The inflammatory potential of diet is associated with the risk of age-related eye diseases

Joëlle E Vergroesen; Eric F Thee; Tosca O E de Crom; Jessica C Kiefte-de Jong; Magda A Meester-Smoor; Trudy Voortman; Caroline C W Klaver; Wishal D Ramdas

doi:10.1016/j.clnu.2023.10.008

The inflammatory potential of diet is associated with the risk of age-related eye diseases

Clin Nutr. 2023 Dec;42(12):2404-2413. doi: 10.1016/j.clnu.2023.10.008. Epub 2023 Oct 12.

Authors

Joëlle E Vergroesen¹, Eric F Thee², Tosca O E de Crom³, Jessica C Kiefte-de Jong⁴, Magda A Meester-Smoor⁵, Trudy Voortman⁶, Caroline C W Klaver⁷, Wishal D Ramdas⁸

Affiliations

¹ Department of Ophthalmology, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands. Electronic address: j.vergroesen@erasmusmc.nl.
² Department of Ophthalmology, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands; EyeNED Reading Center, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands. Electronic address: e.thee@erasmusmc.nl.
³ Department of Epidemiology, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands. Electronic address: t.decrom@erasmusmc.nl.
⁴ Department of Public Health and Primary Care/Health Campus The Hague, Leiden University Medical Centre, The Hague, The Netherlands. Electronic address: J.C.Kiefte@lumc.nl.
⁵ Department of Ophthalmology, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands. Electronic address: m.meester-smoor@erasmusmc.nl.
⁶ Department of Epidemiology, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands; Division of Human Nutrition and Health, Wageningen University & Research, P.O. Box 17 6700 AA Wageningen, the Netherlands. Electronic address: trudy.voortman@erasmusmc.nl.
⁷ Department of Ophthalmology, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands; EyeNED Reading Center, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Ophthalmology, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands; Institute of Molecular and Clinical Ophthalmology, University of Basel, CH-4031 Basel, Switzerland. Electronic address: c.c.w.klaver@erasmusmc.nl.
⁸ Department of Ophthalmology, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands. Electronic address: w.ramdas@erasmusmc.nl.

PMID: 37865012
DOI: 10.1016/j.clnu.2023.10.008

Abstract

Background & aims: Inflammation is involved in the pathogenesis of cataract, age-related macular degeneration (AMD), and possibly open-angle glaucoma (OAG). We assessed whether the inflammatory potential of diet (quantified using the dietary inflammatory index; DII) affects the incidence of these common blinding age-related eye diseases. Serum inflammation markers were investigated as possible mediators.

Methods: Participants aged >45 years were selected from the prospective, population-based Rotterdam Study. From 1991 onwards, every 4-5 years, participants underwent extensive eye examinations. At baseline, blood samples and dietary data (using food frequency questionnaires) were collected. The DII was adapted based on the data available. Of the 7436 participants free of eye diseases at baseline, 4036 developed incident eye diseases during follow-up (cataract = 2895, early-intermediate AMD = 891, late AMD = 81, OAG = 169).

Results: The adapted DII (aDII) ranged from -4.26 (i.e., anti-inflammatory) to 4.53 (i.e., pro-inflammatory). A higher aDII was significantly associated with increased inflammation. A higher neutrophil-lymphocyte ratio (NLR) was associated with an increased risk of cataract and AMD. Additionally, complement component 3c (C3c) and systemic immune-inflammation index (SII) were associated with increased risks of cataract and late AMD, respectively. Every point increase in the aDII was associated with a 9% increased risk of cataract (Odds ratio [95% confidence interval]: 1.09 [1.04-1.14]). The NLR and C3c partly mediated this association. We also identified associations of the aDII with risk of AMD (early-intermediate AMD, OR [95% CI]: 1.11 [1.03-1.19]; late AMD, OR [95% CI]: 1.24 [1.02-1.53]). The NLR partly mediated these associations. The aDII was not associated with OAG.

Conclusions: A pro-inflammatory diet was associated with increased risks of cataract and AMD. Particularly the NLR, a marker of subclinical inflammation, appears to be implicated. These findings are relevant for patients with AMD and substantiate the current recommendations to strive for a healthy lifestyle to prevent blindness.

Keywords: Age-related macular degeneration; Cataract; Dietary inflammatory index; Nutrition; Open-angle glaucoma; Rotterdam Study.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Biomarkers
Cataract* / epidemiology
Diet / adverse effects
Glaucoma, Open-Angle*
Humans
Incidence
Inflammation / epidemiology
Macular Degeneration* / epidemiology
Prospective Studies
Risk Factors

Substances

Biomarkers