Lutein and zeaxanthin intake and the risk of age-related macular degeneration: A systematic review and meta-analysis
Open accessAbstract
Lutein and zeaxanthin are thought to decrease the incidence of age-related macular degeneration (AMD); however, findings have been inconsistent. We conducted a systematic literature review and meta-analysis to evaluate the relationship between dietary intake of lutein and zeaxanthin and AMD risk. Relevant studies were identified by searching five databases up to April 2010. Reference lists of articles were retrieved, and experts were contacted. Literature search, data extraction and study quality assessment were performed independently by two reviewers and results were pooled quantitatively using meta-analysis methods. The potential sources of heterogeneity and publication bias were also estimated. The search yielded six longitudinal cohort studies. The pooled relative risk (RR) for early AMD, comparing the highest with the lowest category of lutein and zeaxanthin intake, was 0·96 (95 % CI 0·78, 1·17). Dietary intake of these carotenoids was significantly related with a reduction in risk of late AMD (RR 0·74; 95 % CI 0·57, 0·97); and a statistically significant inverse association was observed between lutein and zeaxanthin intake and neovascular AMD risk (RR 0·68; 95 % CI 0·51, 0·92). The results were essentially consistent among subgroups stratified by participant characteristics. The findings of the present meta-analysis indicate that dietary lutein and zeaxanthin is not significantly associated with a reduced risk of early AMD, whereas an increase in the intake of these carotenoids may be protective against late AMD. However, additional studies are needed to confirm these relationships.
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Intake of the carotenoids lutein and zeaxanthin, but not beta-carotene, showed a lower risk of developing age-related macular degeneration.
“Recent studies have reported that intake of carotenoids lutein and zeaxanthin, but not β-carotene, showed a lower risk of developing this illness [257,258].”
From Vitamin A Update: Forms, Sources, Kinetics, Detection, Function, Deficiency, Therapeutic Use and Toxicity (2021) · cites this paper as [257]
The Abstract and Discussion report that higher lutein and zeaxanthin intake was associated with lower risk of late and neovascular AMD, but not significantly with lower risk of early AMD. The paper does not establish the claimed contrast with β-carotene (searched: β-carotene, beta-carotene, b-carotene). (LLM, conf=0.88)
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Cites
Measuring inconsistency in meta-analyses
Higgins, J. P. T., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003) · BMJ · doi:10.1136/bmj.327.7414.557 · Cited by 63,139 · see citing works
Bias in meta-analysis detected by a simple, graphical test
Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997) · BMJ · doi:10.1136/bmj.315.7109.629 · Cited by 56,722 · see citing works
(2014) · Medical Entomology and Zoology · Cited by 17,633 · see citing works
Complement factor H polymorphism in age-related macular degeneration
Klein, R. J., Zeiss, C., Chew, E. Y., Tsai, J.-Y., Sackler, R. S., Haynes, C., Henning, A. K., SanGiovanni, J. P., Mane, S. M., Mayne, S. T., et al. (2005) · Science · doi:10.1126/science.1109557 · Cited by 4,492 · see citing works
Funnel plots for detecting bias in meta-analysis
Sterne, J. A. C., & Egger, M. (2001) · Journal of Clinical Epidemiology · doi:10.1016/s0895-4356(01)00377-8 · Cited by 3,779 · see citing works
Prevalence of Age-Related Macular Degeneration in the United States
The Eye Diseases Prevalence Research Group* (2004) · Archives of Ophthalmology · doi:10.1001/archopht.122.4.564 · Cited by 2,742 · see citing works
Age-related macular degeneration
Jager, R. D., Mieler, W. F., & Miller, J. W. (2008) · New England Journal of Medicine · doi:10.1056/nejmra0801537 · Cited by 1,379 · see citing works
Risk factors for age-related macular degeneration
Smith, W., Assink, J., Klein, R., Mitchell, P., Klaver, C. C. W., Klein, B. E. K., Hofman, A., Jensen, S., Wang, J. J., & de Jong, P. T. V. M. (2001) · Ophthalmology · doi:10.1016/s0161-6420(00)00580-7 · Cited by 1,071 · see citing works
Dietary carotenoids, vitamins A, C, and E, and advanced age-related macular degeneration
Seddon, J. M. (1994) · JAMA: The Journal of the American Medical Association · doi:10.1001/jama.1994.03520180037032 · Cited by 993 · see citing works
The epidemiology of age-related macular degeneration
Klein, R., Peto, T., Bird, A., & Vannewkirk, M. R. (2004) · American Journal of Ophthalmology · doi:10.1016/j.ajo.2003.11.069 · Cited by 932 · see citing works
Krinsky, N. I., Landrum, J. T., & Bone, R. A. (2003) · Annual Review of Nutrition · doi:10.1146/annurev.nutr.23.011702.073307 · Cited by 779 · see citing works
Friedman, D. S. (2004) · Archives of Ophthalmology · doi:10.1001/archopht.122.7.1019 · Cited by 656 · see citing works
Oxidative damage and protection of the RPE
Cai, J., Nelson, K. C., Wu, M., Sternberg, P., & Jones, D. P. (2000) · Progress in Retinal and Eye Research · doi:10.1016/s1350-9462(99)00009-9 · Cited by 628 · see citing works
Smoking and age-related macular degeneration: a review of association
Thornton, J., Edwards, R., Mitchell, P., Harrison, R. A., Buchan, I. E., & Kelly, S. P. (2005) · Eye · doi:10.1038/sj.eye.6701978 · Cited by 559 · see citing works
The Role of Inflammation in the Pathogenesis of Age-related Macular Degeneration
Donoso, L. A., Kim, D. S., Frost, A. T., Callahan, A., & Hageman, G. S. (2006) · Survey of Ophthalmology · doi:10.1016/j.survophthal.2005.12.001 · Cited by 480 · see citing works
Seddon, J. M. (2005) · Archives of Ophthalmology · doi:10.1001/archopht.123.3.321 · Cited by 446 · cited 1× · see citing works
“Fifth, it is possible that populations with specific genetic backgrounds or nutritional status may affect the analysis of the relationship((56)).”
BackgroundAge-Related Eye Disease Study Research Group (2007) · Archives of Ophthalmology · doi:10.1001/archopht.125.9.1225 · Cited by 434 · see citing works
Seddon, J. M. (2006) · Archives of Ophthalmology · doi:10.1001/archopht.124.7.995 · Cited by 413 · see citing works
Beatty, S., Murray, I. J., Henson, D. B., Carden, D. E., Koh, H.-H., & Boulton, M. (2001) · PubMed · Cited by 408 · see citing works
Identification of lutein and zeaxanthin oxidation products in human and monkey retinas.
Khachik, F., Bernstein, P. S., & Garland, D. L. (1997) · PubMed · Cited by 404 · see citing works
Dietary Antioxidants and the Long-term Incidence of Age-Related Macular Degeneration
Tan, J. S. L., Wang, J. J., Flood, V., Rochtchina, E., Smith, W., & Mitchell, P. (2008) · Ophthalmology · doi:10.1016/j.ophtha.2007.03.083 · Cited by 381 · see citing works
Association Between C-Reactive Protein and Age-Related Macular Degeneration
Keenan, T. D. L., & Chew, E. Y. (2017) · JAMA Ophthalmology · doi:10.1001/jamaophthalmol.2017.2210 · Cited by 378 · see citing works
Association between C-reactive protein and age-related macular degeneration
Seddon, J. M. (2004) · JAMA · doi:10.1001/jama.291.6.704 · Cited by 376 · see citing works
Macular pigment in donor eyes with and without AMD: a case-control study.
Bone, R. A., Landrum, J. T., Mayne, S. T., Gomez, C. M., Tibor, S. E., & Twaroska, E. E. (2001) · PubMed · Cited by 364 · see citing works
Dietary intake of antioxidants and risk of age-related macular degeneration
van Leeuwen, R. (2005) · JAMA · doi:10.1001/jama.294.24.3101 · Cited by 345 · see citing works
Marse-Perlman, J. A., Fisher, A. I., Klein, R., Palta, M., Block, G., Millen, A. E., & Wright, J. D. (2001) · American Journal of Epidemiology · doi:10.1093/aje/153.5.424 · Cited by 286 · see citing works
Cho, E. (2004) · Archives of Ophthalmology · doi:10.1001/archopht.122.6.883 · Cited by 266 · see citing works
Effects of lutein and zeaxanthin on aspects of eye health
Ma, L., & Lin, X.-M. (2009) · Journal of the Science of Food and Agriculture · doi:10.1002/jsfa.3785 · Cited by 263 · see citing works
Self-citationMoeller, S. M. (2006) · Archives of Ophthalmology · doi:10.1001/archopht.124.8.1151 · Cited by 257 · see citing works
Do blue light filters confer protection against age-related macular degeneration?
Margrain, T. H. (2004) · Progress in Retinal and Eye Research · doi:10.1016/j.preteyeres.2004.05.001 · Cited by 257 · see citing works
Rapp, L. M., Maple, S. S., & Choi, J. H. (2000) · PubMed · Cited by 255 · see citing works
VandenLangenberg, G. M., Mares-Perlman, J. A., Klein, R., Klein, B. E. K., Brady, W. E., & Palta, M. (1998) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a009625 · Cited by 234 · see citing works
Macular Pigments Lutein and Zeaxanthin as Blue Light Filters Studied in Liposomes
Junghans, A., Sies, H., & Stahl, W. (2001) · Archives of Biochemistry and Biophysics · doi:10.1006/abbi.2001.2411 · Cited by 224 · see citing works
Lutein and Zeaxanthin in the Eyes, Serum and Diet of Human Subjects
Bone, R. A., Landrum, J. T., Dixon, Z., Chen, Y., & Law, C. L. (2000) · Experimental Eye Research · doi:10.1006/exer.2000.0870 · Cited by 206 · see citing works
Macular Pigment Lutein Is Antiinflammatory in Preventing Choroidal Neovascularization
Izumi‐Nagai, K., Nagai, N., Ohgami, K., Satofuka, S., Ozawa, Y., Tsubota, K., Umezawa, K., Ohno, S., Oike, Y., & Ishida, S. (2007) · Arteriosclerosis Thrombosis and Vascular Biology · doi:10.1161/atvbaha.107.151431 · Cited by 162 · see citing works
Beneficial Effect of Zeaxanthin on Retinal Metabolic Abnormalities in Diabetic Rats
Kowluru, R. A., Menon, B., & Gierhart, D. L. (2008) · Investigative Ophthalmology & Visual Science · doi:10.1167/iovs.07-0764 · Cited by 148 · see citing works
Elevated retinal zeaxanthin and prevention of light-induced photoreceptor cell death in quail.
Thomson, L. R., Toyoda, Y., Langner, A., Delori, F. C., Garnett, K. M., Craft, N. E., Nichols, C. R., Cheng, K. M., & Dorey, C. K. (2002) · PubMed · Cited by 137 · see citing works
Macular pigment and melanin in age-related maculopathy in a general population.
Berendschot, T. T. J. M., Willemse-Assink, J. J. M., Bastiaanse, M., de Jong, P. T. V. M., & Norren, D. V. (2002) · PubMed · Cited by 131 · see citing works
Haegele, A. D., Gillette, C. D., O'Neill, C., Wolfe, P., Heimendinger, J., SEDLACEK, S. M., & Thompson, H. J. (2000) · PubMed · Cited by 125 · see citing works
SanGiovanni, J. P., Chew, E. Y., Clemons, T. E., Ferris, F. L., Gensler, G. R., Lindblad, A. S., Milton, R. C., Seddon, J. M., & Sperduto, R. D. (2007) · Cited by 122 · see citing works
Age related macular degeneration and sun exposure, iris colour, and skin sensitivity to sunlight
Khan, J. C. (2006) · British Journal of Ophthalmology · doi:10.1136/bjo.2005.073825 · Cited by 121 · see citing works
Physical Quenching of Singlet Oxygen and cis‐trans Isomerization of Carotenoidsa
Stahl, W., & Sies, H. (1993) · Annals of the New York Academy of Sciences · doi:10.1111/j.1749-6632.1993.tb26153.x · Cited by 121 · see citing works
Nutritional supplements for age-related macular degeneration
Krishnadev, N., Meleth, A. D., & Chew, E. Y. (2010) · Current Opinion in Ophthalmology · doi:10.1097/icu.0b013e32833866ee · Cited by 116 · see citing works
Flood, V., Smith, W., Wang, J. J., Manzi, F., Webb, K., & Mitchell, P. (2002) · Ophthalmology · doi:10.1016/s0161-6420(02)01263-0 · Cited by 109 · see citing works
Prospective study of lutein/zeaxanthin intake and risk of age-related macular degeneration
Cho, E., Hankinson, S. E., ROSNER, B. A., Willett, W. C., & Colditz, G. A. (2008) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/87.6.1837 · Cited by 94 · see citing works
Thomson, L. R., Toyoda, Y., Delori, F. C., Garnett, K. M., Wong, Z.-Y., Nichols, C. R., Cheng, K. M., Craft, N. E., & Dorey, C. K. (2002) · Experimental Eye Research · doi:10.1006/exer.2002.2050 · Cited by 84 · see citing works
Chiu, C., Milton, R. C., Klein, R., Gensler, G. R., & Taylor, A. (2009) · Ophthalmology · doi:10.1016/j.ophtha.2008.12.025 · Cited by 83 · see citing works
Evans, J. (2004) · Ophthalmology · doi:10.1016/j.ophtha.2003.07.012 · Cited by 83 · see citing works
Wüstemeyer, H., Jahn, C., Nestler, A., Barth, T. F. E., & Wolf, S. (2002) · Graefe s Archive for Clinical and Experimental Ophthalmology · doi:10.1007/s00417-002-0515-6 · Cited by 79 · see citing works
Dillon, J. P., Zheng, L., Merriam, J. C., & Gaillard, E. R. (2004) · Experimental Eye Research · doi:10.1016/j.exer.2004.06.025 · Cited by 76 · see citing works
Subramanian, M. L., Ness, S. D., Abedi, G., Ahmed, E., Daly, M. K., Feinberg, E. B., Bhatia, S. P., Patel, P. M., Nguyen, M., & Houranieh, A. M. (2009) · American Journal of Ophthalmology · doi:10.1016/j.ajo.2009.07.009 · Cited by 72 · see citing works
Joint effects of smoking history and APOE genotypes in age-related macular degeneration.
Schmidt, S., Haines, J. L., Postel, E. A., Agarwal, A., Kwan, S. Y., Gilbert, J. R., Pericak‐Vance, M. A., & Scott, W. K. (2005) · PubMed · Cited by 55 · see citing works
Influence of Using Different Sources of Carotenoid Data in Epidemiologic Studies
VANDENLANGENBERG, G. M., Brady, W. E., Nebeling, L. C., Block, G., Forman, M. R., Bowen, P. E., Stacewicz‐Sapuntzakis, M., & Mares‐Perlman, J. A. (1996) · Journal of the American Dietetic Association · doi:10.1016/s0002-8223(96)00332-x · Cited by 51 · see citing works
Macular pigment density in age-related maculopathy
Jahn, C., W�stemeyer, H., Brinkmann, C. K., et al. (2004) · Graefe s Archive for Clinical and Experimental Ophthalmology · doi:10.1007/s00417-004-0995-7 · Cited by 50 · see citing works
Inhibition of nNOS and COX-2 expression by lutein in acute retinal ischemia
Choi, J., Kim, D.-M., Hong, Y., et al. (2006) · Nutrition · doi:10.1016/j.nut.2005.08.011 · Cited by 34 · see citing works
Zhang, X., Shu, X.-O., Chow, W.-H., Yang, G., Li, H., Gao, J., Yt, G., & Zheng, W. (2008) · International Journal of Obesity · doi:10.1038/ijo.2008.63 · Cited by 21 · see citing works
Scanning Laser Entoptic Perimetry for the Detection of Age-RelatedMacular Degeneration
Freeman, W. R. (2004) · Archives of Ophthalmology · doi:10.1001/archopht.122.11.1647 · Cited by 11 · see citing works
Muni, R. H., Altaweel, M. M., TENNANT, M. T. S., et al. (2008) · Retina · doi:10.1097/iae.0b013e3181814470 · Cited by 8 · see citing works
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Industrial potential of carotenoid pigments from microalgae: Current trends and future prospects
Ambati, R. R., Gogisetty, D., Aswathanarayana, R. G., Ravi, S., Bikkina, P. N., Bo, L., & Yuepeng, S. (2019) · Critical Reviews in Food Science and Nutrition · doi:10.1080/10408398.2018.1432561 · Cited by 372 · see citing works
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- Authors
- Ma, L., Dou, H.-L., Wu, Y.-Q., Huang, Y.-M., Huang, Y.-B., Xu, X.-R., Zou, Z.-Y., & Lin, X.-M.
- Affiliations
- Peking University (CN)
- Corresponding author
- Lin, Xiao-Ming
- ORCID
- Venue
- British Journal of Nutrition
- Publisher
- Cambridge University Press (CUP)
- Published
- 2011-09-08
- Volume
- 107
- Issue
- 3
- Pages
- 350-359
- ISSN
- 0007-1145 (ISSN-L)
- 1475-2662
- OpenAlex
- W1972454552
- Cited by
- 237
- References
- 58
- Citations by year
- 2026: 11 · 2025: 15 · 2024: 12 · 2023: 17 · 2022: 16 · 2021: 18 · 2020: 16 · 2019: 14 · 2018: 19 · 2017: 20 · 2016: 13 · 2015: 22 · 2014: 13 · 2013: 25 · 2012: 6
- FWCI
- 2.26
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal Of Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Natural Science Foundation of China
- Ministry of Education of the People's Republic of China
- Topics
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Health Sciences › Medicine › Biochemistry › Antioxidant Activity and Oxidative Stress
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Keywords
- lutein, zeaxanthin, age-related macular degeneration, dietary carotenoids, neovascular AMD, late AMD, early AMD, dietary intake
- MeSH terms
- Aged, Diet, Humans, Macular Degeneration, Middle Aged, Risk, Lutein, Age of Onset, Evidence-Based Medicine, Xanthophylls, Wet Macular Degeneration, Zeaxanthins
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