Progression of age-related macular degeneration - Association with dietary fat, transunsaturated fat, nuts, and fish intake
Progression of age-related macular degeneration - Association with dietary fat, transunsaturated fat, nuts, and fish intake
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DOI：
10.1001/archopht.121.12.1728
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发表时间：
2003-12-01
影响因子：
--
通讯作者：
Rosner, B
中科院分区：
文献类型：
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作者：
Seddon, JM;Cote, J;Rosner, B
背景：老年性黄斑变性(AMD)早期或中期患者在老年人口中占很大比例，且不断增长。关于可以降低发展为晚期AMD的风险的可改变因素，证据稀少。目的：通过我们对饮食脂肪摄入与AMD早期或中期进展到与视力损失相关的疾病的晚期之间的关系的评估，建议晚期AMD高危患者采取预防措施。设计：一项前瞻性队列研究，平均随访时间为4.6年。背景：一项以医院为基础的视网膜临床实践，专门研究黄斑变性。患者：261名参与者年龄在60岁及以上，有非渗出性AMD和视力的一些迹象至少1只眼的视力达到20/200或更高。主要观察指标：进展为晚期AMD，结果：较高的总脂肪摄入量增加了发展为晚期AMD的风险，在控制其他因素后，最高脂肪摄入量四分位数相对于最低脂肪摄入量四分位数的相对危险度(RR)为2.90(95%可信区间，1.15-7.32)(P趋势=0.01)。动物脂肪摄入量与进展风险增加2倍相关(与最低四分位数相比，最高四分位数的RR为2.29；95%可信区间为0.91-5.72)，尽管动物脂肪摄入量较高的风险增加的趋势并不显著(P=0.09)。较高的植物脂肪摄入量与AMD进展的风险增加有更强的相关性，与最低四分位数相比，最高四分位数的RR为3.82(95%可信区间，1.58-9.28)(P趋势=0.003)。饱和、单不饱和、多不饱和和反不饱和脂肪增加了进展的可能性(RR，2.09，P趋势=0.08；RR，2.21，P趋势=0.04；RR，2.28，P趋势=0.04；RR，2.39，P趋势=0.008)。在亚油酸摄入量较低的受试者中，较高的鱼类摄入量与AMD进展的风险较低相关。加工烘焙食品，其中一些脂肪含量较高，使AMD进展速度增加约2倍，小屋受到保护。结论：在AMD早期或中期阶段的个体中，总的和特定类型的脂肪摄入，以及一些含脂肪的食物组，改变了进展为晚期AMD的风险。鱼和坚果的摄入量降低了风险。由于晚期AMD与视力丧失和生活质量下降有关，这些预防措施值得进一步研究和更多重视。
Background: Individuals with early or intermediate stages of age-related macular degeneration (AMD) make up a large, growing segment of the elderly population. Evidence is sparse regarding modifiable factors that may decrease the risk of progression to the advanced forms of AMD.Objective: To advise patients with a high risk for advanced forms of AMD about preventive measures through our evaluation of the relationship between dietary fat intake and the progression of early or intermediate AMD to the advanced stages of the disease associated with visual loss.Design: A prospective cohort study with an average follow-up time of 4.6 years.Setting: A hospital-based clinical retinal practice specializing in macular degeneration.Patients: The 261 participants were aged 60 years and older and had some sign of nonexudative AMD and visual acuity of 20/200 or better in at least 1 eye.Main Outcome Measure: Progression to advanced AMD, which was defined as having geographic atrophy or neovascular disease.Results: Higher total fat intake increased the risk of progression to the advanced forms of AMD, with a relative risk (RR) of 2.90 (95% confidence interval, 1.15-7.32) for the highest fat-intake quartile relative to the lowest fat-intake quartile, after controlling for other factors (P trend=.01). Animal fat intake was associated with a 2-fold increased risk of progression (RR, 2.29 for the highest quartile compared with the lowest quartile; 95% confidence interval, 0.91-5.72), although the trend for increasing risk with higher animal fat intake was not significant (P=.09). Higher vegetable fat intake had a stronger relationship with increased risk of AMD progression with an RR of 3.82 (95% confidence interval, 1.58-9.28) for the highest quartile compared with the lowest quartile (P trend=.003). Saturated, monounsaturated, polyunsaturated, and transunsaturated fats increased the likelihood of progression (RR, 2.09 and P trend=.08; RR, 2.21 and P trend=.04; RR, 2.28 and P trend=.04; RR, 2.39 and P trend=.008, respectively). Higher fish intake was associated with a lower risk of AMD progression among subjects with lower linoleic acid intake. Processed baked goods, which are higher in some of these fats, increased the rate of AMD progression approximately 2-fold, and huts were protective.Conclusions: Among individuals with the early or intermediate stages of AMD, total and specific types of fat intake, as well as some fat-containing food groups, modified the risk of progression to advanced AMD. Fish intake and nuts reduced risk. Since advanced AMD is associated with visual loss and reduced quality of life, these preventive measures deserve additional research and greater emphasis.