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Diet patterns and the incidence of age-related macular degeneration in the Atherosclerosis Risk in Communities (ARIC) study
  1. Shruti Dighe1,
  2. Jiwei Zhao2,
  3. Lyn Steffen3,
  4. J A Mares4,
  5. Stacy M Meuer4,
  6. Barbara E K Klein4,
  7. Ronald Klein4,
  8. Amy E Millen1
  1. 1 Department of Epidemiology and Environmental health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, New York, USA
  2. 2 Department of Biostatistics, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, New York, USA
  3. 3 Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, Minneapolis, Minnesota, USA
  4. 4 Department of Ophthalmology and Visual Sciences, University of Wisconsin Madison School of Medicine and Public Health, Madison, Wisconsin, USA
  1. Correspondence to Dr Amy E Millen, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY 14214-8001, USA; aemillen{at}


Background Age-related macular degeneration (AMD) is the leading cause of irreversible vision loss among the elderly.

Objective This study aimed to determine the association between dietary patterns and food groups (used to make them) with the 18-year incidence of AMD.

Methods ARIC (Atherosclerosis Risk in Communities) participants who showed change in AMD lesions between retinal photographs taken at visit 3 and visit 5 were graded side by side to determine incident AMD (any=144; early=117; late=27). A 66-line item food frequency questionnaire, administered at visit 1 and visit 3, was used to identify 29 food groups. Principal component analysis was used to derive dietary patterns from average food group servings. Logistic regression was used to estimate ORs and 95% CIs for incident AMD (any, early and late) by tertiles of dietary pattern scores, adjusted for age, race, education, total calories and smoking status. P-trend was estimated using continuous scores.

Results Western (unhealthy) and Prudent (healthy) dietary patterns were identified. No significant associations were observed between either dietary pattern and incident any or incident early AMD. However, a threefold higher incidence of late AMD was observed among participants with a Western pattern score above, as compared with below, the median (OR=3.44 (95% CI 1.33 to 8.87), p-trend=0.014). The risk of developing late AMD was decreased, but not statistically significant, among participants with a Prudent pattern score above, as compared with below, the median (OR=0.51 (95% CI 0.22 to 1.18), p-trend=0.054).

Conclusions Diet patterns were not significantly associated with incident any or incident early AMD. However, consumption of a Western pattern diet may be a risk factor for development of late AMD.

  • incident age-related macular degeneration
  • late age-related macular degeneration
  • dietary patterns
  • Western pattern
  • Prudent pattern
  • food groups

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  • This work was previously presented as a poster at the Society of Epidemiologic Research annual meeting, Baltimore, Maryland, June 19-22, 2018 (Poster presentation)

  • Correction notice This article has been corrected since it was published Online First. Repeated content in Acknowledgement section has been removed.

  • Contributors SD and AEM had full access to all of the data in the study and take responsibility for the integrity for the data and the accuracy of the data analysis. SD, AEM and JZ designed the study. SD and AEM directed and conducted analyses. RK, BEKK, and SMM oversaw and conducted all retinal grading. SD and AEM wrote the primary manuscript, with all coauthors aiding in the interpretation of the data analysis and drafting of the manuscript.

  • Funding This research is supported by the National Institutes of Health (NIH) National Institute on Aging grant number R01 AG041776. The Atherosclerosis Risk in Communities study has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services (contract numbers HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700004I and HHSN268201700005I). Neurocognitive data are collected by U012U01HL096812, 2U01HL096814, 2U01HL096899, 2U01HL096902 and 2U01HL096917 from the NIH (NHLBI, NINDS, NIA and NIDCD), and with previous brain MRI examinations funded by R01-HL70825 from the NHLBI. R01HL087641, R01HL086694; National Human Genome Research Institute contract U01HG004402; and National Institutes of Health contract HHSN268200625226C. Infrastructure was partly supported by Grant Number UL1RR025005, a component of the NIH and NIH Roadmap for Medical Research.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The authors did not interact with human subjects per say. This study acquired de identified participant data from the multicentre Atherosclerosis Risk in Communities (ARIC) study. The ARIC protocol has been approved by all participating institutions.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available. All data relevant to the study are included in the article or uploaded as supplementary information.