ACE-Vitamin Index and Risk of Glaucoma: The SUN Project

Abstract

Background: Previous studies regarding antioxidant consumption and glaucoma have shown contradictory results. The aim of this study was to analyze the combined effect of the consumption of three vitamins (A, C and E) on the incidence of glaucoma in the SUN Project. Methods: For this study, 18,669 participants were included. The mean follow-up was 11.5 years. An index including vitamins A, C and E (ACE-Vitamin Index) was calculated. Vitamin intake was extracted from participants’ dietary data and vitamin supplements, if taken. Information on glaucoma incidence was collected by previously validated self-reported questionnaires. The association between glaucoma and vitamin intake was assessed by repeated-measures Cox regression using multi-adjusted hazard ratios. Results: A total of 251 (1.3%) cases of glaucoma were detected. Participants with a higher ACE-Vitamin Index presented a reduced risk of glaucoma compared to participants with lower consumption (adjusted HR = 0.73; 95% CI, (0.55–0.98)). When each vitamin was analyzed individually, none of them had a significant protective effect. The protective effect of the ACE-Vitamin Index was higher in men and older participants (≥55 year). Conclusions: The consumption of vitamins A, C and E considered separately do not seem to exert a protective effect against glaucoma, but when these vitamins are considered together, they are associated with a lower risk of glaucoma.

Nutritional Factors: Benefits in Glaucoma and Ophthalmologic Pathologies

“…Quercetin has shown a photopic negative response, an index of glaucomatous damage in murine models, proving it to be a viable anti-glaucoma supplement [ 361 ]. Quercetin has also been shown to reduce apoptotic cell death, thereby protecting retinal ganglion cells in rat models [ 362 , 363 ].…”

The causal effect of oxidative stress on the risk of glaucoma

“…Additionally, Moreno et al found an inverse correlation between the multilocus genetic risk score (GRS) for POAG and plasma vitamin E concentration [ 57 ]. However, results from the SUN Project study suggested that the intake of vitamins A, C, and E alone may not confer a protective effect against glaucoma, but when taken together, they were associated with lower disease risk [ 58 ]. In our study, we observed a significant association between retinol and glaucoma.…”

Assessment of Causality Between Diet-Derived Antioxidants and Primary Open-Angle Glaucoma: A Mendelian Randomization Study

“…9 , 10 Conversely, other cohort studies have not found that diet-derived antioxidants have a protective effect against glaucoma. 11 , 12 These apparently contradictory results may arise from the confounding factors and reverse causality in observational studies. Moreover, a randomized clinical trial (RCT) has failed to confirm the clinical benefit of a high intake of vegetables and fruits in POAG management.…”