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Chapter 2 / Cataract

127

3.3.7. THIAMIN

Thiamin is a water-soluble vitamin that plays a role in the metabolism of carbohydrates and branched-chain amino acids. The biochemistry, metabolism, and functions of thiamin are presented in more detail in Chapter 7. Severe thiamin deficiency results in the beriberi, and cataract is not considered to be part of the clinical syndrome of beriberi. Data from the Beaver Dam Eye Survey suggests that the total dietary intake of thiamin is protective against nuclear cataract in men but not women (55). In the Blue Mountains Eye Study, total dietary intake of thiamin was protective against nuclear cataract (56). No significant relationships have been found between thiamin intake or supplementation and cortical cataract (48,51,56), or posterior subcapsular cataract (51,56).

3.3.9. RIBOFLAVIN

Riboflavin is a precursor to the coenzymes FMN and FAD and other covalently bound flavins that are involved in many oxidation-reduction reactions. Riboflavin has strong antioxidant activity through its role in the glutathione redox cycle. The biochemistry, metabolism, and functions of riboflavin are presented in more detail in Chapter 7. Riboflavin deficiency has been associated with cataract in experimental animal models, but the association between riboflavin deficiency and cataract in humans is less clear. Epidemiological studies suggest that a higher dietary intake of riboflavin is associated with lower risk of nuclear cataract (52,55,56). No significant relationship has been found between riboflavin intake or supplementation and cortical cataract or posterior subcapsular cataract. The relationship between laboratory indicators of riboflavin status, such as erythrocyte glutathione reductase, erythrocyte flavin, or urinary flavin and risk of cataract has not been characterized. In a subsample of subjects from the Nurses’ Health Study, higher long-term intake of riboflavin and/or thiamin was associated with reduced progression of nuclear lens opacities over 5 yr of follow-up (70).

3.3.10. NIACIN

Niacin is a generic term for nicotinic acid, nicotinamide, and derivatives that have the biological activity of nicotinamide. Niacin is a water soluble vitamin that plays a central role in oxidation and reduction reactions of both catabolic pathways of carbohydrates, lipids, and proteins, and anabolic pathways of fatty acid and cholesterol synthesis. The biochemistry, metabolism, and functions of niacin are presented in more detail in Chapter 7. Severe niacin deficiency results in pellagra, and cataract is not considered to be part of the clinical syndrome of pellagra. Two studies suggest that low dietary intake of niacin is associated with a higher risk of nuclear cataract (55,56). No significant relationship has been described between dietary niacin intake and cortical cataract or posterior subcapsular cataract.

3.3.11. PYRIDOXINE

Vitamin B6, or pyridoxine and related compounds, plays a role in gluconeogenesis, metabolism of amino acids, hormone modulation, immune function, erythrocyte function, lipid metabolism, and neurotransmitter synthesis. No significant relationship has been found between pyridoxine intake in supplements and nuclear cataracts (48,51) or posterior subcapsular cataract (51). Individuals with the highest pyridoxine intake in

128	Handbook of Nutrition and Ophthalmology

supplements had an increased risk of cortical cataract in the Beaver Dam Eye Study (OR 2.0, 95% CI 1.1–3.7) (48).

3.3.12. FOLATE

Folate is a generic term used to describe a family of compounds with the activity of folic acid, including folylpolyglutamates and folic acid (pteroylglutamic acid) and its derivatives. Folate plays an important role as coenzymes in the synthesis of nucleic acids and amino acids, and folate deficiency has been linked with nutritional amblyopia, as discussed in detail in Chapter 7. Higher folate intake has been associated with lower risk of nuclear cataract among men and women in the Beaver Dam Eye Survey (55) and in the Nurses’ Health Study (52). No significant association has been found between folate intake and cortical cataract or posterior subcapsular cataract.

3.3.13. VITAMIN B12

Vitamin B12 is a generic term for corrinoids that have the biological activity of cyanocobalamin. Deficiency of vitamin B12 has been linked with nutritional amblyopia. The biochemistry, metabolism, and functions of vitamin B12 are presented in more detail in Chapter 7. In the Blue Mountains Eye Study, vitamin B12 supplementation of >8.0 μg per day was associated with a decreased risk of nuclear cataract and decreased risk of cortical cataract (51).

3.3.14. ZINC

Zinc is involved in the metabolism of nucleic acids, protein, and lipids, synthesis of hormones, and apoptosis, as presented in more detail in Chapter 8. Dietary zinc intake has not been associated with the risk of nuclear cataract, cortical cataract, or posterior subcapsular cataract (56), but there have been relatively few studies to examine the relationship between zinc status and cataract. The relationships between the various nutrients and the three major types of cataracts in different studies are summarized in Tables 1–3.

3.3.15. PROTEIN

Low consumption of protein foods was associated with a higher risk of concurrent cataract in the Punjab (45). Authors believe that low total protein consumption may account for as much as 40% of the excess prevalence of cataract in the Punjab region compared with that in the United States (45). Low protein intake was also associated with increased risk of nuclear cataract, posterior subcapsular cataract, and mixed cataracts in India (30).

3.3.16. ANTIOXIDANT INDEX

A composite “antioxidant index” based on various combinations of glutathione peroxidase, glucose-6-phosphate dehydrogenase, ascorbic acid, vitamin E, and carotenoids has been utilized to relate antioxidant systems to cataract (30,71). In India, a high antioxidant index (glutathione peroxidase, glucose-6-phosphate dehydrogenase, ascorbic acid, and vitamin E combined) was associated with a decreased risk of posterior subcapsular cataract (OR 0.23, 95% CI 0.06–0.88) and decreased risk of combined nuclear and posterior subcapsular cataract (OR 0.12, 95% CI 0.03–0.56) (30). Another antioxidant index, consisting of high concentrations of at least two or three vitamins or nutrients (vitamin C, vitamin E, carotenoids) were associated with a reduced risk of cataract (71).

Chapter 2 / Cataract	129

Nutritional Factors and Risk of Nuclear Cataract

Table 1

Reference	48	48	48	48	53	49	50	51	52	57	48	55	55	sex 56	51	55	55	59	59	59	60	52	61	(continued)
CI95% Comment	Multivitamin supplementCurrent0.7–1.1 use;nondiabeticsubjects	supplementCurrent0.8–3.8 use;diabeticsubjects	Supplement.80.5–0useover10yr;nondiabeticsubjects	Supplement0.4–2.7useover10yr;diabeticsubjects	supplementationDaily0.48–2.32 foratleast1wk/mo	Supplementation.990.48–0 atleastonceperweekfor≥1yr	Supplemented.90.4–0>10yr	Supplemented0.0–1.0>10yr	Supplemented.930.35–0>10yr	AVitamin concentration;Plasma0.49–1.76 highestvslowestquartile	supplements;inIntake0.5–1.7 highestvslowesttertile	intake;Total0.35–0.86men;highestvslowestquintile	intake;Total0.54–1.18women;highestvslowestquintile	intake;Total0.3–0.8highestvslowestquintile;adjustedage,	Supplemented0.0–0.9>3000μg/d carotene-α	intake;Dietary0.39–0.95men;highestvslowestquintile	0.55–1.19intake;Dietarywomen;highestvslowestquintile	intake;Dietary0.11–0.84men;highestvslowestquintile	intake;Dietary0.87–5.04women;highestvslowestquintile	concentration;Serum0.61–2.14 highestvslowestquintile	concentration;Serum0.4–2.2 highestvslowesttertile	intake;Dietary0.37–1.35highestvslowestquintile	concentration;Plasma0.3–0.9 highestvslowesttertile
c
OR	0.9	1.7	0.6	1.1	1.06	0.69	0.6	0.1	0.57	0.93	0.9	0.55	0.80	0.5	0.1	0.61	0.80	0.30	2.09	1.14	0.9	0.71	0.5
b
n	1980	172	1980	172	4314	744	3089	2873	478	660	1980	859	1060	2900	2873	859	1060	180	220	400	400	478	372
Design	Cross-sectional	Cross-sectional	Prospective	Prospective	Cross-sectional	Prospective	Prospective	Cross-sectional	Prospective	Prospective	Prospective	Prospective	Prospective	Cross-sectional	Cross-sectional	Prospective	Prospective	Cross–sectional	Cross-sectional	Cross-sectional	Prospective	Prospective	Cross-sectional
Study	BeaverDam	BeaverDam	BeaverDam	BeaverDam	Barbados	LongitudinalCataract	BeaverDam	BlueMountains	Nurses’Health	BaltimoreLongitudinal	BeaverDam	BeaverDam	BeaverDam	BlueMountains	BlueMountains	BeaverDam	BeaverDam	BeaverDam	BeaverDam	BeaverDam	BeaverDam	Nurses’Health	Sheffield
a

129

130	Handbook of Nutrition and Ophthalmology

Table 1 (Continued)

Reference	57	55	55	59	59	59	60	52	61	55	55	59	59	59	60	52	61	55	55	59	59	59	60	61
CI95% Comment	carotene-β concentration;Plasma0.84–2.93 highestvslowestquartile	intake;Dietary0.46–1.10men;highestvslowestquintile	intake;Dietary0.55–1.22women;highestvslowestquintile	intake;Dietary0.44–1.23men;highestvslowestquintile	intake;Dietary0.56–3.10women;highestvslowestquintile	concentration;Serum0.81–2.91 highestvslowestquintile	concentration;Serum0.4–2.2 highestvslowesttertile	intake;Dietary.970.28–0highestvslowestquintile	concentration;Plasma0.4–1.4 highestvslowesttertile cryptoxanthin-β	intake;Dietary0.56–1.34men;highestvslowestquintile	intake;Dietary0.76–1.66women;highestvslowestquintile	intake;Dietary0.40–2.87men;highestvslowestquintile	intake;Dietary.761.72–9women;highestvslowestquintile	concentration;Serum0.45–1.57 highestvslowestquintile	concentration;Serum0.3–1.6 highestvslowesttertile	intake;Dietary0.34–1.35highestvslowestquintile	concentration;Plasma0.3–1.1 highestvslowesttertile	Lutein intake;Dietary0.53–1.26men;highestvslowestquintile	intake;Dietary0.50–1.06women;highestvslowestquintile	intake;Dietary0.30–2.01men;highestvslowestquintile	intake;Dietary0.61–3.37women;highestvslowestquintile	concentration;Serum0.75–2.80 highestvslowestquintile	concentration;Serum0.3–1.6 highestvslowesttertile	concentration;Plasma0.4–1.5 highestvslowesttertile
c
OR	1.57	0.71	0.82	0.44	1.31	1.54	0.9	0.52	0.7	0.87	1.13	1.07	4.10	0.84	0.7	0.68	0.6	0.82	0.73	0.77	1.43	1.45	0.7	0.8
b
n	660	859	1060	180	220	400	400	478	372	859	1060	180	220	400	400	478	372	859	1060	180	220	400	400	372
Design	Prospective	Prospective	Prospective	Cross-sectional	Cross-sectional	Cross-sectional	Prospective	Prospective	Cross-sectional	Prospective	Prospective	Cross-sectional	Cross-sectional	Cross-sectional	Prospective	Prospective	Cross-sectional	Prospective	Prospective	Cross-sectional	Cross-sectional	Cross-sectional	Prospective	Cross-sectional
Study	BaltimoreLongitudinal	BeaverDam	BeaverDam	BeaverDam	BeaverDam	BeaverDam	BeaverDam	Nurses’Health	Sheffield	BeaverDam	BeaverDam	BeaverDam	BeaverDam	BeaverDam	BeaverDam	Nurses’Health	Sheffield	BeaverDam	BeaverDam	BeaverDam	BeaverDam	BeaverDam	BeaverDam	Sheffield
a

130

Chapter 2 / Cataract	131

61	52	55	55	59	59	59	60	52	61	59	59	59	52	52	48	57	64	55	55	59	59	59	48	65	(continued)
Zeaxanthin 0.4–1.4 Plasmaconcentration;highestvslowesttertile	Lutein/Zeaxanthin 0.29–0.91 Dietaryintake;highestvslowestquintile	Lycopene 0.71–1.72 Dietaryintake;men;highestvslowestquintile	1.01–2.19 Dietaryintake;women;highestvslowestquintile	0.23–1.66 Dietaryintake;men;highestvslowestquintile	0.52–2.79 Dietaryintake;women;highestvslowestquintile	0.98–3.95 Serumconcentration;highestvslowestquintile	0.5–2.6 Serumconcentration;highestvslowesttertile	0.63–2.16 Totalintake;highestvslowestquintile	0.5–1.8 Plasmaconcentration;highestvslowesttertile	TotalCarotenoids 0.82–4.35 Dietaryintake;women;highestvslowestquintile	0.15–1.10 Dietaryintake;men;highestvslowestquintile	0.99–3.66 Serumconcentration;highestvslowestquintile	0.34–1.13 Totalintake;highestvslowestquintile;adjusted	0.91–3.43 Plasmaconcentration;highestvslowestquintile	VitaminD 0.4–4.5 Intakeinsupplements;highestvslowesttertile	VitaminE 0.26–1.07 Plasmaconcentration;highestvslowestquartile	0.21–0.90 Plasmaα-tocopherol;highestvslowestquintile	0.43–1.03 Dietaryintake;men;highestvslowestquintile	0.53–1.14 Totalintake;women;highestvslowestquintile	0.82–4.35 Dietaryintake;women;highestvslowestquintile	0.32–2.25 Dietaryintake;men;highestvslowestquintile	1.05–4.34 Serumα-tocopherol;highestvslowestquintile	0.6–1.5 Intakeinsupplements;highestvslowesttertile	0.96–1.03 PlasmavitaminE;highestvslowestquartile
0.7	0.52	1.10	1.49	0.62	1.21	1.96	1.1	1.16	0.9	1.89	0.41	1.90	0.62	1.77	1.3	0.52	0.44	0.67	0.78	1.89	0.85	2.13	0.9	0.99
372	478	859	1060	180	220	400	400	478	372	220	180	400	478	478	1980	660	1380	859	1060	220	180	400	1980	410
Cross-sectional	Prospective	Prospective	Prospective	Cross-sectional	Cross-sectional	Cross-sectional	Prospective	Prospective	Cross-sectional	Cross-sectional	Cross-sectional	Cross-sectional	Prospective	Cross-sectional	Prospective	Prospective	Case-control	Prospective	Prospective	Cross-sectional	Cross-sectional	Cross-sectional	Prospective	Prospective
Sheffield	Nurses’Health	BeaverDam	BeaverDam	BeaverDam	BeaverDam	BeaverDam	BeaverDam	Nurses’Health	Sheffield	BeaverDam	BeaverDam	BeaverDam	Nurses’Health	Nurses’Health	BeaverDam	BaltimoreLongitudinal	LensOpacities	BeaverDam	BeaverDam	BeaverDam	BeaverDam	BeaverDam	BeaverDam	KuopioAtherosclerosis

131

132	Handbook of Nutrition and Ophthalmology

Table 1 (Continued)

Reference

c Comment

CI95%

b OR

Design

a Study

49	49	60	66	51	52	52	52	61	57	48	55	55	49	56	51	52	52	52	61	48	55	55	56	51
VitaminE(continued) 0.19–0.99 Supplementationatleastonceperweekfor≥1yr	0.36–0.94 Plasmaα-tocopherol;highestvslowestquintile	0.2–1.1 Serumα-tocopherol;highestvslowesttertile	0.47–1.70 “Ever”vs“never”usedsupplements,byhistory	– Nosignificantrelationshipfoundwithsupplements	0.22–1.09 Supplemented>10yr	0.23–0.86 Totalintake;highestvslowestquintile	0.25–0.95 Plasmaconcentration;highestvslowestquintile	0.3–1.3 Plasmaconcentration;highestvslowesttertile	VitaminC 0.65–2.60 Plasmaconcentration;highestvslowestquartile	0.5–1.0 Intakeinsupplements;highestvslowesttertile	0.39–0.97 Totalintake;men;highestvslowestquintile	0.51–1.11 Totalintake;women;highestvslowestquintile	0.49–1.32 Supplementationatleastonceperweekfor≥1yr	0.5–1.1 Totalintake;highestvslowestquintile;adjustedage,sex	– Nosignificantrelationshipfoundwithsupplements	0.18–0.72 Supplemented>10yr	0.16–0.58 Totalintake;highestvslowestquintile	0.28–1.02 Plasmaconcentration;highestvslowestquintile	0.5–1.9 Plasmaconcentration;highestvslowesttertile	Thiamin 0.5–1.2 Intakeinsupplements;highestvslowesttertile	0.38–0.91 Totalintake;men;highestvslowestquintile	0.51–1.10 Totalintake;women;highestvslowestquintile	0.4–0.9 Totalintake;highestvslowestquintile;adjustedage,sex	0.4–1.0 Supplemented>4.4mg/d
0.43	0.58	0.5	0.89	–	0.49	0.45	0.48	0.6	1.31	0.7	0.62	0.75	0.80	0.7	–	0.36	0.31	0.54	1.0	0.7	0.58	0.75	0.6	0.6
744	744	400	1104	2873	478	478	478	372	660	1980	859	1060	744	2900	2873	478	478	478	372	1980	859	1060	2900	2873
Prospective	Prospective	Prospective	Cross-sectional	Cross-sectional	Prospective	Prospective	Cross-sectional	Cross-sectional	Prospective	Prospective	Prospective	Prospective	Prospective	Cross-sectional	Cross-sectional	Prospective	Prospective	Cross-sectional	Cross-sectional	Prospective	Prospective	Prospective	Cross-sectional	Cross-sectional
LongitudinalCataract	LongitudinalCataract	BeaverDam	VitaminE&Cataract	BlueMountains	Nurses’Health	Nurses’Health	Nurses’Health	Sheffield	BaltimoreLongitudinal	BeaverDam	BeaverDam	BeaverDam	LongitudinalCataract	BlueMountains	BlueMountains	Nurses’Health	Nurses’Health	Nurses’Health	Sheffield	BeaverDam	BeaverDam	BeaverDam	BlueMountains	BlueMountains

132

Chapter 2 / Cataract	133

48	55	55	56	51	52	48	55	55	56	51	48	51	48	55	55	51	52
Intakeinsupplements;highestvslowesttertile	Totalintake;men;highestvslowestquintile	Totalintake;women;highestvslowestquintile	Totalintake;highestvslowestquintile;adjustedage,sex	Supplemented>6.8mg/d	Totalintake;highestvslowestquintile	Intakeinsupplements;highestvslowesttertile	Totalintake;men;highestvslowestquintile	Totalintake;women;highestvslowestquintile	Totalintake;highestvslowestquintile;adjustedage,sex	Supplemented>64mg/d	Intakeinsupplements;highestvslowesttertile	Supplemented>6.0mg/d	Intakeinsupplements;highestvslowesttertile	Totalintake;men;highestvslowestquintile	Totalintake;women;highestvslowestquintile	Supplemented200to≤800μg/d	Totalintake;highestvslowestquintile
Riboflavin 0.5–1.3	0.36–0.87	0.46–0.98	0.4–0.9	0.4–1.1	0.19–0.73	Niacin 0.4–1.2	0.36–0.86	0.49–1.04	0.4–0.9	0.1–1.4	Pyridoxine 0.5–1.4	0.3–1.0	Folate 0.2–1.7	0.32–0.79	0.43–0.92	0.2–1.2	0.24–0.81
0.8	0.56	0.67	0.6	0.6	0.37	0.7	0.56	0.71	0.6	0.4	0.9	0.6	0.5	0.50	0.63	0.5	0.44
1980	859	1060	2900	2873	478	1980	859	1060	2900	2873	1980	2873	1980	859	1060	2873	478
Prospective	Prospective	Prospective	Cross-sectional	Cross-sectional	Prospective	Prospective	Prospective	Prospective	Cross-sectional	Cross-sectional	Prospective	Cross-sectional	Prospective	Prospective	Prospective	Cross-sectional	Prospective

BeaverDam BeaverDam BeaverDam BlueMountains BlueMountains Nurses’Health

BeaverDam BeaverDam BeaverDam BlueMountains BlueMountains

BeaverDam BlueMountains

BeaverDam BeaverDam BeaverDam BlueMountains Nurses’Health

	51	56
	μg/d	vslowestquintile;adjustedage,sex
12	Supplemented>8.0	Totalintake;highest
VitaminB	0.1–0.7	Zinc 0.5–1.1
	0.3	0.7
	2873	2900
	Cross-sectional	Cross-sectional

BlueMountains

foundis thein text.main

characteristicsother theof studiesindividual

anddemographic

regardingDetails a

confounders.potential

(OR)ratios fromare modelsmultivariate foradjusting

oddsAll b

supplementsfrom

intakedietary intakeplus

=intake

Total c

133

134	Handbook of Nutrition and Ophthalmology

(95%CI) Comment Reference

Multivitamin 0.8–1.5 Currentsupplementuse;nondiabeticsubjects 48

0.4–2.6 Currentsupplementuse;diabeticsubjects 48

1.1–2.1 Supplementuseover10yr;nondiabeticsubjects 48

0–0.9 Supplementuseover10yr;diabeticsubjects 48

0.47–1.05 Dailysupplementationforatleast1wkpermonth 53

0.2–0.8 Supplemented>10yr 50

0.3–1.1 Supplemented>10yr 51

0.75–1.63 Supplemented≥10yr 54

VitaminA 0.9–3.8 Intakeinsupplements;highestvslowesttertile 48

1.16–4.83 Plasmaconcentration;highestvslowestquartile 57

0.6–1.1 Totalintake;highestvslowestquintile;adjustedage,sex 56

– Nosignificantrelationshipfound 51 α-carotene

0.23–3.12 Serumconcentration;women;highestvslowestquintile 59

0.20–3.44 Serumconcentration;men;highestvslowestquintile 59

0.5–1.7 Plasmaconcentration;highestvslowesttertile 61

0.64–1.64 Dietaryintake;highestvslowestquintile 54 β-carotene

0.37–1.42 Plasmaconcentration;highestvslowestquartile 57

0.57–6.98 Serumconcentration;women;highestvslowestquintile 59

0.06–1.24 Serumconcentration;men;highestvslowestquintile 59

0.3–1.1 Plasmaconcentration;highestvslowesttertile 61

0.81–2.19 Dietaryintake;highestvslowestquintile 54 β-cryptoxanthin

0.43–4.90 Serumconcentration;women;highestvslowestquintile 59

0.08–3.78 Serumconcentration;men;highestvslowestquintile 59

1.1

1.0

1.6

0.1

0.70

0.4

0.5

1.11

1.8

2.37

0.8

–

0.87

0.82

0.9

1.03

0.72

2.00

0.28

0.6

1.33

1.45

0.54

RiskofCorticalCataract

Design n

Cross-sectional 1980

Cross-sectional 172

Prospective 1980

Prospective 172

Cross-sectional 4314

Prospective 3089

Cross-sectional 2873

Prospective 492

Prospective 1980

Prospective 600

Cross-sectional 2900

Cross-sectional 2873

Cross-sectional 217

Cross-sectional 179

Cross-sectional 372

Prospective 492

Prospective 600

Cross-sectional 217

Cross-sectional 179

Cross-sectional 372

Prospective 492

Cross-sectional 217

Cross-sectional 179

Table2 NutritionalFactorsand

Study

BeaverDam

Barbados

BeaverDam

BlueMountains

Nurses’Health

BeaverDam

BaltimoreLongitudinal

BlueMountains

BeaverDam

Sheffield

Nurses’Health

BaltimoreLongitudinal

BeaverDam

Sheffield

Nurses’Health

BeaverDam

134

Chapter 2 / Cataract	135

0.5–2.0 Plasmaconcentration;highestvslowesttertile 61

0.59–1.71 Dietaryintake;highestvslowestquintile 54

0.49–6.21 Serumconcentration;women;highestvslowestquintile 59

0.83–28.1 Serumconcentration;men;highestvslowestquintile 59

0.7–2.4 Plasmaconcentration;highestvslowesttertile 61

Zeaxanthin 0.5–2.0 Plasmaconcentration;highestvslowesttertile 61

Lutein/Zeaxanthin 0.52–1.44 Dietaryintake;highestvslowestquintile 54

Lycopene 0.78–13.2 Serumconcentration;women;highestvslowestquintile 59

0.06–2.36 Serumconcentration;men;highestvslowestquintile 59

0.2–0.7 Plasmaconcentration;highestvslowesttertile 61

0.87–2.35 Dietaryintake;highestvslowestquintile 54

TotalCarotenoids 0.92–11.5 Serumconcentration;women;highestvslowestquintile 59

0.12–3.20 Serumconcentration;men;highestvslowestquintile 59

0.69–1.86 Dietaryintake;highestvslowestquintile 54

0.64–1.82 Plasmaconcentration;highestvslowestquintile 54

VitaminD 0.5–7.9 Intakeinsupplements;highestvslowesttertile 48

VitaminE 0.52–1.78 Plasmaconcentration;highestvslowestquartile 57

0.6–2.3 Intakeinsupplements;highestvslowesttertile 48

0.43–1.27 Plasmaα-tocopherol;highestvslowestquintile 64

0.44–10.06 Serumα-tocopherol;women;highestvslowestquintile 59

0.59–26.2 Serumα-tocopherol;men;highestvslowestquintile 59

0.08–0.86 PlasmavitaminE;highestvslowestquartile 65

0.25–0.77 “Ever”vs“never”usedsupplements,byhistory 66

– Nosignificantrelationshipfound;datanotshown 51

(continued)

1.0

1.00

1.75

4.84

1.3

1.0

0.86

3.21

0.37

0.4

1.43

3.26

0.62

1.13

1.08

2.0

0.96

1.2

0.74

2.11

3.94

0.27

0.44

–

372

492

217

179

372

492

217

179

372

492

217

179

492

1980

600

1980

1380

217

179

410

1104

2873

Cross-sectional

Prospective

Lutein Cross-sectional

Cross-sectional

Prospective

Cross-sectional

Prospective

Cross-sectional

Prospective

Case-control

Cross-sectional

Prospective

Cross-sectional

Sheffield

Nurses’Health

BeaverDam

Sheffield

Nurses’Health

BeaverDam

Sheffield

Nurses’Health

BeaverDam

Nurses’Health

BeaverDam

BaltimoreLongitudinal

BeaverDam

LensOpacities

BeaverDam

KuopioAtherosclerosis

VitaminE&Cataract

BlueMountains

135

136	Handbook of Nutrition and Ophthalmology

Reference

sex56

(95%CI) Comment

VitaminE(continued) 0.3–1.1 Plasmaconcentration;highestvslowesttertile

0.75–1.95 Totalintake;highestvslowestquintile

0.65–2.09 Supplemented≥10yr

0.81–2.14 Plasmaconcentration;highestvslowestquintile

VitaminC 0.45–2.26 Plasmaconcentration;highestvslowestquartile

1.2–2.9 Intakeinsupplements;highestvslowesttertile

0.7–1.4 Totalintake;highestvslowestquintile;adjustedage,

– Nosignificantrelationshipfound;datanotshown

0.6–2.2 Plasmaconcentration;highestvslowesttertile

0.55–1.45 Totalintake;highestvslowestquintile

0.55–1.44 Supplemented≥10yr

0.86–2.52 Plasmaconcentration;highestvslowestquintile

Thiamin 0.9–3.1 Intakeinsupplements;highestvslowesttertile

0.6–1.1 Totalintake;highestvslowestquintile;adjustedage,

0.5–1.0 Fordose>4.4mg/d

0.9–3.1 Intakeinsupplements;highestvslowesttertile

0.5–1.0 Totalintake;highestvslowestquintile;adjustedage,

0.5–1.0 Fordose>6.8mg/d

0.91–2.44 Totalintake;highestvslowestquintile

Niacin 1.0–3.8 Intakeinsupplements;highestvslowesttertile

0.5–1.0 Totalintake;highestvslowestquintile;adjustedage,

0.3–1.2 Fordose>64mg/d

0.6

1.21

1.17

1.32

1.01

1.8

1.0

–

1.1

0.89

1.47

1.7

0.8

0.7

1.7

0.7

1.49

2.0

0.7

0.6

372

492

600

1980

2900

2873

372

492

1980

2900

2873

1980

2900

2873

492

1980

2900

2873

Design

Cross-sectional

Prospective

Cross-sectional

Prospective

Cross-sectional

Prospective

Cross-sectional

Prospective

Cross-sectional

Table2(Continued)

Study

Sheffield

Nurses’Health

BaltimoreLongitudinal

BeaverDam

BlueMountains

Sheffield

Nurses’Health

BeaverDam

BlueMountains

Riboflavin BeaverDam

BlueMountains

Nurses’Health

BeaverDam

BlueMountains

136

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