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Antioxidant vitamin and mineral supplements for preventing age-related macular degeneration.

Abstract

BACKGROUND

There is inconclusive evidence from observational studies to suggest that people who eat a diet rich in antioxidant vitamins (carotenoids, vitamins C and E) or minerals (selenium and zinc) may be less likely to develop age-related macular degeneration (AMD).

OBJECTIVES

To examine the evidence as to whether or not taking antioxidant vitamin or mineral supplements prevents the development of AMD.

SEARCH METHODS

We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2011, Issue 12), MEDLINE (January 1950 to January 2012), EMBASE (January 1980 to January 2012), Open Grey (System for Information on Grey Literature in Europe) (www.opengrey.eu/), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 26 January 2012.

SELECTION CRITERIA

We included all randomised controlled trials (RCTs) comparing an antioxidant vitamin and/or mineral supplement (alone or in combination) to control.

DATA COLLECTION AND ANALYSIS

Both review authors independently assessed risk of bias in the included studies and extracted data. One author entered data into RevMan 5 and the other author checked the data entry. We pooled data using a fixed-effect model.

MAIN RESULTS

We included four RCTs in this review; 62,520 people were included in the analyses. The trials were conducted in Australia, Finland and the USA and investigated vitamin E and beta-carotene supplements. Overall the quality of the evidence was high. People who took these supplements were not at decreased (or increased) risk of developing AMD. The pooled risk ratio for any antioxidant supplement in the prevention of any AMD was 0.98 (95% confidence interval 0.89 to 1.08) and for advanced AMD was 1.05 (95% CI 0.80 to 1.39). Similar results were seen when the analyses were restricted to beta-carotene and alpha-tocopherol alone.

AUTHORS' CONCLUSIONS

There is accumulating evidence that taking vitamin E or beta-carotene supplements will not prevent or delay the onset of AMD. There is no evidence with respect to other antioxidant supplements, such as vitamin C, lutein and zeaxanthin, or any of the commonly marketed multivitamin combinations. Although generally regarded as safe, vitamin supplements may have harmful effects and clear evidence of benefit is needed before they can be recommended. People with AMD should see the related Cochrane review 'Antioxidant vitamin and mineral supplements for slowing the progression of age-related macular degeneration' written by the same review team.

Authors+Show Affiliations

Cochrane Eyes and Vision Group, ICEH, London School of Hygiene & Tropical Medicine, London, UK. jennifer.evans@lshtm.ac.uk.No affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

22696317

Citation

Evans, Jennifer R., and John G. Lawrenson. "Antioxidant Vitamin and Mineral Supplements for Preventing Age-related Macular Degeneration." The Cochrane Database of Systematic Reviews, 2012, p. CD000253.
Evans JR, Lawrenson JG. Antioxidant vitamin and mineral supplements for preventing age-related macular degeneration. Cochrane Database Syst Rev. 2012.
Evans, J. R., & Lawrenson, J. G. (2012). Antioxidant vitamin and mineral supplements for preventing age-related macular degeneration. The Cochrane Database of Systematic Reviews, (6), CD000253. https://doi.org/10.1002/14651858.CD000253.pub3
Evans JR, Lawrenson JG. Antioxidant Vitamin and Mineral Supplements for Preventing Age-related Macular Degeneration. Cochrane Database Syst Rev. 2012 Jun 13;(6)CD000253. PubMed PMID: 22696317.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Antioxidant vitamin and mineral supplements for preventing age-related macular degeneration. AU - Evans,Jennifer R, AU - Lawrenson,John G, Y1 - 2012/06/13/ PY - 2012/6/15/entrez PY - 2012/6/15/pubmed PY - 2012/8/14/medline SP - CD000253 EP - CD000253 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 6 N2 - BACKGROUND: There is inconclusive evidence from observational studies to suggest that people who eat a diet rich in antioxidant vitamins (carotenoids, vitamins C and E) or minerals (selenium and zinc) may be less likely to develop age-related macular degeneration (AMD). OBJECTIVES: To examine the evidence as to whether or not taking antioxidant vitamin or mineral supplements prevents the development of AMD. SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2011, Issue 12), MEDLINE (January 1950 to January 2012), EMBASE (January 1980 to January 2012), Open Grey (System for Information on Grey Literature in Europe) (www.opengrey.eu/), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 26 January 2012. SELECTION CRITERIA: We included all randomised controlled trials (RCTs) comparing an antioxidant vitamin and/or mineral supplement (alone or in combination) to control. DATA COLLECTION AND ANALYSIS: Both review authors independently assessed risk of bias in the included studies and extracted data. One author entered data into RevMan 5 and the other author checked the data entry. We pooled data using a fixed-effect model. MAIN RESULTS: We included four RCTs in this review; 62,520 people were included in the analyses. The trials were conducted in Australia, Finland and the USA and investigated vitamin E and beta-carotene supplements. Overall the quality of the evidence was high. People who took these supplements were not at decreased (or increased) risk of developing AMD. The pooled risk ratio for any antioxidant supplement in the prevention of any AMD was 0.98 (95% confidence interval 0.89 to 1.08) and for advanced AMD was 1.05 (95% CI 0.80 to 1.39). Similar results were seen when the analyses were restricted to beta-carotene and alpha-tocopherol alone. AUTHORS' CONCLUSIONS: There is accumulating evidence that taking vitamin E or beta-carotene supplements will not prevent or delay the onset of AMD. There is no evidence with respect to other antioxidant supplements, such as vitamin C, lutein and zeaxanthin, or any of the commonly marketed multivitamin combinations. Although generally regarded as safe, vitamin supplements may have harmful effects and clear evidence of benefit is needed before they can be recommended. People with AMD should see the related Cochrane review 'Antioxidant vitamin and mineral supplements for slowing the progression of age-related macular degeneration' written by the same review team. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/22696317/Antioxidant_vitamin_and_mineral_supplements_for_preventing_age_related_macular_degeneration_ L2 - https://doi.org/10.1002/14651858.CD000253.pub3 DB - PRIME DP - Unbound Medicine ER -