Mediterranean Diet and Incidence of Advanced Age-Related Macular Degeneration: The EYE-RISK Consortium

Purpose: To investigate associations of adherence to the Mediterranean diet (MeDi) with incidence of advanced age-related macular degeneration (AMD; the symptomatic form of AMD) in 2 European population-based prospective cohorts. Design: Prospective cohort study of the Rotterdam Study I (RS-I) and the Antioxydants, Lipides Essentiels, Nutrition et Maladies Oculaires (Alienor) Study populations. Participants: Four thousand four hundred forty-six participants 55 years of age or older from the RS-I (The Netherlands) and 550 French adults 73 years of age or older from the Alienor Study with complete ophthalmologic and dietary data were included in the present study. Methods: Examinations were performed approximately every 5 years over a 21-year period (1990–2011) in RS-I and every 2 years over a 4-year period (2006–2012) in the Alienor Study. Adherence to the MeDi was evaluated using a 9-component score based on intake of vegetables, fruits, legumes, cereals, fish, meat, dairy products, alcohol, and the monounsaturated-to-saturated fatty acids ratio. Associations of incidence of AMD with MeDi were estimated using multivariate Cox proportional hazard models. Main Outcomes Measures: Incidence of advanced AMD based on retinal fundus photographs. Results: Among the 4996 included participants, 155 demonstrated advanced incident AMD (117 from the RS-I and 38 from the Alienor Study). The mean follow-up time was 9.9 years (range, 0.6–21.7 years) in the RS-I and 4.1 years (range, 2.5–5.0 years) in the Alienor Study. Pooling data for both the RS-I and Alienor Study, participants with a high (range, 6–9) MeDi score showed a significantly reduced risk for incident advanced AMD compared with participants with a low (range, 0–3) MeDi score in the fully adjusted Cox model (hazard ratio, 0.59; 95% confidence interval, 0.37–0.95; P = 0.04 for trend). Conclusions: Pooling data from the RS-I and Alienor Study, higher adherence to the MeDi was associated with a 41% reduced risk of incident advanced AMD. These findings support the role of a diet rich in healthful nutrient-rich foods such as fruits, vegetables, legumes, and fish in the prevention of AMD.The author(s) have made the following disclosure(s): B.M.J.M.: Consultant e Bausch & Lomb (Rochester, New York); Financial support e Laboratoires Théa (Clermont-Ferrand, France). A.C.-G.: Financial support e Laboratoires Théa (Clermont-Ferrand, France). M.-N.D.: Consultant e Bayer (Leverkusen, Germany), Allergan (Irvine, California), Novartis (Basel, Switzerland); Board membership e Bayer (Leverkusen, Germany), Allergan (Irvine, California), Novartis (Basel, Switzerland). O.H.F.: Financial support e Nestle (Vevey, Switzerland). J.-F.K.: Consultant e Alcon (Hünenberg, Switzerland), Alimera (Alpharetta, Georgia), Novartis (Basel, Switzerland), Roche (Basel, Switzerland), Thea (Clermont-Ferrand, France), Zeiss (Oberkochen, Germany), Bayer (Leverkusen, Germany). C.C.W.K.: Consultant e Bayer (Leverkusen, Germany); Lecturer e Novartis (Basel, Switzerland), Thea Pharma (Clermont-Ferrand, France). C.D.: Consultant e Allergan (Irvine, California), Bausch & Lomb (Rochester, New York), Laboratoires Théa (Clermont-Ferrand, France), Novartis (Basel, Switzerland), Roche (Basel, Switzerland); Financial support e Laboratoires Théa (Clermont-Ferrand, France), Essilor (Charenton le Pont, France). M.B.: Travel fees e Bayer (Leverkusen, Germany); Consultant e Roche (Basel, Switzerland). R.I., H.L., C.M., and E.N.: Employees e F. Hoffmann-La Roche Ltd (Basel, Switzerland). J.M.: Financial support e Bayer (Leverkusen, Germany), Alcon (Hünenberg, Switzerland), Ophthotech (New-York, NY), Notal Vision (Manassas, VA), Novartis (Basel, Switzerland), Roche (Basel, Switzerland). I.L.: Unrestricted research support e OPTOS Plc (Dunfermline, UK). Competing financial interest of members of the EYE-RISK consortium not otherwise disclosed: Verena Arndt, Sebastian Bühren, Tanja Endermann, and Markus Zumbansen are employees of AYOXXA. The EYE-RISK project is supported by the European Union’s Horizon 2020 Research and Innovation Programme (grant no.: 634479). The Rotterdam Study is funded by Erasmus Medical Center and Erasmus University, Rotterdam, The Netherlands; the Organization for the Health Research and Development (ZonMw); the Research Institute for Diseases in the Elderly (RIDE); the Ministry of Education, Culture and Science; the Ministry for Health, Welfare and Sports; the European Commission (DG XII), and the Municipality of Rotterdam, Rotterdam, The Netherlands. Additionally, the ophthalmic research within the Rotterdam Study was supported by the following foundations: Oogfonds; Bartiméus Sonneheerdt Vereniging; Landelijke Stichting voor Blinden en Slechtzienden; Algemene Nederlandse Vereniging Ter Voorkoming Van Blindheid; Novartis Foundation; and MaculaFonds, which contributed through UitZicht (grant nos.: 2015-36 and 2016-19). The funding organizations had no role in the design or conduct of this research and provided unrestricted grants. The Antioxydants, Lipides Essentiels, Nutrition et Maladies Oculaires Study is funded by Laboratoires Théa; Fondation Voir et Entendre; Retina France; Agence Nationale de la Recherche (ANR 2010-PRSP-011 VISA); and Caisse Nationale pour la Solidarité et l’Autonomie