western University of Health Sciences, 309 E Second St, Pomona, CA 91766, USA;
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Lawler T, Korger J, Liu Y, Liu Z, Pak JW, Barrett N, Blodi B, Domalpally A, Johnson E, Wallace R, Mares JA. Serum and Macular Carotenoids in Relation to Retinal Vessel Caliber Fifteen Years Later, in the Second Carotenoids in Age-Related Eye Disease Study. Invest Ophthalmol Vis Sci 2021; 62:20. [PMID: 34254974 PMCID: PMC8288049 DOI: 10.1167/iovs.62.9.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose We investigated whether dietary carotenoids lutein and zeaxanthin (L/Z) in the serum and macula were associated with central retinal arteriole and venule calibers in a follow-up ancillary study among older women in the Women's Health Initiative. Methods Among 390 women who participated in Carotenoids in Age-Related Eye Disease Study 2 (CAREDS2) (2016–2019), we investigated associations between serum L/Z at Women's Health Initiative baseline (1994–1998), and macular pigment optical density (MPOD) at CAREDS baseline (2001–2004), with central retinal vessel caliber in CAREDS2. MPOD was measured using heterochromatic flicker photometry (0.5° from the foveal center) in CAREDS baseline and CAREDS2. Vessel calibers were measured from fundus photographs (CAREDS2). We also explored associations in women with stable MPOD (±0.10 optical density units) over 15 years (n = 106), given the long-term increases in MPOD related to diet patterns and supplement use. Associations were investigated using linear modeling. Results In the full sample (n = 390), higher serum L/Z (tertile 3 vs. 1) was positively associated with arteriole caliber (mean ± SE, 145.0 ± 1.4 µm vs. 140.8 ± 1.4 µm; P = 0.05) and venule caliber (214.6 ± 2.2 µm vs. 207.5 ± 2.2 µm; P = 0.03). MPOD was also associated with wider vessel calibers (tertile 3 vs. 1), but the trend was only statistically significant for venules (144.4 ± 1.4 µm vs. 141.1 ± 1.4 µm [P = 0.12] and 213.3 ± 2.1 µm vs. 206.0 ± 2.1 µm [P = 0.02], respectively.) Most associations were strengthened in women with stable MPOD over 15 years, including between MPOD and arteriole caliber (149.8 ± 2.6 µm vs.135.8 ± 3.0 µm; P = 0.001). Conclusions Higher L/Z status in serum and retina was associated with larger central retinal vessel calibers. Prospective studies and clinical trials are needed to elucidate whether L/Z supplementation prevents vision loss through increasing blood flow.
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Affiliation(s)
- Thomas Lawler
- Department of Nutritional Sciences, College of Agricultural & Life Sciences, University of Wisconsin, Madison, Wisconsin, United States
| | - Jackson Korger
- Department of Ophthalmology and Visual Sciences, School of Medicine and Population Health, University of Wisconsin, Madison, Wisconsin, United States
| | - Yao Liu
- Department of Ophthalmology and Visual Sciences, School of Medicine and Population Health, University of Wisconsin, Madison, Wisconsin, United States
| | - Zhe Liu
- Department of Ophthalmology and Visual Sciences, School of Medicine and Population Health, University of Wisconsin, Madison, Wisconsin, United States
| | - Jeong W Pak
- Department of Ophthalmology and Visual Sciences, School of Medicine and Population Health, University of Wisconsin, Madison, Wisconsin, United States
| | - Nancy Barrett
- Department of Ophthalmology and Visual Sciences, School of Medicine and Population Health, University of Wisconsin, Madison, Wisconsin, United States
| | - Barbara Blodi
- Department of Ophthalmology and Visual Sciences, School of Medicine and Population Health, University of Wisconsin, Madison, Wisconsin, United States
| | - Amitha Domalpally
- Department of Ophthalmology and Visual Sciences, School of Medicine and Population Health, University of Wisconsin, Madison, Wisconsin, United States
| | - Elizabeth Johnson
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts, United States
| | - Robert Wallace
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, United States
| | - Julie A Mares
- Department of Nutritional Sciences, College of Agricultural & Life Sciences, University of Wisconsin, Madison, Wisconsin, United States.,The full list of CAREDS2 Investigators and research team is listed in the Acknowledgments
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13
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Green-Gomez M, Moran R, Stringham J, Hernández-Alcaraz C, Mendoza-Herrera K, Fromow-Guerra JJ, Prado-Cabrero A, Nolan J. Environmental and Nutritional Determinants of Macular Pigment in a Mexican Population. Invest Ophthalmol Vis Sci 2021; 62:18. [PMID: 34241622 PMCID: PMC8288050 DOI: 10.1167/iovs.62.9.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/21/2021] [Indexed: 01/23/2023] Open
Abstract
Purpose The carotenoids lutein (L), zeaxanthin (Z), and meso-zeaxanthin deposit at the macula as macular pigment (MP) and provide visual benefits and protection against macular diseases. The present study investigated MP, its nutritional and environmental determinants, and its constituent carotenoids in serum from a Mexican sample, in healthy participants and with metabolic diseases. Additionally, we compared these variables with an Irish sample. Methods MP was measured in 215 subjects from a rural community in Mexico with dual-wavelength autofluorescence imaging reported as MP optical volume (MPOV). Dietary intake and serum concentrations of L and Z were evaluated. Results The mean MPOV was 8429 (95% confidence interval, 8060-8797); range. 1171-15,976. The mean L and Z serum concentrations were 0.25 ± 0.15 µmol/L and 0.09 ± 0.04 µmol/L, respectively. The MPOV was positively correlated with L and Z serum concentrations (r = 0.347; P < 0.001 and r = 0.311; P < 0.001, respectively), but not with L + Z dietary estimates. Subjects with daily sunlight exposure of more than 50% were found to have significantly higher MPOV than those with less than 50% (P = 0.005). MPOV and serum concentrations of L and Z were significantly higher in the Mexican sample compared with the Irish sample, but this difference was not reflected in dietary analysis. Conclusions These new data from a Mexican sample provide evidence of the multifactorial interactions and environmental determinants of MP such as sunlight exposure and dietary patterns. These findings will be essential for future studies in Mexico for eye health, visual function, and ocular pathology.
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Affiliation(s)
- Marina Green-Gomez
- Nutrition Research Centre Ireland, School of Health Science, Waterford Institute of Technology, Waterford, Ireland
| | - Rachel Moran
- Nutrition Research Centre Ireland, School of Health Science, Waterford Institute of Technology, Waterford, Ireland
| | - James Stringham
- Nutrition Research Centre Ireland, School of Health Science, Waterford Institute of Technology, Waterford, Ireland
| | - Cesar Hernández-Alcaraz
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Kenny Mendoza-Herrera
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - J Jans Fromow-Guerra
- Retina Division, Asociación Para Evitar la Ceguera en México I.A.P., México City, México
| | - Alfonso Prado-Cabrero
- Nutrition Research Centre Ireland, School of Health Science, Waterford Institute of Technology, Waterford, Ireland
| | - John Nolan
- Nutrition Research Centre Ireland, School of Health Science, Waterford Institute of Technology, Waterford, Ireland
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Hayashi R, Hayashi S, Machida S. Changes in macular pigment optical density among pseudophakic patients following intake of a lutein-containing supplement. Ophthalmic Res 2021; 64:828-836. [PMID: 34148037 DOI: 10.1159/000517573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 05/29/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Rijo Hayashi
- Department of Ophthalmology, Saitama Medical Center, Dokkyo Medical University, Koshigaya, Japan
| | - Shimmin Hayashi
- Department of Ophthalmology, Saitama Medical Center, Dokkyo Medical University, Koshigaya, Japan
- Lively Eye Clinic, Soka, Japan
| | - Shigeki Machida
- Department of Ophthalmology, Saitama Medical Center, Dokkyo Medical University, Koshigaya, Japan
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15
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Bartlett H, Howells O, Eperjesi F. The role of macular pigment assessment in clinical practice: a review. Clin Exp Optom 2021; 93:300-8. [DOI: 10.1111/j.1444-0938.2010.00499.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Hannah Bartlett
- Ophthalmic Research Group, School of Life & Health Sciences, Aston University, Birmingham, United Kingdom
E‐mail:
| | - Olivia Howells
- Ophthalmic Research Group, School of Life & Health Sciences, Aston University, Birmingham, United Kingdom
E‐mail:
| | - Frank Eperjesi
- Ophthalmic Research Group, School of Life & Health Sciences, Aston University, Birmingham, United Kingdom
E‐mail:
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16
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Rutledge GA, Pratt SG, Richer SP, Huntjens B, Perry CB, Pratt G, Podella C. Foveal macular pigment dip in offspring of age-related macular degeneration patients is inversely associated with omega-3 index. BMC Ophthalmol 2020; 20:473. [PMID: 33267825 PMCID: PMC7709463 DOI: 10.1186/s12886-020-01742-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 11/23/2020] [Indexed: 12/23/2022] Open
Abstract
Background Offspring of parent(s) with age-related macular degeneration (AMD) have a 45% lifetime risk of developing the disease. High foveal macular pigment optical density (MPOD) is protective, whereas individuals with a “foveal macular pigment dip” (FMPD) are at increased risk. Shortage of the dietary carotenoids lutein, zeaxanthin as well as fish consumption are reported AMD risk factors. This Early Biomarkers of AMD (EBAMD) study evaluates serum factors that protect foveal MPOD architecture in Caucasian offspring of parent(s) with AMD. Methods N = 130 subjects [mean (SD) age 62.8 (8.6) years; 36/94 male/female] were recruited from Scripps Health/ Scripps Memorial Hospital/ Scripps Mericos Eye Institute between 2012 and 2017. Macula pigment 3D topography was evaluated using specular reflectance. Buccal genetic cheek swab, circulating serum dietary carotenoids and long-term RBC omega-3 fatty acid status, as well as common secondary clinical structural and vision function parameters were obtained. Results 41 % of offspring of AMD parent(s) presented with FMPD. These offspring were about 4 years younger than those without FMPD (controls; P = 0.012) and had thinner foveas (P = 0.010). There were no differences in gender, BMI, % body fat, visual acuity or contrast sensitivity between those with and without FMPD. % RBC membrane docosahexaenoic acid (DHA) was reduced in FMPD offspring vs. control offspring (P = 0.04). The Omega-3 Index was significantly decreased in the FMPD group (P = 0.03). Conclusions The percentage of FMPD in AMD offspring is nearly twice that reported for the general population in the scientific literature. Offspring presenting FMPD had similar AMD genetic risk, but significantly reduced % RBC membrane omega-3 fatty acids and thinner foveas compared with those without FMPD. Our data supports the importance of ‘essential fatty’ acids as an independent AMD risk factor.
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Affiliation(s)
- Grant A Rutledge
- Scripps Health/Scripps Memorial Hospital/Scripps Mericos Eye Institute - Scripps Clinical Research Service, La Jolla, CA, USA. .,Department of Ecology and Evolutionary Biology, University of California, Irvine, CA, USA. .,USDA Human Nutrition Research Center on Aging, Boston, MA, USA.
| | - Steven G Pratt
- Scripps Health/Scripps Memorial Hospital/Scripps Mericos Eye Institute - Scripps Clinical Research Service, La Jolla, CA, USA
| | - Stuart P Richer
- Eye Clinics, Captain James A. Lovell Federal Health Care Center, North Chicago, IL, USA
| | - Byki Huntjens
- Centre for Applied Vision Research, Division of Optometry and Vision Sciences, City, University of London, London, UK
| | - C Blake Perry
- Scripps Health/Scripps Memorial Hospital/Scripps Mericos Eye Institute - Scripps Clinical Research Service, La Jolla, CA, USA
| | - Gunilla Pratt
- Scripps Health/Scripps Memorial Hospital/Scripps Mericos Eye Institute - Scripps Clinical Research Service, La Jolla, CA, USA
| | - Carla Podella
- Eye Clinics, Captain James A. Lovell Federal Health Care Center, North Chicago, IL, USA
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Investigation of Surrogate Biomarkers Associated with Macular Pigment Status in a Group of Older Irish Adults. Optom Vis Sci 2020; 97:879-888. [PMID: 33055512 DOI: 10.1097/opx.0000000000001587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SIGNIFICANCE Macular pigment (MP) confers potent antioxidant and anti-inflammatory effects at the macula; however, its optical density in the eye is not routinely measured in clinical practice. PURPOSE This study explored a range of surrogate biomarkers including anthropometric, clinical, and plasma measures that may be associated with lower MP optical density (MPOD). METHODS Two thousand five hundred ninety-four subjects completed a full MP assessment as part of wave 1 of The Irish Longitudinal Study of Aging. Macular pigment optical density was measured using customized heterochromatic flicker photometry. Clinical (blood pressure), plasma (lipoproteins, inflammatory markers), and anthropometric (waist, hip, height, weight) biomarkers were measured for each participant. RESULTS Mean (standard deviation) MPOD for the study group was 0.223 (0.161), with a range of 0 to 1.08. One-way ANOVA revealed that MPOD was significantly lower among participants with low plasma high-density lipoprotein (HDL; P = .04), raised plasma triglyceride-to-HDL ratio (P = .003), and raised total cholesterol-to-HDL ratio (P = .03). Subjects with an elevated waist circumference (WC) had a significantly lower MPOD (mean, 0.216 [0.159]) compared with those with an ideal WC (mean, 0.229 [0.162]; P = .03). Significant correlates of MPOD on mixed linear model analysis included education, smoking status, and WC. CONCLUSIONS Higher abdominal fat is associated with lower MPOD in this representative sample of older Irish adults. Although altered lipoprotein profiles (low HDL, raised triglyceride-to-HDL ratio, raised total cholesterol-to-HDL ratio) may affect the transport, uptake, and stabilization of carotenoids in the retina, these plasma biomarkers were not predictive of low MPOD after adjustment for abdominal circumference. Although WC emerged as a viable anthropometric predictor of lower MPOD, its effect size seems to be small.
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Zanón-Moreno V, Domingo Pedrol JC, Sanz-González SM, Raga-Cervera J, Salazar-Corral J, Pinazo-Durán MD. Feasibility study of a docosahexaenoic acid optimized nutraceutical formulation on the macular levels of lutein in a healthy Mediterranean population. Ophthalmic Res 2020; 64:1068-1076. [PMID: 32544914 DOI: 10.1159/000509439] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/15/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Macular pigment optical density plays a pivotal role in maintaining macular structure and functioning. Research shows that daily consumption of lutein reduces the risk of eye diseases such as age-related macular degeneration. OBJECTIVE This study analyzes the influence of a supplementation containing lutein and antioxidant vitamins either with or without docosahexaenoic acid (DHA), with the main objective of identifying macular pigment optical density (MPOD) changes in both eyes at the end of the follow-up using the Visucam® retinograph. The secondary endpoint was to determine variation in the lutein and DHA levels in plasma and red blood cell membranes respectively. METHODS One hundred healthy participants (200 eyes) aged 40-70 years (mean age 49.3 years, SEM=13.7) were randomized in a 1:1 ratio to receive daily one of the following supplements for 3 months: Lutein group (LT-G, n=49), Lutein /Docosahexaenoic acid group (LT/DHA-G, n= 51). The MPOD was measured at baseline and end of the follow-up by retinography (Visucam® retinograph). Lutein in plasma was determined by HPLC and DHA in red blood cell membranes was analyzed by gas chromatograph/mass spectrometer. RESULTS From baseline, macular pigment optical density showed significantly higher values in the Lutein/DHA group than in the Lutein group at the end of the study (p<0.0001). Significantly higher Lutein in plasma (p<0.0001) and DHA (p<0.0001) levels in the red blood cell membrane were seen in the Lutein/DHA group than in the Lutein group at the 3-month follow-up. CONCLUSION Lutein supplementation improves macular pigment optical density in healthy subjects from a Mediterranean population being significantly increased in the presence of DHA. Therefore, our findings highlight the relevance of the adjunctive role of DHA for a better Lutein availability.
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Affiliation(s)
- Vicente Zanón-Moreno
- Ophthalmic Research Unit "Santiago Grisolía" FISABIO, and Cellular and Molecular Ophthalmobiology Group of the Department of Surgery at University of Valencia, Valencia, Spain
- Spanish Network of Cooperative Research in Ophthalmology (OFTARED), Carlos III Health Institute, Ministry of Science, Innovation and Universities, Madrid, Spain
- Faculty of Health Sciences, Valencian International University, Valencia, Spain
| | - Joan C Domingo Pedrol
- Department of Biochemistry and Molecular Biomedicine at the Faculty of Biology, University of Barcelona, Barcelona, Spain
| | - Silvia M Sanz-González
- Ophthalmic Research Unit "Santiago Grisolía" FISABIO, and Cellular and Molecular Ophthalmobiology Group of the Department of Surgery at University of Valencia, Valencia, Spain
- Spanish Network of Cooperative Research in Ophthalmology (OFTARED), Carlos III Health Institute, Ministry of Science, Innovation and Universities, Madrid, Spain
| | - Jorge Raga-Cervera
- Ophthalmic Research Unit "Santiago Grisolía" FISABIO, and Cellular and Molecular Ophthalmobiology Group of the Department of Surgery at University of Valencia, Valencia, Spain
- Department of Ophthalmology, Hospital of Manises, Manises, Spain
| | - Juan Salazar-Corral
- Spanish Network of Cooperative Research in Ophthalmology (OFTARED), Carlos III Health Institute, Ministry of Science, Innovation and Universities, Madrid, Spain
- Institute of Ophthalmic Research "Ramón Castroviejo", Complutensis University of Madrid, Madrid, Spain
| | - Maria Dolores Pinazo-Durán
- Ophthalmic Research Unit "Santiago Grisolía" FISABIO, and Cellular and Molecular Ophthalmobiology Group of the Department of Surgery at University of Valencia, Valencia, Spain
- Spanish Network of Cooperative Research in Ophthalmology (OFTARED), Carlos III Health Institute, Ministry of Science, Innovation and Universities, Madrid, Spain
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Tanprasertsuk J, Mohn ES, Matthan NR, Lichtenstein AH, Barger K, Vishwanathan R, Johnson MA, Poon LW, Johnson EJ. Serum Carotenoids, Tocopherols, Total n-3 Polyunsaturated Fatty Acids, and n-6/n-3 Polyunsaturated Fatty Acid Ratio Reflect Brain Concentrations in a Cohort of Centenarians. J Gerontol A Biol Sci Med Sci 2019; 74:306-314. [PMID: 29893813 DOI: 10.1093/gerona/gly125] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Indexed: 02/01/2023] Open
Abstract
Investigating the role of nutrition on cognitive health is challenging. Human brain tissue is inaccessible in living humans and is often limited in deceased individuals. Therefore, biomarkers of brain nutrient levels are of interest. The objective of this study was to characterize the relationships between levels of fat-soluble nutrients in serum and matched brain tissues from the frontal and temporal cortices of participants in the Georgia Centenarian Study (n = 47). After adjusting for sex, race, cognitive status (Global Deterioration Scale), body mass index, and presence of hypertension and/or diabetes, there was a significant relationship (p < 0.05) between serum and brain levels of carotenoids (lutein, zeaxanthin, cryptoxanthin, β-carotene), α-, γ-tocopherols, total n-3 polyunsaturated fatty acids (PUFAs), and n-6/n-3 PUFA ratio. The relationship between serum and brain total n-6 PUFAs was inconsistent among the two brain regions. No significant relationship was identified between serum and brain retinol, total saturated fatty acid, total monounsaturated fatty acid, and trans-fatty acid levels. These findings suggest that serum carotenoids, tocopherols, total n-3 PUFAs, and n-6/n-3 PUFA ratio reflect levels in brain and can be used as surrogate biomarkers in older population.
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Affiliation(s)
- Jirayu Tanprasertsuk
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts
| | - Emily S Mohn
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts
| | - Nirupa R Matthan
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts
| | - Alice H Lichtenstein
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts
| | - Kathryn Barger
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts
| | - Rohini Vishwanathan
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts
| | - Mary Ann Johnson
- Department of Foods and Nutrition, University of Georgia, Athens, Georgia.,Institute of Gerontology, University of Georgia, Athens, Georgia
| | - Leonard W Poon
- Institute of Gerontology, University of Georgia, Athens, Georgia
| | - Elizabeth J Johnson
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts
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20
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A review of the putative causal mechanisms associated with lower macular pigment in diabetes mellitus. Nutr Res Rev 2019; 32:247-264. [PMID: 31409441 DOI: 10.1017/s095442241900012x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Macular pigment (MP) confers potent antioxidant and anti-inflammatory effects at the macula, and may therefore protect retinal tissue from the oxidative stress and inflammation associated with ocular disease and ageing. There is a body of evidence implicating oxidative damage and inflammation as underlying pathological processes in diabetic retinopathy. MP has therefore become a focus of research in diabetes, with recent evidence suggesting that individuals with diabetes, particularly type 2 diabetes, have lower MP relative to healthy controls. The present review explores the currently available evidence to illuminate the metabolic perturbations that may possibly be involved in MP's depletion. Metabolic co-morbidities commonly associated with type 2 diabetes, such as overweight/obesity, dyslipidaemia, hyperglycaemia and insulin resistance, may have related and independent relationships with MP. Increased adiposity and dyslipidaemia may adversely affect MP by compromising the availability, transport and assimilation of these dietary carotenoids in the retina. Furthermore, carotenoid intake may be compromised by the dietary deficiencies characteristic of type 2 diabetes, thereby further compromising redox homeostasis. Candidate causal mechanisms to explain the lower MP levels reported in diabetes include increased oxidative stress, inflammation, hyperglycaemia, insulin resistance, overweight/obesity and dyslipidaemia; factors that may negatively affect redox status, and the availability, transport and stabilisation of carotenoids in the retina. Further study in diabetic populations is warranted to fully elucidate these relationships.
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Scanlon G, McCartney D, Butler JS, Loskutova E, Loughman J. Identification of Surrogate Biomarkers for the Prediction of Patients at Risk of Low Macular Pigment in Type 2 Diabetes. Curr Eye Res 2019; 44:1369-1380. [PMID: 31225969 DOI: 10.1080/02713683.2019.1635166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Purpose: This cross-sectional study compared macular pigment (MP) levels among persons with Type 2 diabetes relative to healthy controls. Additionally, a range of behavioral, anthropometric, clinical and serum measures were explored as possible predictors of low MP optical density (MPOD) in diabetes.Methods: Two health status groups; Group 1: Type 2 diabetes (n = 188), and Group 2: Healthy controls (n = 2,594) completed a full MP assessment using customized heterochromatic flicker photometry, as part of The Irish Longitudinal Study on Aging (TILDA). Clinical [blood pressure; cataract status; MPOD] and anthropometric [waist (cm); weight (kg); hip (cm)] measurements were taken, and a blood sample drawn for analysis of serum biomarkers [lipoproteins; inflammatory markers (C reactive protein and vitamin-D)].Results: One-way ANOVA revealed lower MPOD in subjects with Type 2 diabetes relative to controls (p = .047). Amongst participants with diabetes, those with low serum vitamin D (≤50 nmol/L) had significantly lower mean MPOD compared to those with sufficient serum vitamin D levels >50 nmol/L (0.173(0.148) vs. 0.226(0.145); p = .006). Concomitantly, MP was significantly lower in diabetes participants with raised serum triglyceride (TG) to high density lipoprotein (HDL) ratio (TG/HDL); values >1.74 mmol/L (0.172 (0.140) vs 0.215 (0.152); p = .039). Body mass index, waist-to-height ratio and waist circumference, were all significantly negatively correlated with MPOD (Pearson's correlation, p < .05 for all). Significant correlates of MPOD in the multivariate regression model included smoking, cataract, and vitamin D, which collectively contributed 18.5% of the overall variability in MPOD status amongst participants with Type 2 diabetes.Conclusions: This study provides additional evidence that low MP may indeed be a feature of Type 2 diabetes, and further identifies smoking, cataract and vitamin D status as plausible predictors of low MPOD amongst persons with Type 2 diabetes.
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Affiliation(s)
- Grainne Scanlon
- Centre for Eye Research Ireland, School of Physics, Clinical & Optometric Sciences, Environmental Sustainability and Health Institute, Technological University Dublin, Dublin, Ireland
| | - Daniel McCartney
- School of Biological and Health Sciences, Technological University Dublin, City Campus, Dublin, Ireland
| | - John S Butler
- Centre for Eye Research Ireland, School of Physics, Clinical & Optometric Sciences, Environmental Sustainability and Health Institute, Technological University Dublin, Dublin, Ireland.,School of Mathematical Sciences, Technological University Dublin, City Campus, Dublin, Ireland
| | - Ekaterina Loskutova
- Centre for Eye Research Ireland, School of Physics, Clinical & Optometric Sciences, Environmental Sustainability and Health Institute, Technological University Dublin, Dublin, Ireland
| | - James Loughman
- Centre for Eye Research Ireland, School of Physics, Clinical & Optometric Sciences, Environmental Sustainability and Health Institute, Technological University Dublin, Dublin, Ireland
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Stringham JM, Johnson EJ, Hammond BR. Lutein across the Lifespan: From Childhood Cognitive Performance to the Aging Eye and Brain. Curr Dev Nutr 2019; 3:nzz066. [PMID: 31321376 PMCID: PMC6629295 DOI: 10.1093/cdn/nzz066] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 05/05/2019] [Accepted: 05/30/2019] [Indexed: 12/21/2022] Open
Abstract
Lutein is a non-provitamin A dietary carotenoid found in dark green leafy vegetables, corn, eggs, and avocados. Among the carotenoids, lutein and its isomer, zeaxanthin, are the only 2 that cross the blood-retina barrier to form macular pigment in the retina. Lutein also preferentially accumulates in the human brain across multiple life stages. A variety of scientific evidence supports a role for lutein in visual as well as cognitive function across the lifespan. The purpose of this review is to summarize the latest science on lutein's role in the eye and the brain across different ages.
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Affiliation(s)
| | | | - B Randy Hammond
- Department of Psychology, University of Georgia-Athens, Athens, GA, USA
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Dietary Antioxidants, Macular Pigment, and Glaucomatous Neurodegeneration: A Review of the Evidence. Nutrients 2019; 11:nu11051002. [PMID: 31052471 PMCID: PMC6567242 DOI: 10.3390/nu11051002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 04/26/2019] [Accepted: 04/29/2019] [Indexed: 12/29/2022] Open
Abstract
Primary open-angle glaucoma (POAG) is a leading cause of irreversible blindness worldwide, and the prevalence is projected to increase to 112 million worldwide by 2040. Intraocular pressure is currently the only proven modifiable risk factor to treat POAG, but recent evidence suggests a link between antioxidant levels and risk for prevalent glaucoma. Studies have found that antioxidant levels are lower in the serum and aqueous humor of glaucoma patients. In this review, we provide a brief overview of the evidence linking oxidative stress to glaucomatous pathology, followed by an in-depth discussion of epidemiological studies and clinical trials of antioxidant consumption and glaucomatous visual field loss. Lastly, we highlight a possible role for antioxidant carotenoids lutein and zeaxanthin, which accumulate in the retina to form macular pigment, as evidence has emerged supporting an association between macular pigment levels and age-related eye disease, including glaucoma. We conclude that the evidence base is inconsistent in showing causal links between dietary antioxidants and glaucoma risk, and that prospective studies are needed to further investigate the possible relationship between macular pigment levels and glaucoma risk specifically.
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Abstract
Health professionals consider the evaluation of eating habits to be challenging, given the potential biases of dietary questionnaires based on self-reported data. Circulating carotenoid concentrations are reliable biomarkers of dietary carotenoid intake and could be useful in the validation of dietary assessment tools. However, there is a sex difference in circulating carotenoids, with women displaying higher concentrations compared with men independent of intake. The aim of the present study was to identify the correlates of plasma carotenoid concentrations among men (n 155) and women (n 110) enrolled in six fully controlled dietary interventions with varying dietary carotenoid intakes. We looked at the associations of post-intervention fasting plasma carotenoid concentrations (α-carotene, β-carotene, β-cryptoxanthin, lutein, lycopene and zeaxanthin) with physical and metabolic characteristics. We found that increased body weight (r -0·47, P<0·0001) and waist circumference (r -0·46, P<0·0001) were associated with lower plasma total carotenoid concentrations, while elevated plasma LDL-cholesterol (r 0·49, P<0·0001) and HDL-cholesterol (r 0·50, P<0·0001) concentrations were correlated with higher total carotenoids in plasma. Women had significantly higher plasma total carotenoid concentrations compared with men, despite significantly lower dietary carotenoid intake. Adjustment of circulating carotenoid concentrations for plasma HDL-cholesterol eliminated sex difference in plasma carotenoid concentrations. Our results suggest that physical characteristics as well as plasma lipids are associated with circulating carotenoid concentrations and that these variables should be taken into account when using plasma carotenoids as biomarkers for food intake in men and women.
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Olmedilla-Alonso B, Estévez-Santiago R, Silván JM, Sánchez-Prieto M, de Pascual-Teresa S. Effect of Long-Term Xanthophyll and Anthocyanin Supplementation on Lutein and Zeaxanthin Serum Concentrations and Macular Pigment Optical Density in Postmenopausal Women. Nutrients 2018; 10:nu10080959. [PMID: 30044439 PMCID: PMC6116081 DOI: 10.3390/nu10080959] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 11/16/2022] Open
Abstract
Xanthophylls (lutein, L; zeaxanthin, Z) and anthocyanins are often included in food supplements to improve ocular health. There are no dietary reference intakes for them. The aim was to assess the effects of L, Z and anthocyanin supplementation on short and long-term lutein status markers (serum concentration and macular pigment optical density (MPOD)). Seventy-two postmenopausal women were randomized into a parallel study of 8 months: Group A-anthocyanines (60 mg/day); Group X-xanthophylls (6 mg L + 2 mg Z/day); Group X+A-anthocyanines (60 mg/day) + xanthophylls (6 mg L + 2 mg Z/day). At the beginning of the study, 4 and 8 month serum L and Z concentrations were determined (HPLC), as well as L, Z and anthocyanine dietary intake and MPOD (heterochromic flicker photometry). Baseline concentrations of L (0.35 ± 0.19 μmol/L), Z (0.11 ± 0.05 μmol/L), L+Z/cholesterol/triglycerides (0.07 ± 0.04 μmol/mmol) increased in Group X (2.8- and 1.6-fold in L and Z concentrations) and in group XA (2- and 1.4-fold in L and Z concentrations). MPOD (baseline: 0.32 ± 0.13 du) was not modified in any of the groups at the end of the study. There were no differences in the dietary intake of L+Z and anthocyanin at any point in time in any group. Supplementation of L and Z at a dietary level provoked an increase in their serum concentration that was not modified by simultaneous supplementation with anthocyanins.
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Affiliation(s)
- Begoña Olmedilla-Alonso
- Instituto de Ciencia y Tecnología de Alimentos y Nutrición (ICTAN-CSIC), C/José Antonio Novais, 10, 28040 Madrid, Spain.
| | - Rocío Estévez-Santiago
- Instituto de Ciencia y Tecnología de Alimentos y Nutrición (ICTAN-CSIC), C/José Antonio Novais, 10, 28040 Madrid, Spain.
| | - José-Manuel Silván
- Instituto de Ciencia y Tecnología de Alimentos y Nutrición (ICTAN-CSIC), C/José Antonio Novais, 10, 28040 Madrid, Spain.
| | - Milagros Sánchez-Prieto
- Instituto de Ciencia y Tecnología de Alimentos y Nutrición (ICTAN-CSIC), C/José Antonio Novais, 10, 28040 Madrid, Spain.
| | - Sonia de Pascual-Teresa
- Instituto de Ciencia y Tecnología de Alimentos y Nutrición (ICTAN-CSIC), C/José Antonio Novais, 10, 28040 Madrid, Spain.
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Moran NE, Mohn ES, Hason N, Erdman JW, Johnson EJ. Intrinsic and Extrinsic Factors Impacting Absorption, Metabolism, and Health Effects of Dietary Carotenoids. Adv Nutr 2018; 9:465-492. [PMID: 30032230 PMCID: PMC6054194 DOI: 10.1093/advances/nmy025] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 11/06/2017] [Accepted: 03/22/2018] [Indexed: 12/16/2022] Open
Abstract
Carotenoids are orange, yellow, and red lipophilic pigments present in many fruit and vegetables, as well as other food groups. Some carotenoids contribute to vitamin A requirements. The consumption and blood concentrations of specific carotenoids have been associated with reduced risks of a number of chronic conditions. However, the interpretation of large, population-based observational and prospective clinical trials is often complicated by the many extrinsic and intrinsic factors that affect the physiologic response to carotenoids. Extrinsic factors affecting carotenoid bioavailability include food-based factors, such as co-consumed lipid, food processing, and molecular structure, as well as environmental factors, such as interactions with prescription drugs, smoking, or alcohol consumption. Intrinsic, physiologic factors associated with blood and tissue carotenoid concentrations include age, body composition, hormonal fluctuations, and variation in genes associated with carotenoid absorption and metabolism. To most effectively investigate carotenoid bioactivity and to utilize blood or tissue carotenoid concentrations as biomarkers of intake, investigators should either experimentally or statistically control for confounding variables affecting the bioavailability, tissue distribution, and metabolism of carotene and xanthophyll species. Although much remains to be investigated, recent advances have highlighted that lipid co-consumption, baseline vitamin A status, smoking, body mass and body fat distribution, and genetics are relevant covariates for interpreting blood serum or plasma carotenoid responses. These and other intrinsic and extrinsic factors are discussed, highlighting remaining gaps in knowledge and opportunities for future research. To provide context, we review the state of knowledge with regard to the prominent health effects of carotenoids.
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Affiliation(s)
- Nancy E Moran
- USDA–Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Emily S Mohn
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA
| | - Noor Hason
- USDA–Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - John W Erdman
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, IL
| | - Elizabeth J Johnson
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA
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Zarubina AV, Huisingh CE, Clark ME, Sloan KR, McGwin G, Crosson JN, Curcio CA, Owsley C. Rod-Mediated Dark Adaptation and Macular Pigment Optical Density in Older Adults with Normal Maculas. Curr Eye Res 2018; 43:913-920. [PMID: 29634370 DOI: 10.1080/02713683.2018.1460380] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To examine the association between macular pigment optical density (MPOD) and rod-mediated dark adaptation (RMDA) in persons ≥60 years old with normal maculas as determined by an accepted color fundus photography grading system. METHODS This cross-sectional analysis used baseline data from eyes in the Alabama Study on Early Age-Related Macular Degeneration. Eyes at step 1 in the AREDS 9-step grading system were considered normal. Eyes were additionally assessed by spectral domain optical coherence tomography (SD-OCT). Foveal MPOD was estimated via heterochromatic flicker photometry, and RMDA was assessed with a computerized dark adaptometer. The association between RMDA and MPOD was examined via Spearman correlation coefficients adjusted for age. RESULTS In 306 eyes from 306 persons (mean age 68.2 years) in normal macular health, MPOD was not associated with RMDA (age-adjusted rank correlation = 0.043, p = 0.45). After 81 eyes with incidental macular findings by SD-OCT evaluation were excluded, the association between MPOD and RMDA remained null (N = 225, age-adjusted r = 0.015, p = 0.82). CONCLUSION In a large sample of normal aged eyes, RMDA, a visual function that is rate limited by retinoid availability to photoreceptors across the complex of retinal pigment epithelium, Bruch's membrane, and choriocapillaris, is not related to MPOD in the neurosensory retina.
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Affiliation(s)
- Anna V Zarubina
- a Department of Ophthalmology , School of Medicine, University of Alabama at Birmingham , Birmingham , AL , USA
| | - Carrie E Huisingh
- a Department of Ophthalmology , School of Medicine, University of Alabama at Birmingham , Birmingham , AL , USA
| | - Mark E Clark
- a Department of Ophthalmology , School of Medicine, University of Alabama at Birmingham , Birmingham , AL , USA
| | - Kenneth R Sloan
- a Department of Ophthalmology , School of Medicine, University of Alabama at Birmingham , Birmingham , AL , USA.,b Department of Computer Science , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Gerald McGwin
- a Department of Ophthalmology , School of Medicine, University of Alabama at Birmingham , Birmingham , AL , USA.,c Department of Epidemiology , School of Public Health, University of Alabama at Birmingham , Birmingham , AL , USA
| | - Jason N Crosson
- a Department of Ophthalmology , School of Medicine, University of Alabama at Birmingham , Birmingham , AL , USA.,d Retina Consultants of Alabama , Birmingham , AL , USA
| | - Christine A Curcio
- a Department of Ophthalmology , School of Medicine, University of Alabama at Birmingham , Birmingham , AL , USA
| | - Cynthia Owsley
- a Department of Ophthalmology , School of Medicine, University of Alabama at Birmingham , Birmingham , AL , USA
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What do we know about the macular pigment in AMD: the past, the present, and the future. Eye (Lond) 2018; 32:992-1004. [PMID: 29576617 DOI: 10.1038/s41433-018-0044-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 01/19/2018] [Indexed: 12/15/2022] Open
Abstract
Carotenoids are lipophilic isoprenoid pigments with a common C40H56 core chemical structure that are naturally synthesized by many plants, algae, bacteria, and fungi. Humans and animals cannot synthesize carotenoids de novo and must obtain them solely through dietary sources. Among the more than 750 carotenoids in nature, only lutein, zeaxanthin, meso-zeaxanthin, and their oxidative metabolites selectively accumulate in the foveal region of the retina where they are collectively referred to as the macular pigment (MP) of the macula lutea. MP serves an ocular protective role through its ability to filter phototoxic blue light radiation and also via its antioxidant activity. These properties have led to the hypothesis that carotenoids may protect against the development of age-related macular degeneration (AMD), the most common cause of blindness in the aged population >60 years old. Epidemiological studies have supported this by showing that patients with lower concentrations of serum carotenoids and macular pigment optical density (MPOD) measurements are at a higher risk of developing AMD. Conversely, nutritional supplementation and diets rich in lutein and zeaxanthin readily impact MP concentrations and reduce the risk of progression to advanced AMD, and the AREDS2 supplement formulation containing 10 mg of lutein and 2 mg of zeaxanthin is the standard-of-care recommendation for individuals at risk for visual loss from advanced AMD. This article reviews the rich history of research on the MP dating back to the 1700s and outlines their potential for further therapeutic improvements for AMD in the future.
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Van Der Veen RL, Ostendorf S, Hendrikse F, Berendschot TT. Macular Pigment Optical Density Relates to Foveal Thickness. Eur J Ophthalmol 2018; 19:836-41. [DOI: 10.1177/112067210901900524] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Rob L.P. Van Der Veen
- Department of Ophthalmology, University Hospital Maastricht, Maastricht, The Netherlands
| | - Saskia Ostendorf
- Department of Ophthalmology, University Hospital Maastricht, Maastricht, The Netherlands
| | - Fred Hendrikse
- Department of Ophthalmology, University Hospital Maastricht, Maastricht, The Netherlands
| | - Tos T.J.M. Berendschot
- Department of Ophthalmology, University Hospital Maastricht, Maastricht, The Netherlands
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Abstract
OBJECTIVES The present study constitutes the first randomized controlled trial to investigate the relation of lutein (L) and zeaxanthin (Z) to brain function using functional magnetic resonance imaging (fMRI). It was hypothesized that L and Z supplementation in older adults would enhance neural efficiency (i.e., reduce activation) and cognitive performance on a verbal learning task relative to placebo. METHODS A total of 44 community-dwelling older adults (mean age=72 years) were randomly assigned to receive either placebo or L+Z supplementation (12 mg/daily) for 1 year. Neurocognitive performance was assessed at baseline and post-intervention on an fMRI-adapted task involving learning and recalling word pairs. Imaging contrasts of blood-oxygen-level-dependent (BOLD) signal were created by subtracting active control trials from learning and recall trials. A flexible factorial model was employed to investigate the expected group (placebo vs. supplement) by time (baseline vs. post-intervention) interaction in pre-specified regions-of-interest. RESULTS L and Z appeared to buffer cognitive decline on the verbal learning task (Cohen's d=.84). Significant interactions during learning were observed in left dorsolateral prefrontal cortex and anterior cingulate cortex (p < .05, family-wise-error corrected). However, these effects were in the direction of increased rather than decreased BOLD signal. Although the omnibus interaction was not significant during recall, within-group contrasts revealed significant increases in left prefrontal activation in the supplement group only. CONCLUSIONS L and Z supplementation appears to benefit neurocognitive function by enhancing cerebral perfusion, even if consumed for a discrete period of time in late life. (JINS, 2018, 24, 77-90).
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Merle BMJ, Buaud B, Korobelnik JF, Bron A, Delyfer MN, Rougier MB, Savel H, Vaysse C, Creuzot-Garcher C, Delcourt C. Plasma long-chain omega-3 polyunsaturated fatty acids and macular pigment in subjects with family history of age-related macular degeneration: the Limpia Study. Acta Ophthalmol 2017; 95:e763-e769. [PMID: 28271618 DOI: 10.1111/aos.13408] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 12/31/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE In numerous epidemiological studies, omega-3 polyunsaturated fatty acids (PUFAs) have been associated with a decreased risk of age-related macular degeneration (AMD). Beyond their structural, functional and neuroprotective roles, omega-3 PUFAs may favour the retinal accumulation of lutein and zeaxanthin and thus increase macular pigment optical density (MPOD). We examined the associations of MPOD with plasma omega-3 PUFAs in subjects with family history of AMD. METHODS The Limpia study is a double-blind, placebo-controlled, prospective randomized clinical trial performed in 120 subjects. Subjects with at least one parent treated for neovascular AMD, aged 40-70, with a best corrected visual acuity (BCVA) >20/25, free of late AMD and other major eye conditions and with no use of supplement containing lutein or zeaxanthin the preceding year were recruited in Bordeaux and Dijon, France. At baseline, MPOD within 1° of eccentricity was measured by modified Heidelberg retinal analyser (Heidelberg, Germany) and plasma omega-3 PUFAs by gas chromatography. Medical history and lifestyle data were collected from a standardized questionnaire. Associations of MPOD with plasma omega-3 PUFAs were assessed at the baseline examination, using mixed linear models adjusted for age, gender, centre, body mass index, smoking, plasma high-density lipoprotein (HDL) cholesterol and lutein+zeaxanthin. RESULTS After multivariate adjustment, high MPOD was significantly associated with higher level of plasma docosapentaenoic acid (DPA) (β = 0.029, 95% CI: 0.003, 0.055; p = 0.03). Plasma alpha linolenic, eicosapentaenoic and docosahexaenoic acids were not significantly associated with MPOD. CONCLUSION In the Limpia study, high MPOD within 1° was significantly associated with higher plasma levels of omega-3 DPA.
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Affiliation(s)
- Bénédicte M. J. Merle
- Inserm; Bordeaux Population Health Research Center; Team LEHA; UMR 1219; University of Bordeaux; Bordeaux France
| | - Benjamin Buaud
- ITERG - Equipe Nutrition Métabolisme & Santé; Bordeaux France
| | - Jean-François Korobelnik
- Inserm; Bordeaux Population Health Research Center; Team LEHA; UMR 1219; University of Bordeaux; Bordeaux France
- Ophthalmology Department; CHU of Bordeaux; Bordeaux France
| | - Alain Bron
- Ophthalmology Department; CHU of Dijon; Dijon France
| | - Marie-Noëlle Delyfer
- Inserm; Bordeaux Population Health Research Center; Team LEHA; UMR 1219; University of Bordeaux; Bordeaux France
- Ophthalmology Department; CHU of Bordeaux; Bordeaux France
| | | | - Hélène Savel
- Pôle Santé Publique USMR; CHU de Bordeaux; Bordeaux France
| | - Carole Vaysse
- ITERG - Equipe Nutrition Métabolisme & Santé; Bordeaux France
| | | | - Cécile Delcourt
- Inserm; Bordeaux Population Health Research Center; Team LEHA; UMR 1219; University of Bordeaux; Bordeaux France
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Korobelnik JF, Rougier MB, Delyfer MN, Bron A, Merle BMJ, Savel H, Chêne G, Delcourt C, Creuzot-Garcher C. Effect of Dietary Supplementation With Lutein, Zeaxanthin, and ω-3 on Macular Pigment: A Randomized Clinical Trial. JAMA Ophthalmol 2017; 135:1259-1266. [PMID: 28973076 DOI: 10.1001/jamaophthalmol.2017.3398] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Importance Nutritional uptake of lutein, zeaxanthin, and ω-3 polyunsaturated fatty acids may increase macular pigment optical density (MPOD) and thereby protect against the development of age-related macular degeneration (AMD). Objectives To estimate the efficiency of dietary supplementation containing lutein, zeaxanthin, ω-3 polyunsaturated fatty acids, and vitamins to increase the density of macular pigment in first-generation offspring of parents with neovascular AMD. Design, Setting, and Participants This study was a randomized clinical trial (Lutein Influence on Macula of Persons Issued From AMD Parents [LIMPIA]) with a 6-month treatment period, followed by a 6-month follow-up period. Analyses were based on the intent-to-treat principle. The setting was 2 university hospitals in France (at Bordeaux and Dijon) from January 2011 (first participant first visit) to February 2013 (last participant last visit). The analysis was conducted from January to November 2016. Participants were 120 individuals free of any retinal ocular disease. They were first-generation offspring of parents with neovascular AMD. Interventions Participants were randomized in a 1:1 ratio to receive either 2 daily dietary supplementation capsules or placebo for 6 months. Main Outcomes and Measures The primary assessment criterion was the evolution of MPOD after 6 months of supplementation (value of both eligible eyes) measured using the modified MPD-Visucam 200 (Carl Zeiss Meditec) and the modified Heidelberg Retina Angiograph (Heidelberg Engineering) (HRA) at 0.98° eccentricity. The statistical analysis was adjusted for hospital and for risk factors. Results Overall, 120 participants (60 in each group) were included, and 239 eyes were analyzed (119 in the lutein plus zeaxanthin [L + Z] group and 120 in the placebo group). Their mean (SD) age was 56.7 (6.6) years, and 71.7% (n = 86) were female. A statistically significant increase in plasma lutein and zeaxanthin was shown in the L + Z group after 3 months and 6 months of treatment compared with the placebo group. However, the difference between groups in the evolution of MPOD measured by HRA 0.98° eccentricity between 6 months and baseline was 0.036 (95% CI, -0.037 to 0.110) (P = .33). Conclusions and Relevance Among first-generation offspring of parents with neovascular AMD in the LIMPIA trial, MPOD as measured with the modified HRA and the MPD-Visucam was not modified after 6 months of lutein and zeaxanthin dietary supplementation despite plasma levels showing continuous exposure to lutein and zeaxanthin. Further research is necessary to understand the mechanism of absorption and metabolism of these nutrients in the macula, the best way to measure MPOD, and the clinical benefit for the patients. Trial Registration clinicaltrials.gov Identifier: NCT01269697.
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Affiliation(s)
- Jean-François Korobelnik
- Service d'Ophtalmologie, Centre Hospitalier Universitaire Bordeaux, Bordeaux, France.,Universitaire Bordeaux, Institut National de la Santé et de la Récherche Médicale, Bordeaux Population Health Research Center, Team Lifelong Exposures Health and Aging (LEHA), Unité Mixte de Recherche (UMR) 1219, Bordeaux, France
| | | | - Marie-Noëlle Delyfer
- Service d'Ophtalmologie, Centre Hospitalier Universitaire Bordeaux, Bordeaux, France.,Universitaire Bordeaux, Institut National de la Santé et de la Récherche Médicale, Bordeaux Population Health Research Center, Team Lifelong Exposures Health and Aging (LEHA), Unité Mixte de Recherche (UMR) 1219, Bordeaux, France
| | - Alain Bron
- Service d'Ophtalmologie, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Bénédicte M J Merle
- Universitaire Bordeaux, Institut National de la Santé et de la Récherche Médicale, Bordeaux Population Health Research Center, Team Lifelong Exposures Health and Aging (LEHA), Unité Mixte de Recherche (UMR) 1219, Bordeaux, France
| | - Hélène Savel
- Centre Hospitalier Universitaire de Bordeaux, Pôle de Santé Publique, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique and Centre d'Investigation Clinique (CIC) 1401-Epidémiologie Clinique (EC), Bordeaux, France
| | - Geneviève Chêne
- Universitaire Bordeaux, Institut National de la Santé et de la Récherche Médicale, Bordeaux Population Health Research Center, Team Lifelong Exposures Health and Aging (LEHA), Unité Mixte de Recherche (UMR) 1219, Bordeaux, France.,Centre Hospitalier Universitaire de Bordeaux, Pôle de Santé Publique, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique and Centre d'Investigation Clinique (CIC) 1401-Epidémiologie Clinique (EC), Bordeaux, France
| | - Cécile Delcourt
- Universitaire Bordeaux, Institut National de la Santé et de la Récherche Médicale, Bordeaux Population Health Research Center, Team Lifelong Exposures Health and Aging (LEHA), Unité Mixte de Recherche (UMR) 1219, Bordeaux, France
| | - Catherine Creuzot-Garcher
- Centre Hospitalier Universitaire de Bordeaux, Pôle de Santé Publique, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique and Centre d'Investigation Clinique (CIC) 1401-Epidémiologie Clinique (EC), Bordeaux, France
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The Macular Carotenoids Lutein and Zeaxanthin Are Related to Increased Bone Density in Young Healthy Adults. Foods 2017; 6:foods6090078. [PMID: 28880221 PMCID: PMC5615290 DOI: 10.3390/foods6090078] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 08/10/2017] [Accepted: 08/29/2017] [Indexed: 11/16/2022] Open
Abstract
Lutein (L) and zeaxanthin (Z) status can be quantified by measuring their concentrations both in serum and, non-invasively, in retinal tissue. This has resulted in a unique ability to assess their role in a number of tissues ranging from cardiovascular to central nervous system tissue. Recent reports using animal models have suggested yet another role, a developmental increase in bone mass. To test this, we assessed L and Z status in 63 young healthy adults. LZ status was determined by measuring LZ in serum (using HPLC) and retina tissue (measuring macular pigment optical density, MPOD, using customized heterochromatic flicker photometry). Bone density was measured using dual-energy X-ray absorptiometry (DXA). Although serum LZ was generally not related to bone mass, MPOD was significantly related to bone density in the proximal femur and lumbar spine. In general, our results are consistent with carotenoids, specifically LZ, playing a role in optimal bone health.
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Abstract
Current evidence suggests lutein and its isomers play important roles in ocular development in utero and throughout the life span, in vision performance in young and later adulthood, and in lowering risk for the development of common age-related eye diseases in older age. These xanthophyll (oxygen-containing) carotenoids are found in a wide variety of vegetables and fruits, and they are present in especially high concentrations in leafy green vegetables. Additionally, egg yolks and human milk appear to be bioavailable sources. The prevalence of lutein, zeaxanthin, and meso-zeaxanthin in supplements is increasing. Setting optimal and safe ranges of intake requires additional research, particularly in pregnant and lactating women. Accumulating evidence about variable interindividual response to dietary intake of these carotenoids, based on genetic or metabolic influences, suggests that there may be subgroups that benefit from higher levels of intake and/or alternate strategies to improve lutein and zeaxanthin status.
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Affiliation(s)
- Julie Mares
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin 53726-2336;
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36
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Combined influence of poor health behaviours on the prevalence and 15-year incidence of age-related macular degeneration. Sci Rep 2017; 7:4359. [PMID: 28659620 PMCID: PMC5489492 DOI: 10.1038/s41598-017-04697-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 05/18/2017] [Indexed: 01/03/2023] Open
Abstract
We aimed to establish the collective influence of four lifestyle practices (physical activity, diet, smoking and alcohol consumption) on the prevalence and incidence of AMD. At baseline, 2428 participants aged 49+ with complete lifestyle and AMD data were examined, and of these, 1903 participants were re-examined 15 years later. AMD was assessed from retinal photographs. A health behaviour score was calculated, allocating 1 point for each poor behaviour: current smoking; fruits and vegetables consumed <4 serves daily; <3 episodes of physical activity per week; and >2 alcoholic drinks per day. Cross-sectional analysis showed that participants who engaged in all 4 poor health behaviours (n = 29) versus those who did not engage in unhealthy behaviours (reference group; n = 677) had greater odds of any and late AMD: multivariable-adjusted OR, 5.14 (95% CI, 1.04–25.45) and OR 29.53 (95% CI 2.72–321.16), respectively. A marginally non-significant association was observed between increasing number of poor health behaviours and 15-year incidence of early AMD (multivariable-adjusted P-trend = 0.08). Our data suggests that motivating patients with AMD to eat better, exercise more, limit alcohol intake and avoid smoking seems advisable to decelerate the development or worsening of existing AMD.
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Moran R, Nolan JM, Stack J, O'Halloran AM, Feeney J, Akuffo KO, Kenny RA, Beatty S. Non-Dietary Correlates and Determinants of Plasma Lutein and Zeaxanthin Concentrations in the Irish Population. J Nutr Health Aging 2017; 21:254-261. [PMID: 28244563 DOI: 10.1007/s12603-016-0729-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate non-dietary correlates and determinants of plasma lutein (L) and zeaxanthin (Z) concentrations in The Irish Longitudinal Study on Ageing (TILDA) sample. DESIGN Cross-sectional study. SETTING Community dwelling adults in the Republic of Ireland (ROI). PARTICIPANTS 3,681 participants aged 50 years and older. MEASUREMENTS TILDA is a nationally representative prospective cohort study of community dwelling adults aged 50 years and over in the ROI. Demographic and health variables were collected during a face-to-face interview carried out in the home (n=8175), and a substantial proportion of these (n=5035; 62%) also attended a study visit in a health assessment centre. Blood samples collected at baseline (wave 1, the subject of the current study), were analysed for plasma concentrations of L and Z by reversed-phase high performance liquid chromatography, and macular pigment (MP) optical density was also measured (using customized heterochromatic flicker photometry). RESULTS After excluding participants with eye disease, data from 3,681 participants were available for analysis. For this group of participants, plasma L and Z were inversely and significantly associated with body mass index (BMI), and were positively and significantly associated with MP, total cholesterol, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) (p<0.001, for all). Plasma L and Z were significantly lower in males, current smokers, participants reporting less physical exercise, and participants reporting lower levels of education (p<0.05, for all). Plasma L was significantly higher in participants reporting a family history of age-related macular degeneration (AMD) (p=0.001), and in the group of ≥75 years old (p<0.05). For each of these variables, the significant associations remained after controlling for other potential confounding variables. CONCLUSION The findings of this large study indicate that plasma concentrations of L and Z were lower in association with indicators of a poor lifestyle (high BMI, tobacco use, and less physical exercise) and in association with lower education, indicating that modifying lifestyle in a positive way is likely to be reflected in higher concentrations of plasma carotenoids, with consequential and putative health benefits.
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Affiliation(s)
- R Moran
- Rachel Moran, Macular Pigment Research Group, Nutrition Research Centre Ireland, Waterford Institute of Technology West Campus, Carriganore, Waterford, Ireland, Tel: +353 (0)51 306261;
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Lutein and zeaxanthin supplied by red/orange foods and fruits are more closely associated with macular pigment optical density than those from green vegetables in Spanish subjects. Nutr Res 2016; 36:1210-1221. [PMID: 27866829 DOI: 10.1016/j.nutres.2016.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 08/17/2016] [Accepted: 09/12/2016] [Indexed: 11/23/2022]
Abstract
Lutein and zeaxanthin (L+Z) accumulate in the retina. Although vegetables are major contributors to their intake, a stronger association between fruits and macular pigment optical density (MPOD) has been reported. We hypothesized that L+Z intake from fruits would have a stronger association with L+Z status markers (MPOD, serum concentrations) than intake from vegetables or eggs, and that those associations would also differ according to plant foods color. One hundred eight subjects (57 men; age groups, 20-35 and 45-65 years) were enrolled in a cross-sectional study. L+Z intake from fruits, vegetables, and eggs was determined using three 24-hour diet recalls and a country-specific carotenoid database. Vegetables were the major contributors (75%) to L+Z intake, followed by eggs (10%) and fruits (4%). Vegetables supplied 86% and 84% of the LandZ intake, respectively, and fruits supplied 3% and 16%. Green foods supplied 78% and 52% of LandZ, respectively, followed by red/orange (9% and 38%) and white/yellow (14% and 9%). Factorial analysis showed associations in older subjects. The explained variance of the first 2 principal components was 54% considering L+Z intake from fruits, vegetables, and eggs, and 55% considering L+Z intake from plant foods grouped by color. Macular pigment optical density is related to L+Z intake from fruits (0.264, P=.003) and is independent of that from vegetables and eggs. It is related to L+Z intake from red/orange foods (0.320, P=.000) and the serum concentrations to that from green foods (0.222, P=.11). Although vegetables and green foods of plant origin are the major contributors to L+Z intake, red/orange foods and fruits have the strongest relationship to MPOD in study participants (45-65 years of age).
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Crosby-Nwaobi R, Hykin P, Peto T, Sivaprasad S. An exploratory study evaluating the effects of macular carotenoid supplementation in various retinal diseases. Clin Ophthalmol 2016; 10:835-44. [PMID: 27274188 PMCID: PMC4869621 DOI: 10.2147/opth.s102798] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Purpose The aim of this study was to assess the impact of daily oral supplementation with Macushield (10 mg/d meso-zeaxanthin, 10 mg/d lutein, and 2 mg/d zeaxanthin) on eye health in patients with retinal diseases by assessing the macular pigment (MP) profile, the visual function, and the quality of life. Methods Fifty-one patients with various retinal diseases were supplemented daily and followed up for 6 months. The MP optical density was measured using the customized heterochromatic flicker photometry and dual-wavelength autofluorescence. Visual function was evaluated by assessing the change in best corrected visual acuity, contrast sensitivity, and glare sensitivity in mesopic and photopic conditions. Vision-related and general quality of life changes were determined using the National Eye Insititute- Visual Function Questionnaire-25 (NEI-VFQ-25) and EuroQoL-5 dimension questionnaires. Results A statistically significant increase in the MP optical density was observed using the dual-wavelength autofluorescence (P=0.04) but not with the customized heterochromatic flicker photometry. Statistically significant (P<0.05) improvements in glare sensitivity in low and medium spatial frequencies were observed at 3 months and 6 months. Ceiling effects confounded other visual function tests and quality of life changes. Conclusion Supplementation with the three carotenoids enhances certain aspects of visual performance in retinal diseases.
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Affiliation(s)
- Roxanne Crosby-Nwaobi
- NIHR Clinical Research Facility, NIHR Moorfields Biomedical Research Centre, London, UK
| | - Philip Hykin
- NIHR Clinical Research Facility, NIHR Moorfields Biomedical Research Centre, London, UK
| | - Tunde Peto
- NIHR Clinical Research Facility, NIHR Moorfields Biomedical Research Centre, London, UK
| | - Sobha Sivaprasad
- NIHR Clinical Research Facility, NIHR Moorfields Biomedical Research Centre, London, UK
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Wu J, Cho E, Willett WC, Sastry SM, Schaumberg DA. Intakes of Lutein, Zeaxanthin, and Other Carotenoids and Age-Related Macular Degeneration During 2 Decades of Prospective Follow-up. JAMA Ophthalmol 2016; 133:1415-24. [PMID: 26447482 DOI: 10.1001/jamaophthalmol.2015.3590] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Despite strong biological plausibility, evidence from epidemiologic studies and clinical trials on the relations between intakes of lutein and zeaxanthin and age-related macular degeneration (AMD) has been inconsistent. The roles of other carotenoids are less thoroughly investigated. OBJECTIVE To investigate the associations between intakes of carotenoids and AMD. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study, with cohorts from the Nurses' Health Study and the Health Professionals Follow-up Study in the United States. A total of 63,443 women and 38,603 men were followed up, from 1984 until May 31, 2010, in the Nurses' Health Study and from 1986 until January 31, 2010, in the Health Professionals Follow-up Study. All participants were aged 50 years or older and were free of diagnosed AMD, diabetes mellitus, cardiovascular disease, and cancer at baseline. MAIN OUTCOMES AND MEASURES Predicted plasma carotenoid scores were computed directly from food intake, assessed by repeated food frequency questionnaires at baseline and follow-up, using validated regression models to account for bioavailability and reporting validity of different foods, and associations between predicted plasma carotenoid scores and AMD were determined. RESULTS We confirmed 1361 incident intermediate and 1118 advanced AMD cases (primarily neovascular AMD) with a visual acuity of 20/30 or worse by medical record review. Comparing extreme quintiles of predicted plasma lutein/zeaxanthin score, we found a risk reduction for advanced AMD of about 40% in both women and men (pooled relative risk comparing extreme quintiles = 0.59; 95% CI, 0.48-0.73; P for trend < .001). Predicted plasma carotenoid scores for other carotenoids, including β-cryptoxanthin, α-carotene, and β-carotene, were associated with a 25% to 35% lower risk of advanced AMD when comparing extreme quintiles. The relative risk comparing extreme quintiles for the predicted plasma total carotenoid index was 0.65 (95% CI, 0.53-0.80; P for trend < .001). We did not identify any associations of carotenoids, either as predicted plasma score or calculated intake, with intermediate AMD. CONCLUSIONS AND RELEVANCE Higher intake of bioavailable lutein/zeaxanthin is associated with a long-term reduced risk of advanced AMD. Given that some other carotenoids are also associated with a lower risk, a public health strategy aimed at increasing dietary consumption of a wide variety of fruits and vegetables rich in carotenoids may reduce the incidence of advanced AMD.
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Affiliation(s)
- Juan Wu
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Eunyoung Cho
- Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Rhode Island3Department of Epidemiology, Brown School of Public Health, Providence, Rhode Island4Channing Division of Network Medicine, Department of Medicine, Brigham
| | - Walter C Willett
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts4Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts5Department of Epidemiolog
| | | | - Debra A Schaumberg
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts7Moran Center for Translational Medicine, John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt L
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Ren XT, Gu H, Han X, Zhang JY, Li X, Yang XF, Xu J, Snellingen T, Liu XP, Wang NL, Liu NP. Measurement of macular pigment optical density among healthy Chinese people and patients with early-stage age-related macular degeneration. Int J Ophthalmol 2015; 8:1190-5. [PMID: 26682171 DOI: 10.3980/j.issn.2222-3959.2015.06.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 03/23/2015] [Indexed: 01/13/2023] Open
Abstract
AIM To measure the macular pigment optical density (MPOD) in healthy Chinese people and patients with early age-related macular degeneration (AMD). METHODS Cross-sectional population based study. Demographic and lifestyle characteristics were ascertained by questionnaire. A food frequency questionnaire was completed for all participants. Participants underwent general physical and ophthalmic examinations and MPOD was measured by heterochromatic flicker photometry. Foveal architecture was measured by optical coherence tomography. RESULTS MPOD of 225 participants (122 healthy and 103 early AMD) was 0.48±0.18. Patients with early AMD (0.52±0.19) tended to have higher MPOD levels than healthy people (0.47±0.17), but the difference was not statistically significant (P=0.06). Participants with carrot or corn oil intake every week tended to have higher levels of MPOD (P=0.002 and 0.008 respectively) while those with corn intake had relatively lower level of MPOD (P=0.01). MPOD increased with the center foveal thickness (P=0.01). CONCLUSION Our findings show that there is no statistically significant association between MPOD and early AMD in the studied population. MPOD is related to center foveal thickness and diets would influence MPOD levels.
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Affiliation(s)
- Xue-Tao Ren
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China
| | - Hong Gu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China
| | - Xu Han
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China
| | - Jun-Yan Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China
| | - Xue Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China
| | - Xiu-Fen Yang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China
| | - Jun Xu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China
| | | | - Xi-Pu Liu
- Department of Ophthalmology, the First Hospital of Tsinghua University, Beijing 100016, China
| | - Ning-Li Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China
| | - Ning-Pu Liu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China
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Walsh RP, Bartlett H, Eperjesi F. Variation in Carotenoid Content of Kale and Other Vegetables: A Review of Pre- and Post-harvest Effects. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2015; 63:9677-82. [PMID: 26477753 DOI: 10.1021/acs.jafc.5b03691] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Lutein and zeaxanthin are carotenoids that are selectively taken up into the macula of the eye, where they are thought to protect against the development of age-related macular degeneration. They are obtained from dietary sources, with the highest concentrations found in dark green leafy vegetables, such as kale and spinach. In this Review, compositional variations due to variety/cultivar, stage of maturity, climate or season, farming practice, storage, and processing effects are highlighted. Only data from studies which report on lutein and zeaxanthin content in foods are reported. The main focus is kale; however, other predominantly xanthophyll containing vegetables such as spinach and broccoli are included. A small amount of data about exotic fruits is also referenced for comparison. The qualitative and quantitative composition of carotenoids in fruits and vegetables is known to vary with multiple factors. In kale, lutein and zeaxanthin levels are affected by pre-harvest effects such as maturity, climate, and farming practice. Further research is needed to determine the post-harvest processing and storage effects of lutein and zeaxanthin in kale; this will enable precise suggestions for increasing retinal levels of these nutrients.
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Affiliation(s)
- Rachel P Walsh
- School of Life and Health Sciences, Aston University , Birmingham B4 7ET, United Kingdom
| | - Hannah Bartlett
- School of Life and Health Sciences, Aston University , Birmingham B4 7ET, United Kingdom
| | - Frank Eperjesi
- School of Life and Health Sciences, Aston University , Birmingham B4 7ET, United Kingdom
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Meyers KJ, Liu Z, Millen AE, Iyengar SK, Blodi BA, Johnson E, Snodderly DM, Klein ML, Gehrs KM, Tinker L, Sarto GE, Robinson J, Wallace RB, Mares JA. Joint Associations of Diet, Lifestyle, and Genes with Age-Related Macular Degeneration. Ophthalmology 2015; 122:2286-94. [PMID: 26354764 PMCID: PMC4714866 DOI: 10.1016/j.ophtha.2015.07.029] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 07/23/2015] [Accepted: 07/27/2015] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Unhealthy lifestyles have been associated with increased odds for age-related macular degeneration (AMD). Whether this association is modified by genetic risk for AMD is unknown and was investigated. DESIGN Interactions between healthy lifestyles AMD risk genotypes were studied in relation to the prevalence of AMD, assessed 6 years later. PARTICIPANTS Women 50 to 79 years of age in the Carotenoids in Age-Related Eye Disease Study with exposure and AMD data (n=1663). METHODS Healthy lifestyle scores (0-6 points) were assigned based on Healthy Eating Index scores, physical activity (metabolic equivalent of task hours/week), and smoking pack years assessed in 1994 and 1998. Genetic risk was based on Y402H in complement factor H (CFH) and A69S in age-related maculopathy susceptibility locus 2 (ARMS2). Additive and multiplicative interactions in odds ratios were assessed using the synergy index and a multiplicative interaction term, respectively. MAIN OUTCOME MEASURES AMD presence and severity were assessed from grading of stereoscopic fundus photographs taken in 2001-2004. AMD was present in 337 women, 91% of whom had early AMD. RESULTS The odds of AMD were 3.3 times greater (95% confidence interval [CI], 1.8-6.1) in women with both low healthy lifestyle score (0-2) and high-risk CFH genotype (CC), relative to those who had low genetic risk (TT) and high healthy lifestyle scores (4-6). There were no significant additive (synergy index [SI], 1.08; 95% CI, 0.70-1.67) or multiplicative (Pinteraction=0.94) interactions in the full sample. However, when limiting the sample to women with stable diets before AMD assessment (n=728) the odds for AMD associated with low healthy lifestyle scores and high-risk CFH genotype were strengthened (odds ratio, 4.6; 95% CI, 1.8-11.6) and the synergy index was significant (SI, 1.34; 95% CI, 1.05-1.70). Adjusting for dietary lutein and zeaxanthin attenuated, and therefore partially explained, the joint association. There were no significant additive or multiplicative interactions for ARMS2 and lifestyle score. CONCLUSIONS Having unhealthy lifestyles and 2 CFH risk alleles increased AMD risk (primarily in the early stages), in an or additive or greater (synergistic) manner. However, unhealthy lifestyles increased AMD risk regardless of AMD risk genotype.
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Affiliation(s)
- Kristin J Meyers
- Department of Ophthalmology and Visual Sciences, McPherson Eye Research Institute, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Zhe Liu
- Department of Ophthalmology and Visual Sciences, McPherson Eye Research Institute, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Amy E Millen
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, New York
| | - Sudha K Iyengar
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio
| | - Barbara A Blodi
- Department of Ophthalmology and Visual Sciences, McPherson Eye Research Institute, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Elizabeth Johnson
- Jean Mayer USDA Human Nutrition, Research Center on Aging, Tufts University, Boston, Massachusetts
| | - D Max Snodderly
- Department of Neuroscience, University of Texas, Austin, Texas
| | - Michael L Klein
- Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon
| | - Karen M Gehrs
- Department of Ophthalmology & Visual Sciences, University of Iowa Hospital & Clinics, Iowa City, Iowa
| | - Lesley Tinker
- Department of Cancer Prevention Research Program, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Gloria E Sarto
- Department of Obstetrics & Gynecology, School of Medicine & Public Health, University of Wisconsin, Madison, Wisconsin
| | - Jennifer Robinson
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa
| | - Robert B Wallace
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa
| | - Julie A Mares
- Department of Ophthalmology and Visual Sciences, McPherson Eye Research Institute, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
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Millen AE, Meyers KJ, Liu Z, Engelman CD, Wallace RB, LeBlanc ES, Tinker LF, Iyengar SK, Robinson J, Sarto GE, Mares JA. Association between vitamin D status and age-related macular degeneration by genetic risk. JAMA Ophthalmol 2015; 133:1171-9. [PMID: 26312598 PMCID: PMC4841267 DOI: 10.1001/jamaophthalmol.2015.2715] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
IMPORTANCE Deficient 25-hydroxyvitamin D (25[OH]D) concentrations have been associated with increased odds of age-related macular degeneration (AMD). OBJECTIVE To examine whether this association is modified by genetic risk for AMD and whether there is an association between AMD and single-nucleotide polymorphisms of genes involved in vitamin D transport, metabolism, and genomic function. DESIGN, SETTING, AND PARTICIPANTS Postmenopausal women (N = 913) who were participants of the Carotenoids in Age-Related Eye Disease Study (CAREDS) (aged 54 to <75 years) with available serum 25(OH)D concentrations (assessed October 1, 1993, to December 31, 1998), genetic data, and measures of AMD (n = 142) assessed at CAREDS baseline from May 14, 2001, through January 31, 2004, were studied. MAIN OUTCOMES AND MEASURES Prevalent early or late AMD was determined from graded, stereoscopic fundus photographs. Logistic regression was used to estimate odds ratios (ORs) and 95% CIs for AMD by the joint effects of 25(OH)D (<12, ≥12 to <20, ≥20 to <30, and ≥30 ng/mL) and risk genotype (noncarrier, 1 risk allele, or 2 risk alleles). The referent group was noncarriers with adequate vitamin D status (≥30 ng/mL). Joint effect ORs were adjusted for age, smoking, iris pigmentation, self-reported cardiovascular disease, self-reported diabetes status, and hormone use. Additive and multiplicative interactions were assessed using the synergy index (SI) and an interaction term, respectively. To examine the association between AMD and variants in vitamin D-related genes, age-adjusted ORs and 95% CIs were estimated using logistic regression. RESULTS Among the 913 women, 550 had adequate levels of vitamin D (≥20 ng/mL), 275 had inadequate levels (≥12 to <20 mg/mL), and 88 had deficient levels (<12 ng/mL). A 6.7-fold increased odds of AMD (95% CI, 1.6-28.2) was observed among women with deficient vitamin D status (25[OH]D <12 ng/mL) and 2 risk alleles for CFH Y402H (SI for additive interaction, 1.4; 95% CI, 1.1-1.7; P for multiplicative interaction = .25). Significant additive (SI, 1.4; 95% CI, 1.1-1.7) and multiplicative interactions (P = .02) were observed for deficient women with 2 high-risk CFI (rs10033900) alleles (OR, 6.3; 95% CI, 1.6-24.2). The odds of AMD did not differ by genotype of candidate vitamin D genes. CONCLUSIONS AND RELEVANCE In this study, the odds of AMD were highest in those with deficient vitamin D status and 2 risk alleles for the CFH and CFI genotypes, suggesting a synergistic effect between vitamin D status and complement cascade protein function. Limited sample size led to wide CIs. Findings may be due to chance or explained by residual confounding.
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Affiliation(s)
- Amy E. Millen
- Corresponding author/Address for Reprints: Amy E. Millen, PhD. Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, 270 Farber Hall, Buffalo, NY 14214-8001. Telephone: (716) 829-5377, Fax: (716) 829-2979,
| | - Kristin J Meyers
- Department of Ophthalmology and Visual Sciences, The University of Wisconsin-Madison, Madison, WI
| | - Zhe Liu
- Department of Ophthalmology and Visual Sciences, The University of Wisconsin-Madison, Madison, WI
| | - Corinne D Engelman
- Department of Population Health Sciences, The University of Wisconsin-Madison, Madison, WI
| | - Robert B Wallace
- Department of Epidemiology, The University of Iowa, Iowa City, IA
| | - Erin S LeBlanc
- The Center for Health Research, Kaiser Permanente Research, Portland, OR
| | - Lesley F. Tinker
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Sudha K Iyengar
- Department of Epidemiology and Biostatistics, Case-Western, Cleveland, OH
| | - Jennifer Robinson
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA
| | - Gloria E. Sarto
- University of Wisconsin, Madison. School of Medicine & Public Health, Department of Obstetrics & Gynecology, Madison, WI
| | - Julie A Mares
- Department of Ophthalmology and Visual Sciences, The University of Wisconsin-Madison, Madison, WI
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Thiele S, Rauscher FG, Wiedemann P, Dawczynski J. Influence of macular oedema on the measurement of macular pigment optical density. Graefes Arch Clin Exp Ophthalmol 2015; 254:455-65. [DOI: 10.1007/s00417-015-3079-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 05/06/2015] [Accepted: 06/03/2015] [Indexed: 11/29/2022] Open
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Broadhead GK, Grigg JR, Chang AA, McCluskey P. Dietary modification and supplementation for the treatment of age-related macular degeneration. Nutr Rev 2015; 73:448-62. [PMID: 26081455 DOI: 10.1093/nutrit/nuv005] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Age-related macular degeneration (AMD) causes a significant proportion of visual loss in the developed world. Currently, little is known about its pathogenesis, and treatment options are limited. Dietary intake is one of the few modifiable risk factors for this condition. The best-validated therapies remain oral antioxidant supplements based on those investigated in the Age-Related Eye Disease Study (AREDS) and the recently completed Age-Related Eye Disease Study 2 (AREDS2). In this review, current dietary guidelines related to AMD, along with the underlying evidence to support them, are presented in conjunction with current treatment recommendations. Both AREDS and AREDS2 are discussed, as are avenues for further research, including supplementation with vitamin D and saffron. Despite the considerable disease burden of atrophic AMD, few effective therapies are available to treat it, and further research is required.
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Affiliation(s)
- Geoffrey K Broadhead
- G.K. Broadhead, J. Grigg, A.A Chang, and P. McCluskey are with the Save Sight Institute, Department of Ophthalmology, The University of Sydney, Sydney, New South Wales, 2000, Australia. G.K. Broadhead and A.A Chang are with the Sydney Institute of Vision Science, Sydney, New South Wales, 2000, Australia.
| | - John R Grigg
- G.K. Broadhead, J. Grigg, A.A Chang, and P. McCluskey are with the Save Sight Institute, Department of Ophthalmology, The University of Sydney, Sydney, New South Wales, 2000, Australia. G.K. Broadhead and A.A Chang are with the Sydney Institute of Vision Science, Sydney, New South Wales, 2000, Australia
| | - Andrew A Chang
- G.K. Broadhead, J. Grigg, A.A Chang, and P. McCluskey are with the Save Sight Institute, Department of Ophthalmology, The University of Sydney, Sydney, New South Wales, 2000, Australia. G.K. Broadhead and A.A Chang are with the Sydney Institute of Vision Science, Sydney, New South Wales, 2000, Australia
| | - Peter McCluskey
- G.K. Broadhead, J. Grigg, A.A Chang, and P. McCluskey are with the Save Sight Institute, Department of Ophthalmology, The University of Sydney, Sydney, New South Wales, 2000, Australia. G.K. Broadhead and A.A Chang are with the Sydney Institute of Vision Science, Sydney, New South Wales, 2000, Australia
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Widjaja-Adhi MAK, Lobo GP, Golczak M, Von Lintig J. A genetic dissection of intestinal fat-soluble vitamin and carotenoid absorption. Hum Mol Genet 2015; 24:3206-19. [PMID: 25701869 DOI: 10.1093/hmg/ddv072] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 02/18/2015] [Indexed: 12/20/2022] Open
Abstract
Carotenoids are currently investigated regarding their potential to lower the risk of chronic disease and to combat vitamin A deficiency. Surprisingly, responses to dietary supplementation with these compounds are quite variable between individuals. Genome-wide studies have associated common genetic polymorphisms in the BCO1 gene with this variability. The BCO1 gene encodes an enzyme that is expressed in the intestine and converts provitamin A carotenoids to vitamin A-aldehyde. However, it is not clear how this enzyme can impact the bioavailability and metabolism of other carotenoids such as xanthophyll. We here provide evidence that BCO1 is a key component of a regulatory network that controls the absorption of carotenoids and fat-soluble vitamins. In this process, conversion of β-carotene to vitamin A by BCO1 induces via retinoid signaling the expression of the intestinal homeobox transcription factor ISX. Subsequently, ISX binds to conserved DNA-binding motifs upstream of the BCO1 and SCARB1 genes. SCARB1 encodes a membrane protein that facilitates absorption of fat-soluble vitamins and carotenoids. In keeping with its role as a transcriptional repressor, SCARB1 protein levels are significantly increased in the intestine of ISX-deficient mice. This increase results in augmented absorption and tissue accumulation of xanthophyll carotenoids and tocopherols. Our study shows that fat-soluble vitamin and carotenoid absorption is controlled by a BCO1-dependent negative feedback regulation. Thus, our findings provide a molecular framework for the controversial relationship between genetics and fat-soluble vitamin status in the human population.
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Affiliation(s)
- M Airanthi K Widjaja-Adhi
- Department of Pharmacology, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - Glenn P Lobo
- Department of Pharmacology, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - Marcin Golczak
- Department of Pharmacology, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - Johannes Von Lintig
- Department of Pharmacology, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
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48
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Gong X, Rubin LP. Role of macular xanthophylls in prevention of common neovascular retinopathies: retinopathy of prematurity and diabetic retinopathy. Arch Biochem Biophys 2015; 572:40-48. [PMID: 25701588 DOI: 10.1016/j.abb.2015.02.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 02/03/2015] [Accepted: 02/08/2015] [Indexed: 12/20/2022]
Abstract
Retinopathy of prematurity (ROP) and diabetic retinopathy (DR) are important causes of blindness among children and working-age adults, respectively. The development of both diseases involves retinal microvascular degeneration, vessel loss and consequent hypoxic and inflammatory pathologic retinal neovascularization. Mechanistic studies have shown that oxidative stress and subsequent derangement of cell signaling are important factors in disease progression. In eye and vision research, role of the dietary xanthophyll carotenoids, lutein and zeaxanthin, has been more extensively studied in adult onset macular degeneration than these other retinopathies. These carotenoids also may decrease severity of ROP in preterm infants and of DR in working-age adults. A randomized controlled clinical trial of carotenoid supplementation in preterm infants indicated that lutein has functional effects in the neonatal eye and is anti-inflammatory. Three multicenter clinical trials all showed a trend of decreased ROP severity in the lutein supplemented group. Prospective studies on patients with non-proliferative DR indicate serum levels of lutein and zeaxanthin are significantly lower in these patients compared to normal subjects. The present review describes recent advances in lutein and zeaxanthin modulation of oxidative stress and inflammation related to ROP and DR and discusses potential roles of lutein/zeaxanthin in preventing or lessening the risks of disease initiation or progression.
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Affiliation(s)
- Xiaoming Gong
- Department of Pediatrics, Texas Tech University Health Science Center, Paul L. Foster School of Medicine, El Paso, TX 79905, USA
| | - Lewis P Rubin
- Department of Pediatrics, Texas Tech University Health Science Center, Paul L. Foster School of Medicine, El Paso, TX 79905, USA.
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Kyle-Little Z, Zele AJ, Morris CP, Feigl B. The Effect of BCMO1 Gene Variants on Macular Pigment Optical Density in Young Healthy Caucasians. Front Nutr 2014; 1:22. [PMID: 25988124 PMCID: PMC4428481 DOI: 10.3389/fnut.2014.00022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 11/21/2014] [Indexed: 12/04/2022] Open
Abstract
Background: Serum lutein (L) and zeaxanthin (Z) positively correlate with macular pigment optical density (MPOD); hence, the latter is a valuable indirect tool for measuring L and Z content in the macula. L and Z have been attributed antioxidant capacity and protection from certain retinal diseases but their uptake within the eye is thought to depend on genetic, age, and environmental factors. In particular, gene variants within beta-carotene monooxygenase (BCMO1) are thought to modulate MPOD in the macula. Objectives: To determine the effect of BCMO1 single nucleotide polymorphisms (SNPs) rs11645428, rs6420424, and rs6564851 on MPOD in a cohort of young healthy participants of Caucasian origin with normal ocular health. Design: In this cohort study, MPOD was assessed in 46 healthy participants (22 male and 24 female) with a mean age of 23.8 ± 4.0 years (range 19–33). The three SNPs, rs11645428, rs6420424, rs6564851 that have established associations with MPOD were determined using MassEXTEND (hME) Sequenom assay. One-way analysis of variance was performed on groups segregated into homozygous and heterozygous BCMO1 genotypes. Correlations between body mass index (BMI), iris color, gender, central retinal thickness (CRT), diet, and MPOD were investigated. Results: Macular pigment optical density neither significantly varied with BCMO1 rs11645428 (F2,41 = 0.70, p = 0.503), rs6420424 (F2,41 = 0.21, p = 0.801) nor rs6464851 homozygous or heterozygous genotypes (F2,41 = 0,13, p = 0.88), in this young healthy cohort. The combination of these three SNPs into triple genotypes based on plasma conversion efficiency did not affect MPOD (F2,41 = 0.07, p = 0.9). There was a significant negative correlation with MPOD and CRT (r = −0.39, p = 0.01) but no significant correlation between BMI, iris color, gender, and MPOD. Conclusion: Our results indicate that macular pigment deposition within the central retina is not dependent on BCMO1 gene variants in young healthy people. We propose that MPOD is saturated in younger persons and/or other gene variant combinations determine its deposition.
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Affiliation(s)
- Zachary Kyle-Little
- Medical Retina Laboratory, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology , Brisbane, QLD , Australia ; School of Biomedical Sciences, Queensland University of Technology , Brisbane, QLD , Australia
| | - Andrew J Zele
- Medical Retina Laboratory, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology , Brisbane, QLD , Australia ; School of Optometry and Vision Science, Queensland University of Technology , Brisbane, QLD , Australia
| | - C Phillip Morris
- Medical Retina Laboratory, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology , Brisbane, QLD , Australia ; School of Biomedical Sciences, Queensland University of Technology , Brisbane, QLD , Australia
| | - Beatrix Feigl
- Medical Retina Laboratory, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology , Brisbane, QLD , Australia ; School of Biomedical Sciences, Queensland University of Technology , Brisbane, QLD , Australia ; Queensland Eye Institute , South Brisbane, QLD , Australia
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50
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The gender-differentiated antioxidant effects of a lutein-containing supplement in the aqueous humor of patients with senile cataracts. Exp Eye Res 2014; 129:5-12. [PMID: 25305576 DOI: 10.1016/j.exer.2014.10.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 10/06/2014] [Accepted: 10/08/2014] [Indexed: 12/19/2022]
Abstract
Antioxidant supplements are expected to decrease oxidative damage and prevent ocular diseases. In this study, changes in the anti-oxidative ability and oxidative status in the aqueous humor before and after intake of a lutein-containing supplement were measured. Forty patients who all had identical grades of cataracts in both eyes were included. The aqueous humor was collected as pre-intake samples during cataract surgery. Ocuvite + Lutein(Ⓡ), an antioxidant supplement, was administered orally beginning the day after surgery. Six weeks later, the aqueous humor was collected as a post-intake sample during cataract surgery of the opposite eye. To determine the anti-oxidative ability, the levels of superoxide (O2(*-)) scavenging activity were measured. To determine the oxidative status, the levels of hydrogen peroxide (H2O2) and total amount of hydroperoxides (TH, including H2O2 and peroxides of lipids, proteins, and nucleic acids) were measured. In post-intake samples, the O2(*-) scavenging activities were significantly higher in both genders (p < 0.05). The levels of H2O2 were significantly higher (p < 0.01) while the levels of TH were significantly lower (p < 0.01) only in females. The level of H2O2 was significantly negatively correlated to the TH in the post-intake samples of both genders (r = -0.50 and p < 0.05 for males; r = -0.59 and p < 0.01 for females) while the level of H2O2 was significantly positively correlated to the O2(*-) scavenging activity in both pre- and post-intake aqueous humor in females only (r = 0.66 and p < 0.01 for pre-intake samples, r = 0.71 and p < 0.01 for post-intake samples). After the introduction of the antioxidant supplement, O2(*-) scavenging activity increased while H2O2 levels remained the same in males, suggesting that scavenging rates are proportional. In postmenopausal females, the superoxide scavenging activity also increased, however unlike in males, the H2O2 levels also increased meaning H2O2 was not completely scavenged. H2O2 is a non-free radical and can be excreted from the aqueous humor to prevent further oxidation of lipids, proteins, and nucleic acids, which was confirmed by the low levels of TH in post-intake samples. Antioxidant supplements are suggested to be effective in reducing oxidation in the aqueous humor by different mechanisms in both genders.
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