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Cited by 385Retinal Diseases and TreatmentsRetinal Imaging and AnalysisAntioxidant Activity and Oxidative Stress

Progression of Age-Related Macular Degeneration: Association With Dietary Fat, Transunsaturated Fat, Nuts, and Fish Intake

Open access
Seddon, Johanna M.·2003·Archives of Ophthalmology
DOI 10.1001/archopht.121.12.1728PMC PMC8443211
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Abstract

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 nuts 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.

Integrity signals

Registry

Crossref · 10.1001/archopht.121.12.1728

Cites

39 of 39 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 31 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    In this cohort, saturated fat intake increased the likelihood of progression to advanced AMD (RR, 2.09; P trend=.08).

    “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).”
    Quote in the paperSubstantial claim
  • Findingown data

    In this cohort, higher fish intake was associated with a lower risk of AMD progression among subjects with lower linoleic acid intake.

    “Higher fish intake was associated with a lower risk of AMD progression among subjects with lower linoleic acid intake.”
    Quote in the paperSubstantial claim
  • Findingown data

    In this cohort, monounsaturated fat intake increased the likelihood of progression to advanced AMD (RR, 2.21; P trend=.04).

    “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).”
    Quote in the paperSubstantial claim
  • Findingown data

    In this cohort, transunsaturated fat intake increased the likelihood of progression to advanced AMD (RR, 2.39; P trend=.008).

    “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).”
    Quote in the paperSubstantial claim
  • Findingown data

    In this cohort, polyunsaturated fat intake increased the likelihood of progression to advanced AMD (RR, 2.28; P trend=.04).

    “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).”
    Quote in the paperSubstantial claim
  • May combine two claims. 23
  • Classified as probably not a substantial claim. 42
  • The quote only partly states this claim. 2

  • May combine two claims.

    Findingown data

    In this cohort, the highest quartile of total fat intake was associated with a higher risk of progression to advanced AMD than the lowest quartile, with an adjusted relative risk of 2.90 (95% CI, 1.15-7.32) and a significant trend (P=.01).

    “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).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In this cohort, higher vegetable fat intake was associated with increased risk of AMD progression, with a relative risk of 3.82 (95% CI, 1.58-9.28) for the highest versus lowest quartile and a significant trend (P=.003).

    “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).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In this cohort, the highest quartile of animal fat intake was associated with about twice the risk of progression to advanced AMD compared with the lowest quartile (RR, 2.29; 95% CI, 0.91-5.72), but the trend across quartiles was not statistically significant (P=.09).

    “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).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Meat intake tended to increase risk of AMD progression (RR, 2.09), but the trend was not statistically significant.

    “High-fat dairy foods (RRs = 1.91) and meat (RRs = 2.09) tended to increase risk, although the overall trend was not statistically significant.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Higher vegetable fat intake was associated with an increased rate of progression to advanced AMD, and the association was stronger and statistically significant.

    “For both, there was an increased rate of progression associated with the highest intake, and results were somewhat stronger and statistically significant for vegetable fat.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Higher monounsaturated fat intake was associated with increased risk of AMD progression (RR, 2.18; 95% CI, 0.90-5.26; P trend=.04), and results were similar after including other nutrients.

    “For monounsaturated fat intake, the results were similar with an RR of 2.18 (95% CI, 0.90-5.26)for the highest intake compared with the lowest intake, which was significant (P trend=.04),with similar results after including the other nutrients (P trend=.04).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based). May combine two claims. The quote only partly states this claim.

    Findingown data

    Higher animal fat intake was associated with an increased rate of progression to advanced AMD, but the association was not statistically significant.

    “For both, there was an increased rate of progression associated with the highest intake, and results were somewhat stronger and statistically significant for vegetable fat.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    High-fat dairy food intake tended to increase risk of AMD progression (RR, 1.91), but the trend was not statistically significant.

    “High-fat dairy foods (RRs = 1.91) and meat (RRs = 2.09) tended to increase risk, although the overall trend was not statistically significant.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    After additional adjustment for zinc, vitamin C, and vitamin E, the association between total fat intake and AMD progression was slightly strengthened, with an RR of 2.90 for the highest vs lowest quartile (P trend=.01).

    “Further adjustments for intake of zinc, vitamin C, and vitamin E slightly strengthened the association between AMD and total fat, with an RR of 2.90 for the highest quartile of total fat compared with the lowest (P trend=.01).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Polyunsaturated fat intake had a nonsignificant positive association with AMD progression; after other nutrients were considered, the association became stronger and significant (RR, 2.28; P=.04).

    “There was a nonsignificant, positive association between polyunsaturated fat intake and progression of AMD, which became stronger and significant (RR, 2.28; P=.04) after consideration of the other nutrients.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Higher intake of vegetable fat, and to a lesser extent animal fat, increased the rates of AMD progression.

    “Specifically, higher intake of vegetable fat, and to a lesser extent animal fat, increased rates of progression.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Participants' dietary reports at baseline reflect their habitual intake over the follow-up period during which AMD progression was ascertained.

  • May combine two claims.

    Findingown data

    Saturated, monounsaturated, polyunsaturated, and transunsaturated fats were related to AMD progression.

    “Saturated, monounsaturated, polyunsaturated, and transunsaturated fats were also related to progression.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Participants' dietary reports at baseline reflect their habitual intake over the follow-up period during which AMD progression was ascertained.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The nutrient values used to compute intake scores came mainly from US Department of Agriculture sources.

    “Nutrient values were primarily derived from US Department of Agriculture sources.20”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The interview took place in person before the ophthalmologic examination.

    “The interview was conducted in person and preceded the ophthalmologic examination.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    More women than men were lost to follow-up (10% vs 3%; P=.03).

    “however, more women were lost to follow-up (10%) compared with men (3%) (P=.03).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The food frequency questionnaire used in this study was a modification of an extensively validated questionnaire.

    “The FFQ, a modification of an extensively validated questionnaire, 18 contained a list of food items that were selected as the major sources of a variety of nutrients.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18]

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Dietary fat is associated with atherosclerosis.

    “For example, it is plausible that dietary fat, which is associated with atherosclerosis, [11][12] could affect ocular blood vessels or could be involved in oxidative processes that contribute to the development of the advanced stage of AMD characterized by atrophy or choroidal neovascularization.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [11][12]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The interviewer did not know the participants' ocular status.

    “The interviewer was unaware of the subjects' ocular status.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Waist and hip measurements were self-recorded at home by participants following an established protocol that included instructions and a standard tape measure.

    “Waist and hip measurements were recorded by participants at home using an established protocol, including instructions and a standard tape measure.21”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Height, weight, and blood pressure were measured with standard protocols and equipment.

    “Height, weight, and blood pressure were measured using standard protocols and equipment.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Participants whose dietary responses were excluded from analysis (n=8) did not differ significantly from included participants in age, sex, or education.

    “Participants whose responses were not included in the analyses (n=8) did not differ significantly by age, sex, or education from those who were included.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Forty-seven participants were censored during follow-up because of death.

    “Additionally, 47 participants were censored during follow-up because of death.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Some studies have found an association between dietary fat intake and AMD onset or diagnosis, while others have not, and the type of fat associated with AMD differs across studies.

    “In fact, a few studies have demonstrated an association between dietary fat intake and the onset or diagnosis of AMD, [13][14][15][16] but others do not, 17 and the type of fat associated with AMD differs across studies.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [13][14][15][16]

      Not checked in the free run.

    • cites [17]

      Not checked in the free run.

  • May combine two claims.

    Study design and conductcitation

    The modified food frequency questionnaire was found to be reliable in an age-related eye disease study population, with reproducibility correlation coefficients for fats of 0.59 to 0.73, similar to other established diet questionnaires.

    “This questionnaire, which we modified and adapted to facilitate its use among elderly subjects with eye disease, was found to be reliable in an age-related eye disease study population.19 Reproducibility correlation coefficients for fats, ranging from 0.59 to 0.73, were similar to results from other established diet questionnaires.19”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Data from all questionnaires were reviewed, coded, and entered into the computer by staff who did not know the participants' ocular status.

    “We reviewed, coded, and entered the data from all questionnaires into the computer without knowledge of the ocular status of the participant.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The analysis controlled specific fat types for vitamin C, vitamin E, zinc, and total beta carotene consumption, both with and without supplements.

    “We adjusted specific types of fat for intake of vitamins C and E, zinc, and total beta carotene intake with and without supplements.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    All participants were interviewed by a trained interviewer who used a standardized risk factor questionnaire.

    “All subjects were interviewed by a trained interviewer using a standardized risk factor questionnaire.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Nineteen participants (7%) were lost to follow-up because they were unwilling to return for additional examinations.

    “Nineteen individuals (7%) were lost to follow-up because of unwillingness to return for additional follow-up examinations.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The relative risks from those models can be understood as approximate effects of replacing carbohydrates with animal or vegetable fat while holding total energy constant.

    “The RRs from the latter models can be interpreted as approximate substitution effects of animal fat and vegetable fat for carbohydrates, holding total energy constant.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Substituting lutein and zeaxanthin for total beta carotene in the analysis of total fat did not materially change the results.

    “In a separate analysis of total fat, substituting lutein and zeatanthin for total beta carotene, the results were not materially different.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Additional adjustment for initial best eye grade and initial worst eye grade did not change the results.

    “Results were unchanged after the additional adjustment and are not presented in the tables.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Cases with a discrepancy of 2 or more AMD grades were reevaluated and adjudicated by one of the study authors.

    “Cases in which there was inconsistency of 2 or more AMD grades were reevaluated and adjudicated by one of us (J.M.S.).”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Study design and conductown data

    The unweighted kappa statistic for agreement between the study grader and the Wisconsin reading center on AMD grade was 0.77.

    “The κ statistic for interrater reliability was 0.77 and the weighted κ score was 0.84.26”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26]

      Not checked in the free run.

    • Rests on an assumption: The Wisconsin Fundus Photographic Reading Center uses a 4-point grading system to measure AMD.
    • Rests on an assumption: Reading center grades 1 and 2 are similar to the study's grades 1 and 2.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationreasoning

    Dietary fat might increase oxidative damage in the macula, an area susceptible to oxidation because of high oxygen tension and light exposure.

    “Dietary fat might also increase oxidative damage in the macula, an area that is susceptible to oxidation owing to high oxygen tension and light exposure.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Epidemiological findings continue to point to a possible cardiovascular risk profile among some persons with AMD, suggesting that the two conditions may be interrelated.

    “Epidemiological findings continue to point to a possible cardiovascular risk profile among some persons with AMD, suggesting that the 2 conditions may be interrelated.10”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [10]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The Blue Mountains Eye Study reported an odds ratio of 1.48 for monounsaturated fat for early age-related maculopathy.

    “The Blue Mountains Eye Study reported odds ratios of 1.48 for monounsaturated fat for early age-related maculopathy.14”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The Third National Health and Nutrition Examination Survey suggested no relationship between any type of fat intake and prevalence of early or late age-related maculopathy, although the number of advanced cases was small (n=51).

    “However, more recent results from the Third National Health and Nutrition Examination Survey 17 suggested no relationship between any type of fat intake and prevalence of early or late age-related maculopathy, although the number of advanced cases was small (n=51).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    The present findings are generally consistent with the authors' previous case-control study that compared the dietary habits of individuals with advanced exudative AMD with control subjects.

    “Findings are generally consistent with the results of our previous case-control study in which we compared the dietary habits of individuals with advanced, exudative disease with control subjects.15”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Long-chain omega-3 fatty acids, especially docosahexaenoic acid found primarily in fish, have been associated with an inverse risk for cardiovascular disease in some studies.

    “Long-chain ω-3 fatty acids, especially docosahexanoic acid found primarily in fish, have been associated with an inverse risk for cardiovascular disease in some studies.28”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Cross-sectional data from the Beaver Dam Study and the Blue Mountains Eye Study both reported significantly increased prevalence of age-related maculopathy with greater dietary fat intake, although the results were not consistent for specific types of fat.

    “Cross-sectional data from the Beaver Dam Study 13 and the Blue Mountains Eye Study 14 both reported significantly increased prevalence of age-related maculopathy with greater dietary fat intake, although these results were not consistent for specific types of fat.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [13]

      Not checked in the free run.

    • cites [14]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    One possible mechanism linking dietary fat to AMD is atherosclerosis of the blood vessels supplying the choroid and retina.

    “One mechanism could involve atherosclerosis of the blood vessels supplying the choroid and retina.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The Nurses' Health Study found a 35% lower risk of coronary heart disease and a 27% decrease in risk for type 2 diabetes mellitus among women who consumed nuts 5 or more times per week compared with none.

    “Additionally, the Nurses' Health Study found a 35% lower risk of coronary heart disease and a 27% decrease in risk for type 2 diabetes mellitus among women who consumed nuts 5 or more times per week vs none.29,32”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [29]

      Not checked in the free run.

    • cites [32]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Resveratrol, one of the bioactive compounds in nuts, has antioxidant, antithrombotic, and anti-inflammatory properties.

    “One of the bioactive compounds in nuts, resveratrol, has antioxidant, antithrombotic, and anti-inflammatory properties.33”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [33]

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The study assessed progression rates prospectively.

    “the prospective assessment of progression rates”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Increased fat intake and obesity are known to be associated with inflammation, and inflammatory factors are known to be associated with cardiovascular disease and may possibly be associated with AMD.

    “Furthermore, increased fat intake and obesity are known to be associated with inflammation, and inflammatory factors are known to be associated with cardiovascular disease and may possibly be associated with AMD. 10”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [10]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The Physicians' Health Study reported nearly a 50% reduction in risk for sudden cardiac death (RR, 0.53; 95% CI, 0.30-0.92) and a 30% lowered risk for total coronary heart disease death among men who consumed nuts 2 or more times per week.

    “The Physicians' Health Study reported nearly a 50% reduction in risk for sudden cardiac death (RR, 0.53) (95% CI, 0.30-0.92)and a 30% lowered risk for total coronary heart disease death among men who consumed nuts 2 or more times per week.30”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [30]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Nuts may lower total cholesterol levels and protect against coronary heart disease and atherosclerosis because they are dietary sources of vitamin E, copper, magnesium, and dietary fiber.

    “In addition, nuts may lower total cholesterol levels and protect against coronary heart disease and atherosclerosis because they are dietary sources of vitamin E, copper, magnesium, and dietary fiber.34”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    The potential beneficial effect of the nut food group on AMD progression risk complements other literature reporting a protective role for nuts in cardiovascular disease and type 2 diabetes mellitus.

    “The potential beneficial effect of the nut food group on risk of AMD progression complements other literature reporting a protective role for nuts and cardiovascular disease [29][30][31] and type 2 diabetes mellitus.32”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [29]

      Not checked in the free run.

    • cites [30]

      Not checked in the free run.

    • cites [31]

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The study evaluated the progression of AMD, as opposed to its onset or diagnosis.

    “Unique features of this study include the evaluation of the progression of AMD, as opposed to its onset or diagnosis.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Metabolic studies have shown that trans fats adversely affect blood lipid levels by increasing low-density lipoprotein cholesterol while decreasing high-density lipoprotein levels, and this effect can be twice that of saturated fatty acids.

    “Metabolic studies have shown that trans fats have adverse effects on blood lipid levels by increasing low-density lipoprotein cholesterol while decreasing high-density lipoprotein levels, 35 and this effect can be twice that of saturated fatty acids.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [35]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Trans fats are known to be associated with an increased risk of coronary heart disease.

    “Trans fats are also known to be associated with an increased risk of coronary heart disease.36”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [36]

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    AMD end points were assessed by standardized ophthalmologic examination and fundus photography.

    “assessment of AMD end points by standardized ophthalmologic examination and fundus photography”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The possibility cannot be ruled out that some reporting of risk factors was related to the initial level of AMD at baseline.

    “One cannot rule out the possibility that some reporting of risk factors could have been related to the initial level of AMD at baseline.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Unmeasured and therefore uncontrolled factors might still confound the observed relationships, but they would have to be highly associated with dietary fat intake and a strong risk factor for AMD progression to explain the results.

    “Although some unmeasured and therefore uncontrolled factors might still be confounding the relationships seen, they would have to be highly associated with dietary fat intake and a strong risk factor for AMD progression to explain these results.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationnone given

    The adverse effect of dietary fat found in this study may represent the deleterious effect of other aspects of high-fat diets rather than fat itself.

    “It is possible that the adverse effect of dietary fat found in our study may represent the deleterious effect of other aspects of high-fat diets rather than fat.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Standardized data collection instruments were used, including interviews and direct measurements of height, weight, and blood pressure.

    “standardized data collection instruments, including interviews and direct measurements of height, weight, and blood pressure”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Identification of modifiable risk factors for AMD may improve the ability to identify and treat the approximately 8 million persons in the United States with signs of AMD who are at high risk of progressing to the more severe forms of the disease.

    “Identification of modifiable risk factors for AMD may improve our ability to identify and treat the approximately 8 million persons in the United States with signs of AMD who are at high risk of progressing to the more severe forms of the disease.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Any random misclassification would tend to bias the associations toward a relative risk of 1.0 (no association).

    “Any random misclassification would tend to bias our associations toward an RR of 1.0 (no association).”
    Quote in the paperNot a substantial claim
58 of 58

  • The paper relies on this without support.

    No studies have evaluated the association between dietary fat intake and progression of AMD among individuals already diagnosed with early or intermediate stages.

    “However, to our knowledge, no studies have evaluated the association between dietary fat intake and progression of AMD among individuals already diagnosed with the early or intermediate stages of the disease.”

  • The paper relies on this without support.

    Evidence is sparse regarding modifiable factors that may decrease the risk of progression to advanced AMD.

    “Evidence is sparse regarding modifiable factors that may decrease the risk of progression to the advanced forms of AMD.”
    “However, despite these advances, evidence is sparse regarding other modifiable factors that could reduce the rate of conversion from early or intermediate disease to the advanced stages that cause irreversible visual loss.”

  • The paper relies on this without support.

    The Wisconsin Fundus Photographic Reading Center uses a 4-point grading system to measure AMD.

    “The reading center uses a 4-point grading system to measure AMD; so we created an algorithm to convert their 4-point grade scale into our 5-grade scale for comparison.”

  • The paper relies on this without support.

    Reading center grades 1 and 2 are similar to the study's grades 1 and 2.

    “Reading center grades 1 and 2 did not require conversion because they were similar to our grades 1 and 2.”

  • The paper relies on this without support.

    Linoleic acid is the primary dietary source of omega-6 fatty acids.

    “linoleic acid, the major source of ω-6 fatty acids”

  • The paper relies on this without support.

    Participants' dietary reports at baseline reflect their habitual intake over the follow-up period during which AMD progression was ascertained.

    “since they were reported prior to the progression of AMD”
6 of 6

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Both fat intake and obesity are linked to increased risk of AMD.

    “Both fat intake and obesity have been linked to increased risk of AMD (Mares-Perlman et al., 1995; Seddon et al., 2003)”

    From Molecular pathology of age-related macular degeneration (2009) · cites this paper as Seddon et al., 2003

  • Diets high in antioxidants lutein and zeaxanthin and in omega-3 fatty acids have been linked to a decreased risk of neovascular AMD.

    “Diets high in antioxidants lutein and zeaxanthin (found mostly in green leafy vegetables) and in omega-3 fatty acids (primarily found in fish) have been linked to a decreased risk of neovascular AMD (48, 134).”

    From Unraveling a Multifactorial Late-Onset Disease: From Genetic Susceptibility to Disease Mechanisms for Age-Related Macular Degeneration (2009) · cites this paper as [134]

  • Some case-control studies have found evidence of decreasing risk of neovascular age-related macular degeneration among individuals reporting the highest intake of omega-3 fatty acids and fish, especially if in conjunction with lower levels of intake of linoleic acid.

    “Some case–control studies have found evidence of decreasing risk of neovascular age-related macular degeneration among individuals reporting the highest intake of omega-3 fatty acids and fish,105,106 especially if in conjunction with lower levels of intake of linoleic acid.107”

    From Age-related macular degeneration (2008) · cites this paper as [107]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Reported racial percentage is impossible for the enrolled cohort

    Minor

    The study enrolled 366 people. In a group of that size, one nonwhite participant would make the white proportion about 99.7%, while none would make it 100%; neither can round to 99.9%.

1 of 1

Cites

Flagged first, then by citations

1 of the 40 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. Sunness JS, Gonzalez-Baron J, Bressler NM, Hawkins B, Applegate CA. The development of choroidal neovascularization in eyes with the geographic atrophy form of age-related macular degeneration. Ophthalmology. 1999;106:910-919. [PubMed: 10328389]

Cited by

Sorted by citations

Related

Authors
Seddon, J. M.
Affiliations
Massachusetts Eye and Ear Infirmary (US)
Corresponding author
Seddon, Johanna M.
ORCID
Seddon, Johanna M.
Venue
Archives of Ophthalmology
Publisher
American Medical Association (AMA)
Published
2003-12-01
Volume
121
Issue
12
Pages
1728
ISSN
0003-9950 (ISSN-L)
DOI
10.1001/archopht.121.12.1728
PMC
PMC8443211
OpenAlex
W2099756978
Cited by
384
References
40
Citations by year
2026: 6 · 2025: 7 · 2024: 9 · 2023: 10 · 2022: 15 · 2021: 10 · 2020: 15 · 2019: 12 · 2018: 16 · 2017: 19 · 2016: 14 · 2015: 13 · 2014: 14 · 2013: 19 · 2012: 21
FWCI
19.69
Type
journal article
Language
en
Open access
Locations
  • Archives of Ophthalmology (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Foundation Fighting Blindness
  • Research to Prevent Blindness
  • Harvard University
  • Massachusetts Eye and Ear
  • Massachusetts Lions Eye Research Fund
  • National Eye Institute (R01EY011309)
Topics
  • Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal Imaging and Analysis
  • Health Sciences › Medicine › Biochemistry › Antioxidant Activity and Oxidative Stress
Keywords
age-related macular degeneration, disease progression, dietary fat intake, animal fats, vegetable fats, saturated fat, monounsaturated fatty acids, polyunsaturated fat, trans fatty acids, fish consumption, linoleic acid, geographic atrophy, neovascular AMD, vision loss, older adults, preventive nutrition, modifiable risk factors, nutrition counseling
MeSH terms
Aged, Animals, Energy Intake, Diet, Dietary Fats, Dietary Fats, Unsaturated, Female, Fish Products, Humans, Macular Degeneration, Male, Middle Aged, Nuts, Prospective Studies, Surveys and Questionnaires, Risk Factors, Cohort Studies, Diet Records, Disease Progression

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-05.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-05.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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