Association of Dietary Nitrate Intake With Primary Open-Angle Glaucoma: A Prospective Analysis From the Nurses' Health Study and Health Professionals Follow-up Study
Kang JH, Willett WC, Rosner BA, Buys E, Wiggs JL, Pasquale LR
JAMA ophthalmology · 95 citations
Review labels
Neutral facts our review recorded about how this study was done. They describe method, never whether we like the result.
How it was studied
- Design
- Cohort study (indexed by PubMed)
- Studied in
- People
- Main outcome
- Clinical events such as disease or death
- Intake measured by
- Food frequency questionnaire
Who paid for it
- Funding
- Independent funding
- Government
- National Institutes of Health
- Government
- National Eye Institute
- Government
- National Cancer Institute
- Government
- NEI NIH HHS
- Government
- NCI NIH HHS
- Grants
- National Cancer Institute (UM1 CA186107); National Eye Institute (R01 EY009611); National Cancer Institute (UM1-CA-167552); National Eye Institute (R01EY015473); National Eye Institute (EY 015473); National Eye Institute (R21 EY022766); National Eye Institute (R01EY022746); National Eye Institute (EY09611)
Based on 5 listed funder(s).
Publication
- Published
- 2016-01-15 · JAMA Ophthalmol · vol. 134 · issue 3 · p. 294
- Publisher
- American Medical Association
- Cited
- 118 citations · more than 98% of similar papers · 10.1× the field average
- Impact
- Top 10% most cited in its field
- References
- 105 works
- Access
- Free to read
- Research areas
- Glaucoma and retinal disorders · Retinal Diseases and Treatments · Retinal and Macular Surgery
- Keywords
- Medicine, Confounding, Intraocular pressure, Glaucoma, Body mass index, Prospective cohort study, Open angle glaucoma, Incidence (geometry), Nitric oxide, Ophthalmology, Internal medicine
- MeSH
- humans, vegetables, glaucoma, open-angle, nitrates, tonometry, ocular, diet, incidence, risk factors, follow-up studies, prospective studies, feeding behavior, intraocular pressure, adult, aged, middle aged, health personnel, united states, female, male, surveys and questionnaires
6 authors
From US
- Jae Hee Kang · correspondingBrigham and Women's Hospital; Harvard University
- Walter Churchill WillettBrigham and Women's Hospital; Harvard University
- BERNARD A. ROSNERBrigham and Women's Hospital; Harvard University
- Emmanuel S. BuysMassachusetts General Hospital
- Janey L. WiggsMassachusetts Eye and Ear Infirmary
- Louis Robert PasqualeBrigham and Women's Hospital; Massachusetts Eye and Ear Infirmary; Harvard University
Abstract
Importance
Nitric oxide signaling alterations in outflow facility and retinal blood flow autoregulation are implicated in primary open-angle glaucoma (POAG). Nitric oxide donation has emerged as a POAG therapeutic target. An exogenous source of nitric oxide is dietary nitrates.
Objective
To evaluate the association between dietary nitrate intake, derived mainly from green leafy vegetables, and POAG.
Design, setting, and participants
We followed up participants biennially in the prospective cohorts of the Nurses' Health Study (63 893 women; 1984-2012) and the Health Professionals Follow-up Study (41 094 men; 1986-2012) at each 2-year risk period. Eligible participants were 40 years or older, were free of POAG, and reported eye examinations.
Exposures
The primary exposure was dietary nitrate intake. Information on diet and potential confounders was updated with validated questionnaires.
Main outcomes and measures
The main outcome was the incidence of POAG and POAG subtypes; 1483 cases were confirmed with medical records and classified into subtypes defined by intraocular pressure (IOP) (≥22 or <22 mm Hg) or by visual field (VF) loss pattern at diagnosis (peripheral loss only or early paracentral loss). Cohort-specific and pooled multivariable rate ratios (MVRRs) and 95% CIs were estimated.
Results
During 1 678 713 person-years of follow-up, 1483 incident cases of POAG were identified. The mean (SD) age for the 1483 cases was 66.8 (8.3). Compared with the lowest quintile of dietary nitrate intake (quintile 1: approximately 80 mg/d), the pooled MVRR for the highest quintile (quintile 5: approximately 240 mg/d) was 0.79 (95% CI, 0.66-0.93; P for trend = .02). The dose response was stronger (P for heterogeneity = .01) for POAG with early paracentral VF loss (433 cases; quintile 5 vs quintile 1 MVRR = 0.56; 95% CI, 0.40-0.79; P for trend < .001) than for POAG with peripheral VF loss only (835 cases; quintile 5 vs quintile 1 MVRR = 0.85; 95% CI, 0.68-1.06; P for trend = .50). The association did not differ (P for heterogeneity = .75) by POAG subtypes defined by IOP (997 case patients with IOP ≥22 mm Hg: quintile 5 vs quintile 1 MVRR = 0.82; 95% CI, 0.67-1.01; P for trend = .11; 486 case patients with IOP <22 mm Hg: quintile 5 vs quintile 1 MVRR = 0.71; 95% CI, 0.53-0.96; P for trend = .12). Green leafy vegetables accounted for 56.7% of nitrate intake variation. Compared with consuming 0.31 servings per day, the MVRR for consuming 1.45 or more servings per day was 0.82 for all POAG (95% CI, 0.69-0.97; P for trend = .02) and 0.52 for POAG with paracentral VF loss (95% CI, 0.29-0.96; P for trend < .001).
Conclusions and relevance
Higher dietary nitrate and green leafy vegetable intake was associated with a lower POAG risk, particularly POAG with early paracentral VF loss at diagnosis.
Abstract via Europe PMC. Copyright remains with the authors or publisher.
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