Serum antioxidant vitamins and risk of cataract.

Abstract

Three of the four bandages had to be ordered by the district supplies department as they could not be obtained on prescription. The cost of bandages for all six clinics for one year was about C35-40 000. The family health services committee probably already pays a similar or larger amount for materials currently available and used on FP10 prescription but which are largely ineffective in achieving ulcer healing. Transfer of this budget to district supplies or the recognition of these bandages on drug tariff would seem to be the way forward.About a tenth of the patients in this study had significant arterial disease shown by low ankle/ brachial pressure indices, so that compression bandaging was contraindicated and may have lead to pressure necrosis and amputation.3 It is therefore essential that the community staff are trained to assess patients for arterial disease so that the correct treatment is offered.The main thrust of this study was the setting up of community ulcer clinics and assessing the results of this service. Despite the success of this service in treating ulcerated legs it must be acknowledged that reulceration is a major problem in these patients. Preliminary analysis of rates of recurrence in this study has shown that about a fifth of legs reulcerate within six months of healing and a third by one year, despite regular visits for compression hosiery. These results may be improved by using skin grafting techniques or venous surgery in more patients than was possible in this first attempt at a comprehensive community ulcer service.This study has drawn together community and hospital staff around a single common problem. Community nurses have observed real improvements in the care of their patients, which has given them additional job satisfaction. There is a clear need for a coordinated community based approach to this common and socially isolating condition, centred on a nurse specialising in venous ulcers. Design-A case-control study, nested within a cohort study, based on the linkage of records of subjects aged 40-83 from a health survey with those from the national Finnish hospital discharge register.Subjects-47 patients admitted to ophthalmological wards for senile cataract over 15 years and two controls per patient individually matched for sex, age, and municipality.Main outcome measure-Concentration of serum micronutrients, development of cataract according to whether operation was performed.Results-Low serum concentrations of antioxidant vitamins predicted the development ofsenile cataract, the odds ratio between the lowest third and the two higher thirds of the distribution of serum concentrations of ot tocopherol and 3 carotene being 1 9 (950/o confidence interval 0 9 to 4.1) and 17 (0.8 to 3 8), respectively. Patients with both ox tocopherol and 1 carotene concentrations in the lowest third had an odds ratio of 2-6 (10 to 6 8) of cataract compared with subjects in the top two thirds. The associations were strengthened by adjustment for potential confounding factors such as occupation, s...

Recommendations for the nutritional management of patients with diabetes mellitus

“…Animal studies have suggested that vitamin A de®ciency may be important in lens cellular damage (Linkater et al, 1992). Epidemiological studies have identi®ed a reduced risk of cataract associated with a high vitamin A intake (Leske et al, 1991) and high levels of carotenoids in plasma (Knekt et al, 1992;Jacques et al, 1988). On the basis of such preliminary ®ndings, supplementation has been suggested as having a role in prevention of disease.…”

“…Vitamin E has been shown to reduce protein glycation in some diabetic subjects (Ceriello et al, 1991) but other evidence is con¯icting. Recent epidemiological studies have also associated high vitamin E intake with low incidence of cataract in the non diabetic population (Jacques et al, 1988;Knekt et al, 1992;Roberston et al, 1989). The dosage of vitamin E associated with reduced cataract risk is yet to be de®ned, however multivitamin supplementation once per week is associated with protection against cataractogenesis (Leske et al, 1991).…”

Serum antioxidants and risk of non‐insulin dependent diabetes mellitus

“…We previously investigated the risks of several common chronic diseases and serum concentrations of antioxidants and micronutrients in a large prospective population study (Knekt et al, 1988;Knekt et al, 1992;Reunanen et al, 1992;Helio Èvaara et al, 1994). In this report of a nested casecontrol study we analyse the associations between the incidence of NIDDM and levels of b-carotene, retinol and a-tocopherol.…”

Vitamin E and risk of age-related cataract: a meta-analysis

“…Upon closer examination, forty-seven articles were excluded for the following reasons: thirty-six articles were irrelevant to the interest of the exposure or the outcome, seven articles (30)(31)(32)(33)(34)(35)(36) did not provide OR/RR and its 95 % CI, three articles (37)(38)(39) were duplicated studies and one article (40) was a review. Finally, twenty-seven articles (6,(10)(11)(12)(13)(15)(16)(17)(19)(20)(21)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56) were included in the present meta-analysis. The detailed literature search for article inclusion is shown in Fig.…”

“…Serum tocopherol levels and the risk of age-related cataract A forest plot of the seventeen included studies from fourteen articles (11)(12)(13)18,41,42,46,(48)(49)(50)(51)(54)(55)(56) with 17 194 participants and 4179 cases is shown in Fig. 4.…”