|Zhang, Fang Fang|
Submitted to: American Journal of Ophthalmology
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/17/2014
Publication Date: 7/1/2014
Citation: Chiu, C., Chang, M., Zhang, F., Li, T., Gensler, G., Schleicher, M., Taylor, A. 2014. The relationship of major American dietary patterns to age-related macular degeneration. American Journal of Optthalmology. 158(1):118-128. Interpretive Summary: Age related macular degeneration (AMD) is the major cause of blindness in persons aged 65+ years in developed countries. Currently, clinical treatments for AMD are costly and limited. Therefore, nutritional intervention seems to hold some promise toward preventing or delaying AMD. Most of the previous attempts to determine relationships between diet and AMD have focused on single nutrients. However, foods and nutrients are not eaten in isolation. Analyzing the diet as a whole may inform us about the effects of actual eating patterns on risk for AMD. We hypothesized that major American dietary patterns are associated with AMD risk. We identified two major dietary patterns, named Oriental and Western patterns. The Oriental pattern was characterized by higher intake of vegetables, legumes, fruit, whole grains, tomatoes, and seafood. The Western pattern was characterized by higher intake of red meat, processed meat, high-fat dairy products, French fries, refined grains, and eggs. We found that both patterns showed a significant association with odds for either early or advanced AMD. The Oriental pattern is associated with reduced odds and closer adherents to the Oriental pattern gain larger benefit. In contrast, people who consume the Western pattern are at markedly increased odds. In summary, our data give further support to the opinion that overall diet plays an important role in the development of AMD and that dietary pattern analysis may provide better insight into the human diet than single food/nutrient approach.
Technical Abstract: We hypothesized that major American dietary patterns are associated with age-related macular degeneration (AMD) risk. This was a cross-sectional study with 8,103 eyes from 4,088 eligible participants in the baseline Age-Related Eye Disease Study (AREDS) were classified into control (n=2,739), early AMD (n=4,599), and advanced AMD (n=765) by AREDS AMD Classification System. Food consumption data were collected by a 90-item food frequency questionnaire. Two major dietary patterns were identified by factor (principle component) analysis based on 37 food groups and named Oriental and Western patterns. The Oriental pattern was characterized by higher intake of vegetables, legumes, fruit, whole grains, tomatoes, and seafood. The Western pattern was characterized by higher intake of red meat, processed meat, high-fat dairy products, French fries, refined grains, and eggs. We ranked our participants according to how closely their diets line up with the two patterns by calculating the two factor scores for each participant. For early AMD, multivariate-adjusted odds ratio (OR) from generalized estimating equation logistic analysis comparing the highest to lowest quintile of the Oriental pattern score was ORE5O=0.74 (95% confidence interval (CI): 0.59-0.91; Ptrend=0.01), and the OR comparing the highest to lowest quintile of the Western pattern score was ORE5W=1.56 (1.18-2.06; Ptrend=0.01). For advanced AMD, the ORA5O was 0.38 (0.27-0.54; Ptrend<0.0001), and the ORA5W was 3.70 (2.31-5.92; Ptrend<0.0001). Our data indicate that overall diet is significantly associated with the odds of AMD and that dietary management as an AMD prevention strategy warrants further study.