Fatty acids and antioxidants in older adults with visual impairment: A contribution to Healthy Ageing

[eng] This research aims to study the effect of supplementation with docosahexaenoic acid (DHA) and antioxidants in older adults diagnosed with age-related macular degeneration or cataracts to contribute to preventive nutritional care and healthy ageing. This study involves a randomised and observed-blinded trial that included 106 patients >50 years of age with a previous diagnosis of Age-Related-Macular Degeneration (AMD) and was conducted in nine sites in Spain and Portugal between November 2014 and April 2018. We study the effect of a 2-year intervention with a nutritional supplement. Plasma samples were analysed at baseline and after 12 and 24 months to determine the fatty acid (FA) status. The omega-3 index (O3I) was additionally calculated to assess the coronary heart disease (CHD) mortality risk. Additionally, a review of another visual impairment and the effects on antioxidants was made to support the nutrition strategies as an essential factor for healthy ageing. The FA levels at baseline showed no differences between groups. However, at month 12 and 24-month follow-up, the mean changes in the polyunsaturated fatty acids (PUFAs) were statistically significantly different between the intervention and control groups except for the total omega-6 (n-6) long-chain (LC) PUFAs; thus, DHA, total omega-3 (n-3) PUFAs and total n-3 LCPUFAs showed a greater increase with the intervention than with the control treatment, with an effect size that was moderate to large. In contrast, the total n-6 PUFAs, total n-6 LCPUFAs and the ratios of n-6/n-3 PUFAs and LCPUFAs showed a greater decrease in the intervention group than in the control group. On the primary visual acuity assessment after a year, ETDRS letters had decreased with the intervention (N = 45; mean change −1.73, 95% CI −3.28 to −0.19) and in the control group (N = 48; mean change −0.10, 95% CI −2.03 to 1.83), for an estimated treatment difference between the intervention and control groups of –1.63 (95% CI –0.83 to 4.09; p = 0.192). The O3I at baseline exhibited both study groups at the second highest cardiovascular risk category (O3I >2.9 - 4.0). Nonetheless, by the 2-year intervention, the supplemented patients presented an O3I of 4.16%, reaching the second-best category of low risk for cardiovascular diseases (O3I >4.0 – 5.2), while the control group remained the same. Additionally, a review was conducted on the role of the antioxidant vitamin C in cataracts, another common eye disease to back up nutritional strategies as an essential factor in healthy ageing. While dietary intake of vitamin C might have a positive effect in cataracts, its supplementation does not show the same effect. The protective effects of vitamin C in cataracts still need to be clarified; further assessments are encouraged. The collection of analyses performed in this research allows us to confirm: 1)The link between FAs and health; 2) that DHA supplementation is promising to slow the progression of visual acuity loss in the older adult population with a previous AMD diagnosis; 3) the need to balance n-6, and n-3 proportions; 4) that DHA supplementation optimizes two markers of health, n6-n3 ratio and the O3I; 5) the antioxidant effect of vitamin C in cataracts remains unclear. Altogether, these results endorse the role of nutrition in healthy ageing decreasing the risk for NCDs, which are responsible for poor health and quality of life

Fatty acids and antioxidants in older adults with visual impairment: A contribution to Healthy Ageing

Programa de Doctorat en Nutrició i Salut[eng] This research aims to study the effect of supplementation with docosahexaenoic acid (DHA) and antioxidants in older adults diagnosed with age-related macular degeneration or cataracts to contribute to preventive nutritional care and healthy ageing. This study involves a randomised and observed-blinded trial that included 106 patients >50 years of age with a previous diagnosis of Age-Related-Macular Degeneration (AMD) and was conducted in nine sites in Spain and Portugal between November 2014 and April 2018. We study the effect of a 2-year intervention with a nutritional supplement. Plasma samples were analysed at baseline and after 12 and 24 months to determine the fatty acid (FA) status. The omega-3 index (O3I) was additionally calculated to assess the coronary heart disease (CHD) mortality risk. Additionally, a review of another visual impairment and the effects on antioxidants was made to support the nutrition strategies as an essential factor for healthy ageing. The FA levels at baseline showed no differences between groups. However, at month 12 and 24-month follow-up, the mean changes in the polyunsaturated fatty acids (PUFAs) were statistically significantly different between the intervention and control groups except for the total omega-6 (n-6) long-chain (LC) PUFAs; thus, DHA, total omega-3 (n-3) PUFAs and total n-3 LCPUFAs showed a greater increase with the intervention than with the control treatment, with an effect size that was moderate to large. In contrast, the total n-6 PUFAs, total n-6 LCPUFAs and the ratios of n-6/n-3 PUFAs and LCPUFAs showed a greater decrease in the intervention group than in the control group. On the primary visual acuity assessment after a year, ETDRS letters had decreased with the intervention (N = 45; mean change −1.73, 95% CI −3.28 to −0.19) and in the control group (N = 48; mean change −0.10, 95% CI −2.03 to 1.83), for an estimated treatment difference between the intervention and control groups of –1.63 (95% CI –0.83 to 4.09; p = 0.192). The O3I at baseline exhibited both study groups at the second highest cardiovascular risk category (O3I >2.9 - 4.0). Nonetheless, by the 2-year intervention, the supplemented patients presented an O3I of 4.16%, reaching the second-best category of low risk for cardiovascular diseases (O3I >4.0 – 5.2), while the control group remained the same. Additionally, a review was conducted on the role of the antioxidant vitamin C in cataracts, another common eye disease to back up nutritional strategies as an essential factor in healthy ageing. While dietary intake of vitamin C might have a positive effect in cataracts, its supplementation does not show the same effect. The protective effects of vitamin C in cataracts still need to be clarified; further assessments are encouraged. The collection of analyses performed in this research allows us to confirm: 1)The link between FAs and health; 2) that DHA supplementation is promising to slow the progression of visual acuity loss in the older adult population with a previous AMD diagnosis; 3) the need to balance n-6, and n-3 proportions; 4) that DHA supplementation optimizes two markers of health, n6-n3 ratio and the O3I; 5) the antioxidant effect of vitamin C in cataracts remains unclear. Altogether, these results endorse the role of nutrition in healthy ageing decreasing the risk for NCDs, which are responsible for poor health and quality of life

A randomized study of nutritional supplementation in patients with unilateral wet age-related macular degeneration

The purpose of this study is evaluate the efficacy and safety of medicinal products containing the original Age-Related Eye Disease group (AREDS) formulation at doses approved in Europe (EU, control group; n = 59) with a product that adds DHA, lutein, zeaxanthin, resveratrol and hydroxytyrosol to the formula (intervention group; n = 50). This was a multicenter, randomized, observer-blinded trial conducted in patients aged 50 years or older diagnosed with unilateral exudative Age related Macular Degeneration AMD. At month 12, the intervention did not have a significant differential effect on visual acuity compared with the control group, with an estimated treatment difference in Early Treatment Diabetic Retinopathy Study (ETDRS) of −1.63 (95% CI −0.83 to 4.09; p = 0.192). The intervention exhibited a significant and, in most cases, relevant effect in terms of a reduction in some inflammatory cytokines and a greater improvement in the fatty acid profile and serum lutein and zeaxantin concentration. In patients with unilateral wet AMD, the addition of lutein, zeaxanthin, resveratrol, hydroxytyrosol and DHA to the AREDS EU recommended doses in the short-term did not have a differential effect on visual acuity compared to a standard AREDS EU formula but, in addition to improving the fatty acid profile and increasing carotenoid serum levels, may provide a beneficial effect in improving the proinflammatory and proangiogenic profile of patients with AMD.The research was funded by Laboratorios Théa (Barcelona, Spain) and by research grants from the “Instituto de Salud Carlos III/European Regional Development Fund (ERDF)” and RD16/0008/0011, OFTARED: Enfermedades oculares: “Prevención, detección precoz, tratamiento y rehabilitación de las patologías oculares”.Peer reviewe