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S. A. Sondel, R. Voland, A. E. Millen, R. Wallace, L. Tinker, B. A. Blodi, M. L. Klein, K. Gehrs, J. A. Mares; Relationship of Healthy Lifestyles to the Prevalence of Intermediate Age-Related Macular Degeneration (AMD) in the Carotenoids in Age-Related Eye Diseases Study (CAREDS), an Ancillary Study of the Women’s Health Initiative Observational Study (WHIOS). Invest. Ophthalmol. Vis. Sci. 2010;51(13):4529.
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We investigated relationships between a combination of healthy lifestyle behaviors and prevalence of intermediate AMD assessed an average of 6 years later.
Post-menopausal women indicated diet, lifestyle and risk factors at entry into the WHI Observational Studies (1994-1997) in Iowa, Wisconsin and Oregon. Intermediate AMD was assessed by stereoscopic fundus photographs of CAREDS participants from 2001-2004. Analyses were limited to 1313 women based on evidence for selective mortality bias in older women. The Healthy Lifestyle Score evaluated 5 modifiable risk factors: 1)overall dietary pattern estimated by the Healthy Eating Index (HEI) or the Alternative Mediterranean Diet (AMed) scoring of food frequency questionnaires, 2)intake of vitamin D from diet or supplements (above vs. below 400 IU/day), 3) level of physical activity (tertiles of MET-hrs/week), 4) smoking history (0, 7, 7 pack years), and 5)body weight(body mass index 25, >30 kg/m2). Among women with serum samples (N=968), we explored whether adding vitamin D status (25-hydroxyvitamin D (25(OH)D) >50,>75 nmol/L) to the Healthy Lifestyle Score further reduced odds for AMD.
Healthy Lifestyle Scores were more strongly associated with AMD than independent scores on both the HEI and AMed dietary patterns. Scores in the highest vs the lowest quintile for adherence to US Dietary Guideline, as assessed with the HEI, plus the other healthy lifestyle factors were associated with a 46% lower odds for AMD (Odds ratio (95%CI= 0.54 [0.33-0.89]); Ptrend = 0.01, after adjusting for age, history of diabetes or cardiovascular disease, iris pigment color, hormone replacement therapy and family history of AMD. Adding serum 25(OH)D to the scores strengthened relationships to AMD slightly. Multiple variable adjusted odds ratios for AMD among women with HEI based healthy lifestyle scores including serum vitamin D in the highest quintile were 55% lower than women with scores in the lowest quintile(P trend = 0.006).
Having a combination of 5 modifiable lifestyle factors (consuming a healthy diet, ensuring adequate vitamin D status, being physically active and lean and avoidance of smoking), may cut risk for intermediate AMD in women more than two-fold.
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