Sustained supplementation and monitored response with differing carotenoid formulations in early age-related macular degeneration.

PURPOSE: To compare the impact of sustained supplementation using different macular carotenoid formulations on macular pigment (MP) and visual function in early age-related macular degeneration (AMD). PATIENTS AND METHODS: Sixty-seven subjects with early AMD were randomly assigned to: Group 1 (20 mg per day lutein (L), 0.86 mg per day zeaxanthin (Z); Ultra Lutein), Group 2 (10 mg per day meso-zeaxanthin (MZ), 10 mg per day L, 2 mg per day Z; Macushield; Macuhealth), Group 3 (17 mg per day MZ, 3 mg per day L, 2 mg per day Z). MP was measured using customised heterochromatic flicker photometry and visual function was assessed by measuring contrast sensitivity (CS) and best-corrected visual acuity (BCVA). AMD was graded using the Wisconsin Age-Related Maculopathy Grading System (AREDS 11-step severity scale). RESULTS: At 3 years, a significant increase in MP from baseline was observed in all groups at each eccentricity (P<0.05), except at 1.75° in Group 1 (P=0.160). Between 24 and 36 months, significant increases in MP at each eccentricity were seen in Group 3 (P<0.05 for all), and at 0.50° in Group 2 (P<0.05), whereas no significant increases were seen in Group 1 (P>0.05 for all). At 36 months, compared with baseline, the following significant improvements (P<0.05) in CS were observed: Group 2-1.2, 6, and 9.6 cycles per degree (c.p.d.); Group 1-15.15 c.p.d.; and Group 3-6, 9.6, and 15.15 c.p.d. No significant changes in BCVA, or progression to advanced AMD, were observed. CONCLUSION: In early AMD, MP can be augmented with a variety of supplements, although the inclusion of MZ may confer benefits in terms of panprofile augmentation and in terms of CS enhancement.

The relation of coffee and caffeine to the 5-year incidence of early age-related maculopathy: the Beaver Dam Eye Study.

PURPOSE: To examine the relationship between coffee and caffeine consumption and the 5-year incidence of early age-related maculopathy and its component lesions, soft indistinct drusen or pigmentary abnormalities. DESIGN: A prospective cohort study conducted from 1988 to 1995 with an average follow-up of 4.8 years. METHODS: Data from baseline and 5-year follow-up examinations were analyzed for Beaver Dam Eye Study participants (n = 3435). The Wisconsin Age-Related Maculopathy Grading System was used to assess the presence and severity of early age-related maculopathy. RESULTS: Men were more likely to be coffee and caffeine drinkers than were women. For both men and women, coffee and caffeine intake decreased with age. Coffee and caffeine consumption were not associated with the 5-year incidence of early age-related maculopathy, soft indistinct drusen, or pigmentary abnormalities. CONCLUSION: Neither a history of coffee nor caffeine consumption is associated with incident early age-related maculopathy.

The relation of socioeconomic factors to the incidence of early age-related maculopathy: the Beaver Dam eye study.

PURPOSE: To investigate the relationship between socioeconomic factors and the 5-year incidence of age-related maculopathy. METHODS: The Beaver Dam Eye Study, a population-based cohort study, examined 3681 adults (range, 43-86 years of age at baseline) living in Beaver Dam, Wisconsin, at baseline and 5 years later. Standardized protocols for physical examination, including administration of a questionnaire that included questions regarding income, education level, and status and type of employment, and fundus photography to determine age-related maculopathy, were performed. RESULTS: While controlling for age and sex, less education, and being in a service-related occupation compared with a white collar professional occupation, was associated (P <.05) with the incidence of early age-related maculopathy. CONCLUSION: These data show an association of education and occupation but not income with the incidence of early age-related maculopathy that appears independent of smoking or vitamin supplement use status.

Supplement users differ from nonusers in demographic, lifestyle, dietary and health characteristics.

This study delineates demographic, lifestyle, dietary and health factors associated with the use of supplements at varying levels. Data are from a population-based cohort of 2,152 middle- to older-age adults living in Beaver Dam, Wisconsin. Information was collected by in-person interviews between 1988-1990. Associations were adjusted for gender and age. Use of supplements was more prevalent among women, persons with more than 12 years of education, those with relatively low body mass indices, persons with active lifestyles, and persons who never smoked as compared to current smokers (P

Usual consumption of plant foods containing phytoestrogens and sex hormone levels in postmenopausal women in Wisconsin.

Consumption of phytoestrogens may reduce hormone-dependent cancer risk through alterations in the actions or metabolism of steroid hormones. Studies in humans of phytoestrogen-hormone interactions have been limited and inconsistent. Relations between the consumption of phytoestrogen-containing foods and serum sex hormones and sex hormone-binding globulin were studied in a population-based sample of postmenopausal women who participated in the Nutritional Factors in Eye Disease Study of the Beaver Dam Eye Study. Information on phytoestrogen-containing foods (broccoli, carrots, cauliflower, chili, dark bread, peas, and dried beans) was collected by interviewer-administered food-frequency questionnaires. Estrone, sex hormone-binding globulin, dehydroepiandrosterone sulfate, and total and free testosterone were measured. Analyses included 246 postmenopausal women not taking hormone replacements. Partial correlations between hormones and intake of phytoestrogen-containing foods were computed, with adjustment for age, body mass index, years since menopause, and total energy intake. Number of standard servings per week of whole-grain products from the dark bread group was inversely associated with total testosterone (r = -0.20, p = 0.002). Although not statistically significant, other hormones displayed similar inverse associations with dark bread consistent with a common metabolic pathway. Although the magnitude of association was small, the data are consistent with the possibility that consumption of some phytoestrogen-containing foods may affect levels of testosterone in postmenopausal women.

Relation of smoking to the incidence of age-related maculopathy. The Beaver Dam Eye Study.

To date, a number of reports have been published on the relation of cigarette smoking to age-related maculopathy, an important cause of blindness in the United States. However, few studies have examined the relation between smoking and the incidence of age-related maculopathy. In this report, the authors examine this association in persons aged 43-86 years (n = 3,583) at baseline who were participants in the baseline examination and 5-year follow-up of the Beaver Dam Eye Study, Beaver Dam, Wisconsin (1988-1990 and 1993-1995). Exposure data on cigarette smoking were obtained from questions about present and past smoking, duration of smoking, and the number of cigarettes smoked per day. Age-related maculopathy status was determined by grading stereoscopic color fundus photographs using the Wisconsin Age-related Maculopathy Grading System. After controlling for age, sex, vitamin supplement use, and beer consumption, men who smoked greater amounts of cigarettes were more likely to develop early age-related maculopathy (odds ratio (OR) per 10 pack-years smoked = 1.06, 95% confidence interval (CI) 1.00-1.13, p = 0.06) than men who had smoked less. This association was not observed in women. Men (OR = 3.21, 95% CI 1.09-9.45) and women (OR = 2.20, 95% CI 1.04-4.66) who were current smokers at the time of the baseline examination had significantly higher odds of developing large drusen (> or = 250 microns in diameter) after 5 years than those who had never smoked or who quit before the baseline study. Current or past history of cigarette smoking was not related to the incidence of retinal pigment epithelial depigmentation. The authors conclude that smoking appears to be related to the incidence of some lesions associated with early age-related maculopathy.

Changes in the optic disc over a five-year interval: the Beaver Dam Eye Study.

PURPOSE: To determine the relationship of change in vertical optic disc cupping to change in intraocular pressure over a five-year interval. METHODS: Non-simultaneous stereoscopic photographs were taken of optic discs of participants in the baseline and follow-up examinations of The Beaver Dam Eye Study cohort. Optic discs and cups were measured and other disc features were graded according to a standard protocol by trained graders. Intraocular pressures were measured by Goldmann applanation tonometry. RESULTS: Change in pressure was significantly associated with change in vertical cup-to-disc ratio. Incident disc hemorrhage, flattened temporal rim, notching, cup reaching disc margin, and undercutting were not significantly associated with change in intraocular pressure. CONCLUSION: Change in intraocular pressure in this adult population was associated with increased optic disc cupping. This finding, if confirmed, would lend support to the practice of periodic follow-up of older adults who have shown changes in their intraocular pressure.

Dietary fat and age-related maculopathy.

OBJECTIVE: To describe the relationship between type and level of fat in the diet and the prevalence of age-related maculopathy. DESIGN: Retrospective population-based study. SETTING AND PARTICIPANTS: Residents of Beaver Dam, Wis, between the ages of 45 and 84 years, participating in the Beaver Dam Eye Study and Nutritional Factors in Eye Disease Study. DATA COLLECTION: Presence and severity of age-related maculopathy were determined from masked grading of fundus photographs taken from 1988 through 1990. Diets in the past (1978 through 1980) were assessed retrospectively using a food frequency questionnaire during in-person home interviews. RESULTS: Persons with intake of saturated fat and cholesterol in the highest compared with the lowest quintile had 80% and 60% increased odds for early age-related maculopathy, respectively, after adjusting for age and intake of beer. These relationships were not influenced by adjusting for several other potential confounding variables (carotenoid intake, intake of vitamins C or E in supplements, smoking, body mass index, time spent outdoors in the summer, gender, and history of diabetes, hypertension, or cardiovascular disease). Odds ratios for late age-related maculopathy were in similar directions but were not statistically significant. CONCLUSIONS: High intake of saturated fat and cholesterol is associated with increased risk for early age-related maculopathy in the Beaver Dam population. This supports the hypothesis that atherosclerosis or its risk factors are related to age-related maculopathy. Confirmation of this finding in other populations and in prospective studies is needed.

Diet and nuclear lens opacities.

Relations between diet and nuclear opacities in the lens of the eye were investigated in a population-based cohort of middle-aged and older adults who lived in Beaver Dam, Wisconsin. Nuclear sclerosis was assessed from photographs of the lens taken during 1988-1990 in 1,919 persons in the Beaver Dam Eye Study. Diets in the past (1978-1980) were assessed retrospectively with the use of a food frequency questionnaire in home interviews. Relations with intake of foods and nutrients were evaluated using logistic regression analyses. In men, after controlling for age, smoking, and heavy drinking, intakes of numerous nutrients in the highest versus lowest quintile were associated with 40-50 percent reduced odds of more severe nuclear sclerosis. Relations with some nutrients (vitamins A, C, and E, riboflavin, thiamin, niacin) were at least partly explained by previously identified inverse associations with multivitamin use. Relations with other nutrients (folate, alpha-carotene, and dietary fiber) appeared to reflect associations with intake of foods, particularly vegetables. Inverse associations with individual nutrients and foods were often weaker or nonexistent in women. These data indicate that the intake of vitamin supplements (in men and women) and certain foods (particularly in men) may explain associations of several nutrients with risk for nuclear sclerosis.

Relation between lens opacities and vitamin and mineral supplement use.

PURPOSE: The authors evaluated the cross-sectional and longitudinal relations between lens opacities and intake of vitamins and minerals in supplements. METHODS: Type and quantity of vitamins and minerals taken currently and 10 years before interview were obtained in a population-based sample of persons in the Nutritional Factors in Eye Disease Study (n = 2152). RESULTS: In persons without diabetes, regular use of multivitamin preparations 10 years in the past was associated with decreased risk for nuclear sclerosis (odds ratio [OR], 0.6; 95% confidence interval [CI], 0.5, 0.8) and increased the risk for cortical opacities (OR, 1.6; CI, 1.1, 2.2). In persons with diabetes, past multivitamin use was not associated with nuclear sclerosis (OR, 1.1; CI, 0.4,2.7) but with decreased risk for cortical opacities (OR, 0.1; CI, 0.0, 0.9). Cross-sectional associations with current intake of supplements were weaker, but in the same direction. Multivitamin use was not cross-sectionally or longitudinally related to posterior subcapsular cataract in persons with or without diabetes. CONCLUSION: Use of vitamin supplements is longitudinally associated with nuclear and cortical opacities. However, the direction of the association is influenced by the type of opacity and diabetes status.

Glycosylated hemoglobin concentrations and vitamin E, vitamin C, and beta-carotene intake in diabetic and nondiabetic older adults.

Studies indicate that large doses of all-rac-alpha-tocopherol in people with diabetes or ascorbic acid in nondiabetic subjects reduces protein glycosylation. The mechanisms by which these nutrients influence glycosylation are poorly understood but may be related to their ability to function as antioxidants. We examined the relationship between glycosylated hemoglobin (GHb) and intake of vitamins E and C and beta-carotene in a population-based sample of middle-aged and older adults participating in the Beaver Dam Eye Study. In people with diabetes, no significant associations were observed between GHb and intake of vitamins E and C and beta-carotene. In people without diabetes, energy-adjusted vitamin C intake was negatively associated with GHb after age and sex were controlled for (dietary, P = 0.02; total, P = 0.04). No significant relationships between GHb and intake of vitamin E and beta-carotene were observed.

A diet history questionnaire ranks nutrient intakes in middle-aged and older men and women similarly to multiple food records.

We evaluated the reproducibility of a modified version of the National Cancer Institute diet history questionnaire and also studied comparability of nutrient estimates from this questionnaire to those from four 2-d food records. Subjects (n = 211) were from a population-based sample of middle-aged and older adults participating in the Beaver Dam Eye Study in south-central Wisconsin. Median age-specific correlation coefficients between the questionnaire, administered twice at a 3-mo interval, were 0.8 in men and 0.7 in women (range = 0.5 to 0.9). Questionnaire estimates of protein, cholesterol, thiamin, niacin, iron and zinc were consistently lower than food record estimates whereas estimates of fat were higher. Correlation coefficients between estimates from the questionnaire and records were generally > 0.5, indicating overall good agreement in ranking. However, the range in correlation coefficients was wide [ranging from 0.06 for iron (without supplements) in middle-aged women to 0.8 for alcohol in middle-aged men and women]. Questionnaire estimates similarly classified persons into the lowest two food record quintiles of intake 50 to 93% of the time depending on nutrient. These results suggest that the questionnaire produces nutrient estimates that rank individuals on the basis of intake of most nutrients similarly to estimates from multiple food records.

Nutrient supplements contribute to the dietary intake of middle- and older-aged adult residents of Beaver Dam, Wisconsin.

Intake of macronutrients and micronutrients was estimated from a diet history questionnaire in a population-based sample of persons (n = 2152), 43-86 y of age. Men and women 65 y of age or older consumed less protein, fat, cholesterol, niacin, riboflavin, calcium, iron, zinc and lycopene than their middle-aged counterparts. After including nutrient intake from supplements, age differences in intake were no longer significant for zinc in women or for niacin and iron in men. After further adjusting for energy intake, only protein, cholesterol, and lycopene mean intakes were lower in older compared with middle-aged men and women. Regular use of supplements was most prevalent among older men and women (40 and 48%, respectively). Supplement use was greater in the current time period compared with retrospective reports of supplement use 10 y before interview. The impact of supplement intake on median values of intake was greatest in women, particularly for vitamins A, C and E, riboflavin and calcium. The high prevalence of supplement use emphasizes the importance of considering this source of nutrients in future investigations in which dietary intake is measured.

Optic disc cupping: prevalence findings from the WESDR.

Increased cupping of the optic disc is considered to be an indication of pressure-related damage of the optic nerve. This paper explores the relationship of intraocular pressure and cupping in persons with diabetes mellitus, a group of people whose optic nerves may be more susceptible to the effects of intraocular pressure. Stereoscopic fundus photographs of the seven standard fields were obtained in all persons participating in the Wisconsin Epidemiologic Study of Diabetic Retinopathy at the time of the initial prevalence survey. Measurements of disc and cup diameters in the vertical and horizontal meridia were made by two trained graders. Cup-to-disc ratios were computed for both diameters of each eye and the mean of the two gradings was used. A history of glaucoma was significantly associated with larger cup-to-disc ratios at the prevalence examination. Cup-to-disc ratios were not larger in those with high IOP, nor in those who had panretinal photocoagulation.

Optic disc cupping: four year follow-up from the WESDR.

Change in optic disc cupping was evaluated in a 4-year follow-up of a well defined cohort of people with diabetes mellitus. Cup-to-disc ratios were computed for both vertical and horizontal diameters of each eye at the baseline and 4-year follow-up examinations. Graders were masked as to the identity of participants and to the dates of the photographs. Increases of at least 0.1 between baseline and follow-up were used as clinically significant change in the ratios. None of the following factors at baseline were consistent predictors of such a change: intraocular pressure, age, duration of diabetes, hypertension or severity of diabetic retinopathy. People who developed proliferative retinopathy by the follow-up examination were not more likely to have such an increase in ratio at the follow-up. We conclude that clinically significant increases in cup-to-disc ratio cannot be consistently predicted in people with diabetes from the risk factors evaluated with the grading system used in this study.

Optic disc cupping as clinically estimated from photographs.

Cup-to-disc ratios of 204 right eyes were evaluated by two clinicians and by a trained grader using a standardized grading scheme. Mean measurements by the grader were greater than estimates made by either clinician. The measurement scheme used by the trained grader has a high degree of reliability and validity. The standard protocol provides an objective assessment of optic disc cupping and could be easily adapted for office use.

Quantitation of optic disc cupping.

In population-based studies and in clinical practice a reliable, objective measure of optic disc cupping is needed. This measure is of special importance when following patients with diagnosed or suspected glaucoma. We have developed a new system using stereoscopic fundus photographs for quantitating optic disc cupping from these photographs. Measurements of the cup are based on cup contour. For this system, measurements of longest and shortest cup and longest and shortest disc diameters by two observers were highly correlated, with correlation coefficients of 0.88, 0.88, 0.77, and 0.82, respectively. Mean cup to disc ratios for long and short disc diameters were within 0.04 (n = 330) between the two observers. The measurements show a high degree of inter- and intra-observer reliability, and are inexpensive in time and materials to perform. This method is well suited to population-based studies.