Abstract
Purpose :
Lifestyle and dietary factors affect health and disease. A traditional Mediterranean diet, rich in unsaturated fats and oils, is often purported as a healthy diet. This study tested the hypothesis that a greater adherence to a Mediterranean diet is associated with a lower risk of dry eye disease (DED).
Methods :
58,993 participants from the Dutch Lifelines population-based cohort were included (aged 20-94 years, 60% female). The Women’s Health Study (WHS) dry eye questionnaire was used to assess the primary outcome, WHS-defined DED. Level of adherence to a Mediterranean diet was quantified using a modified Trichopoulou's Mediterranean Diet Score (mMDS). The mMDS ranks participants across nine categories, yielding a sum score from zero to nine, with higher values indicating greater adherence. Logistic regression models were used to assess the relationship between WHS-defined DED and mMDS. Models were corrected for age and sex only (Model 1), age, sex, BMI, smoking status, and income and education level (Model 2), and all variables in Model 2 plus 48 traits and medical comorbidities associated with DED (Model 3). To assess possible reverse causality, participants with a diagnosis of dry eye were excluded, and the relationship between mMDS and symptomatic dry eye was assessed separately.
Results :
9.1% of participants had WHS-defined DED. Greater adherence to a Mediterranean diet was not linked to a decreased risk of dry eye. Contrarily, increasing mMDS values were significantly tied to an increased risk of WHS-defined DED in all models (odds ratio per mMDS unit 1.040, 95% CI 1.020-1.059, P<0.0001, Model 3). Higher mMDS scores were associated with a greater risk of symptomatic dry eye in all models, after excluding those with a diagnosis of dry eye (odds ratio 1.034, 95% CI 1.021-1.048, P<0.0001, Model 3).
Conclusions :
Greater adherence to a Mediterranean diet was not tied to a lower risk of dry eye in this large, population-based Dutch cohort. In fact, higher mMDS scores were associated with an increased likelihood of having WHS-defined DED, which was also seen for symptomatic dry eye after excluding those with a clinical dry eye diagnosis. Causes of this observed effect should be explored further.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.