DIETARY CAROTENOIDS, VITAMIN-A, VITAMIN-C, AND VITAMIN-E, AND ADVANCED AGE-RELATED MACULAR DEGENERATION

Objective.-To evaluate the relationships between dietary intake of car otenoids and vitamins A, C, and E and the risk of neovascular age-rela ted macular degeneration (AMD), the leading cause of irreversible blin dness among adults. Design.-The multicenter Eye Disease Case-Control S tudy. Setting.-Five ophthalmology centers in the United States. Patien ts.-A total of 356 case subjects who were diagnosed with the advanced stage of AMD within 1 year prior to their enrollment, aged 55 to 80 ye ars, and residing near a participating clinical center. The 520 contro l subjects were from the same geographic areas as case subjects, had o ther ocular diseases, and were frequency-matched to cases according to age and sex. Main Outcome Measures.-The relative risk for AMD was est imated according to dietary indicators of antioxidant status, controll ing for smoking and other risk factors, by using multiple logistic-reg ression analyses. Results.-A higher dietary intake of carotenoids was associated with a lower risk for AMD. Adjusting for other risk factors for AMD, we found that those in the highest quintile of carotenoid in take had a 43% lower risk for AMD compared with those in the lowest qu intile (odds ratio, 0.57; 95% confidence interval, 0.35 to 0.92; P for trend=.02). Among the specific carotenoids, lutein and zeaxanthin, wh ich are primarily obtained from dark green, leafy vegetables, were mos t strongly associated with a reduced risk for AMD (P for trend=.001). Several food items rich in carotenoids were inversely associated with AMD. In particular, a higher frequency of intake of spinach or collard greens was associated with a substantially lower risk for AMD (P for trend<.001). The intake of preformed vitamin A (retinol) was not appre ciably related to AMD. Neither vitamin E nor total vitamin C consumpti on was associated with a statistically significant reduced risk for AM D, although a possibly lower risk for AMD was suggested among those wi th higher intake of vitamin C, particularly from foods. Conclusion.-In creasing the consumption of foods rich in certain carotenoids, in part icular dark green, leafy vegetables, may decrease the risk of developi ng advanced or exudative AMD, the most visually disabling form of macu lar degeneration among older people. These findings support the need f or further studies of this relationship.