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Archive for September, 2007

Pine bark extract may reduce ADHD

From ScienceDaily

Pycnogenol, from the bark of the French maritime pine tree, may reduce attention-deficit hyperactivity disorder in children, a study found.

The study, published in the journal Nutritional Neurosciene, shows Pycnogenol balances stress hormones, which lowers adrenaline and dopamine, resulting in a decrease of ADHD.

The study sampled 57 outpatients with ADHD with an average age of 9 years in Slovakia.

Forty-one patients received Pycnogenol and 16 received a placebo. Patients were not supplemented with any other drugs or with vitamins E or C during the study.

Participants in the Pycnogenol group received 1 milligram of Pycnogenol or placebo for every kilogram of body weight, daily, for one month, said study author Dr. Peter Rohdewald of the University of Munster, in Germany. Stress hormones were quantified from urine samples.

The researchers found Pycnogenol lowered stress hormones — adrenaline by 26.2 percent, and dopamine by 10.8 percent.

“The findings acknowledge that children with ADHD have dramatically elevated levels of stress hormones known to increase heart rate and blood pressure, causing excitement, arousal and irritability, as compared to children without ADHD symptoms,” Rohdewald said.

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Alzheimer’s Disease Could Be A Third Form Of Diabetes

From ScienceDaily

Insulin, it turns out, may be as important for the mind as it is for the body. Research in the last few years has raised the possibility that Alzheimer’s memory loss could be due to a novel third form of diabetes.

Now scientists at Northwestern University have discovered why brain insulin signaling — crucial for memory formation — would stop working in Alzheimer’s disease. They have shown that a toxic protein found in the brains of individuals with Alzheimer’s removes insulin receptors from nerve cells, rendering those neurons insulin resistant. (The protein, known to attack memory-forming synapses, is called an ADDL for “amyloid -derived diffusible ligand.”)

With other research showing that levels of brain insulin and its related receptors are lower in individuals with Alzheimer’s disease, the Northwestern study sheds light on the emerging idea of Alzheimer’s being a “type 3″ diabetes.

The new findings, published online by the FASEB Journal, could help researchers determine which aspects of existing drugs now used to treat diabetic patients may protect neurons from ADDLs and improve insulin signaling in individuals with Alzheimer’s.

In the brain, insulin and insulin receptors are vital to learning and memory. When insulin binds to a receptor at a synapse, it turns on a mechanism necessary for nerve cells to survive and memories to form. That Alzheimer’s disease may in part be caused by insulin resistance in the brain has scientists asking how that process gets initiated.

“We found the binding of ADDLs to synapses somehow prevents insulin receptors from accumulating at the synapses where they are needed,” said William L. Klein, professor of neurobiology and physiology in the Weinberg College of Arts and Sciences, who led the research team. “Instead, they are piling up where they are made, in the cell body, near the nucleus. Insulin cannot reach receptors there. This finding is the first molecular evidence as to why nerve cells should become insulin resistant in Alzheimer’s disease.”

ADDLS are small, soluble aggregated proteins. The clinical data strongly support a theory in which ADDLs accumulate at the beginning of Alzheimer’s disease and block memory function by a process predicted to be reversible.

In earlier research, Klein and colleagues found that ADDLs bind very specifically at synapses, initiating deterioration of synapse function and causing changes in synapse composition and shape. Now Klein and his team have shown that the molecules that make memories at synapses — insulin receptors — are being removed by ADDLs from the surface membrane of nerve cells.

“We think this is a major factor in the memory deficiencies caused by ADDLs in Alzheimer’s brains,” said Klein, a member of Northwestern’s Cognitive Neurology and Alzheimer’s Disease Center. “We’re dealing with a fundamental new connection between two fields, diabetes and Alzheimer’s disease, and the implication is for therapeutics. We want to find ways to make those insulin receptors themselves resistant to the impact of ADDLs. And that might not be so difficult.”

Using mature cultures of hippocampal neurons, Klein and his team studied synapses that have been implicated in learning and memory mechanisms. The extremely differentiated neurons can be investigated at the molecular level. The researchers studied the synapses and their insulin receptors before and after ADDLs were introduced.

They discovered the toxic protein causes a rapid and significant loss of insulin receptors from the surface of neurons specifically on dendrites to which ADDLs are bound. ADDL binding clearly damages the trafficking of the insulin receptors, preventing them from getting to the synapses. The researchers measured the neuronal response to insulin and found that it was greatly inhibited by ADDLs.

“In addition to finding that neurons with ADDL binding showed a virtual absence of insulin receptors on their dendrites, we also found that dendrites with an abundance of insulin receptors showed no ADDL binding,” said co-author Fernanda G. De Felice, a visiting scientist from Federal University of Rio de Janeiro who is working in Klein’s lab. “These factors suggest that insulin resistance in the brains of those with Alzheimer’s is a response to ADDLs.”

“With proper research and development the drug arsenal for type 2 diabetes, in which individuals become insulin resistant, may be translated to Alzheimer’s treatment,” said Klein. “I think such drugs could supercede currently available Alzheimer’s drugs.”

Klein, Grant A. Krafft, formerly at Northwestern University’s Feinberg School of Medicine and now chief scientific officer at Acumen Pharmaceuticals, Inc., and Caleb E. Finch, professor of biological sciences and gerontology at the University of Southern California, reported the discovery of ADDLs in 1998. Krafft is a co-author of the FASEB Journal paper. Northwestern and USC hold joint patents on the composition and use of ADDLs in neurodisorders.

The patent rights have been licensed to Acumen Pharmaceuticals, based in South San Francisco, for the development of drugs that treat Alzheimer’s disease and other memory-related disorders.

In addition to Klein, De Felice and Krafft, other authors on the paper are Wei-Qin Zhao, a former visiting scientist at Northwestern, now with Merck & Co., Inc. (lead author); Hui Chen, from the National Center for Complementary and Alternative Medicine at the National Institutes of Health; Michael Quo, from Blanchette Rockefeller Neurosciences Institute; and Sara Fernandez and Mary Lambert, from Northwestern University.

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Authorities divided over popcorn lung regulations

A proposed bill that calls for emergency regulatory actionto protect workers from diacetyl, a chemical linked to lung disease, has met with resistance from the Bush administrationFrom FoodNavigator.com

The bill, submitted to the House of Representatives,would require the Occupational Safety and Health Administration (OSHA) to take immediate action in protecting workers from diacetyl, used in butter flavorings for popcorn and snacks, by limiting how it is used in factories.Manufacturers and regulators haveso far been careful in their approach to dealing withthe diacetyl food scare, treading a fine line between protecting workers’health, and making overly-cautious changes to operations that could later prove to be unnecessary and expensive.

Senator Lynn Woolsey, who sponsored the bill, said that it was a “travesty” that the OSHA had not taken definite action earlier.

“While OSHA is dragging is feet over the numerous reports of workers who have died or suffered serious lung disease from exposure to diacetyl, this new case raises concerns that consumers may be at risk as well,” she said.

Her bill would force the OSHA to limit worker exposure to diacetyl over an interim period of two years, during which time permanent regulations would be put in place.

However, the Bush administration said that it would be premature to force through the bill, Reuters reported yesterday.

According to the press agency, the White House said it wants to protect workers, but regulators need more time to figure out the causes of the disease, how much exposure is hazardous, and what control measures should indeed be put in place.

“We need a science-based solution, not a hasty legislative quick-fix,” said Republican senator Mike Enzi.

OSHA said yesterday that it is doing all it can to research the link between diacetyl and popcorn lung at this time, and that will propose regulatory changes once it is confident of knowing all the facts.

“Our open, transparent regulatory process will seek information and guidance from all stakeholders to gather the best information on the health effects of exposure to diacetyl,” said OSHA’s secretary of labor Edwin Foulke Jr. “That information will allow us to institute effective protections for workers.”The bill is expected to come to vote later today.

The bill is expected to come to vote later today.Industry fears over the use of diacetyl were initially raised after researchers from the Netherlands linked the industrial use of the additive, often used in flavorings for snacks, sweets and frozen foods, with the debilitating lung disease bronchiolitis obliterans syndrome (BOS), an incurable disease that causes thickening and scarring of the lungs.

The research team examined a population of workers at an unnamed chemical plant that produced diacetyl, and found a cluster of previously undiagnosed BOS cases.

While the researchers said they were unable to rule out contributions of other chemicals to the development of BOS, the study significantly narrows the field of suspects to diacetyl, and the components and byproducts of its manufacturing process.

Last month, fears were heightened further when a doctor in Denver reported that the disease may also affect consumers, after a man seemingly developed the disease after microwaving popcorn several times a day for years.

Several food companies, including popcorn giants ConAgra and PopWeaver, have now removed diacetyl from popcorn flavorings, and Flavor and Extract Manufacturers Association (FEMA) recommends that all manufacturers should do the same.

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One Doctor’s Lonely Quest To Heal Brain Injury

From WallStreet JournalAs a young researcher in the 1960s, Donald G. Stein drilled through the skulls of anesthetized rats and vacuumed out sections of their brains to see the effect on their behavior. But he quickly became fascinated by something outside the scope of the research: Why did some female rats promptly recover from their injuries, while males remained impaired?

His supervisors told him the difference was inconsequential and urged him to move on to more important topics. But over his 40-year career as a brain researcher and university administrator, he never let go of the question.

Decades of research — often conducted in his spare time and with piecemeal funding — led him to a surprising hypothesis: that progesterone, a natural female hormone that protects fetuses in the womb, may actually protect and heal injured brains. His work slowly helped overturn medical orthodoxy that states that brain tissue, once injured, stays that way. Now he and colleagues plan a large-scale human trial over the next several years. While the outcome is far from assured, the effort could produce a new treatment for the estimated 10 million people world-wide who suffer traumatic brain injuries each year.

Dr. Stein’s journey shows just how difficult it is to challenge the medical establishment, which often begrudges ideas outside the mainstream. It also underscores how difficult it is for a lone researcher to persevere without drug-company or other major financial support: For many years, Dr. Stein held administrative jobs and had to moonlight to continue his research. Drug companies tend to focus more on blockbuster drugs they design than on naturally occurring ones with minimal profit potential.

“This is probably the most promising breakthrough in improving outcomes for traumatic brain injury,” says Gregory O’Shanick, national medical director of the Brain Injury Association of America, which advocates for families of people disabled from brain injury. He first heard Dr. Stein present his findings at an international medical meeting in 1992. “It’s absolutely astonishing that it’s taken this long,” he says.

Dr. Stein, an energetic and wise-cracking 68-year-old researcher at Emory University, was the only member of his family to take up a career in science. “If you grow up in a tenement in the Bronx,” Dr. Stein says, “the last thing you want is to work with rats.”

As an undergraduate at Michigan State University in the early 1960s, he helped pay some of his school costs by working in a state mental hospital and the psychiatric ward of a veterans’ hospital.

He grew appalled by the ineffective treatments of the day, such as blasting hopelessly psychotic patients with water from a high-pressure hose to shock them out of their condition and wrapping them in wet bedsheets. Some of these patients had been given lobotomies, an operation that mimics a form of brain injury. The therapies “seemed medieval to me and I was convinced there had to be a better way,” he says.

A few years later, as a doctoral candidate at the University of Oregon in 1964, he stumbled onto what would turn out to be his life’s work. His job was to surgically injure rats’ brains to help determine which parts control memory and consciousness. But he was struck by an anomaly: Why was it that about 30% of the injured rats didn’t act impaired at all?

Medicine’s prevailing view held that injured brain tissue would never heal, so his professors found his data of little interest. “I was told, ‘Don’t waste your time on that. Stick to your topic.’” They explained the differences as “natural variation,” he said. But he was skeptical.

Dr. Stein took the question with him later that year to the Massachusetts Institute of Technology, where he embarked on a prestigious postdoctoral fellowship. His supervisor, Steven Chorover, and others at MIT urged him to stick with the memory work. “The work he wanted to pursue was not something we were working on,” recalls Dr. Chorover.

Dr. Stein still wanted to figure out why those brain-injured rats seemed to recover. But he says he concluded that he wouldn’t win tenure if he pursued the question.

In 1966, with a wife and young child to support, he left MIT to take a job as a psychology professor and director of the brain-research lab at Clark University in Worcester, Mass.

His growing interest in the possibility of recovery from brain injury put him in a tiny minority. Most neurologists at the time still agreed with Nobel laureate Santiago Ramn y Cajal, who wrote in 1913, “In the adult brain, nervous pathways are fixed and immutable. Everything may die, nothing may be regenerated.”

Starting in the late 1960s, Dr. Stein began publishing research that suggested the Nobel winner was wrong.

His lab began methodically studying precisely why some rats stayed smart despite injury. The researchers would place rats in a large vat of water. The rats had to swim to reach a safe platform in a test called a “water maze.” Then the scientists surgically damaged the animals’ brains to study what happened after injury: Would they still be able to maneuver through the maze? The rats that recovered quickly were all female, although not all of the females recovered.

Dr. Stein considered whether the explanation might be something complex, like molecular or genetic differences between males and females. But investigating that would take much more time and money than seeing if a female hormone might yield some clues. First his team evaluated estrogen, but didn’t find a major correlation. Then they tried progesterone — a female hormone that helps protect fetuses from injury during pregnancy.

In these early experiments, Dr. Stein tested female rats to see if they would recover better or worse at different times during their hormonal cycles that resemble human menstruation. Progesterone levels rise and fall during these cycles, and these early studies did indeed show that female rats that were high in progesterone recovered faster.

Dr. Stein thought he had a big part of the answer to the question that had been vexing him for years. The medical establishment, however, largely shrugged off the results.

A naturally occurring hormone like progesterone, some forms of which have been available generically for infertility, is of little interest to drug makers. That’s because the substance probably can’t gain secure patent protection. That shut off a major avenue of potential funding for his research. “Big pharma likes more of an airtight protection,” says Todd Scherer, director of the Office of Technology Transfer at Emory, Dr. Stein’s current academic home.

Caroline Loew, senior vice president for science and regulatory affairs at Pharmaceutical Research and Manufacturers of America, the main drug-industry trade group, says drug companies need patent protection for their research investments. But she suggested the situation could benefit from a government action along the lines of the federal Orphan Drug Act, which increased financial incentives for companies researching rare diseases. A similar idea “may apply to this case,” she says.

Dr. Stein was turned down for half a dozen or more grants from the National Institutes of Health during the 1970s and 1980s. Zaven S. Khachaturian, a leading scientist and former NIH official, says his ideas were “really creative but the NIH system never gave them the good scores they deserved.” At one point, he says, “I just told Don Stein that sometimes it doesn’t pay to keep hitting your head against the wall,” Dr. Khachaturian says.

Dr. Stein recalls feeling “shaken” by the denials, while at the same time growing more determined to prove his case. He kept up a steady drumbeat of research, published in a wide range of journals such as Science, Brain Research, Experimental Neurology and others.

During his time at Clark, Dr. Stein was given to jeans, long hair and shooting his mouth off in faculty meetings or challenging guest speakers, even eminent ones. “Eyebrows would go up whenever Don’s hand would go up,” recalls Julio Ramirez, a former student, now a professor of neuroscience at Davidson College.

But Dr. Stein also was developing into a powerful speaker himself. One speech in Copenhagen in the late 1980s ended up offering a lifeline for his research.

Diane Bistany, then a senior officer at reinsurance company General Re Corp., heard the talk and was impressed. Dr. Stein spoke for 40 minutes without notes, pacing the stage as he made an impassioned argument for the notion that progesterone could be crucial to recovery for thousands of people with traumatic brain injury.

There are five million patients in the U.S. alone disabled from brain injury. “Not only was it his knowledge, but he had a passion for his research and conveyed that this research was going to get somewhere and mean something,” Ms. Bistany says. Gen Re soon contributed grants of $50,000 a year for eight years, keeping his research going.

Around the same time, Dr. Stein grew frustrated at Clark, which was emphasizing clinical psychology and less so the research he preferred. He applied for various positions at other universities, but his ideas, while intriguing enough to win him speaking invitations, still seemed too far out of the mainstream to win him a pure research job.

Finally, in 1988, he landed an administrative position, as dean of the graduate school and associate provost for research at Rutgers University in Newark, N.J. He would work as dean until about 4 p.m., then return to the lab for several hours of work in the evening along with his research team.

Their work progressed step by step. First, did progesterone lower swelling in the brain? If so, did it matter if the animals were females? What did estrogen do, if anything? When did the progesterone have to be given? At what dose? Did progesterone affect animals’ memories?

He found that female rats with much higher, pregnancy-level amounts of progesterone did far better than other rats in following mazes. Even male rats also recovered far better from injury when given the hormone, performing just as well as the highest-performing females. The stuff worked when given up to 24 hours after injury.

Then, in one crucial experiment in 1991, his team tested the amount of cerebral edema, or brain swelling, in brain-injured rats with high progesterone levels versus others with none. Edema is important because of its role in causing brain damage to proliferate.

Robin L. Roof, then a postdoctoral fellow in Dr. Stein’s lab, was waiting for the results while vacationing in a Michigan cottage. When a colleague left a message that there was “no difference,” she thought the experiment had failed. But it turned out the colleague meant that progesterone-protected, injured rats did just as well as rats with no injury at all. Immediately, says Dr. Roof, now a researcher at Pfizer Inc., she realized “this was career-changing research.”

Still, why would a hormone that rises and falls with menstrual cycles and enables fertility, protect the brain? Unlike estrogen, progesterone doesn’t produce visible female sex characteristics. It is present in men at low levels. It rises sharply during pregnancy and helps protect the fetus. Through multiple studies, Dr. Stein and colleagues concluded that it protects the brain in similar fashion.

In 1995, Dr. Stein joined Emory as dean of the graduate school and vice provost. University administrators neglected to provide him lab space, thinking his brain-injury research was little more than a hobby. So for six years his team worked in a moldy double-wide trailer between a parking lot and an industrial-size trash bin. To complete the picture, they installed plastic flamingos in front.

But meanwhile NIH began to back his progesterone research, and the Centers for Disease Control and Prevention also began giving him grants. His studies continued to show positive findings with progesterone, and scientists elsewhere began to confirm them. Often, such confirming studies get done because other scientists start out skeptical.

Dr. Robert Vink, chairman of neurosurgical research at the University of Adelaide in Australia, was among the skeptics, but he grew intrigued by Dr. Stein’s work. Dr. Vink has confirmed that progesterone is beneficial in brain-injured animals in numerous ways, such as lowering brain swelling and cell death, and improving animals’ cognitive abilities. He says Dr. Stein is “persevering. He’s got data, 10 or 12 years now, showing that progesterone in animals is neuroprotective. There’s no doubt about it.”

Still, others remain on the fence. David A. Hovda, a prominent University of California, Los Angeles, neurosurgery professor, says he is still unconvinced that progesterone will prove to be an effective human treatment. But he says he admires Dr. Stein’s work. “Don Stein has a history of stirring the pot,” he says.

In the past decade, Dr. Stein says he and his team have repeatedly run into walls when trying to discern the cellular and molecular mechanism through which progesterone works. But at other times, they did have success on this “cellular pathway” research, and now are finding that there are at least three or four such mechanisms.

By 2000, the findings of Dr. Stein and other brain scientists were swaying the textbooks. One leading neurology tome, “Principles of Neuroscience,” said in its 2000 edition that functions such as thought, language and memory “are all made possible by the serial and parallel interlinkages of several brain regions, each with specific functions. As a result, damage to a single area need not result in the loss of an entire faculty as many earlier neurologists predicted.”

Still, as a practical matter, this was just nifty rat science. Dr. Stein’s hypotheses wouldn’t really matter until they were borne out in humans.

After hearing Dr. Stein lecture a decade ago, Arthur Kellermann, then Emory’s chief of emergency medicine, resolved to get human studies going. He introduced Dr. Stein to David Wright, a young Emory emergency doctor with research ambitions. Drs. Wright and Kellermann wrote an NIH grant application in 1999 for the first phase of human study. Two years later, the federal agency approved a grant of $2.2 million for the first stage of human research.

Over the next three years, the study focused on 100 head-injured patients who had been brought into the emergency room at Grady Memorial Hospital in downtown Atlanta. Some patients received standard treatment to control bleeding and fevers along with state-of-the-art head-injury treatment. Others were also given intravenous progesterone, at triple the highest natural levels at the end of pregnancy.

One Saturday morning in 2005, Dr. Stein was driving north of Atlanta on a shopping trip with his wife when a stern-sounding Dr. Kellermann called him. Dr. Kellermann said he had just learned the study’s findings, adding, “Pull over to the side of the road.”

Dr. Stein froze, fearing that decades of research with animals would prove useless, that progesterone might have turned out to raise the death rate in humans for some unforeseen reason.

His heart was thumping as Dr. Kellermann told him the results: Patients on progesterone had a death rate of just 13% from their head injuries, less than half the 30% death rate of those on standard treatment. And progesterone showed no negative side effects. The 100-subject study was too small to prove that progesterone caused the lowered death rate, but the findings were consistent with animal research. Don Stein was so elated that he had to ask his wife to take over the driving.

In the respected journal “Annals of Emergency Medicine” this past April, Dr. Stein and his researchers summarized the study: “Moderate traumatic brain injury survivors who received progesterone were more likely to have a moderate to good outcome than those randomized to placebo.”

The story is still far from over. Before progesterone can be approved as a treatment, Dr. Stein’s findings must be proved in a larger study of humans. But as he and his team have persisted in research, he has himself become the mainstream of neuroscience. His animal research now has been replicated in dozens of studies at numerous research institutions.

Dr. Stein and his Emory team have applied for NIH funds to do a 1,000-patient study, which will give the definitive word. The NIH already has given an initial $229,000 grant to plan the study, but Emory hasn’t yet officially applied for the full grant. Such a trial could take five years or more. Meanwhile, Emory’s technology-transfer office is “optimistic” about developing and marketing progesterone as a treatment for brain injury, says Dr. Scherer, director of that office.

For Dr. Stein, the results of the clinical study in emergency head-trauma patients were further reason for enthusiasm — “a tremendous culmination,” as he puts it.

“Most bench scientists work for years to discover a truth about nature,” he says. “Very few of us ever get to have a major impact on people’s lives. How can you not be excited?”

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Dietary Lutein and Zeaxanthin Protect Eyes from Wet-Type Macular Degeneration

From MedPage Today

Risk of developing the neovascular or “wet” type of age-related macular degeneration is significantly reduced in patients with diets rich in lutein and zeaxanthin, investigators found.

Among more than 4,500 adults ages 60 to 80, those with diets highest in the cartenoids lutein and zeaxanthin had a 35% lower risk compared with patients who consumed little of the nutrients, reported Traci E. Clemons, Ph.D., of the Emmes Corporation here, and colleagues, in the September issue of the Archives of Ophthalmology.

Their multi-center Age-Related Eye Disease Study research group also found that diets high in lutein and zeaxanthin — found in eggs, leafy greens, and cruciferous vegetables such as broccoli — were associated with a 55% reduction in risk of geographic atrophy.

The group also saw an association for a 27% drop in risk for large or extensive intermediate drusen, the lesions seen with age-related macular degeneration.

There were no clear associations, however, between risk of macular degeneration and the other nutrients studied, including retinol, alpha tocopherol (vitamin E), or vitamin C.

“If these cross-sectional results can be confirmed in prospective samples and experimental studies, lutein and zeaxanthin may be considered as useful agents in food or supplement-based interventions designed to reduce the risk of [age-related macular degeneration],” they wrote.

The report, the group’s 22nd, focused on the relationship between the various nutrients and neovascular age-related macular degeneration risk in the study cohort, which consisted of 4,519 adults who ranged in age from 60 to 80 at enrollment.

The researchers used color fundus photographs to categorize the participants according to severity of macular degeneration, as follows:

Group 1 (1,115 patients) had fewer than 15 small drusen and served as referent controls.

Group 2 (1,060 patients) had at least one eye with one or more intermediate drusen (63 m-124 m), extensive small drusen (cumulative area at least 1/12 diameter of AREDS standard disc area), or pigment abnormalities associated with age-related macular degeneration.

Group 3 (1,568 patients) had at least one eye with one or more large drusen (125 m or larger) or extensive intermediate drusen (soft, indistinct drusen present in a cumulative area equivalent to that occupied by 20 drusen each having a diameter of 100 m or 65 distinct drusen each having a diameter of 100 m).

Group 4 (118 patients) had at least one eye with definite geographic atrophy anywhere within 3000 mm of the fovea.

Group 5 (658 patients) had evidence suggesting choroidal neovascularization retinal pigment epithelial cell detachment in one eye (non-drusenoid retinal pigment epithelial detachment, serous sensory or hemorrhagic retinal detachment, subretinal hemorrhage, subretinal pigment epithelial hemorrhage, subretinal fibrosis) or scars of photocoagulation for macular degeneration.

The investigators estimated the patients’ nutrient intake from their responses to a self-administered semi-quantitative food frequency questionnaire at enrollment. The intake values, including nutrients from vitamins and dietary supplements, were energy adjusted and classified by quintiles. The authors also created logistic regression models to explore the relationship between diet and macular degeneration.

They found that in an analysis adjusted for total energy intake and non-nutrient-based risk factors, there was an inverse association between dietary intake of lutein/zeaxanthin and neovascular age-related macular degeneration, with an odds ratio for patients in the highest versus lowest quintiles of 0.65 (95% confidence interval, 0.45 to 0.93).

The patients with the highest intake of the two carotenoids also had a lower risk for geographic atrophy (odds ratio 0.45, 95% CI, 0.24 to 0.86), and for large or extensive intermediate drusen (odds ratio 0.73; 95% CI, 0.56 to 0.96), again comparing the highest with the lowest quintiles of intake.

“There is biologic plausibility to our findings because lutein and zeaxanthin are the major diet-based macular carotenoids,” the investigators wrote. “These compounds may affect processes modulating light or oxidant exposure. Lutein and zeaxanthin have the capacity to filter short-wavelength light associated both with photochemical damage and the generation of reactive oxygen species that attack cellular lipids, proteins, and nuclear material; these carotenoids also have the capacity to reduce the potency of nascent reactive oxygen species.”

The authors noted that the results could have been confounded by the case-control sampling design of the study and by recall bias of food intake on the part of study participants.

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