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在2年的前瞻性随访过程中叶黄素,玉米黄质和其他类胡萝卜素的摄入量与年龄相关性黄斑变性之间的关联

Wu J, Cho E, Willett WC

期刊名称:Archives of Ophthalmology 眼科学纪要

卷期:第133卷(2015年)12期

关键词:

吴铮铮 教授

 吴铮铮  教授   四川省人民医院

点评:到目前为止,年龄相关性黄斑病变(AMD)的病因仍在研究中,而且该疾病已经成为老年人群视力损害的一大疾病。本文通过前瞻性研究发现:叶黄素,玉米黄质和其他类胡萝卜素的摄入可以减少AMD的发病率,为公共卫生策略提供了较好的依据:增加膳食中各种各样丰富的类胡萝卜素的水果和蔬菜可以减少AMD的发病率。

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摘要

 意义:尽管有明显的生物学的合理性,流行病研究和临床试验中关于叶黄素、玉米黄质的摄入和年龄相关性黄斑变性(AMD)关系的证据仍是不一致的。其它类胡萝卜素的意义更少有彻底的研究。

目的:为了调查类胡萝卜素摄入和AMD的关系。
对象和设计:前瞻性队列研究。研究队列来自美国护理健康研究和卫生专业人员随访研究。共对63443名女性和38603名男性进行了随访,护理健康研究从1984年到2010年5月31日,卫生专业人员随访研究从1986年持续到2010年1月31日。所有的参加者为50或50岁以上,在入组时没有AMD、糖尿病、心血管疾病和肿瘤。
主要观察和测量指标:通过入组和随访时重复的食物摄取频率法,预估的血浆类胡萝卜素评分从所摄取食物直接计算得到,使用经过验证的回归模型来说明生物利用度和不同食物的有效性,预估的血浆类胡萝卜素评分和AMD的关系得到确定。
结果:我们通过病例记录回顾,确定了1361例中度的和1118例进展的AMD视力在20/30甚至更差的病例(主要是新生血管性AMD)。比较预估的血浆叶黄素/玉米黄素评分的extreme quintiles,我们发现在男性和女性中,对于进展的AMD都有约40%的导致风险增加的降低,混合的极端比较相关风险=0.59,95%CI:0.48-0.73;P<0.001。对于其它类胡萝卜的预测血浆类胡萝卜素评分,包括β-隐黄素、α-胡萝卜素和β-胡萝卜素,与进展的AMD25%和35%的风险降低有关,当进行extreme quintiles比较。预估的血浆总类胡萝卜素指数的极端比较相关风险是0.65(95% CI:0.53-0.80; P<0.001)。我们没有发现任何类胡萝卜素,不管是预测血浆评分还是计算出的摄入量,与中度AMD有任何关系。结论和相关性:具有生物活性的叶黄素/玉米黄素的高摄取与进展的AMD 长期风险降低有关。给出其它一些类胡萝卜素同样和长期风险降低有关,为了增加各种各样的富含类胡萝卜素的水果蔬菜食用的公共卫生政策可能会降低进展期AMD的风险。
 
Importance: Despite strong biological plausibility, evidence from epidemiologic studies and clinical trials on the relations between intakes of lutein and zeaxanthin and age-related macular degeneration (AMD) has been inconsistent. The roles of other carotenoids are less thoroughly investigated.
Objective: To investigate the associations between intakes of carotenoids and AMD. Design, Setting, and Participants: Prospective cohort study, with cohorts from the Nurses’ Health Study and the Health Professionals Follow-up Study in the United States. A total of 63443 women and 38603 men were followed up, from 1984 until May 31, 2010, in the Nurses’ Health Study and from 1986 until January 31, 2010, in the Health Professionals Follow-up Study. All participants were aged 50 years or older and were free of diagnosed AMD, diabetes mellitus, cardiovascular disease, and cancer at baseline. 
Main Outcomes and Measures: Predicted plasma carotenoid scores were computed directly from food intake, assessed by repeated food frequency questionnaires at baseline and follow-up, using validated regression models to account for bioavailability and reporting validity of different foods, and associations between predicted plasma carotenoid scores and AMD were determined. 
Results: We confirmed 1361 incident intermediate and 1118 advanced AMD cases (primarily neovascular AMD) with a visual acuity of 20/30 or worse by medical record review. Comparing extreme quintiles of predicted plasma lutein/zeaxanthin score, we found a risk reduction for advanced AMD of about 40% in both women and men (pooled relative risk comparing extreme quintiles = 0.59; 95% CI, 0.48-0.73; P for trend < .001). Predicted plasma carotenoid scores for other carotenoids, including beta-cryptoxanthin, alpha-carotene, and beta-carotene, were associated with a 25% to 35% lower risk of advanced AMD when comparing extreme quintiles. The relative risk comparing extreme quintiles for the predicted plasma total carotenoid index was 0.65 (95% CI, 0.53-0.80; P for trend < .001). We did not identify any associations of carotenoids, either as predicted plasma score or calculated intake, with intermediate AMD. 
Conclusions and Relevance: Higher intake of bioavailable lutein/zeaxanthin is associated with a long-term reduced risk of advanced AMD. Given that some other carotenoids are also associated with a lower risk, a public health strategy aimed at increasing dietary consumption of a wide variety of fruits and vegetables rich in carotenoids may reduce the incidence of advanced AMD. 

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