title: Association between blood cadmium level and age-related macular degeneration in a representative Korean population.
abstract: OBJECTIVE
  To investigate the association between blood cadmium level and AMD.
  
  
  METHODS
  This population-based, cross-sectional study using a nationwide, systemically stratified, multistage, clustered sampling method included 4933 subjects older than 40 years who participated in the Korean National Health and Nutrition Examination Survey (KNHANES) between 2008 and 2012 and had fundus photographs taken. All participants underwent a standardized interview, evaluation of blood cadmium concentrations, and comprehensive ophthalmic examination. A 45° digital fundus photograph was taken from both eyes under physiologic mydriasis, and were graded using the international classification and grading system for AMD.
  
  
  RESULTS
  Mean blood cadmium levels were 1.47 μg/L in women and 1.19 μg/L in men. After adjusting for potential confounders, including age, sex, and smoking status, the odds ratio (OR) for AMD was significantly increased in the highest quintile blood cadmium group (OR, 1.96; 95% confidence interval [CI], 1.17-3.29; P for trend = 0.017). This association between blood cadmium level and AMD was significant in men (OR, 2.11; 95% CI, 1.11-4.02; P for trend = 0.024), but not in women (OR, 1.29; 95% CI, 0.70-2.52; P for trend = 0.158).
  
  
  CONCLUSIONS
  This study provides the first epidemiologic evidence that higher blood cadmium level is associated with AMD. Results of the present study indicate that an elevated cadmium burden may increase the risk of AMD development.
authors.affiliation: Department of Ophthalmology and Visual Science, Buchon St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea.
authors.forename: Eun Chul
authors.initials: EC
authors.lastname: Kim
authors.affiliation: Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, Unites States.
authors.forename: Eunyoung
authors.initials: E
authors.lastname: Cho
authors.affiliation: Department of Ophthalmology and Visual Science, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea.
authors.forename: Donghyun
authors.initials: D
authors.lastname: Jee
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D002104:Cadmium / Q000097:blood*; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008268:Macular Degeneration / Q000097:blood*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D056910:Republic of Korea
chemical_list: D015415:Biomarkers; D002104:Cadmium
keywords: Korea; age-related macular degeneration; cadmium; sex difference