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A prospective study of folate, vitamin B₆, and vitamin B₁₂ intake in relation to exfoliation glaucoma or suspected exfoliation glaucoma.

Abstract

IMPORTANCE

Effective strategies for primary prevention are lacking for exfoliation glaucoma (EG), which is the most common type of secondary glaucoma.

OBJECTIVE

To examine the association between B vitamin intake and EG or suspected EG (EG/SEG) risk.

DESIGN, SETTING, AND PARTICIPANTS

National prospective cohort study using more than 20 years of follow-up data from the Nurses' Health Study (all female registered nurses) and the Health Professionals Follow-up Study (all male health professionals) from June 1, 1980, to May 31, 2010 (Nurses' Health Study) and January 1, 1986, to December 31, 2010 (Health Professionals Follow-up Study). We included a subset of 78,980 Nurses' Health Study women and 41,221 Health Professionals Follow-up Study men who were 40 years or older, free of glaucoma, had completed diet questionnaires, and reported eye examinations (follow-up rate, >85%).

EXPOSURES

Cumulatively updated intake of B vitamins (folate, vitamin B6, and vitamin B12) as ascertained by repeated administration of validated questionnaires.

MAIN OUTCOMES AND MEASURES

Incident cases of EG/SEG, totaling 399 (329 women and 70 men), were first identified with the questionnaires and were subsequently confirmed with medical records. Multivariable relative risks for EG/SEG were calculated in each cohort and then pooled with meta-analysis.

RESULTS

Vitamin B₆ and vitamin B₁₂ intake was not associated with EG/SEG risk in pooled analyses (P = .52 and P = .99 for linear trend, respectively). However, a suggestive trend of a reduced risk was observed with higher intake of folate: compared with the lowest quintile of cumulatively averaged updated total folate intake, the multivariable relative risk for EG/SEG for the highest quintile (≥654 μg/d) was 0.75 (95% CI, 0.54-1.04; P = .02 for linear trend). These results were not materially altered after adjustment for vitamin B₆ and vitamin B₁₂ intake. An association was observed for supplemental folate intake but not for dietary folate only (P = .03 and P = .64 for linear trend, respectively). Greater frequency of multivitamin use showed a modest suggestive inverse association (current multivitamin use of ≥6 times per week vs nonuse multivariable relative risk, 0.84; 95% CI, 0.64-1.11; P = .06 for linear trend).

CONCLUSIONS AND RELEVANCE

Higher total folate intake was associated with a suggestive lower risk for EG/SEG, supporting a possible causal role of homocysteine in EG/SEG.

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  • Authors+Show Affiliations

    ,

    Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital, and Harvard Medical School, Boston, Massachusetts.

    ,

    Glaucoma Service, Massachusetts Eye and Ear, Boston, Massachusetts.

    ,

    Glaucoma Service, Massachusetts Eye and Ear, Boston, Massachusetts.

    ,

    Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital, and Harvard Medical School, Boston, Massachusetts3Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts4Department of Epidemiology, Harvar.

    Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital, and Harvard Medical School, Boston, Massachusetts2Glaucoma Service, Massachusetts Eye and Ear, Boston, Massachusetts.

    Source

    JAMA ophthalmology 132:5 2014 May pg 549-59

    MeSH

    Adult
    Dietary Supplements
    Exfoliation Syndrome
    Female
    Folic Acid
    Humans
    Intraocular Pressure
    Male
    Middle Aged
    Prospective Studies
    Surveys and Questionnaires
    Time Factors
    Treatment Outcome
    Vitamin B 12
    Vitamin B 6
    Vitamin B Complex

    Pub Type(s)

    Journal Article
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    24699833

    Citation

    Kang, Jae H., et al. "A Prospective Study of Folate, Vitamin B₆, and Vitamin B₁₂ Intake in Relation to Exfoliation Glaucoma or Suspected Exfoliation Glaucoma." JAMA Ophthalmology, vol. 132, no. 5, 2014, pp. 549-59.
    Kang JH, Loomis SJ, Wiggs JL, et al. A prospective study of folate, vitamin B₆, and vitamin B₁₂ intake in relation to exfoliation glaucoma or suspected exfoliation glaucoma. JAMA Ophthalmol. 2014;132(5):549-59.
    Kang, J. H., Loomis, S. J., Wiggs, J. L., Willett, W. C., & Pasquale, L. R. (2014). A prospective study of folate, vitamin B₆, and vitamin B₁₂ intake in relation to exfoliation glaucoma or suspected exfoliation glaucoma. JAMA Ophthalmology, 132(5), pp. 549-59. doi:10.1001/jamaophthalmol.2014.100.
    Kang JH, et al. A Prospective Study of Folate, Vitamin B₆, and Vitamin B₁₂ Intake in Relation to Exfoliation Glaucoma or Suspected Exfoliation Glaucoma. JAMA Ophthalmol. 2014;132(5):549-59. PubMed PMID: 24699833.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - A prospective study of folate, vitamin B₆, and vitamin B₁₂ intake in relation to exfoliation glaucoma or suspected exfoliation glaucoma. AU - Kang,Jae H, AU - Loomis,Stephanie J, AU - Wiggs,Janey L, AU - Willett,Walter C, AU - Pasquale,Louis R, PY - 2014/4/5/entrez PY - 2014/4/5/pubmed PY - 2014/7/9/medline SP - 549 EP - 59 JF - JAMA ophthalmology JO - JAMA Ophthalmol VL - 132 IS - 5 N2 - IMPORTANCE: Effective strategies for primary prevention are lacking for exfoliation glaucoma (EG), which is the most common type of secondary glaucoma. OBJECTIVE: To examine the association between B vitamin intake and EG or suspected EG (EG/SEG) risk. DESIGN, SETTING, AND PARTICIPANTS: National prospective cohort study using more than 20 years of follow-up data from the Nurses' Health Study (all female registered nurses) and the Health Professionals Follow-up Study (all male health professionals) from June 1, 1980, to May 31, 2010 (Nurses' Health Study) and January 1, 1986, to December 31, 2010 (Health Professionals Follow-up Study). We included a subset of 78,980 Nurses' Health Study women and 41,221 Health Professionals Follow-up Study men who were 40 years or older, free of glaucoma, had completed diet questionnaires, and reported eye examinations (follow-up rate, >85%). EXPOSURES: Cumulatively updated intake of B vitamins (folate, vitamin B6, and vitamin B12) as ascertained by repeated administration of validated questionnaires. MAIN OUTCOMES AND MEASURES: Incident cases of EG/SEG, totaling 399 (329 women and 70 men), were first identified with the questionnaires and were subsequently confirmed with medical records. Multivariable relative risks for EG/SEG were calculated in each cohort and then pooled with meta-analysis. RESULTS: Vitamin B₆ and vitamin B₁₂ intake was not associated with EG/SEG risk in pooled analyses (P = .52 and P = .99 for linear trend, respectively). However, a suggestive trend of a reduced risk was observed with higher intake of folate: compared with the lowest quintile of cumulatively averaged updated total folate intake, the multivariable relative risk for EG/SEG for the highest quintile (≥654 μg/d) was 0.75 (95% CI, 0.54-1.04; P = .02 for linear trend). These results were not materially altered after adjustment for vitamin B₆ and vitamin B₁₂ intake. An association was observed for supplemental folate intake but not for dietary folate only (P = .03 and P = .64 for linear trend, respectively). Greater frequency of multivitamin use showed a modest suggestive inverse association (current multivitamin use of ≥6 times per week vs nonuse multivariable relative risk, 0.84; 95% CI, 0.64-1.11; P = .06 for linear trend). CONCLUSIONS AND RELEVANCE: Higher total folate intake was associated with a suggestive lower risk for EG/SEG, supporting a possible causal role of homocysteine in EG/SEG. SN - 2168-6173 UR - https://www.unboundmedicine.com/medline/citation/24699833/A_prospective_study_of_folate_vitamin_B₆_and_vitamin_B₁₂_intake_in_relation_to_exfoliation_glaucoma_or_suspected_exfoliation_glaucoma_ L2 - https://jamanetwork.com/journals/jamaophthalmology/fullarticle/10.1001/jamaophthalmol.2014.100 DB - PRIME DP - Unbound Medicine ER -