Effect of Dietary Supplementation With Lutein, Zeaxanthin, and ω-3 on Macular Pigment

Abstract

IMPORTANCE Nutritional uptake of lutein, zeaxanthin, and ω-3 polyunsaturated fatty acids may increase macular pigment optical density (MPOD) and thereby protect against the development of age-related macular degeneration (AMD).OBJECTIVES To estimate the efficiency of dietary supplementation containing lutein, zeaxanthin, ω-3 polyunsaturated fatty acids, and vitamins to increase the density of macular pigment in first-generation offspring of parents with neovascular AMD. DESIGN, SETTING, AND PARTICIPANTSThis study was a randomized clinical trial (Lutein Influence on Macula of Persons Issued From AMD Parents [LIMPIA]) with a 6-month treatment period, followed by a 6-month follow-up period. Analyses were based on the intent-to-treat principle. The setting was 2 university hospitals in France (at Bordeaux and Dijon) from January 2011 (first participant first visit) to February 2013 (last participant last visit). The analysis was conducted from January to November 2016. Participants were 120 individuals free of any retinal ocular disease. They were first-generation offspring of parents with neovascular AMD.INTERVENTIONS Participants were randomized in a 1:1 ratio to receive either 2 daily dietary supplementation capsules or placebo for 6 months. MAIN OUTCOMES AND MEASURESThe primary assessment criterion was the evolution of MPOD after 6 months of supplementation (value of both eligible eyes) measured using the modified MPD-Visucam 200 (Carl Zeiss Meditec) and the modified Heidelberg Retina Angiograph (Heidelberg Engineering) (HRA) at 0.98°eccentricity. The statistical analysis was adjusted for hospital and for risk factors.RESULTS Overall, 120 participants (60 in each group) were included, and 239 eyes were analyzed (119 in the lutein plus zeaxanthin [L + Z] group and 120 in the placebo group). Their mean (SD) age was 56.7 (6.6) years, and 71.7% (n = 86) were female. A statistically significant increase in plasma lutein and zeaxanthin was shown in the L + Z group after 3 months and 6 months of treatment compared with the placebo group. However, the difference between groups in the evolution of MPOD measured by HRA 0.98°eccentricity between 6 months and baseline was 0.036 (95% CI, −0.037 to 0.110) (P = .33).CONCLUSIONS AND RELEVANCE Among first-generation offspring of parents with neovascular AMD in the LIMPIA trial, MPOD as measured with the modified HRA and the MPD-Visucam was not modified after 6 months of lutein and zeaxanthin dietary supplementation despite plasma levels showing continuous exposure to lutein and zeaxanthin. Further research is necessary to understand the mechanism of absorption and metabolism of these nutrients in the macula, the best way to measure MPOD, and the clinical benefit for the patients.TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01269697

Omega-3 fatty acids supplementation protects the retina from age-associated degeneration in aged C57BL/6J mice

“…In recent studies, particular emphasis has been placed on the role of ω3 PUFAs in eye diseases. The positive effect of ω3 treatment was investigated in animal models of retinal and optic nerve pathologies45 47 48 52 and in clinical studies of AMD and dry eyes 57–59. Although the results were not conclusive, we investigated the effect of ω3 PUFAs in age-associated retinal degeneration in healthy mice.…”

Antecedents of Soft Drusen, the Specific Deposits of Age-Related Macular Degeneration, in the Biology of Human Macula

“…A detailed time course of XP repletion in two volunteers has shown a steady increase for 140 days after initiation of supplementation, followed by a plateau or slight decrease to 1 year or more 157. Many studies report that dietary supplementation results in higher MPOD (measured behaviorally or via several imaging technologies) at the earliest time points tested, typically 2 to 4 months and depending on the dose and baseline XP levels in test subjects 131,158–169. XP removal is less well documented, with limited data suggesting stable, slightly decreasing, or baseline MPOD 157,169.…”

Dietary Habits, Fatty Acids and Carotenoid Levels Are Associated with Neovascular Age-Related Macular Degeneration in Chinese

“…In the Western countries, the relationship with macular pigment density and circulating levels of DHA and EPA has been studied [30]. Limpia study recently found an association between increased macular pigment optical density (MPOD) with circulating levels of omega-3 docosapentaenoic acid as well [31], but nutrient supplementation did not change the MPOD [32].…”