Is Ultra-Processed Food Intake Associated with a Higher Risk of Glaucoma? A Prospective Cohort Study including 19,255 Participants from the SUN Project.

OBJECTIVE: The aim of this study was to examine the relationship of ultra-processed food (UPF) intake with the incidence of glaucoma in a large sample of Spanish university graduates followed prospectively. METHODS: Prospective cohort study using data from the SUN Project. A final sample of 19,225 participants (60.1% women) was included in this study, with a mean age of 38.2 years (standard deviation (SD) = 12.4). Participants were followed-up for a mean time of 12.9 years (SD = 5.4). Dietary intake was measured using a 136-item semiquantitative food-frequency questionnaire. UPFs were defined based on the NOVA classification system. Glaucoma diagnosis was determined by asking the participants if they had ever been diagnosed with glaucoma by an ophthalmologist. This self-reported diagnosis of glaucoma has been previously validated. RESULTS: After adjusting for several covariates, participants with the highest UPF consumption were at higher risk of glaucoma (hazard ratio (HR) = 1.83; 95% confidence interval (CI) 1.06 to 3.17) when compared to participants in the lowest category of UPF consumption. Regarding subgroup analyses, a significant multiplicative interaction was found for age (p = 0.004) and omega 3:6 ratio (p = 0.040). However, an association between UPF consumption and glaucoma was only found in older participants (aged ≥ 55 years), in men, in the most physically active group, in the group of non- or former smokers, in those with a lower omega 3:6 ratio, and in those with a lower energy intake. Regarding the contribution of each type of UPF group, UPF coming from sweets showed a significant risky effect (HR = 1.51; CI 95% 1.07 to 2.12). CONCLUSIONS: This prospective cohort study shows that participants with a greater UPF consumption have a higher risk of developing glaucoma when compared to participants with a lower consumption. Our findings emphasize the relevance of monitoring and limiting the consumption of UPFs as a means of preventing glaucoma incidence.

ACE-Vitamin Index and Risk of Glaucoma: The SUN Project.

BACKGROUND: Previous studies regarding antioxidant consumption and glaucoma have shown contradictory results. The aim of this study was to analyze the combined effect of the consumption of three vitamins (A, C and E) on the incidence of glaucoma in the SUN Project. METHODS: For this study, 18,669 participants were included. The mean follow-up was 11.5 years. An index including vitamins A, C and E (ACE-Vitamin Index) was calculated. Vitamin intake was extracted from participants' dietary data and vitamin supplements, if taken. Information on glaucoma incidence was collected by previously validated self-reported questionnaires. The association between glaucoma and vitamin intake was assessed by repeated-measures Cox regression using multi-adjusted hazard ratios. RESULTS: A total of 251 (1.3%) cases of glaucoma were detected. Participants with a higher ACE-Vitamin Index presented a reduced risk of glaucoma compared to participants with lower consumption (adjusted HR = 0.73; 95% CI, (0.55-0.98)). When each vitamin was analyzed individually, none of them had a significant protective effect. The protective effect of the ACE-Vitamin Index was higher in men and older participants (≥55 year). CONCLUSIONS: The consumption of vitamins A, C and E considered separately do not seem to exert a protective effect against glaucoma, but when these vitamins are considered together, they are associated with a lower risk of glaucoma.

Plasma rich in growth factors for the treatment of rapidly progressing refractory corneal melting due to erlotinib in nonsmall cell lung cancer.

RATIONALE: Erlotinib, an antineoplastic agent, is indicated for the treatment of patients with advanced nonsmall cell lung cancer. Most common adverse events are manageable, although more severe ones require dose reduction or discontinuation of erlotinib treatment. PATIENT CONCERNS: We present a case of severe corneal ulcer treated with autologous plasma rich in growth factors. DIAGNOSES: A 76-year-old woman with stage IVB (cT2a N0 M1c) lung cancer under erlotinib treatment presented with rapidly progressing corneal ulcer. Evolution was torpid and refractory to conventional treatment. INTERVENTIONS: Surgical options were dismissed because of the poor performance status of the patient. Despite temporary discontinuation of erlotinib treatment, the corneal ulcer continued to worsen with peripheral corneal neovascularization, stromal thinning, corneal edema, and profuse inflammation of the ocular surface. OUTCOMES: Treatment with autologous plasma rich in growth factors prevented an imminent corneal perforation and improved the corneal ulcer for over a year of follow-up. LESSONS: Considering the poor results of conventional treatment, both medical and surgical, management of the inflammation of the ocular surface together with the stimulation of the healing processes through regenerative therapy such as PRGF, can be an option worth considering in these cases.

Omega 3:6 ratio intake and incidence of glaucoma: the SUN cohort.

BACKGROUND & AIMS: Omega 3 and omega 6 polyunsaturated fatty acids have been related to many diseases, especially to cardiovascular diseases. We aimed to assess the association between the intake of omega 3, omega 6 fatty acids and their ratio and the incidence of glaucoma in this prospective cohort study. METHODS: We followed-up 17,128 participants initially free of glaucoma for a median time of 8.2 years. Validated data of diet were collected at baseline with a 136-item semi-quantitative food-frequency questionnaire and information of new diagnosis of glaucoma in biennial follow-up questionnaires. Multivariable Cox regression models were fit to assess the relationship between omega 3, omega 6 and their ratio and the incidence of glaucoma in the total sample and in participants aged ≥40 years at baseline. RESULTS: During a median follow-up time of 8.2 years, 156 new cases of glaucoma were identified. No significant association was observed for the omega 3 or the omega 6 intake and the risk of glaucoma. Participants in the highest quintile of omega 3:6 ratio intake had a significantly higher risk of glaucoma than participants in the lowest quintile (hazard ratio (HR): 1.91 [95%CI: 1.05-3.46], p for trend 0.03). The association became stronger (HR for the comparison of the 5th versus the 1st quintile: 2.43 [95%CI: 1.17-5.03], p for trend 0.02) when we considered only those participants who were ≥40 years old. CONCLUSIONS: Our data suggest an association between omega 3:6 ratio intake and incident glaucoma in our cohort, especially among older participants.

Risks factors and regression model for risk calculation of anesthesiologic intervention in topical and intracameral cataract surgery.

PURPOSE: To determine risk factors for anesthesiologist intervention during routine cataract surgery performed with topical and intracameral anesthesia and establish a regression model to identify high-risk patients. SETTING: Department of Ophthalmology, Clínica Universidad de Navarra, Pamplona, Spain. DESIGN: Prospective case series. METHODS: After cataract surgery at an ambulatory surgical center, anesthesia personnel completed a questionnaire to determine adverse medical events and risk factors related to anesthesiologist intervention. A Poisson regression model was used to calculate the interventional risks. Bootstrapping was performed for internal model validation. RESULTS: Of the 1010 cases, 50 (4.95%) required anesthesiologist intervention. Univariate analysis identified an association between anesthesiologist intervention and hypertension (P<.001), psychiatric history (P=.002), initial systolic blood pressure (P<.001), surgical duration (P=.001), and diabetes (P=.018). Scores were obtained using the following proposed regression model equation: (-8.68 + 0.33 × sex [men, 0; women, 1] + -0.02 × age [years] + 0.68 × hypertensive history [no, 0; yes, 1] + 1.18 × psychiatric background [no, 0; yes, 1] + 0.04 × initial systolic blood pressure [mm Hg]). The area under the receiver-operating curve was 0.803 (95% confidence interval [CI], 0.721-0.886). The area under the curve found in the validation method was 0.813 (95% CI, 0.727-0.887). CONCLUSION: Hypertension was the main risk factor for anesthesiologist intervention. The regression model discriminated between patients at lower and higher risk for intraoperative intervention for monitored anesthesia care. The probability of anesthesiologist intervention was 11.7 times higher when the model obtained a high score. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Consumo de ácidos grasos e incidencia de cataratas: estudio de la cohorte Seguimiento Universidad de Navarra / Dietary fat intake and incidence of cataracts: The SUN Prospective study in the cohort of Navarra, Spain

Fundamento y objetivo: Examinar la asociación entre la ingestión de distintos tipos de ácidos grasos y la incidencia de cataratas en los participantes de la cohorte Seguimiento Universidad de Navarra.acientes y método Entre 12.308 participantes de la cohorte, inicialmente libres de cataratas y seguidos prospectivamente hasta un máximo de 6 años, identificamos 182 casos nuevos de cataratas. La ingestión de ácidos grasos se evaluó mediante un cuestionario validado y semicuantitativo de frecuencia de consumo de alimentos (136 ítems). Se incluyeron variables sociodemográficas, antropométricas, referidas al estilo de vida y hábitos saludables, así como condicionantes médicos. La incidencia declarada de cataratas se recogió a partir de cuestionarios bianuales. Resultados: Los participantes pertenecientes a la categoría de mayor consumo de ácidos grasos omega-6 presentaron una reducción no significativa de riesgo de cataratas en el modelo ajustado por posibles confusores, pero no por otros ácidos grasos (odds ratio [OR] ajustada: 0,58; intervalo de confianza [IC] del 95%: 0,33–1,03). Cuando todos los tipos de ácidos (saturados, monoinsaturados, poliinsaturados omega-6 y poliinsaturados omega-3) se incluyeron simultáneamente en el mismo modelo multivariable, dicha asociación alcanzó significación estadística (OR: 0,54; IC del 95%: 0,29–0,99). Ningún otro tipo de ácido graso mostró asociación independiente significativa con el desarrollo de cataratas. Conclusiones: El elevado consumo de ácidos grasos poliinsaturados omega-6 puede tener una asociación modesta, pero significativa, con la reducción del riesgo de desarrollo de cataratas (AU)

Background and objective: To evaluate prospectively the association between dietary fat intake and the incidence of cataracts in participants from the SUN cohort. Patients and methods: Among 12308 men and women, initially free of cataracts and followed-up for up to 6 years, we identified 182 incident cases of cataracts. Fatty acids intake was assessed by a validated 136-item semiquantitative food frequency questionnaire. Socio-demographic and anthropometric characteristics, lifestyle, health-related habits and information about medical conditions were also collected. Incident cases of cataract were ascertained by self-reports using a biennale questionnaire. Results: Participants belonging to the highest category of omega-6 fatty acids intake had a non-significantly reduced risk of cataracts in the model adjusted for potential confounders but not for other fatty acids (adjusted OR: 0.58; 95% CI: 0.33, 1.03). When all types of fatty acids (saturated, monounsaturated, polyunsaturated omega-6 and polyunsaturated omega-3) were included simultaneously in the same multivariable model, this inverse association became significant (adjusted OR: 0.54 95%CI: 0.29, 0.99). There were no significant associations between other dietary fats and the risk of cataracts. Conclusion:High intake of omega-6 fatty acids showed a modest but significant inverse association with the development of cataracts (AU)