Nutrição

JANEIRO 2011

Le Tien V.

Micronutrition et DMLA.

Cahiers Ophtalmol 2010; 145: 23-25.

La prise en charge globale d’un patient présentant une maculopathie liée à l’âge (MLA) ou une dégénérescence maculaire liée à l’äge (DMLA) ne peut pas faire abstraction aujourd’hui de l’aspect préventif de la maladie. Celle-ci s’articulait essentiellement autour des antioxydants, mais depuis l’étude AREDS I, d’autres voies de prévention ont été explorées. A partir d’une meilleure connaissance des mécanismes physiopathogéniques de la maladie, l’hypothèse du rôle protecteur des acides gras insaturés de la famille des oméga-3 et des caroténoïdes, composants du pigment maculaire, a été évoquée et est maintenant largement admise. Pour autant, de nombreuses questions restent en suspens.

 
Atmani K, Le Tien Valérie.

Actualités de la micronutrition oculaire dans le cadre de la 5^ème journée du GEMO.

Réflexions Ophtalmologiques 2010; 15 (138): 51-54.

-          Acar N, Aknin I. Actualités en micronutrition.

-          Wolf S. Résultats de l’étude EMPOLS : Lutéine et Omega-3 dans la MLA.

-          Lecerf JM. ANC en acides gras pour la population française.

-          Layé S. Rôle des acides gras oméga-3 dans la neuro inflammation et les troubles comportementaux associés.

-          Pauleikhoff G. Inflammation et pathogénèse de la DLMA.

-          Souied E. Génétique de la DMLA.

-          Desmettre F. Le Tien V. Atelier « DMLA et imagerie ».

-          Creuzot-Garcher C, Korobelnik JF. Atelier “Diagnostic à tenir sur la base de cas cliniques.

-          Bron A, Verlaguet M, Aknin I. Ateliers « Quels conseils pratiques donner aux patients ? »

-          Lecerf JM. Quel impact de cuisson sur les aliments.

-          Conclusion.

SETEMBRO/OUTUBRO 2010

Facteurs de risque de la DMLA : la micronutrition peut-elle tout arranger ?
Le Tien V, Souied E.
Réalités ophtalmol 2010; 175: 51-53.
 

“There are important physiopathological and epidemiological arguments in favor of the protective role of antioxydants, omega-3 and carotenoids in Age-related macular Degeneration (ARMD).

However, some questions still remain regarging the dosages and the precise indications. The results of the prospective studies currently ongoing, in particular AREDS 2, will certainly give some answer elements.

Prevention of ARMD is not limited to micronutrition. It is part of a global care process which nowa-days takes in account environmental factors and probably, in the future, genetic predisposition fac-tors.”

 
Wu R, Wang JJ, Mitchell P, Lamoureux EL, Zheng Y, Rochtchina E, Tan AG, Wong TY.
Smoking, socioeconomic factors, and age-related cataract: The Singapore Malay Eye study.
Arch Ophthalmol 2010; 128 (8): 1029-1035.

 
McMahon A, Kedzierski W.
Polyunsaturated very-long-chain C28-C36 fatty acids and retinal physiology.
Br J Ophthalmol 2010; 94 (9): 1127.

Abstract
Recent studies have established that retinal health depends on the presence of polyunsaturated C28-C36 fatty acids, in addition to docosahexaenoic acid (DHA, C22:6n-3). Initially characterised 20 years ago, these C28-C36 fatty acids are found as sn-1 acyl components of retinal phosphatidylcholines (PCs), which have DHA in the sn-2 position. This unique PC species is found in both rod- and cone-dominant retinas, mainly in the photoreceptor outer segments where the majority of phototransduction reactions take place. In bovine photoreceptor outer segments, this species is a significant component of lipid membranes. Its C28-C36 fatty acids account for 10 mol % of total PC fatty acids. Polyunsaturated C28-C36 fatty acids are synthesised in the retina, in contrast to eicosapentaenoic acid (EPA, C20:5n-3) and DHA which in humans are predominantly of dietary origin. Synthesis of C28-C36 fatty acids appears to be exclusively catalysed by elongase of very-long-chain fatty acids-4 (Elovl4). Mutations in Elovl4 cause Stargardt disease-3, a juvenile autosomal dominant macular degeneration. A mouse genetic model of the disease carries a human pathogenic 5 bp deletion in the mouse Elovl4 gene. It demonstrates early selective deficiency of retinal C28-C36 acyl PCs, followed later by reduced electroretinographic signals and increased accumulation of toxic N-retinylidene-N-retinylethanolamine (A2E).

 

JUNHO/JULHO/AGOSTO 2010

Rougier MB.
Mesure du pigment maculaire : pour permettre une prévention de la DMLA.
Réalités Ophtalmol 2010; 174: 46-49.

Il existe à ce jour de fortes présomptions pour accepter que le pigment maculaire ait un rôle protecteur vis-à-vis de la DMLA.
Cependant, nous sommes en attente des résultats des études interventionnelles qui analysent les effets d’une supplémentation sur le risque de développer une DMLA. La mesure du pigment maculaire pourra rapidement être un biomarqueur de ce risque. Les différentes techniques actuellement disponibles sont ici décrites.

Alvarado JA, Katz LJ, Trivedi S, Shifera AS.
Monocyte modulation of aqueous outflow and recruitment to the trabecular meshwork following selective laser trabeculoplasty.
Arch Ophthalmol 2010; 128 (6): 731-737.


OBJECTIVES: To determine whether selective laser trabeculoplasty (SLT) induces monocyte recruitment to the trabecular meshwork (TM) in human and monkey eyes and whether monocytes increase both aqueous outflow in vivo and the conductivity of human Schlemm canal endothelial cells (SCEs) in vitro. METHODS: Monocyte recruitment was examined morphometrically in control human and monkey eyes and compared with that following SLT applied 1 to 3 days earlier. Outflow facility was measured for up to 4 days after the intracameral infusion of autologous macrophages in rabbits. Schlemm canal endothelial cell conductivity was measured using flow meters after exposing cultured SCEs to monocytes and monocyte-secreted factors for 24 hours. RESULTS: Our estimates show that the TM in the human eye normally had an average of 15 003 monocytes, while in the monkey eye there were 3181 monocytes, and this number increased 4- to 5-fold following SLT. The intracameral infusion of autologous macrophages in rabbits increased outflow facility 2-fold in a rapid and sustained manner. Human monocytes and monocyte-secreted factors increased SCE conductivity 2-fold in vitro. CONCLUSIONS: The number of monocytes/macrophages in the TM increases substantially after SLT and monocytes augment both outflow facility and SCE conductivity. Clinical Relevance These findings indicate that the innate immune system in general and monocytes in particular play an important role in aqueous outflow homeostasis. The recruitment of monocytes in increased numbers after SLT likely plays a role in lowering the intraocular pressure after this procedure. The intracameral introduction of autologous monocytes harvested from a vein could have therapeutic potential as a cell-based individualized treatment of glaucoma.

Lestienne-Delaze I.
Nouvelles recommandations pour prévenir la DMLA.
Basse Vision Infos 2010; 42: 37-38.

L’effet protecteur des acides gras oméga-3, notamment l’EPA et le DHA, sur la survenue de la DMLA, est désormais bien établi. Pour preuve : la récente actualisation des apports nutritionnels, con-seillés (ANC) pour les acides gras par l’Agence Française de Sécurité Sanitaire des Aliments (AFSSA). Les nouvelles recommandations préconisent ainsi d’en consommer 500 mg/j en prévention primaire.

Christen WG, Glynn RJ, Chew EY, Buring JE.
Vitamin E and age-related macular degeneration in a randomized trial of women.
Ophthalmology 2010; 117 (6): 1163-1168.


OBJECTIVE: To test whether alternate day vitamin E affects the incidence of age-related macular degeneration (AMD) in a large-scale randomized trial of women. DESIGN: Randomized, double-masked, placebo-controlled trial. PARTICIPANTS: Thirty-nine thousand eight hundred seventy-six apparently healthy female health professionals aged 45 years or older. INTERVENTION: Participants were assigned randomly to receive either 600 IU of natural-source vitamin E on alternate days or pla-cebo. MAIN OUTCOME MEASURES: Incident AMD responsible for a reduction in best-corrected visual acuity to 20/30 or worse based on self-report confirmed by medical record review. RESULTS: After 10 years of treatment and follow-up, there were 117 cases of AMD in the vitamin E group and 128 cases in the placebo group (relative risk, 0.93; 95% confidence interval, 0.72-1.19). CONCLU-SIONS: In a large-scale randomized trial of female health professionals, long-term alternate-day use of 600 IU of natural-source vitamin E had no large beneficial or harmful effect on risk of AMD. Copy-right 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Varma R, Foong AW, Lai MY, Choudhury F, Klein R, Azen SP; Los Angeles Latino Eye Study Group.
Four-year incidence and progression of age-related macular degeneration: the Los Angeles Lati-no Eye Study.
Am J Ophthalmol 2010; 149 (5): 741-751.


PURPOSE: To estimate 4-year incidence and progression of early and advanced age-related macular degeneration (AMD). DESIGN: Population-based cohort study. METHODS: A comprehensive ophthalmologic examination including stereoscopic fundus photography was performed on adult Latinos at baseline and follow-up. Photographs were graded using a modified Wisconsin Age-Related Maculopathy Grading System. For estimations of incidence and progression of AMD, the Age Related Eye Disease Study Scale was used. Main outcome measures are incidence and progression of early AMD (drusen type, drusen size, and retinal pigmentary abnormalities) and advanced AMD (exudative AMD and geographic atrophy). RESULTS: A total of 4658 of 6100 subjects (76%) completed the follow-up examination. The 4-year incidence of early AMD was 7.5% (95% CI: 6.7, 8.4) and advanced AMD was 0.2% (95% CI: 0.1, 0.4). Progression of any AMD occurred in 9.2% (95% CI: 8.3, 10.1) of at-risk participants. Incidence and progression increased with age. Incidence of early AMD in the second eye (11.2%) was higher than incidence in the first eye (6.9%). Baseline presence of soft indistinct large drusen >or=250 microm in diameter was more likely to predict the 4-year incidence of pigmentary abnormalities, geographic atrophy, and exudative AMD than smaller or hard or soft distinct drusen. CONCLUSIONS: Age-specific incidence and progression of AMD in Latinos are lower than in non-Hispanic whites. While incident early AMD is more often unilateral, the risk of its development in the second is higher than in the first eye. Older people and those with soft indistinct large drusen had a higher risk of developing advanced AMD compared to those who were younger and did not have soft indistinct large drusen. Copyright 2010 Elsevier Inc. All rights reserved.

Le Tien V.
Présentation de la DMLA 2010
Réflexions Ophtalmol 2010; 15 (136): 12-13.

Micronutrition oculaire : où en sommes-nous ?
-    Antioxydants : Areds I et Areds II,
-    Pigments oculaires: les caroténoides,
-    Les acides gras polyinsaturés de la famille des oméga -3.
-    Autres traitements préventifs : les vitamines du groupe B,
-    Quels sont les autres aspects de la prévention ?
Compléments alimentaires et DMLA : en pratique
Conclusion

ABRIL/MAIO 2010

Luna C, Li G, Liton PB, Qiu J, Epstein DL, Challa P, Gonzalez P.
Resveratrol prevents the expression of glaucoma markers induced by chronic oxidative stress in trabecular meshwork cells.
Food Chem Toxicol 2009; 47 (1): 198-204.

Elevated intraocular pressure (IOP) constitutes the best characterized risk for primary open-angle glaucoma (POAG). Elevated IOP is believed to result from an increase in aqueous humor outflow resistance at the level of the trabecular meshwork (TM)/Schlemm's canal. Malfunction of the TM in POAG is associated with the expression of markers for inflammation, cellular senescence, oxidative damage, and decreased cellularity. Current POAG treatments rely on lowering IOP, but there is no therapeutic approach available to delay the loss of function of the TM in POAG patients. We evaluated the effects of chronic administration of the dietary supplement resveratrol on the expression of markers for inflammation, oxidative damage, and cellular senescence in primary TM cells subjected to chronic oxidative stress (40% O2). Resveratrol treatment effectively prevented increased production of intracellular reactive oxygen species (iROS) and inflammatory markers (IL1alpha, IL6, IL8, and ELAM-1), and reduced expression of the senescence markers sa-beta-gal, lipofuscin, and accumulation of carbonylated proteins. Furthermore, resveratrol exerted antiapoptotic effects that were not associated with a decrease in cell proliferation. These results suggest that resveratrol could potentially have a role in preventing the TM tissue abnormalities observed in POAG.

Berson EL, Rosner B, Sandberg MA, Weigel-DiFranco C, Brockhurst RJ, Hayes KC, Johnson EJ, Anderson EJ, Johnson CA, Gaudio AR, Willett WC, Schaefer EJ.
Clinical trial of lutein in patients with retinitis pigmentosa receiving vitamin A.
Arch Ophthalmol 2010; 128 (4): 403-411.

OBJECTIVE: To determine whether lutein supplementation will slow visual function decline in patients with retinitis pigmentosa receiving vitamin A. DESIGN: Randomized, controlled, double-masked trial of 225 nonsmoking patients, aged 18 to 60 years, evaluated over a 4-year interval. Patients received 12 mg of lutein or a control tablet daily. All were given 15,000 IU/d of vitamin A palmitate. Randomization took into account genetic type and baseline serum lutein level. MAIN OUTCOME MEASURES: The primary outcome was the total point score for the Humphrey Field Analyzer (HFA) 30-2 program; prespecified secondary outcomes were the total point scores for the 60-4 program and for the 30-2 and 60-4 programs combined, 30-Hz electroretinogram amplitude, and Early Treatment Diabetic Retinopathy Study acuity. RESULTS: No significant difference in rate of decline was found between the lutein plus vitamin A and control plus vitamin A groups over a 4-year interval for the HFA 30-2 program. For the HFA 60-4 program, a decrease in mean rate of sensitivity loss was observed in the lutein plus vitamin A group (P = .05). Mean decline with the 60-4 program was slower among those with the highest serum lutein level or with the highest increase in macular pigment optical density at follow-up (P = .01 and P = .006, respectively). Those with the highest increase in macular pigment optical density also had the slowest decline in HFA 30-2 and 60-4 combined field sensitivity (P = .005). No significant toxic effects of lutein supplementation were observed. CONCLUSION: Lutein supplementation of 12 mg/d slowed loss of midperipheral visual field on average among nonsmoking adults with retinitis pigmentosa taking vitamin A. Application to Clinical Practice Data are presented that support use of 12 mg/d of lutein to slow visual field loss among nonsmoking adults with retinitis pigmentosa taking vitamin A. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00346333.

Karmel M.
Nutrition News: Green tea: It may be good for eye health
EyeNet 2010; 14 (5): 19.

Cohen SY, Mauget-Faysse M, Oubraham H, Algan M, Conrath J, Roquet W.
Impact des habitudes nutritionnelles sur la pathologie maculaire évalué par mesure de la densité optique du pigment maculaire
J Fr Ophtalmol 2010; 33 (4): 234-240.

INTRODUCTION: Low levels of lutein and zeaxanthin in blood or food are associated with an increased risk of age-related macular degeneration (AMD). These molecules, provided by food, form the macular pigment. PATIENTS AND METHODS: Patients included in this pilot study where categorized into four groups : (1) < 50 years with drusen, (2) > or = 50 years without drusen, (3) > or = 50 years with drusen, and (4) > or = 50 years with drusen and neovascularization. During consultation, macular pigment optical density was measured and information on pathology and eating habits were collected. RESULTS: Assessment of macular pigment optical density considering eating habits and groups showed that it was lower in group 1 patients when they ate less than five portions of fruits and vegetables per day and less than two portions of cabbage, broccoli, pepper, corn, or spinach a week. In groups 3 and 4, food supplement intake was related to an increase in optical density. Food supplements were consumed by 58.5 % of patients in group 4. CONCLUSION: Analysis of mean optical density measured by the MPS 9000 QuantifEYE considering eating habits confirmed the impact of food supplement intake on optical density, especially in patients > or = 50 years with drusen and with or without neovascularization. Copyright 2010 Elsevier Masson SAS. All rights reserved.

MARÇO 2010

Creuzot-Garcher C, Brétillon L.
Compléments alimentaires. Science ou marketing ?
Pratiques en ophtalmologie 2010; 4 (31): 45.

Roberts RL, Green J, Lewis B
Lutein and zeaxanthin in eye and skin health
Clin Dermatol 2009; 27: 195–201
 

Less than 20 of the hundreds of carotenoids found in nature are found in the human body. These carotenoids are present in the body from the foods or dietary supplements that humans consume. The body does not synthesize them. Among the carotenoids present in the body, only lutein and its coexistent isomer, zeaxanthin, are found in that portion of the eye where light is focused by the lens, namely, the macula lutea. Numerous studies have shown that lutein and zeaxanthin may provide significant protection against the potential damage caused by light striking this portion of the retina. In the eye, lutein and zeaxanthin have been shown to filter high-energy wavelengths of visible light and act as antioxidants to protect against the formation of reactive oxygen species and subsequent free radi-cals. Human studies have demonstrated that lutein and zeaxanthin are present in the skin, and animal studies have provided evidence of significant efficacy against light-induced skin damage, especially the ultraviolet wavelengths. Little was known about the protective effects of these carotenoids in human skin until recently. This article reviews the scientific literature pertaining to the effects that lutein and zeaxanthin exhibit in the human eye and skin.

Brétillon L.
Supplémentation en acide folique, vitamines B6 et B12 et incidence de la DMLA.
Réflexions ophtalmol 2010; 15 (132): 57-58.

Analyse critique des résultats présentés par William G. Christen et collaborateurs en 2009 dans Arch Intern Med 169 (4): 335-341. Folic acid, pyridoxine, and cyanocobolamin combination treatment and age-related macular degeneration in women. The Women’s antioxidant and folic acid cardiovascular study.

Bartlett H, Acton J, Eperjesi F.
Clinical evaluation of the MacuScope macular pigment densitometer.
Br J Ophthalmol 2010; 94 (3): 328-331.

Background/aims The MacuScope uses a psychophysical technique called heterochromic flicker pho-tometry to measure macular pigment optical density (MPOD). Our aim was to determine the meas-urement variability (noise) of the MacuScope. Methods Thirty-eight normally sighted participants who ranged in age from 19 to 46 years (25.7+/-7.6 years) were recruited from staff and students of Aston University. Data were collected by two operators, HB and JA, in two sessions separated by 1 week in order to assess test repeatability and reproducibility. Results The overall mean MPOD for the cohort was 0.47+/-0.14. There was a significant negative correlation between MacuScope MPOD readings and age (r=-0.368, p=0.023). Coefficients were 0.45 and 0.58 for repeatability, and 0.49 and 0.36 for reproducibility. For each pair of results, there was a significant positive correlation between mean and difference MPOD values. Conclusions If MPOD is being monitored over time then any change less than 0.58 units should not be considered clinically significant as it is very likely to be due to instrument noise. The size of the coefficient appears to be positively correlated with MPOD.

Cukras C, Agrón E, Klein ML, Ferris FL 3rd, Chew EY, Gensler G, Wong WT; Age-Related Eye Dis-ease Study Research Group.
Natural history of drusenoid pigment epithelial detachment in age-related macular degeneration: Age-Related Eye Disease Study Report No. 28.
Ophthalmology 2010; 117 (3): 489-499.

OBJECTIVE: To describe the natural history of eyes with drusenoid pigment epithelial detachments (DPEDs) associated with age-related macular degeneration (AMD). DESIGN: Multicenter, clinic-based, prospective cohort study. PARTICIPANTS: Among 4757 participants enrolled in the Age-Related Eye Disease Study (AREDS), 255 were identified as having DPED in at least 1 eye and having 5 or more years of follow-up after the initial detection of the DPED. METHODS: Baseline and annual fundus photographs were evaluated for the evolution of the fundus features and the development of advanced AMD in the forms of central geographic atrophy (CGA) or neovascular (NV) AMD. Kaplan-Meier analyses of progression to advanced AMD and of moderate vision loss (> or =15 letters compared with baseline) were performed. MAIN OUTCOME MEASURES: Rate of progression to advanced AMD and change in visual acuity from baseline (in terms of mean letters lost and proportion losing > or =15 letters). RESULTS: A total of 311 eyes (from 255 participants) with DPED were followed for a median follow-up time of 8 years subsequent to the initial detection of a DPED. Of the 282 eyes that did not have advanced AMD at baseline, advanced AMD developed within 5 years in 119 eyes (42%) (19% progressing to CGA and 23% progressing to NV-AMD). In the remaining eyes that did not develop advanced AMD (n=163), progressive fundus changes, typified by the development of calcified drusen and pigmentary changes, were detected. Visual decline was prominent among study eyes, with approximately 40% of all eyes decreasing in visual acuity by > or =15 letters at 5 years follow-up. Mean visual acuity decreased from 76 letters ( approximately 20/30) at baseline to 61 letters ( approximately 20/60) at 5 years. Five-year decreases in mean visual acuity averaged 26 letters for eyes progressing to advanced AMD and 8 letters for non-progressing eyes. CONCLUSIONS: The natural history of eyes containing DPED is characterized by a high rate of progression to both CGA and NV-AMD. Among eyes not progressing to advanced AMD, progressive development of pigmentary changes and calcified drusen were observed. Decline of visual acuity is a common outcome, with or without progression to advanced forms of AMD. Copyright 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

FEVEREIRO 2010

Mcneil R.
Dietary supplements and macular health: next-generation supplements may confer greater treatment benefits
EyeNews 2010; 16 (5): 22, 25-26.

Lee CT, Gayton EL, Beulens JW, Flanagan DW, Adler AI.
Micronutrients and Diabetic Retinopathy A Systematic Review.
Ophthalmology 2010; 117 (1): 71-78.
 

BACKGROUND: We have evaluated the evidence for the association between intake and blood levels of micronutrients and diabetic retinopathy. Treatment for diabetic retinopathy requires significant clinical input and specialist ophthalmologic care. Micronutrients, including vitamin C, vitamin E, and magnesium, may interfere with pathologic mechanisms of diabetic retinopathy and potentially alter its risk. METHODS: We conducted a search of epidemiologic literature in PubMed and Embase from 1988 to May 2008, using keywords for exposures, including magnesium, ascorbic acid, alpha-tocopherol and antioxidants, and outcomes, including diabetic retinopathy. Two authors independently extracted data and assessed the quality of the studies using the Newcastle-Ottawa Scale. The overall quality of evidence was graded as I (highest), II, or III (lowest). RESULTS: Of the 766 studies identified, we reviewed 15 studies, comprising 4094 individuals. For vitamin C, hospital-based studies reported an inverse association between plasma levels with retinopathy, whereas population-based studies showed no association between dietary intake and retinopathy. For vitamin E, there was no association with dietary intake or plasma levels and retinopathy. For magnesium, a single prospective analysis showed an association between low levels in plasma and progression of retinopathy, but cross-sectional studies reported inconsistent results. In the assessment of quality, population-based studies had higher ratings than hospital-based studies. CONCLUSIONS: The evidence suggests that dietary intake or plasma levels of vitamins C and E and magnesium do not seem to be associated with diabetic retinopathy. Because of differences in study designs and measurement of micronutrients, incomplete ascertainment of retinopathy, and residual confounding, these findings require confirmation. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any of the materials discussed in this article. Copyright © 2010 American Academy of Oph-thalmology. Published by Elsevier Inc. All rights reserved.