Genetics and the Mediterranean Diet: What is the Risk for Age-Related Macular Degeneration?
DOI:
https://doi.org/10.48560/rspo.28246Keywords:
Diet, Mediterranean, Life Style, Macular Degeneration/diet therapy, Macular Degeneration/genetics, Portugal, Risk FactorsAbstract
INTRODUCTION: Age-related macular degeneration is a degenerative disease of the macula responsible for severe vision loss. It is a multifactorial and complex disease, with genet- ics, lifestyle and environmental factors contributing for its establishment and progression. The adherence to the Mediterranean diet has been suggestive of being protective for disease, but the evidence on the interaction between diet and genetics is scarce.
With this work, we intend to assess the effect of the adherence to the Mediterranean diet on age-related macular degeneration stratified by the genetic risk score, in a well-characterized Por- tuguese population.
METHODS: Participants performed ophthalmological exams and answered a validated food and a lifestyle questionnaire. The adherence to the Mediterranean diet was assessed with mediSCORE, a score ranging from 0 (low adherence) to 9 (high adherence). The score was de- termined individually for each participant, as the sum of the score of 9 food groups in which the food items from questionnaire were organized. A cut-off value of ≥ 6 was used as high adherence. Grading was performed using Rotterdam Classification. Participants’ genotyping was performed in collaboration with The European Eye Epidemiology Consortium. The Genetic Risk Score was calculated for each participant considering the number of alleles at each variant and their effect size. Odds ratio (OR) for the adherence to the Mediterranean diet within strata of high and low genetic risk score were calculated, adjusted for age, sex, physical exercise, and smoking.
RESULTS: People at high genetic risk for age-related macular degeneration benefited from adhering to the Mediterranean diet with a 60%-risk reduction (OR=0.386, 95%CI 0.182-0.821, p=0.013). For subjects with low genetic risk (OR=0.435, 95% CI 0.177-1.072, p=0.070), a risk reduc- tion was also seen, but not significantly. In subjects with a high genetic risk, age increased the risk of having AMD in a 2- and 3 time-fold, for ages 70-75 (p=0.034) and over 75 (p<0.001), respectively. The same was seen for smoking (OR=2.165), though not significantly (p=0.068). Performing physi- cal exercise presented as a protective factor (OR=0.564, p=0.035).
CONCLUSION: Genetics and Mediterranean diet interact to cause age-related macular de- generation, suggesting there is an interplay between genetics and lifestyle factors.
Downloads
References
Wong WL, Su X, Li X, Cheung CM, Klein R, Cheng CY, et al. Global prevalence of age-related macular degeneration and disease burden projection for 2020 and 2040: a systematic review and meta-analysis. Lancet Glob Health. 2014;2:e106-16. doi: 10.1016/S2214-109X(13)70145-1.
Lambert NG, ElShelmani H, Singh MK, Mansergh FC, Wride MA, Padilla M, et al. Risk factors and biomarkers of age-related macular degeneration. Prog Retin Eye Res. 2016;54:64-102. doi: 10.1016/j.preteyeres.2016.04.003.
Chakravarthy U, Wong TY, Fletcher A, Piault E, Evans C, Zlateva G, et al. Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis. BMC Ophthalmol. 2010;10:31. doi: 10.1186/1471-2415-10-31.
Fritsche LG, Igl W, Bailey JN, Grassmann F, Sengupta S, Bragg-Gresham JL, et al. A large genome-wide association study of age-related macular degeneration highlights contributions of rare and common variants. Nat Genet. 2016;48:134-43. doi:10.1038/ng.3448
Raimundo M, Mira F, Cachulo MD, Barreto P, Ribeiro L, Farinha C, et al. Adherence to a Mediterranean diet, lifestyle and age-related macular degeneration: the Coimbra Eye Study - report 3. Acta Ophthalmol. 2018;96:e926-e932. doi: 10.1111/aos.13775.
Nunes S, Alves D, Barreto P, Raimundo M, da Luz Cachulo M, Farinha C, et al. Adherence to a Mediterranean diet and its association with age-related macular degeneration. The Coimbra Eye Study-Report 4. Nutrition. 2018;51-52:6-12. doi: 10.1016/j.nut.2017.12.010.
Merle BM, Silver RE, Rosner B, Seddon JM. Adherence to a Mediterranean diet, genetic susceptibility, and progression to advanced macular degeneration: a prospective co-hort study. Am J Clin Nutr. 2015;102:1196-206. doi: 10.3945/ ajcn.115.111047.
Keenan TD, Agrón E, Mares J, Clemons TE, van Asten F, Swaroop A, et al. Adherence to the Mediterranean Diet and Progression to Late Age-Related Macular Degeneration in the Age-Related Eye Disease Studies 1 and 2. Ophthalmology. 2020;127:1515-28. doi: 10.1016/j.ophtha.2020.04.030.
Merle BMJ, Colijn JM, Cougnard-Grégoire A, de Koning Backus AP, Delyfer MN, Kiefte-de Jong JC, et al. Mediterranean Diet and Incidence of Advanced Age-Related Macular Degeneration: The EYE-RISK Consortium. Ophthalmology. 2019;126:381-90. doi: 10.1016/j.ophtha.2018.08.006.
Hogg RE, Woodside JV, McGrath A, Young IS, Vioque JL, Chakravarthy U, et al. Mediterranean Diet Score and Its Association with Age-Related Macular Degeneration: The European Eye Study. Ophthalmology. 2017;124:82-9. doi: 10.1016/j. ophtha.2016.09.019.
Piermarocchi S, Tognetto D, Piermarocchi R, Masetto M, Monterosso G, Segato T, et al. Risk Factors and Age-Related Macular Degeneration in a Mediterranean-Basin Population: The PAMDI (Prevalence of Age-Related Macular Degeneration in Italy) Study--Report 2. Ophthalmic Res. 2016;55:111-8. doi: 10.1159/000441795.
Guasch-Ferré M, Willett WC. The Mediterranean diet and health: a comprehensive overview. J Intern Med. 2021;290:549-66. doi:10.1111/joim.13333
Tang C, Wang X, Qin LQ, Dong JY. Mediterranean diet and mortality in people with cardiovascular disease: A meta-analysis of prospective cohort studies. Nutrients. 2021;13:2623. doi:10.3390/nu13082623
Keenan TD, Agrón E, Mares JA, Clemons TE, van Asten F, Swaroop A, et al. Adherence to a Mediterranean diet and cognitive function in the Age-Related Eye Disease Studies 1 & 2. Alzheimers Dement. 2020;16:831-42. doi: 10.1002/alz.12077.
Mentella MC, Scaldaferri F, Ricci C, Gasbarrini A, Miggiano GA. Cancer and mediterranean diet: A review. Nutrients. 2019;11:2059. doi:10.3390/nu11092059
Lopes C. Reprodutibilidade e Validação de Um Questionário Semi-Quantitativo de Frequência Alimentar. In: Alimentação e Enfarte Agudo Do Miocárdio: Estudo Caso Controlo de Base Comunitária. Porto: University of Porto; 2000.
Vingerling JR, Dielemans I, Hofman A, Grobbee DE, Hijmering M, Kramer CF, et al. The prevalence of age-related maculopathy in the Rotterdam Study. Ophthalmology. 1995;102:205-10. doi: 10.1016/s0161-6420(95)31034-2.
Klaver CC, Assink JJ, van Leeuwen R, Wolfs RC, Vingerling JR, Stijnen T, et al. Incidence and progression rates of age-related maculopathy: the Rotterdam Study. Invest Ophthalmol Vis Sci. 2001;42:2237-41.
de Breuk A, Acar IE, Kersten E, Schijvenaars MM, Colijn JM, Haer-Wigman L, et al. Development of a Genotype Assay for Age-Related Macular Degeneration: The EYE-RISK Consortium. Ophthalmology. 2021;128:1604-17. doi: 10.1016/j.ophtha.2020.07.037.
Trichopoulou A, Costacou T, Bamia C, Trichopoulos D. Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med. 2003;348:2599-608. doi: 10.1056/NEJMoa025039.
Knol MJ, VanderWeele TJ. Recommendations for presenting analyses of effect modification and interaction. Int J Epidemiol. 2012;41:514-20. doi:10.1093/ije/dyr218
Knol MJ, VanderWeele TJ, Groenwold RH, Klungel OH, Rovers MM, Grobbee DE. Estimating measures of interaction on an additive scale for preventive exposures. Eur J Epidemiol. 2011;26 :433-8. doi:10.1007/s10654-011-9554-9
Dai J, Jones DP, Goldberg J, Ziegler TR, Bostick RM, Wilson PW, et al. Association between adherence to the Mediterranean diet and oxidative stress. Am J Clin Nutr. 2008;88:1364-70. doi: 10.3945/ajcn.2008.26528.
Cougnard-Grégoire A, Merle BM, Korobelnik JF, Rougier MB, Delyfer MN, Le Goff M, et al. Olive Oil Consumption and Age-Related Macular Degeneration: The Alienor Study. PLoS One. 2016;11:e0160240. doi: 10.1371/journal.pone.0160240.
de Koning-Backus AP, Buitendijk GH, Kiefte-de Jong JC, Colijn JM, Hofman A, Vingerling JR, et al. Intake of Vegetables, Fruit, and Fish is Beneficial for Age-Related Macular Degeneration. Am J Ophthalmol. 2019;198:70-9. doi: 10.1016/j. ajo.2018.09.036.
Nani A, Murtaza B, Khan AS, Khan NA, Hichami A. Antioxidant and anti-inflammatory potential of polyphenols contained in Mediterranean diet in obesity: Molecular mechanisms. Molecules. 2021;26:985. doi:10.3390/molecules26040985
Lem DW, Davey PG, Gierhart DL, Rosen RB. A systematic review of carotenoids in the management of age-related macular degeneration. Antioxidants. 2021;10:1255. doi:10.3390/antiox10081255
van Leeuwen EM, Emri E, Merle BM, Colijn JM, Kersten E, Cougnard-Gregoire A, et al. A new perspective on lipid research in age-related macular degeneration. Prog Retin Eye Res. 2018;67:56-86. doi: 10.1016/j.preteyeres.2018.04.006.
Chua B, Flood V, Rochtchina E, Wang JJ, Smith W, Mitchell P. Dietary fatty acids and the 5-year incidence of age-related maculopathy. Arch Ophthalmol. 2006;124:981-6. doi:10.1001/archopht.124.7.981
Colijn JM, Meester-Smoor M, Verzijden T, de Breuk A, Silva R, Merle BM, et al. Genetic Risk, Lifestyle, and Age-Related Macular Degeneration in Europe: The EYE-RISK Consortium. Ophthalmology. 2021;128:1039-49. doi: 10.1016/j.ophtha.2020.11.024.
Ho L, van Leeuwen R, Witteman JC, van Duijn CM, Uitterlinden AG, Hofman A, et al. Reducing the genetic risk of agerelated macular degeneration with dietary antioxidants, zinc, and ω-3 fatty acids: the Rotterdam study. Arch Ophthalmol. 2011;129:758-66. doi: 10.1001/archophthalmol.2011.141.
Reynolds R, Rosner B, Seddon JM. Dietary omega-3 fatty acids, other fat intake, genetic susceptibility, and progression to incident geographic atrophy. Ophthalmology. 2013;120:10208. doi:10.1016/j.ophtha.2012.10.020
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Revista Sociedade Portuguesa de Oftalmologia
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Do not forget to download the Authorship responsibility statement/Authorization for Publication and Conflict of Interest.
The article can only be submitted with these two documents.
To obtain the Authorship responsibility statement/Authorization for Publication file, click here.
To obtain the Conflict of Interest file (ICMJE template), click here
