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Vincent Daien, Isabelle Carriere, Ryo Kawasaki, Max Villain, Pierre Fesler, Jean Paul Cristol, Karen Ritchie, Cecile DelCourt; Associations of malnutrition with retinal vascular caliber in the elderly : the POLA study. Invest. Ophthalmol. Vis. Sci. 2014;55(13):680.
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The pathway linking late-life malnutrition to greater risk of cardiovascular disease is unclear. Microcirulatory changes assessed by retinal vascular caliber have been linked with increased risk of stroke and coronary heart disease. The purpose of this study was to examine whether retinal vascular calibers are associated with malnutrition in elderly subjects free of cardio-vascular diseases.
Cross-sectional analysis of a community-dwelling cohort comprising 1145 individuals aged 60 years and over, without a history of diabetes, coronary or peripheral artery disease, or stroke. Retinal vascular caliber was measured from fundus photographs using the semi-automated standardized imaging software IVAN. Malnutrition was assessed using body mass index (BMI) < 21 kg/m2 and biomarkers of protein malnutrition: plasma albumin and transthyretin. The association of malnutrition parameters with retinal calibers were assessed using analyses of covariance. To take into account the participant’s inflammatory status, the effect of the prognostic inflammatory and nutritional index (PINI) was assessed, and adjusted analyses on inflammatory parameters were also performed.
In a multivariate model controlling for cardiovascular risk factors, retinal venular caliber was related to BMI (p=0.009) with an increased mean caliber for individuals with obesity and to a lesser extent for those with low BMI. After multivariate adjustment for age, gender, hypertension, smoking, HDL cholesterol, glomerular filtration rate and BMI, lower levels of albumin or transthyretin were associated with larger retinal venular caliber (p=0.026 and p=0.0018, respectively), that remain significant when adjusting for CRP (p=0.040 and p=0.0060, respectively) or orosomucoid (p=0.034 and p=0.0020, respectively). A PINI over 1 was also associated with a larger retinal venular caliber (p=0.0003). The relationships between retinal arterial caliber and BMI, albumin and transthyretin did not reach significance (p=0.14, p=0.12 and p=0.15, respectively).
Protein malnutrition was identified as an additional factor associated with retinal venular dilatation beyond inflammation. This suggests that early microvascular changes may be one of the underlying mechanisms of increased risk of cardiovascular disease observed in elderly subjects suffering from malnutrition.
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