Cited by 1,031Retinal Diseases and TreatmentsAntioxidant Activity and Oxidative StressRetinal Imaging and Analysis

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Dietary Carotenoids, Vitamins A, C, and E, and Advanced Age-Related Macular Degeneration

Seddon, Johanna M.·1994·JAMA: The Journal of the American Medical Association

DOI 10.1001/jama.1994.03520180037032

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Abstract

Objective. —To evaluate the relationships between dietary intake of carotenoids and vitamins A, C, and E and the risk of neovascular age-related macular degeneration (AMD), the leading cause of irreversible blindness among adults. Design. —The multicenter Eye Disease Case-Control Study. Setting. —Five ophthalmology centers in the United States. Patients. —A total of 356 case subjects who were diagnosed with the advanced stage of AMD within 1 year prior to their enrollment, aged 55 to 80 years, and residing near a participating clinical center. The 520 control subjects were from the same geographic areas as case subjects, had other ocular diseases, and were frequency-matched to cases according to age and sex. Main Outcome Measures. —The relative risk for AMD was estimated according to dietary indicators of antioxidant status, controlling for smoking and other risk factors, by using multiple logistic-regression analyses. Results. —A higher dietary intake of carotenoids was associated with a lower risk for AMD. Adjusting for other risk factors for AMD, we found that those in the highest quintile of carotenoid intake had a 43% lower risk for AMD compared with those in the lowest quintile (odds ratio, 0.57; 95% confidence interval, 0.35 to 0.92;Pfor trend=.02). Among the specific carotenoids, lutein and zeaxanthin, which are primarily obtained from dark green, leafy vegetables, were most strongly associated with a reduced risk for AMD (Pfor trend=.001). Several food items rich in carotenoids were inversely associated with AMD. In particular, a higher frequency of intake of spinach or collard greens was associated with a substantially lower risk for AMD (Pfor trend<.001). The intake of preformed vitamin A (retinol) was not appreciably related to AMD. Neither vitamin E nor total vitamin C consumption was associated with a statistically significant reduced risk for AMD, although a possibly lower risk for AMD was suggested among those with higher intake of vitamin C, particularly from foods. Conclusion. —Increasing the consumption of foods rich in certain carotenoids, in particular dark green, leafy vegetables, may decrease the risk of developing advanced or exudative AMD, the most visually disabling form of macular degeneration among older people. These findings support the need for further studies of this relationship. (JAMA. 1994;272:1413-1420)

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BackgroundResult
Kurz- und mittelfristige Änderungen der makulären Pigmentdichte infolge der Supplementation mit Lutein und Zeaxanthin sowie Koantioxidanzien
Zeimer, M. B., Hense, H. W., Heimes, B., et al. (2008) · Der Ophthalmologe · doi:10.1007/s00347-008-1773-4 · Cited by 20
A Novel Zinc Compound (Zinc Monocysteine) Enhances the Antioxidant Capacity of Human Retinal Pigment Epithelial Cells
Tate, D., & Newsome, D. (2006) · Current Eye Research · doi:10.1080/02713680600801024 · Cited by 19
Olestra Consumption Is Not Associated with Macular Pigment Optical Density in a Cross-Sectional Volunteer Sample in Indianapolis
Cooper, D. A., Curran‐Celentano, J., Ciulla, T. A., et al. (2000) · Journal of Nutrition · doi:10.1093/jn/130.3.642 · Cited by 20
Eggs Improve Plasma Biomarkers in Patients with Metabolic Syndrome Following a Plant-Based Diet—A Randomized Crossover Study
Thomas, M. S., Puglisi, M. J., Malysheva, O., Caudill, M. A., Sholola, M. J., Cooperstone, J. L., & Fernández, M. L. (2022) · Nutrients · doi:10.3390/nu14102138 · Cited by 22
“Plasma Lipids Fasting plasma total cholesterol (TC), HDL-cholesterol (HDL-C) and triglycerides (TG),) were determined at baseline and the end of each breakfast period using an automated clinical chemistry analyzer (Cobas c 111, Roche Diagnostics, Indianapolis, IN, USA) via enzymatic and photometric detection methods a…”
BackgroundMethod
Comparison of macular pigment optical density in patients with dry and wet age-related macular degeneration
Kaya, M., Özyurt, A., Koçak, N., Akan, P., Çalan, Ö. G., Öztürk, T., Karahan, E., & Kaynak, S. (2017) · Indian Journal of Ophthalmology · doi:10.4103/ijo.ijo_365_16 · Cited by 19
“Many studies have suggested that the risk of wet AMD development is not correlated with serum and dietary levels of MP.[25,26] The dry and wet subtypes of AMD may have different etiologies and risk factors, and the need to examine the density of MP in wet AMD separately has been emphasized.”
Background
Systematic review of the appropriateness of eye care delivery in eye care practice
Ho, K. C., Stapleton, F. J., Wiles, L., Hibbert, P. D., Alkhawajah, S. M. M., White, A. J. R., & Jalbert, I. (2019) · BMC Health Services Research · doi:10.1186/s12913-019-4493-3 · Cited by 20
Lutein as a functional ingredient in sheep milk yogurt: development, characterization and extraction recovery
de Barros, R. F., TORRES, F. R., da Silva, P. H. F., et al. (2020) · Food Science and Technology · doi:10.1590/fst.36019 · Cited by 19
“There is no official Recommended Dietary Allowance (RDA) or Recommended Daily Ontake (RDO) of LT; however, the amount added was based on data indicating a 20 mg limit as safe for daily LT consumption (Agência Nacional de Vigilância Sanitária, 2019; Shao & Hathcock, 2006), and through studies showing the biological eff…”
Background
Natural Tocopherols in a Dietary Supplement of Lutein Affect Tissue Distribution of Tocopherols in Young Rats
Jenkins, M. Y., Mitchell, G. V., & Grundel, E. (2000) · Nutrition and Cancer · doi:10.1207/s15327914nc372_14 · Cited by 19
“The xanthophylls lutein and zeaxanthin are the carotenoids most strongly associated with a decreased risk for age-related macular degeneration (5,6) and are the only carotenoids present in the macular pigment, which is an area of the retina responsible for acute vision (7–9).”
Background
Effects of β-Carotene and Its Cleavage Products in Primary Pneumocyte Type II Cells
Haider, C., Ferk, F., Bojaxhi, E., et al. (2017) · Antioxidants · doi:10.3390/antiox6020037 · Cited by 19
“increased uptake of carotenoids or fruits and vegetables as primary source of carotenoids reduces the risk to develop cardiovascular diseases [7–9], age-dependent macula degeneration [10], cataract formation [11,12], and different types of cancer [13] such as mouth, pharynx, larynx, esophagus, stomach, colon, rectum,…”
Background
The Effect of Undernutrition in the Development of Frailty in Older Persons
Bischoff, H. A., Staehelin, H. B., & Willett, W. C. (2006) · The Journals of Gerontology Series A · doi:10.1093/gerona/61.6.585 · Cited by 19
Does dietary lutein and zeaxanthin increase the risk of age related macular degeneration? The Melbourne Visual Impairment Project
Vu, H. T. V. (2006) · British Journal of Ophthalmology · doi:10.1136/bjo.2005.078055 · Cited by 18
B Vitamins and Incidence of Advanced Age-Related Macular Degeneration: The Alienor Study
Merle, B. M. J., Barthes, S., Féart, C., Cougnard‐Grégoire, A., Korobelnik, J., Rougier, M., Delyfer, M., & Delcourt, C. (2022) · Nutrients · doi:10.3390/nu14142821 · Cited by 17
Association of Dietary Nitrate and a Mediterranean Diet With Age-Related Macular Degeneration Among US Adults
Broadhead, G., Agrón, E., Peprah, D., Keenan, T. D. L., Lawler, T. P., Mares, J. A., Chew, E. Y., AREDS/AREDS2 Investigators, SanGiovanni, J., Ferris, F., et al. (2022) · JAMA Ophthalmology · doi:10.1001/jamaophthalmol.2022.5404 · Cited by 18
Zeaxanthin and α-tocopherol reduce the inhibitory effects of photodynamic stress on phagocytosis by ARPE-19 cells
Olchawa, M., Herrnreiter, A. M., Pilat, A. K., Skumatz, C. M. B., Niziolek, M., Burke, J. M., & Sarna, T. (2015) · Free Radical Biology and Medicine · doi:10.1016/j.freeradbiomed.2015.10.411 · Cited by 18
Intake of Zinc and Antioxidant Micronutrients and Early Age-Related Maculopathy Lesions
Morris, M. S., Jacques, P. F., Chylack, L. T., Hankinson, S. E., Willett, W. C., Hubbard, L. D., & Taylor, A. (2007) · Ophthalmic Epidemiology · doi:10.1080/09286580601186759 · Cited by 17
Biosynthesis of Zeaxanthin via Mevalonate in Paracoccus Species Strain PTA-3335. A Product-Based Retrobiosynthetic Study†
Eisenreich, W., Bacher, A., Berry, A., et al. (2002) · The Journal of Organic Chemistry · doi:10.1021/jo016084r · Cited by 18
Quercetin protects ARPE-19 cells against photic stress mediated by the products of rhodopsin photobleaching
Olchawa, M., Krzysztynska‐Kuleta, O. I., Mokrzynski, K. T., Sarna, P. M., & Sarna, T. (2020) · Photochemical & Photobiological Sciences · doi:10.1039/d0pp00165a · Cited by 18
Dietary Supplements Commonly Used for Prevention
Najm, W. I., & Lie, D. (2008) · Primary Care Clinics in Office Practice · doi:10.1016/j.pop.2008.07.010 · Cited by 19
Antioxidant Activity of Phytochemicals from Distillers Dried Grain Oil
Winkler‐Moser, J. K., & Vaughn, S. F. (2009) · Journal of the American Oil Chemists Society · doi:10.1007/s11746-009-1439-7 · Cited by 18
Age related distribution of 4-hydroxy 2-nonenal immunoreactivity in human retina
Nag, T. C., Kumar, P., & Wadhwa, S. (2017) · Experimental Eye Research · doi:10.1016/j.exer.2017.09.014 · Cited by 19
“Retinal carotenoids (lutein and zeaxanthin) can delay the onset of age-related maculopathy (Seddon et al., 1994; Snodderly, 1995; Nolan et al., 2007) and protect the retina from light-induced OS and aging (Bernstein et al., 2001).”
Background
A Discordant Sib-Pair Linkage Analysis of Age-Related Macular Degeneration
Santangelo, S. L., Yen, C.-H., Haddad, S. A., Fagerness, J. A., Huang, C., & Seddon, J. M. (2005) · Ophthalmic Genetics · doi:10.1080/13816810490967944 · Cited by 18
Self-citation
Use of high-precision gas isotope ratio mass spectrometry to determine natural abundance 13C in lutein isolated from C3 and C4 plant sources
Liang, Y., White, W. S., Yao, L., et al. (1998) · Journal of Chromatography A · doi:10.1016/s0021-9673(97)00897-2 · Cited by 18
Distribution of Carotenoids in Fruits and Vegetables as a Criterion for the Selection of Appropriate Chemopreventive Agents
Khachik, F., Nir, Z., Ausich, R. L., et al. (1997) · Springer eBooks · doi:10.1007/978-4-431-67017-9_41 · Cited by 18
Introduction of the Carotenoid Biosynthesis α-Branch Into Synechocystis sp. PCC 6803 for Lutein Production
Lehmann, M., Vamvaka, E., Torrado, A., Jahns, P., Dann, M., Rosenhammer, L., Aziba, A., Leister, D., & Rühle, T. (2021) · Frontiers in Plant Science · doi:10.3389/fpls.2021.699424 · Cited by 17
Macular Pigment Optical Density in the Korean Population: a Cross Sectional Study
Hong, I. H., Jung, W. H., Lee, J. H., et al. (2020) · Journal of Korean Medical Science · doi:10.3346/jkms.2020.35.e30 · Cited by 17
The Oxygen Paradigm—Quantitative Impact of High Concentrations of Dissolved Oxygen on Kinetics and Large-Scale Production of Arthrospira platensis
Franke, S. M., Steingroewer, J., Walther, T., & Krujatz, F. (2022) · ChemEngineering · doi:10.3390/chemengineering6010014 · Cited by 18

Authors: Seddon, J. M.
Corresponding author: Seddon, Johanna M.
ORCID: Seddon, Johanna M.
Venue: JAMA: The Journal of the American Medical Association
Publisher: American Medical Association (AMA)
Published: 1994-11-09
Volume: 272
Issue: 18
Pages: 1413
ISSN: 0002-9955 (ISSN-L)
0098-7484
DOI: 10.1001/jama.1994.03520180037032
OpenAlex: W4296976934
Cited by: 993
References: 0
Citations by year: 2026: 10 · 2025: 17 · 2024: 48 · 2023: 27 · 2022: 30 · 2021: 30 · 2020: 39 · 2019: 44 · 2018: 35 · 2017: 35 · 2016: 37 · 2015: 41 · 2014: 38 · 2013: 41 · 2012: 56
FWCI: 21.40
Type: journal article
Language: en
Open access: closed
Locations: JAMA (publishedVersion)
Funders: National Eye Institute (EY09972)
Topics: Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
Health Sciences › Medicine › Biochemistry (medical) › Antioxidant Activity and Oxidative Stress
Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal Imaging and Analysis
Keywords: neovascular age-related macular degeneration, dietary carotenoids, lutein, zeaxanthin, vitamin A, vitamin C, vitamin E, antioxidant intake, dark green leafy vegetables, spinach, collard greens, AMD risk factors, dietary intake, older adults, blindness prevention, retinol, dietary supplements

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Dietary Carotenoids, Vitamins A, C, and E, and Advanced Age-Related Macular Degeneration

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