Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Epidemiology

Associations between fruits, vegetables, vitamin A, β-carotene and flavonol dietary intake, and age-related macular degeneration in elderly women in Korea: the Fifth Korea National Health and Nutrition Examination Survey

Abstract

Background/Objectives:

Age-related macular degeneration (AMD) is one of the principal causes of blindness. This study investigated the association between diet and the prevalence of AMD in elderly Korean women.

Subjects/Methods:

Study subjects were women aged 65 years (n=1008) from the Korea National Health and Nutrition Examination Survey (2010–2012). The presence of early- and late-onset AMD was determined on the basis of a fundus photograph from a health examination survey. Food intake was estimated using 24 h recall.

Results:

The prevalence of AMD was 18.8% in elderly women in Korea. Multiple logistic regression analysis showed a significant negative association between vegetable intake and AMD (odds ratio (OR) 0.44, 95% confidence interval (CI) 0.25, 0.77, P for trend=0.002) after adjusting for age, body mass index, postmenopausal period, duration of hormone replacement therapy, residential area, education level, family income, smoking status, alcohol consumption, dietary supplement use and total energy intake. After adjusting for potential confounders, the ORs between extreme quartiles were 0.55 (95% CI 0.29, 1.05, P for trend=0.070) for fruit and vegetable intake, 0.38 (95% CI 0.21, 0.68, P for trend=0.001) for vitamin A, 0.36 (95% CI 0.19, 0.67, P for trend<0.001) for β-carotene and 0.45 (95% CI 0.25, 0.82, P for trend=0.008) for flavonols.

Conclusions:

These results suggest that higher consumption of fruits and vegetables containing antioxidant nutrients and phytochemicals may provide some protection against AMD.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

References

  1. 1

    Pascolini D, Mariotti SP . Global estimates of visual impairment: 2010. Br J Ophthalmol 2012; 96: 614–618.

    Article  Google Scholar 

  2. 2

    Gale CR, Hall NF, Phillips DI, Martyn CN . Lutein and zeaxanthin status and risk of age-related macular degeneration. Invest Ophthalmol Vis Sci 2003; 44: 2461–2465.

    Article  Google Scholar 

  3. 3

    Michikawa T, Ishida S, Nishiwaki Y, Kikuchi Y, Tsuboi T, Hosoda K et al. Serum antioxidants and age-related macular degeneration among older Japanese. Asia Pac J Clin Nutr 2009; 18: 1–7.

    CAS  PubMed  Google Scholar 

  4. 4

    Park SJ, Lee JH, Woo SJ, Ahn J, Shin JP, Song SJ et al. Age-related macular degeneration: prevalence and risk factors from Korean National Health and Nutrition Examination Survey, 2008 through 2011. Ophthalmology 2014; 121: 1756–1765.

    Article  Google Scholar 

  5. 5

    Cho BJ, Heo JW, Shin JP, Ahn J, Kim TW, Chung H . Association between reproductive factors and age-related macular degeneration in postmenopausal women: the Korea National Health and Nutrition Examination Survey 2010-2012. PLoS One 2014; 9: e102816.

    Article  Google Scholar 

  6. 6

    Klein R, Chou CF, Klein BE, Zhang X, Meuer SM, Saaddine JB . Prevalence of age-related macular degeneration in the US population. Arch Ophthalmol 2011; 129: 75–80.

    Article  Google Scholar 

  7. 7

    Cho BJ, Heo JW, Shin JP, Ahn J, Kim TW, Chung H . Epidemiological association between systemic diseases and age-related macular degeneration: the Korea National Health and Nutrition Examination Survey 2008-2011. Invest Ophthalmol Vis Sci 2014; 55: 4430–4437.

    Article  Google Scholar 

  8. 8

    Cho BJ, Heo JW, Kim TW, Ahn J, Chung H . Prevalence and risk factors of age-related macular degeneration in Korea: the Korea National Health and Nutrition Examination Survey 2010-2011. Invest Ophthalmol Vis Sci 2014; 55: 1101–1108.

    Article  Google Scholar 

  9. 9

    Rudnicka AR, Jarrar Z, Wormald R, Cook DG, Fletcher A, Owen CG . Age and gender variations in age-related macular degeneration prevalence in populations of European ancestry: a meta-analysis. Ophthalmology 2012; 119: 571–580.

    Article  Google Scholar 

  10. 10

    Kim EC, Cho E, Jee D . Association between blood cadmium level and age-related macular degeneration in a representative Korean population. Invest Ophthalmol Vis Sci 2014; 55: 5702–5710.

    CAS  Article  Google Scholar 

  11. 11

    Nidhi B, Mamatha BS, Padmaprabhu CA, Pallavi P, Vallikannan B . Dietary and lifestyle risk factors associated with age-related macular degeneration: a hospital based study. Indian J Ophthalmol 2013; 61: 722–727.

    Article  Google Scholar 

  12. 12

    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: 111–118.

    CAS  Article  Google Scholar 

  13. 13

    Shahid H, Khan JC, Cipriani V, Sepp T, Matharu BK, Bunce C et al. Age-related macular degeneration: the importance of family history as a risk factor. Br J Ophthalmol 2012; 96: 427–431.

    Article  Google Scholar 

  14. 14

    Mares-Perlman JA, Fisher AI, Klein R, Palta M, Block G, Millen AE et al. Lutein and zeaxanthin in the diet and serum and their relation to age-related maculopathy in the third national health and nutrition examination survey. Am J Epidemiol 2001; 153: 424–432.

    CAS  Article  Google Scholar 

  15. 15

    Cho E, Seddon JM, Rosner B, Willett WC, Hankinson SE . Prospective study of intake of fruits, vegetables, vitamins, and carotenoids and risk of age-related maculopathy. Arch Ophthalmol 2004; 122: 883–892.

    Article  Google Scholar 

  16. 16

    van Leeuwen R, Boekhoorn S, Vingerling JR, Witteman JC, Klaver CC, Hofman A et al. Dietary intake of antioxidants and risk of age-related macular degeneration. JAMA 2005; 294: 3101–3107.

    CAS  Article  Google Scholar 

  17. 17

    Chiu CJ, Chang ML, Zhang FF, Li T, Gensler G, Schleicher M et al. The relationship of major American dietary patterns to age-related macular degeneration. Am J Ophthalmol 2014; 158: 118–127.e111.

    Article  Google Scholar 

  18. 18

    Amirul Islam FM, Chong EW, Hodge AM, Guymer RH, Aung KZ, Makeyeva GA et al. Dietary patterns and their associations with age-related macular degeneration: the Melbourne collaborative cohort study. Ophthalmology 2014; 121: 1428–1434.e1422.

    Article  Google Scholar 

  19. 19

    Chiu C-J, Chang M-L, Li T, Gensler G, Taylor A . Visualization of dietary patterns and their associations with age-related macular degenerationvisualized dietary patterns and AMD. Invest Ophthalmol Vis Sci 2017; 58: 1404–1410.

    Article  Google Scholar 

  20. 20

    Mares JA, Voland RP, Sondel SA, Millen AE, Larowe T, Moeller SM et al. Healthy lifestyles related to subsequent prevalence of age-related macular degeneration. Arch Ophthalmol 2011; 129: 470–480.

    Article  Google Scholar 

  21. 21

    Merle BM, Silver RE, Rosner B, Seddon JM . Adherence to a Mediterranean diet, genetic susceptibility, and progression to advanced macular degeneration: a prospective cohort study. Am J Clin Nutr 2015; 102: 1196–1206.

    CAS  Article  Google Scholar 

  22. 22

    Abdel-Aal el SM, Akhtar H, Zaheer K, Ali R . Dietary sources of lutein and zeaxanthin carotenoids and their role in eye health. Nutrients 2013; 5: 1169–1185.

    Article  Google Scholar 

  23. 23

    Salguero A, de la Morena B, Vigara J, Vega JM, Vilchez C, Leon R . Carotenoids as protective response against oxidative damage in Dunaliella bardawil. Biomol Eng 2003; 20: 249–253.

    CAS  Article  Google Scholar 

  24. 24

    Tso MO . Experiments on visual cells by nature and man: in search of treatment for photoreceptor degeneration. Friedenwald lecture. Invest Ophthalmol Vis Sci 1989; 30: 2430–2454.

    CAS  PubMed  Google Scholar 

  25. 25

    Hanneken A, Lin FF, Johnson J, Maher P . Flavonoids protect human retinal pigment epithelial cells from oxidative-stress-induced death. Invest Ophthalmol Vis Sci 2006; 47: 3164–3177.

    Article  Google Scholar 

  26. 26

    Chew EY, Clemons TE, Sangiovanni JP, Danis RP, Ferris FL 3rd, Elman MJ et al. Secondary analyses of the effects of lutein/zeaxanthin on age-related macular degeneration progression: AREDS2 report No. 3. JAMA Ophthalmol 2014; 132: 142–149.

    CAS  Article  Google Scholar 

  27. 27

    Weigert G, Kaya S, Pemp B, Sacu S, Lasta M, Werkmeister RM et al. Effects of lutein supplementation on macular pigment optical density and visual acuity in patients with age-related macular degeneration. Invest Ophthalmol Vis Sci 2011; 52: 8174–8178.

    CAS  Article  Google Scholar 

  28. 28

    Johnson LV, Leitner WP, Staples MK, Anderson DH . Complement activation and inflammatory processes in Drusen formation and age related macular degeneration. Exp Eye Res 2001; 73: 887–896.

    CAS  Article  Google Scholar 

  29. 29

    Snellen EL, Verbeek AL, Van Den Hoogen GW, Cruysberg JR, Hoyng CB . Neovascular age-related macular degeneration and its relationship to antioxidant intake. Acta Ophthalmol Scand 2002; 80: 368–371.

    CAS  Article  Google Scholar 

  30. 30

    Ma L, Yan SF, Huang YM, Lu XR, Qian F, Pang HL et al. Effect of lutein and zeaxanthin on macular pigment and visual function in patients with early age-related macular degeneration. Ophthalmology 2012; 119: 2290–2297.

    Article  Google Scholar 

  31. 31

    Aoki A, Inoue M, Nguyen E, Obata R, Kadonosono K, Shinkai S et al. Dietary n-3 fatty acid, alpha-tocopherol, zinc, vitamin D, vitamin C, and beta-carotene are associated with age-related macular degeneration in Japan. Sci Rep 2016; 6: 20723.

    CAS  Article  Google Scholar 

  32. 32

    Korea Centers for Disease Control and Prevention, Ministry of Health & Welfare. An instruction for the fifth Korea National Health and Nutrition Examination Survey 2014, Available from https://knhanes.cdc.go.kr/knhanes/index.do/ accessed 17 July 2017.

  33. 33

    Yoon K-C, Mun G-H, Kim S-D, Kim S-H, Kim CY, Park KH et al. Prevalence of eye diseases in South Korea: data from the Korea national health and nutrition examination survey 2008-2009. Korean J Ophthalmol 2011; 25: 421–433.

    Article  Google Scholar 

  34. 34

    Bird AC, Bressler NM, Bressler SB, Chisholm IH, Coscas G, Davis MD et al. An international classification and grading system for age-related maculopathy and age-related macular degeneration. The International ARM Epidemiological Study Group. Surv Ophthalmol 1995; 39: 367–374.

    CAS  Article  Google Scholar 

  35. 35

    Korea Centers for Disease Control and Prevention. The Fifth Korea National Health and Nutrition Examination Survey (KNHANES V) Korea Centers for Disease Control and Prevention, Ministry of Health and Welfare: Seoul, Korea, 2013.

  36. 36

    US Department of Agriculture, Agricultural Research Service, Nutrient Data LaboratoryUSDA National Nutrient Database 2015, Available from https://ndb.nal.usda.gov/ndb/nutrients/index (assessed 20 August 2016).

  37. 37

    Yang YK, Kim JY, Kwon O . Development of flavonoid database for commonly consumed foods by Koreans. Korean J Nutr 2012; 45: 283–292.

    CAS  Article  Google Scholar 

  38. 38

    Welfare MoHa National Health Plan 2020. Ministry of Health and Welfare: Sejong, 2011.

  39. 39

    Snow KK, Cote J, Yang W, Davis NJ, Seddon JM . Association between reproductive and hormonal factors and age-related maculopathy in postmenopausal women. Am J Ophthalmol 2002; 134: 842–848.

    CAS  Article  Google Scholar 

  40. 40

    Christen WG, Schaumberg DA, Glynn RJ, Buring JE . Dietary ω-3 fatty acid and fish intake and incident age-related macular degeneration in women. Arch Ophthalmol 2011; 129: 921–929.

    Article  Google Scholar 

  41. 41

    Moeller SM, Parekh N, Tinker L, Ritenbaugh C, Blodi B, Wallace RB et al. Associations between intermediate age-related macular degeneration and lutein and zeaxanthin in the Carotenoids in Age-related Eye Disease Study (CAREDS): ancillary study of the Women’s Health Initiative. Arch Ophthalmol 2006; 124: 1151–1162.

    CAS  Article  Google Scholar 

  42. 42

    Padayachee A, Day L, Howell K, Gidley MJ . Complexity and health functionality of plant cell wall fibers from fruits and vegetables. Crit Rev Food Sci Nutr 2017; 57: 59–81.

    CAS  Article  Google Scholar 

  43. 43

    Wu J, Cho E, Willett WC, Sastry SM, Schaumberg DA . Intakes of lutein, zeaxanthin, and other carotenoids and age-related macular degeneration during 2 decades of prospective follow-up. JAMA Ophthalmol 2015; 133: 1415–1424.

    Article  Google Scholar 

  44. 44

    Stahl W, Sies H . Antioxidant activity of carotenoids. Mol Aspects Med 2003; 24: 345–351.

    CAS  Article  Google Scholar 

  45. 45

    Beatty S, Murray IJ, Henson DB, Carden D, Koh H, Boulton ME . Macular pigment and risk for age-related macular degeneration in subjects from a Northern European population. Invest Ophthalmol Vis Sci 2001; 42: 439–446.

    CAS  PubMed  Google Scholar 

  46. 46

    Beatty S, Koh H, Phil M, Henson D, Boulton M . The role of oxidative stress in the pathogenesis of age-related macular degeneration. Surv Ophthalmol 2000; 45: 115–134.

    CAS  Article  Google Scholar 

  47. 47

    Beatty S, Boulton M, Henson D, Koh HH, Murray IJ . Macular pigment and age related macular degeneration. Br J Ophthalmol 1999; 83: 867–877.

    CAS  Article  Google Scholar 

  48. 48

    Sparrow JR, Cai B . Blue light-induced apoptosis of A2E-containing RPE: involvement of caspase-3 and protection by Bcl-2. Invest Ophthalmol Vis Sci 2001; 42: 1356–1362.

    CAS  PubMed  Google Scholar 

  49. 49

    Sparrow JR, Nakanishi K, Parish CA . The lipofuscin fluorophore A2E mediates blue light-induced damage to retinal pigmented epithelial cells. Invest Ophthalmol Vis Sci 2000; 41: 1981–1989.

    CAS  PubMed  Google Scholar 

  50. 50

    Imamura Y, Noda S, Hashizume K, Shinoda K, Yamaguchi M, Uchiyama S et al. Drusen, choroidal neovascularization, and retinal pigment epithelium dysfunction in SOD1-deficient mice: a model of age-related macular degeneration. Proc Natl Acad Sci USA 2006; 103: 11282–11287.

    CAS  Article  Google Scholar 

  51. 51

    Chichili GR, Nohr D, Frank J, Flaccus A, Fraser PD, Enfissi EM et al. Protective effects of tomato extract with elevated beta-carotene levels on oxidative stress in ARPE-19 cells. Br J Nutr 2006; 96: 643–649.

    CAS  PubMed  Google Scholar 

  52. 52

    Sultana B, Anwar F . Flavonols (kaempeferol, quercetin, myricetin) contents of selected fruits, vegetables and medicinal plants. Food Chem 2008; 108: 879–884.

    CAS  Article  Google Scholar 

  53. 53

    Kook D, Wolf AH, Yu AL, Neubauer AS, Priglinger SG, Kampik A et al. The protective effect of quercetin against oxidative stress in the human RPE in vitro. Invest Ophthalmol Vis Sci 2008; 49: 1712–1720.

    Article  Google Scholar 

  54. 54

    Saviranta NM, Veeroos L, Granlund LJ, Hassinen VH, Kaarniranta K, Karjalainen RO . Plant flavonol quercetin and isoflavone biochanin A differentially induce protection against oxidative stress and inflammation in ARPE-19 cells. Food Res Int 2011; 44: 109–113.

    CAS  Article  Google Scholar 

  55. 55

    Liu Y, Song X, Zhang D, Zhou F, Wang D, Wei Y et al. Blueberry anthocyanins: protection against ageing and light-induced damage in retinal pigment epithelial cells. Br J Nutr 2012; 108: 16–27.

    CAS  Article  Google Scholar 

  56. 56

    Chen SJ, Cheng CY, Peng KL, Li AF, Hsu WM, Liu JH et al. Prevalence and associated risk factors of age-related macular degeneration in an elderly Chinese population in Taiwan: the Shihpai Eye Study. Invest Ophthalmol Vis Sci 2008; 49: 3126–3133.

    Article  Google Scholar 

  57. 57

    Cachulo MdL, Laíns I, Lobo C, Figueira J, Ribeiro L, Marques JP et al. Age‐related macular degeneration in Portugal: prevalence and risk factors in a coastal and an inland town. The Coimbra Eye Study–Report 2. Acta Ophthalmol 2016; 94: 442–453.

    Article  Google Scholar 

  58. 58

    Kaarniranta K, Machalinska A, Vereb Z, Salminen A, Petrovski G, Kauppinen A . Estrogen signalling in the pathogenesis of age-related macular degeneration. Curr Eye Res 2015; 40: 226–233.

    CAS  Article  Google Scholar 

  59. 59

    Pfeilschifter J, Koditz R, Pfohl M, Schatz H . Changes in proinflammatory cytokine activity after menopause. Endocrine Rev 2002; 23: 90–119.

    CAS  Article  Google Scholar 

  60. 60

    Vina J, Sastre J, Pallardo FV, Gambini J, Borras C . Role of mitochondrial oxidative stress to explain the different longevity between genders: protective effect of estrogens. Free Radic Res 2006; 40: 1359–1365.

    CAS  Article  Google Scholar 

  61. 61

    Korea Centers for Disease Control and PreventionReport presentation of Korea National Health and Nutrition Examination Survey IV 2009: Korea Centers for Disease Control and Prevention, Ministry of Health and Welfare: Seoul, Korea, 2010.

Download references

Acknowledgements

This study was supported by the Brain Korea 21 PLUS and the Ministry of Science, ICT, and Future Planning through the National Research Foundation (Bio-synergy Research Project NRF2012M3A9C4048761).

Author information

Affiliations

Authors

Corresponding author

Correspondence to N Chang.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kim, Ek., Kim, H., Kwon, O. et al. Associations between fruits, vegetables, vitamin A, β-carotene and flavonol dietary intake, and age-related macular degeneration in elderly women in Korea: the Fifth Korea National Health and Nutrition Examination Survey. Eur J Clin Nutr 72, 161–167 (2018). https://doi.org/10.1038/ejcn.2017.152

Download citation

Further reading

Search

Quick links