Advertisement

Adherence to Dietary Guidelines and the 10-Year Cumulative Incidence of Visual Impairment: The Blue Mountains Eye Study

      Purpose

      To assess whether adherence to dietary guidelines at baseline is associated with the incidence of visual impairment among older persons after 10 years.

      Design

      A population-based cohort of 3654 participants of the Blue Mountains Eye Study were examined at baseline and were reexamined after 5 and 10 years.

      Methods

      The incidence of visual impairment was defined as best-corrected visual acuity (VA) <20/40 at follow-up in 1 or both eyes. Dietary information was obtained at baseline using a validated food frequency questionnaire (FFQ). Total Diet Score (TDS) was calculated based on the Australian diet quality index. TDS includes components of diet quality; poor dietary habits; and energy balance. Discrete logistic regression models with time-dependant outcome variables were used to calculate hazard risk ratios (HR) and 95% confidence intervals (CI) associated with incidence of visual impairment for each unit/quartile increase in TDS, adjusting for potential confounders.

      Results

      Of the 3654 baseline participants, 1963 had up to 10 years follow-up with completed FFQs. With each unit increase in TDS, the risk of visual impairment decreased (HR 0.94, 95% CI 0.88–1.00). The risk of developing visual impairment was lower among persons in the highest compared to the lowest TDS quartile (HR 0.71, 95% CI 0.47–1.05). This association was significant among persons aged 65+ years (HR 0.63, 95% CI 0.38–0.98) but not those aged <65 years (HR 0.95, 95% CI 0.46–1.97).

      Conclusions

      Compliance to dietary guidelines was associated with a decreased long-term risk of visual impairment in this sample of Australians aged 65+ years.
      To read this article in full you will need to make a payment

      References

        • Evans J.R.
        • Fletcher A.E.
        • Wormald R.P.
        • et al.
        Prevalence of visual impairment in people aged 75 years and older in Britain: results from the MRC trial of assessment and management of older people in the community.
        Br J Ophthalmol. 2002; 86: 795-800
        • Casson R.
        • Giles L.
        • Newland H.S.
        Prevalence of blindness and visual impairment in an elderly urban population.
        Aust N Z J Ophthalmol. 1996; 24: 239-243
        • Buys L.
        • Roberto K.A.
        • Miller E.
        • Blieszner R.
        Prevalence and predictors of depressive symptoms among rural older Australians and Americans.
        Aust J Rural Health. 2008; 16: 33-39
        • Buch H.
        • Vinding T.
        • la Cour M.
        • et al.
        Prevalence and causes of visual impairment and blindness among 9980 Scandinavian adults: the Copenhagen City Eye Study.
        Ophthalmology. 2004; 111: 53-61
        • Abdull M.M.
        • Sivasubramaniam S.
        • Murthy G.V.
        • et al.
        Causes of blindness and visual impairment in Nigeria: the Nigeria national blindness and visual impairment survey.
        Invest Ophthalmol Vis Sci. 2009; 50: 4114-4120
        • Ahmad K.
        • Khan M.D.
        • Qureshi M.B.
        • et al.
        Prevalence and causes of blindness and low vision in a rural setting in Pakistan.
        Ophthalmic Epidemiol. 2005; 12: 19-23
        • Casson R.J.
        • Newland H.S.
        • Muecke J.
        • et al.
        Prevalence and causes of visual impairment in rural Myanmar: the Meiktila Eye Study.
        Ophthalmology. 2007; 114: 2302-2308
        • Klein R.
        • Klein B.E.
        • Lee K.E.
        Changes in visual acuity in a population. The Beaver Dam Eye Study.
        Ophthalmology. 1996; 103: 1169-1178
        • Lamoureux E.L.
        • Fenwick E.
        • Moore K.
        • et al.
        Impact of the severity of distance and near-vision impairment on depression and vision-specific quality of life in older people living in residential care.
        Invest Ophthalmol Vis Sci. 2009; 50: 4103-4109
        • Wang J.J.
        • Mitchell P.
        • Smith W.
        • Cumming R.G.
        • Attebo K.
        Impact of visual impairment on use of community support services by elderly persons: the Blue Mountains Eye Study.
        Invest Ophthalmol Vis Sci. 1999; 40: 12-19
      1. Lancet conference 1996: cognitive impairment to dementia.
        Lancet. 1995; 345: 465-466
        • Kennedy E.T.
        • Ohls J.
        • Carlson S.
        • Fleming K.
        The Healthy Eating Index: design and applications.
        J Am Diet Assoc. 1995; 95: 1103-1108
        • Haines P.S.
        • Siega-Riz A.M.
        • Popkin B.M.
        The Diet Quality Index revised: a measurement instrument for populations.
        J Am Diet Assoc. 1999; 99: 697-704
        • Foran S.
        • Wang J.J.
        • Mitchell P.
        Causes of visual impairment in two older population cross-sections: the Blue Mountains Eye Study.
        Ophthalmic Epidemiol. 2003; 10: 215-225
        • Hsu W.M.
        • Cheng C.Y.
        • Liu J.H.
        • Tsai S.Y.
        • Chou P.
        Prevalence and causes of visual impairment in an elderly Chinese population in Taiwan: the Shihpai Eye Study.
        Ophthalmology. 2004; 111: 62-69
        • Wong T.Y.
        • Chong E.W.
        • Wong W.L.
        • et al.
        Prevalence and causes of low vision and blindness in an urban Malay population: the Singapore Malay Eye Study.
        Arch Ophthalmol. 2008; 126: 1091-1099
        • Congdon N.
        • O'Colmain B.
        • Klaver C.C.
        • et al.
        Causes and prevalence of visual impairment among adults in the United States.
        Arch Ophthalmol. 2004; 122: 477-485
        • Nicolosi A.
        • Marighi P.E.
        • Rizzardi P.
        • Osella A.
        • Miglior S.
        Prevalence and causes of visual impairment in Italy.
        Int J Epidemiol. 1994; 23: 359-364
        • National Health and Medical Research Council
        Dietary Guidelines for Australian Adults.
        Commonwealth of Australia, Canberra2003
        • Attebo K.
        • Mitchell P.
        • Smith W.
        Visual acuity and the causes of visual loss in Australia. The Blue Mountains Eye Study.
        Ophthalmology. 1996; 103: 357-364
        • Klein R.
        • Klein B.E.
        • Linton K.L.
        • De Mets D.L.
        The Beaver Dam Eye Study: visual acuity.
        Ophthalmology. 1991; 98: 1310-1315
        • Smith W.
        • Mitchell P.
        • Reay E.M.
        • Webb K.
        • Harvey P.W.
        Validity and reproducibility of a self-administered food frequency questionnaire in older people.
        Aust N Z J Public Health. 1998; 22: 456-463
        • Flood V.M.
        • Smith W.T.
        • Webb K.L.
        • Mitchell P.
        Issues in assessing the validity of nutrient data obtained from a food-frequency questionnaire: folate and vitamin B12 examples.
        Public Health Nutr. 2004; 7: 751-756
        • Foster-Powell K.
        • Holt S.H.
        • Brand-Miller J.C.
        International table of glycemic index and glycemic load values: 2002.
        Am J Clin Nutr. 2002; 76: 5-56
        • Australian Institute of Health and Welfare
        Australian diet quality index project. AIHW cat. no. PHE 85.
        AIHW, Canberra2007
        • Smith A.
        • Kellet E.
        • Schmerlaib Y.
        The Australian guide to healthy eating.
        Commonwealth of Australia, Canberra1998: 1-40
        • Russell J.
        • Flood V.
        • Rochtchina E.
        • et al.
        Adherence to dietary guidelines and 15-year risk of all-cause mortality.
        Br J Nutr. 2013; 109: 547-555
        • Australian Institute of Health
        • National Heart Foundation
        • Risk Factor Prevalence Study Management Committee
        Risk factor prevalence study.
        The Foundation, Canberra1980
        • Craig C.L.
        • Marshall A.L.
        • Sjostrom M.
        • et al.
        International physical activity questionnaire: 12-country reliability and validity.
        Med Sci Sports Exerc. 2003; 35: 1381-1395
        • Hong T.
        • Mitchell P.
        • Rochtchina E.
        • et al.
        Long-term changes in visual acuity in an older population over a 15-year period: the Blue Mountains Eye Study.
        Ophthalmology. 2013; 120: 2091-2099
        • Mares J.A.
        • Voland R.P.
        • Sondel S.A.
        • et al.
        Healthy lifestyles related to subsequent prevalence of age-related macular degeneration.
        Arch Ophthalmol. 2011; 129: 470-480
        • Mares J.A.
        • Voland R.
        • Adler R.
        • et al.
        Healthy diets and the subsequent prevalence of nuclear cataract in women.
        Arch Ophthalmol. 2010; 128: 738-749
        • Wang J.J.
        • Foran S.
        • Mitchell P.
        Age-specific prevalence and causes of bilateral and unilateral visual impairment in older Australians: the Blue Mountains Eye Study.
        Clin Experiment Ophthalmol. 2000; 28: 268-273
        • Foran S.
        • Wang J.J.
        • Mitchell P.
        Causes of incident visual impairment: the Blue Mountains Eye Study.
        Arch Ophthalmol. 2002; 120: 613-619
        • Alderman M.H.
        Non-pharmacological treatment of hypertension.
        Lancet. 1994; 344: 307-311
        • Rodriguez J.
        • Sanchez R.
        • Munoz B.
        • et al.
        Causes of blindness and visual impairment in a population-based sample of U.S. Hispanics.
        Ophthalmology. 2002; 109: 737-743
        • Tan J.S.
        • Wang J.J.
        • Flood V.
        • et al.
        Dietary antioxidants and the long-term incidence of age-related macular degeneration: the Blue Mountains Eye Study.
        Ophthalmology. 2008; 115: 334-341
        • Yoshida M.
        • Takashima Y.
        • Inoue M.
        • et al.
        Prospective study showing that dietary vitamin C reduced the risk of age-related cataracts in a middle-aged Japanese population.
        Eur J Nutr. 2007; 46: 118-124
        • Vu H.T.
        • Robman L.
        • Hodge A.
        • McCarty C.A.
        • Taylor H.R.
        Lutein and zeaxanthin and the risk of cataract: the Melbourne visual impairment project.
        Invest Ophthalmol Vis Sci. 2006; 47: 3783-3786
        • Agte V.
        • Tarwadi K.
        The importance of nutrition in the prevention of ocular disease with special reference to cataract.
        Ophthalmic Res. 2010; 44: 166-172
        • Seddon J.M.
        Multivitamin-multimineral supplements and eye disease: age-related macular degeneration and cataract.
        Am J Clin Nutr. 2007; 85: 304S-307S
        • Barker F.M.
        Dietary supplementation: effects on visual performance and occurrence of AMD and cataracts.
        Curr Med Res Opin. 2010; 26: 2011-2023
        • Chiu C.J.
        • Taylor A.
        Nutritional antioxidants and age-related cataract and maculopathy.
        Exp Eye Res. 2007; 84: 229-245
        • McCarty C.A.
        • Taylor H.R.
        Recent developments in vision research: light damage in cataract.
        Invest Ophthalmol Vis Sci. 1996; 37: 1720-1723
        • Renzi L.M.
        • Johnson E.J.
        Lutein and age-related ocular disorders in the older adult: a review.
        J Nutr Elder. 2007; 26: 139-157
        • Taylor A.
        • Jacques P.F.
        • Chylack Jr., L.T.
        • et al.
        Long-term intake of vitamins and carotenoids and odds of early age-related cortical and posterior subcapsular lens opacities.
        Am J Clin Nutr. 2002; 75: 540-549
        • Stringham J.M.
        • Bovier E.R.
        • Wong J.C.
        • Hammond Jr., B.R.
        The influence of dietary lutein and zeaxanthin on visual performance.
        J Food Sci. 2010; 75: R24-R29
        • Darnton-Hill I.
        • Nishida C.
        • James W.P.
        A life course approach to diet, nutrition and the prevention of chronic diseases.
        Public Health Nutr. 2004; 7: 101-121
        • Tan J.S.
        • Mitchell P.
        • Smith W.
        • Wang J.J.
        Cardiovascular risk factors and the long-term incidence of age-related macular degeneration: the Blue Mountains Eye Study.
        Ophthalmology. 2007; 114: 1143-1150
        • Cackett P.
        • Wong T.Y.
        • Aung T.
        • et al.
        Smoking, cardiovascular risk factors, and age-related macular degeneration in Asians: the Singapore Malay Eye Study.
        Am J Ophthalmol. 2008; 146: 960-967
        • Klein R.
        • Klein B.E.
        • Marino E.K.
        • et al.
        Early age-related maculopathy in the cardiovascular health study.
        Ophthalmology. 2003; 110: 25-33
        • Parada J.
        • Aguilera J.M.
        Food microstructure affects the bioavailability of several nutrients.
        J Food Sci. 2007; 72: R21-R32
        • Touvier M.
        • Kesse E.
        • Clavel-Chapelon F.
        • Boutron-Ruault M.C.
        Dual association of beta-carotene with risk of tobacco-related cancers in a cohort of French women.
        J Natl Cancer Inst. 2005; 97: 1338-1344
        • Kubena K.S.
        • McMurray D.N.
        Nutrition and the immune system: a review of nutrient-nutrient interactions.
        J Am Diet Assoc. 1996; 96: 1156-1164
        • Ellis P.R.
        • Kendall C.W.
        • Ren Y.
        • et al.
        Role of cell walls in the bioaccessibility of lipids in almond seeds.
        Am J Clin Nutr. 2004; 80: 604-613
        • Jacobs Jr., D.R.
        • Tapsell L.C.
        Food, not nutrients, is the fundamental unit in nutrition.
        Nutr Rev. 2007; 65: 439-450
        • Lien E.L.
        • Hammond B.R.
        Nutritional influences on visual development and function.
        Prog Retin Eye Res. 2011; 30: 188-203
        • Gopinath B.
        • Harris D.C.
        • Flood V.M.
        • Burlutsky G.
        • Mitchell P.
        A better diet quality is associated with a reduced likelihood of CKD in older adults.
        Nutr Metab Cardiovasc Dis. 2013; 23: 937-943
        • Gopinath B.
        • Rochtchina E.
        • Flood V.M.
        • Mitchell P.
        Diet quality is prospectively associated with incident impaired fasting glucose in older adults.
        Diabet Med. 2013; 30: 557-562
        • Gopinath B.
        • Russell J.
        • Flood V.M.
        • Burlutsky G.
        • Mitchell P.
        Adherence to dietary guidelines positively affects quality of life and functional status of older adults.
        J Acad Nutr Diet. 2014; 114: 220-229
        • Fowles E.R.
        • Bryant M.
        • Kim S.
        • et al.
        Predictors of dietary quality in low-income pregnant women: a path analysis.
        Nurs Res. 2011; 60: 286-294
        • Keller H.H.
        • Ostbye T.
        • Bright-See E.
        Predictors of dietary intake in Ontario seniors.
        Can J Public Health. 1997; 88: 305-309
        • Ma Y.
        • Li W.
        • Olendzki B.C.
        • et al.
        Dietary quality 1 year after diagnosis of coronary heart disease.
        J Am Diet Assoc. 2008; 108: 240-246