Lutein, zeaxanthin, macular pigment, and visual function in adult cystic fibrosis patients

Abstract

Background: Pancreatic insufficiency in cystic fibrosis (CF), even with replacement pancreatic enzyme therapy, is often associated with decreased carotenoid absorption. Because the macular pigment of the retina is largely derived from 2 carotenoids, lutein and zeaxanthin, the decreased serum concentrations seen in CF may have consequences for ocular and retinal health Objectives: Our aims were to determine plasma carotenoid concentrations, determine absorption and distribution of macular pigment, and assess retinal health and visual function in CF patients. Design: In 10 adult CF patients (ages 21-47 y) and 10 age-and sex-matched healthy control subjects, we measured macular pigment density in vivo, measured serum lutein and zeaxanthin concentrations, and comprehensively assessed visual performance (including contrast sensitivity, color discrimination, and retinal function) under conditions of daylight illumination. Results: Serum lutein and zeaxanthin were significantly reduced (P 0.005) in CF patients (x Ȁ SD: 87 Ȁ 36.1 and 27 Ȁ 15.8 nmol/L, respectively) compared with control subjects (190 Ȁ 72.1 and 75 Ȁ 23.6 nmol/L, respectively). Although macular pigment optical density was significantly lower (P 0.0001) in the CF group (0.24 Ȁ 0.11) than in the control group (0.53 Ȁ 0.12), no significant differences in visual function were observed. Conclusions: Adults with CF have dramatically low serum and macular concentrations of carotenoids (lutein and zeaxanthin), but their ocular status and visual function are surprisingly good. The clinical implications of low plasma concentrations of carotenoids in CF are yet to be clarified.

Dietary and host-related factors influencing carotenoid bioaccessibility from spinach (Spinacia oleracea)

“…Carotenoid micellarisation was strongly decreased when omitting either bile salts, pancreatin, or both, being comparable, if not stronger, to previous studies (Garrett et al, 1999;Hedren et al, 2002;Wright et al, 2008). This situation may occur in vivo, such as in cystic fibrosis patients lacking the ability to secrete sufficient amounts of pancreatin, possibly resulting in inadequate uptake of lutein, zeaxanthin and beta-carotene (Rust, Eichler, Renner, & Elmadfa, 1998;Schupp et al, 2004). Pancreatin is required to cleave triglycerides into mono-and diglycerides, which are part of the formed mixed micelles.…”

Antioxidants in cystic fibrosis☆Conclusions from the CF Antioxidant Workshop, Bethesda, Maryland, November 11-12, 2003

“…Poor absorption, cholestatic liver disease, or rapid turnover of carotenoids due to active inflammation could all contribute to low carotenoid levels [135,136]. However, despite severe reduction of lutein and zeaxanthin in both plasma and retina of people with CF, no related abnormalities of visual function under daylight conditions have been found [137], though poor nocturnal vision in some individuals has been corrected by retinol supplementation [138].…”

Macular Pigment Optical Density Is Lower in Type 2 Diabetes, Compared With Type 1 Diabetes and Normal Controls

“…16 These hydroxycarotenoids are found in the retina to the exclusion of all other 600 carotenoids found in nature. 17 Concentrations of carotenoids in human serum and deposition of the macular carotenoids in the retina to form MP are highly variable and reflect not only dietary intake but also factors such as carotenoid chemistry, 18 individual efficacy of absorption, 19 fat intake, 20 competition among carotenoids for absorption, 21 cholesterol and lipoprotein status, 22,23 metabolic status, 4 body composition, and body fat/body mass index (BMI). 21,24 The relationship between MP and diabetes is only now attracting research interest, possibly as a result of the outcomes of clinical trials, which demonstrate a protective effect of lutein and zeaxanthin supplementation in another oxidative stress-related condition, age-related macular degeneration.…”