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This Article Full Text (Publish Ahead of Print[PDF]) All Versions of this Article: 90/6/1601    most recent ajcn.2009.27594v1 Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by SanGiovanni, J. P. Articles by Chew, E. Y PubMed PubMed Citation Articles by SanGiovanni, J. P. Articles by Chew, E. Y Agricola Articles by SanGiovanni, J. P. Articles by Chew, E. Y

–3 Long-chain polyunsaturated fatty acid intake and 12-y incidence of neovascular age-related macular degeneration and central geographic atrophy: a prospective cohort study from the Age-Related Eye Disease Study^1,2,3,4

¹ From the National Eye Institute, Bethesda, MD (JPS, EA, GFR, RDS, and EYC); the EMMES Corporation, Rockville, MD (TEC); and the Department of Ophthalmology, George Washington University, Washington, DC (ADM).

² JPS and EA contributed equally to this work.

³ Supported by the National Eye Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD.

⁴ Address correspondence to JP SanGiovanni, National Eye Institute, Clinical Trials Branch, National Institutes of Health 10 Center Drive, MSC-1204, Building 10, CRC, Room 3-2521, Bethesda, MD 20892-1204. E-mail: jpsangio{at}post.harvard.edu.

ABSTRACT

Background: –3 (n–3) Long-chain polyunsaturated fatty acids (LCPUFAs) affect processes implicated in vascular and neural retinal pathogenesis and thus may influence the risk of developing age-related macular degeneration (AMD).

Objective: We investigated whether –3 LCPUFA intake was associated with a reduced likelihood of developing central geographic atrophy (CGA) and neovascular (NV) AMD.

Design: We undertook a nested cohort study within a multicenter phase 3 clinical trial, the Age-Related Eye Disease Study (AREDS), to study progression to advanced AMD in 1837 persons at moderate-to-high risk of this condition. The AREDS was designed to assess the clinical course, prognosis, risk factors, and nutrient-based treatments of AMD and ran from November 1992 to December 2005. We obtained baseline data on –3 LCPUFA intake with a validated food-frequency questionnaire. Trained fundus graders ascertained AMD status from annual stereoscopic color photographs by using standardized methods at a single reading center across a 12-y period. We applied multivariable repeated-measures logistic regression with the incorporation of generalized estimating equation methods, because this permitted determination of progression to outcome at each visit.

Results: Participants who reported the highest –3 LCPUFA intake (median: 0.11% of total energy intake) were 30% less likely than their peers to develop CGA and NV AMD. The respective odds ratios were 0.65 (95% CI: 0.45, 0.92; P 0.02) and 0.68 (95% CI: 0.49, 0.94; P 0.02).

Conclusions: The 12-y incidence of CGA and NV AMD in participants at moderate-to-high-risk of these outcomes was lowest for those reporting the highest consumption of –3 LCPUFAs. If these results are generalizable, they may guide the development of low-cost and easily implemented preventive interventions for progression to advanced AMD. This trial was registered at clinicaltrials.gov as NCT00594672.

Received for publication February 5, 2009. Accepted for publication September 2, 2009.