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Original Contribution
December 28, 2005

Dietary Intake of Antioxidants and Risk of Age-Related Macular Degeneration

Author Affiliations

Author Affiliations: Departments of Epidemiology and Biostatistics (Drs van Leeuwen, Boekhoorn, Vingerling, Witteman, Klaver, Hofman, and de Jong) and Ophthalmology (Drs van Leeuwen, Vingerling, and Klaver), Erasmus Medical Centre, Rotterdam, the Netherlands; Netherlands Ophthalmic Research Institute, Royal Netherlands Academy of Arts and Sciences (KNAW) (Drs Klaver and de Jong), and Department of Ophthalmology, Academic Medical Centre (Dr de Jong), Amsterdam, the Netherlands.

JAMA. 2005;294(24):3101-3107. doi:10.1001/jama.294.24.3101

Context Age-related macular degeneration (AMD) is the most prevalent cause of irreversible blindness in developed countries. Recently, high-dose supplementation with beta carotene, vitamins C and E, and zinc was shown to slow the progression of AMD.

Objective To investigate whether regular dietary intake of antioxidants is associated with a lower risk of incident AMD.

Design Dietary intake was assessed at baseline in the Rotterdam Study (1990-1993) using a semiquantitative food frequency questionnaire. Incident AMD until final follow-up in 2004 was determined by grading fundus color transparencies in a masked way according to the International Classification and Grading System.

Setting Population-based cohort of all inhabitants aged 55 years or older in a middle-class suburb of Rotterdam, the Netherlands.

Participants Of 5836 persons at risk of AMD at baseline, 4765 had reliable dietary data and 4170 participated in the follow-up.

Main Outcome Measure Incident AMD, defined as soft distinct drusen with pigment alterations, indistinct or reticular drusen, geographic atrophy, or choroidal neovascularization.

Results Incident AMD occurred in 560 participants after a mean follow-up of 8.0 years (range, 0.3-13.9 years). Dietary intake of both vitamin E and zinc was inversely associated with incident AMD. The hazard ratio (HR) per standard deviation increase of intake for vitamin E was 0.92 (95% confidence interval [CI], 0.84-1.00) and for zinc was 0.91 (95% CI, 0.83-0.98). An above-median intake of all 4 nutrients, beta carotene, vitamin C, vitamin E, and zinc, was associated with a 35% reduced risk (HR, 0.65; 95% CI, 0.46-0.92) of AMD. Exclusion of supplement users did not affect the results.

Conclusion In this study, a high dietary intake of beta carotene, vitamins C and E, and zinc was associated with a substantially reduced risk of AMD in elderly persons.