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The Role of Nutritional Factors in Transitioning between Early, Mid and Late Stages of Age-Related Macular Degeneration: prospective longitudinal analysis.

BACKGROUND: Transitions between different stages of age-related macular degeneration (AMD) are not completely captured by traditional survival models with an endpoint of advanced AMD.

OBJECTIVE: This study aimed to explore the transitions from early and intermediate AMD to higher non-advanced and advanced stages and determine the contributions of nutritional factors to these outcomes.

METHODS: Eyes with early or intermediate AMD at baseline, classified according to the Age-Related Eye Disease Study severity score, were included in this prospective longitudinal analysis. Foods and the biologically active nutrients associated with AMD [green leafy vegetables, fish, lutein/zeaxanthin (LZ), and ω-3 fatty acids] were determined by a baseline food frequency questionnaire. Progression was defined as eyes transitioning to higher severity groups including non-advanced and advanced stages over 5 years, confirmed at 2 consecutive visits. Cox proportional hazards models for foods and nutrients were analyzed adjusting for demographics, lifestyle, baseline macular status, family history of AMD, caloric intake and genetic risk.

RESULTS: Among 2697 eyes, 616 (23%) progressed to higher severity groups. In the food group model, higher intake of green leafy vegetables reduced incidence of transitions [hazard ratio (HR) (≥ 2.7 servings/week vs. none) = 0.75 (95% confidence interval 0.59 - 0.96), P = 0.02]. Higher fish intake was also protective [HR (≥ two 4-ounce servings/week vs. < 2) = 0.79 (0.65 - 0.95), P = 0.01]. In the nutrient model, LZ intake was protective [HR (≥ 2 mg/day vs. < 2) = 0.76 (0.60 - 0.96), P = 0.02]. Higher intake of ω-3 fatty acids also tended to be beneficial [HR (≥ 0.7 g/week vs. < 0.7) = 0.85 (0.71 - 1.01), P = 0.06].

CONCLUSIONS: Increased consumption of green leafy vegetables, LZ, and fish nutritionally rich in ω-3 fatty acids during the initial stages of AMD may reduce rates of progression to higher severity of this debilitating disease.

CLINICAL TRIAL: NCT00594672.

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