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


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


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


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


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


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


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


CONCLUSIONS
In this study, a high dietary intake of beta carotene, vitamins C and E, and zinc was associated with a substantially reduced risk of AMD in elderly persons.
van Leeuwen
Redmer
R
Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands;
Boekhoorn
Sharmila
S
Vingerling
Johannes R
JR
Witteman
Jacqueline C M
JC
Klaver
Caroline C W
CC
Hofman
Albert
A
de Jong
Paulus T V M
PT
D000368:Aged; D000975:Antioxidants; D001205:Ascorbic Acid; D015331:Cohort Studies; D004032:Diet; D004034:Diet Surveys; D005260:Female; D006801:Humans; D008268:Macular Degeneration / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D012306:Risk; D014810:Vitamin E; D015032:Zinc; D019207:beta Carotene
D000975:Antioxidants; D019207:beta Carotene; D014810:Vitamin E; D015032:Zinc; D001205:Ascorbic Acid