Lutein and zeaxanthin are thought to have beneficial effects on protecting the lens against cataract formation, but findings from epidemiologic studies have been inconsistent. We aimed to conduct a meta-analysis of prospective cohort studies to examine the association between dietary lutein and zeaxanthin intake and risk of age-related cataract (ARC).
We systematically searched MEDLINE, EMBASE, Web of Science, and Cochrane Library databases up to March 2013. Reference lists from retrieved articles were also reviewed. The adjusted relative risks (RRs) from each study were extracted to calculate a pooled estimate with its 95 % confidence interval (CI). The dose–response relationships were assessed by using generalized least-squares trend estimation.
Six prospective cohort studies were identified involving 4,416 cases and 41,999 participants. For the comparison between the highest and the lowest categories of dietary lutein and zeaxanthin intake, significant inverse association were found for nuclear cataract (RR: 0.75; 95 % CI: 0.65, 0.85), but not for cortical cataract (RR: 0.85; 95 % CI: 0.53, 1.17) and for posterior subcapsular cataract (RR: 0.77; 95 % CI: 0.40, 1.13). Dose–response analysis showed that every 300 μg/d increment in dietary lutein and zeaxanthin intake was associated with a 3 %, 1 %, or 3 % reduction in the risk of nuclear cataract (RR: 0.97; 95 % CI: 0.94, 0.99), cortical cataract (RR: 0.99; 95 % CI: 0.95, 1.02), or posterior subcapsular cataract (RR: 0.97; 95 % CI: 0.93, 1.01) respectively.
Dietary lutein and zeaxanthin intake is associated with a reduced risk of ARC, especially nuclear cataract in a dose–response manner, indicating a beneficial effect of lutein and zeaxanthin in ARC prevention.
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Pascolini D, Mariotti SP (2012) Global estimates of visual impairment: 2010. Br J Ophthalmol 96:614–618
Congdon N, Vingerling JR, Klein BE, West S, Friedman DS, Kempen J, O’Colmain B, Wu SY, Taylor HR (2004) Prevalence of cataract and pseudophakia/aphakia among adults in the United States. Arch Ophthalmol 122:487–494
Hatch WV, Campbell Ede L, Bell CM, El-Defrawy SR, Campbell RJ (2012) Projecting the growth of cataract surgery during the next 25 years. Arch Ophthalmol 130:1479–1481
Salm M, Belsky D, Sloan FA (2006) Trends in cost of major eye diseases to Medicare, 1991 to 2000. Am J Ophthalmol 142:976–982
Fan X, Zhang J, Theves M, Strauch C, Nemet I, Liu X, Qian J, Giblin FJ, Monnier VM (2009) Mechanism of lysine oxidation in human lens crystallins during aging and in diabetes. J Biol Chem 284:34618–34627
Zhang J, Yan H, Löfgren S, Tian X, Lou MF (2012) Ultraviolet radiation-induced cataract in mice: the effect of age and the potential biochemical mechanism. Invest Ophthalmol Vis Sci 53:7276–7285
Tan AG, Mitchell P, Flood VM, Burlutsky G, Rochtchina E, Cumming RG, Wang JJ (2008) Antioxidant nutrient intake and the long-term incidence of age-related cataract: the Blue Mountains Eye Study. Am J Clin Nutr 87:1899–1905
Barker FM 2nd, Snodderly DM, Johnson EJ, Schalch W, Koepcke W, Gerss J, Neuringer M (2011) Nutritional manipulation of primate retinas, V: effects of lutein, zeaxanthin, and n-3 fatty acids on retinal sensitivity to blue-light-induced damage. Invest Ophthalmol Vis Sci 52:3934–3942
Bian Q, Gao S, Zhou J, Qin J, Taylor A, Johnson EJ, Tang G, Sparrow JR, Gierhart D, Shang F (2012) Lutein and zeaxanthin supplementation reduces photooxidative damage and modulates the expression of inflammation-related genes in retinal pigment epithelial cells. Free Radic Biol Med 53:1298–1307
Christen WG, Liu S, Glynn RJ, Gaziano JM, Buring JE (2008) Dietary carotenoids, vitamins C and E, and risk of cataract in women: a prospective study. Arch Ophthalmol 126:102–109
Lyle BJ, Mares-Perlman JA, Klein BE, Klein R, Greger JL (1999) Antioxidant intake and risk of incident age-related nuclear cataracts in the Beaver Dam Eye Study. Am J Epidemiol 149:801–809
Maralani HG, Tai BC, Wong TY, Tai ES, Li J, Wang JJ, Mitchell P (2013) Metabolic syndrome and risk of age-related cataract over time: an analysis of interval-censored data using a random-effects model. Invest Ophthalmol Vis Sci 54:641–646
Millett GA, Flores SA, Marks G, Reed JB, Herbst JH (2008) Circumcision status and risk of HIV and sexually transmitted infections among men who have sex with men: a meta-analysis. JAMA 300:1674–1684
Borenstein M, Hedges LV, Higgins JPT, Rothstein HR (2009) Introduction to meta-analysis. Wiley, Chichester
Greenland S, Longnecker MP (1992) Methods for trend estimation from summarized dose–response data, with applications to meta-analysis. Am J Epidemiol 135:1301–1309
Deeks JJ, Macaskill P, Irwig L (2005) The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. J Clin Epidemiol 58:882–893
Jacques PF, Chylack LT Jr, Hankinson SE, Khu PM, Rogers G, Friend J, Tung W, Wolfe JK, Padhye N, Willett WC, Taylor A (2001) Long-term nutrient intake and early age-related nuclear lens opacities. Arch Ophthalmol 119:1009–1019
Vu HT, Robman L, Hodge A, McCarty CA, Taylor HR (2006) Lutein and zeaxanthin and the risk of cataract: the Melbourne visual impairment project. Invest Ophthalmol Vis Sci 47:3783–3786
Moeller SM, Voland R, Tinker L, Blodi BA, Klein ML, Gehrs KM, Johnson EJ, Snodderly DM, Wallace RB, Chappell RJ, Parekh N, Ritenbaugh C, Mares JA (2008) Associations between age-related nuclear cataract and lutein and zeaxanthin in the diet and serum in the carotenoids in the Age-Related Eye Disease Study, an Ancillary Study of the Women’s Health Initiative. Arch Ophthalmol 126:354–364
Taylor A, Jacques PF, Chylack LT Jr, Hankinson SE, Khu PM, Rogers G, Friend J, Tung W, Wolfe JK, Padhye N, Willett WC (2002) Long-term intake of vitamins and carotenoids and odds of early age-related cortical and posterior subcapsular lens opacities. Am J Clin Nutr 75:540–549
Zheng Selin J, Rautiainen S, Lindblad BE, Morgenstern R, Wolk A (2013) High-dose supplements of vitamins C and E, low-dose multivitamins, and the risk of age-related cataract: a population-based prospective cohort study of men. Am J Epidemiol 177:548–555
Ma L, Lin XM (2010) Effects of lutein and zeaxanthin on aspects of eye health. J Sci Food Agric 90:2–12
Subczynski WK, Wisniewska A, Widomska J (2010) Location of macular xanthophylls in the most vulnerable regions of photoreceptor outer-segment membranes. Arch Biochem Biophys 504:61–66
Bhosale P, Bernstein PS (2005) Synergistic effects of zeaxanthin and its binding protein in the prevention of lipid membrane oxidation. Biochim Biophys Acta 1740:116–121
Arnal E, Miranda M, Almansa I, Muriach M, Barcia JM, Romero FJ, Diaz-Llopis M, Bosch-Morell F (2009) Lutein prevents cataract development and progression in diabetic rats. Graefes Arch Clin Exp Ophthalmol 247:115–120
Gao S, Qin T, Liu Z, Caceres MA, Ronchi CF, Chen CY, Yeum KJ, Taylor A, Blumberg JB, Liu Y, Shang F (2011) Lutein and zeaxanthin supplementation reduces H2O2-induced oxidative damage in human lens epithelial cells. Mol Vis 17:3180–3190
Kijlstra A, Tian Y, Kelly ER, Berendschot TT (2012) Lutein: more than just a filter for blue light. Prog Retin Eye Res 31:303–315
Seddon JM (2007) Multivitamin–multimineral supplements and eye disease: age-related macular degeneration and cataract. Am J Clin Nutr 85:304S–307S
van Leeuwen R, Boekhoorn S, Vingerling JR, Witteman JC, Klaver CC, Hofman A, de Jong PT (2005) Dietary intake of antioxidants and risk of age-related macular degeneration. JAMA 294:3101–3107
O’Neill ME, Carroll Y, Corridan B, Olmedilla B, Granado F, Blanco I, Van den Berg H, Hininger I, Rousell AM, Chopra M, Southon S, Thurnham DI (2001) A European carotenoid database to assess carotenoid intakes and its use in a five-country comparative study. Br J Nutr 85:499–507
Khanna R, Pujari S, Sangwan V (2011) Cataract surgery in developing countries. Curr Opin Ophthalmol 22:10–14
Chang JR, Koo E, Agrón E, Hallak J, Clemons T, Azar D, Sperduto RD, Ferris FL 3rd, Chew EY (2011) Risk factors associated with incident cataracts and cataract surgery in the Age-related Eye Disease Study (AREDS): AREDS report number 32. Ophthalmology 118:2113–2119
Michael R, Bron AJ (2011) The ageing lens and cataract: a model of normal and pathological ageing. Philos Trans R Soc Lond B Biol Sci 366:1278–1292
Sireesha R, Laxmi SG, Mamata M, Reddy PY, Goud PU, Rao PV, Reddy GB, Vishnupriya S, Padma T (2012) Total activity of glutathione-S-transferase (GST) and polymorphisms of GSTM1 and GSTT1 genes conferring risk for the development of age related cataracts. Exp Eye Res 98:67–74
Beebe DC, Holekamp NM, Siegfried C, Shui YB (2011) Vitreoretinal influences on lens function and cataract. Philos Trans R Soc Lond B Biol Sci 366:1293–1300
Yoshida M, Takashima Y, Inoue M, Iwasaki M, Otani T, Sasaki S, Tsugane S (2007) Prospective study showing that dietary vitamin C reduced the risk of age-related cataracts in a middle-aged Japanese population. Eur J Nutr 46:118–124
Chew EY, SanGiovanni JP, Ferris FL, Wong WT, Agron E, Clemons TE, Sperduto R, Danis R, Chandra SR, Blodi BA, Domalpally A, Elman MJ, Antoszyk AN, Ruby AJ, Orth D, Bressler SB, Fish GE, Hubbard GB, Klein ML, Friberg TR, Rosenfeld PJ, Toth CA, Bernstein P (2013) Lutein/zeaxanthin for the treatment of age-related cataract: AREDS2 Randomized Trial Report No. 4. JAMA Ophthalmol 131:843–850
Served as scientific advisors (LM, JPP); critically reviewed the study proposal (LM, RRL, QS, JPP); collected data (LM, ZXH, RBY); management, analysis and interpretation of the data (LM, ZXH, RRL, RBY, JPP); and preparation of the manuscript (LM, RRL, JPP).
This study was supported in part by grants from the National Natural Science Foundation of China (81202198), the Natural Science Foundation of Shaanxi Province of China (2013JQ4008) and the Fundamental Research Funds for the Central Universities of China (xjj2012052).
Conflict of Interest
None of the authors have any conflicts of interest associated with the work presented in this manuscript.
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Ma, L., Hao, Zx., Liu, Rr. et al. A dose–response meta-analysis of dietary lutein and zeaxanthin intake in relation to risk of age-related cataract. Graefes Arch Clin Exp Ophthalmol 252, 63–70 (2014). https://doi.org/10.1007/s00417-013-2492-3
- Age-related cataract