Elsevier

Ophthalmology

Volume 121, Issue 7, July 2014, Pages 1428-1434.e2
Ophthalmology

Original article
Dietary Patterns and Their Associations with Age-Related Macular Degeneration: The Melbourne Collaborative Cohort Study

Presented at: The Association for Research in Vision and Ophthalmology, May 5–9, 2013, Seattle, Washington.
https://doi.org/10.1016/j.ophtha.2014.01.002Get rights and content

Objective

To evaluate the association between dietary patterns and age-related macular degeneration (AMD).

Design

Food frequency data were collected from Melbourne Collaborative Cohort Study (MCCS) participants at the baseline study in 1990–1994. During follow-up in 2003–2007, retinal photographs were taken and evaluated for AMD.

Participants

At baseline, 41 514 participants aged 40 to 70 years and born in Australia or New Zealand (69%), or who had migrated from the United Kingdom, Italy, Greece, or Malta (31%) were recruited. Of these, 21 132 were assessed for AMD prevalence at follow-up.

Methods

Principal component analysis was used to identify dietary patterns (Factors F1–6) among the food items. Logistic regression was used to assess associations of dietary patterns with AMD.

Main Outcome Measures

Odds ratios (ORs) for early stages and advanced AMD in association with dietary patterns.

Results

A total of 2508 participants (12.8%) had early stages of AMD, and 108 participants (0.6%) had advanced AMD. Six factors characterized by predominant intakes of fruits (F1); vegetables (F2); grains, fish, steamed or boiled chicken, vegetables, and nuts (F3); red meat (F4); processed foods comprising cakes, sweet biscuits, and desserts (F5); and salad (F6) were identified. Higher F3 scores were associated with a lower prevalence of advanced AMD (fourth vs. first quartile) (OR, 0.49; 95% confidence interval [CI], 0.28–0.87), whereas F4 scores greater than the median were associated with a higher prevalence of advanced AMD (OR, 1.46; 95% CI, 1.0–2.17).

Conclusions

Rather than specific individual food items, these factors represent a broader picture of food consumption. A dietary pattern high in fruits, vegetables, chicken, and nuts and a pattern low in red meat seems to be associated with a lower prevalence of advanced AMD. No particular food pattern seemed to be associated with the prevalence of the earliest stages of AMD.

Section snippets

Study Population

The MCCS recruited 41 514 participants (24 469 women) aged 40 to 69 years at baseline (1990–1994) to examine links between diet and chronic diseases.25, 26 To broaden the range of dietary intakes, participants born in Greece and Italy were deliberately oversampled to comprise one quarter of the cohort, whereas participants born in Australia, New Zealand, and United Kingdom made up the remainder of the cohort.25

Of the total sample, 27 883 (67%) attended a follow-up examination between 2003 and

Results

Of the 22 405 participants who had retinal photographs assessed, 21 132 (94%) had retinal photographs gradable for AMD. After excluding 1364 participants at the extreme 1% of energy intake at baseline (n = 311) and participants with a history of heart attack/angina/stroke (n = 688) or diabetes at baseline (n = 365) (with the potential for dietary modification), we included the remaining 19 768 participants in the analysis.

Of the 19 768 participants, 2508 (12.7%) had early stages of AMD and 108

Discussion

The MCCS presents a unique opportunity to study links between diets and those with AMD, because it is the largest single cohort study with comprehensive data on both diet and AMD status. With the use of PCA, we identified 6 dietary factors (patterns) at baseline. Of note, fruit and vegetables ended up in different factors in our data. We observed that participants born in Australia, New Zealand, and the United Kingdom scored higher on the “vegetable” factor, whereas those born in Italy and

References (47)

  • E.W. Chong et al.

    Red meat and chicken consumption and its association with age-related macular degeneration

    Am J Epidemiol

    (2009)
  • E.W. Chong et al.

    Alcohol consumption and the risk of age-related macular degeneration: a systematic review and meta-analysis

    Am J Ophthalmol

    (2008)
  • M.K. Adams et al.

    20/20–Alcohol and Age-related Macular Degeneration: The Melbourne Collaborative Cohort Study

    Am J Epidemiol

    (2012)
  • E.W. Chong et al.

    Fat consumption and its association with age-related macular degeneration

    Arch Ophthalmol

    (2009)
  • E.W. Chong et al.

    Dietary antioxidants and primary prevention of age related macular degeneration: systematic review and meta-analysis

    BMJ

    (2007)
  • Lutein + zeaxanthin and omega-3 fatty acids for age-related macular degeneration: the Age-Related Eye Disease Study 2 (AREDS2) randomized clinical trial

    JAMA

    (2013)
  • J.M. Seddon et al.

    Dietary fat and risk for advanced age-related macular degeneration

    Arch Ophthalmol

    (2001)
  • E.W. Chong et al.

    Dietary omega-3 fatty acid and fish intake in the primary prevention of age-related macular degeneration: a systematic review and meta-analysis

    Arch Ophthalmol

    (2008)
  • W. Smith et al.

    Dietary fat and fish intake and age-related maculopathy

    Arch Ophthalmol

    (2000)
  • J.J. Wang et al.

    Combined effects of complement factor H genotypes, fish consumption, and inflammatory markers on long-term risk for age-related macular degeneration in a cohort

    Am J Epidemiol

    (2009)
  • J.A. Mares et al.

    Healthy lifestyles related to subsequent prevalence of age-related macular degeneration

    Arch Ophthalmol

    (2011)
  • J.A. Mares-Perlman et al.

    Dietary fat and age-related maculopathy

    Arch Ophthalmol

    (1995)
  • J.P. SanGiovanni et al.

    The relationship of dietary carotenoid and vitamin A, E, and C intake with age-related macular degeneration in a case-control study: AREDS Report No. 22

    Arch Ophthalmol

    (2007)
  • Cited by (55)

    • Intake of Vegetables, Fruit, and Fish is Beneficial for Age-Related Macular Degeneration

      2019, American Journal of Ophthalmology
      Citation Excerpt :

      Our findings are consistent with recent studies on dietary patterns and AMD. The Melbourne collaborative cohort study showed that higher intake of grains and fish considerably reduced the risk of late AMD.14 Intake of vegetables and fruit alone was not associated with late AMD; unfortunately, the combined intake of these foods was not studied.

    • Adherence to a mediterranean diet and its association with age-related macular degeneration. The Coimbra Eye Study–Report 4

      2018, Nutrition
      Citation Excerpt :

      When looking at each food group individually, we observed that an increased intake of vegetables, fruit, and nuts was associated with no AMD. This result is in agreement with previous publications [36] and biologically plausible [37,38] because these foods are high in antioxidants. Therefore, one might consider it likely that vegetables, fruit, and nuts drive the results that are observed in our study and thus, the potential protective effect of the Mediterranean diet in AMD.

    View all citing articles on Scopus

    Supplemental material is available online at www.aaojournal.org.

    Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

    Funding: Victoria Health, The Cancer Council Victoria, and National Health & Medical Research Council of Australia (NHMRC) (*Program Grant 209057, Capacity Building Grant 251533, and Enabling Grant 396414) funded the MCCS study. Ophthalmic component was funded by the Ophthalmic Research Institute of Australia and American Health Assistance Foundation. People support was provided through the NHMRC Practitioner Fellowships (R.H.G.), NHMRC Senior Research Fellowships (P.N.B. and J.L.H.), and Macular Degeneration Foundation Blackmores Dr. Paul Beaumont Research Fellowship (L.D.R.). The Centre for Eye Research Australia is a recipient of the NHMRC Centre for Clinical Research Excellence Grant 529923 and Operational Infrastructure Support from the Victorian Government.

    Drs. Islam and Chong contributed equally to this article as first authors.

    View full text