Table 7.

Nutrition and cataract (observational studies and case-control studies).

References	Study design	Endpoint	Study period	Subjects (age, sex, number…)	Method	Results	Strength of evidence
Christen et al. (96)	Observational study	to examine whether higher fruit and vegetable intake reduces the risk of cataract and cataract extraction in a large, prospective cohort of women.	8 years of medium follow up	39,876 apparently healthy female health professionals aged ≥45 y	Fruit and vegetable intake was assessed at baseline with the use of a validated, semiquantitative food-frequency questionnaire. A total of 35 724 of these women were free of a diagnosis of cataract at baseline and were followed for incident cataract and cataract extraction.	During an average of 10 y of follow-up, 2,067 cataracts and 1,315 cataract extractions were confirmed. Compared with women in the lowest quintile of fruit and vegetable intake, women with higher intakes had modest 10–15% reduced risks of cataract (P for trend < 0.05).	Moderate
Jacques et al. (97)	Observational study	To assess the relation between usual nutrient intake and subsequently diagnosed age-related nuclear lens opacities	15 years	Four 478 non-diabetic women aged 53–73 years without previously diagnosed cataracts sampled from the Nurses' Health Study cohort	Usual nutrient intake was calculated as the average intake from 5 food frequency questionnaires that were collected during a 13- to 15-year period before the evaluation of lens opacities. The duration of vitamin supplement use was determined from 7 questionnaires collected during this same period	vitamin C intake remained significantly associated (P = 0.003 for trend) with the prevalence of nuclear opacities. The prevalence of nuclear opacities was significantly lower (P < 0.001) in the highest vitamin C intake quintile category relative to the lowest quintile category (odds ratio, 0.31; 95% confidence interval, 0.16–0.58). There were also statistically significant trends of decreasing prevalence of nuclear opacities with increasing duration of use of vitamin C (P = 0.004 for trend).	MODERATE
Delcourt et al. (84)	Observational study	To assess the associations of plasma lutein and zeaxanthin and other carotenoids with the risk of age-related maculopathy (ARM) and cataract in the population-based Pathologies Oculaires Liées à l'Age (POLA) Study	–	2,584 participants, age over 60 years	Cataract classification was based on a direct standardized lens examination at the slit lamp, according to Lens Opacities Classification System III. Plasma carotenoids were measured by high-performance liquid chromatography (HPLC), in 899 subjects of the cohort.	After multivariate adjustment, the highest quintile of plasma zeaxanthin was significantly associated with reduced risk of nuclear cataract (OR = 0.23; 95% CI: 0.08–0.68; P for trend = 0.003) and any cataract (OR = 0.53; 95% CI: 0.31–0.89; P for trend = 0.01). Among other carotenoids, only β-carotene showed a significant negative association with nuclear cataract.	Moderate
Moeller et al. (98)	Observational study	to evaluate associations between nuclear cataract (determined from slitlamp photographs between May 2001 and January 2004) and lutein and zeaxanthin in the diet and serum	–	total of 1,802 women aged 50 to 79 years with intakes of lutein and zeaxanthin above the 78th (high) and below the 28th (low) percentiles in the Women's Health Initiative Observational Study (1994–1998) were recruited 4 to 7 years later (2001–2004) into the Carotenoids in Age-Related Eye Disease Study.	Serum samples were obtained from participants at WHI baseline examinations (1994–1998) after a ≥ 10-h fast and were stored at −80 degrees centigrade 0.29 Serum levels of lutein, zeaxanthin, and tocopherols were determined at Tufts University (2004–2005) by a reverse phase HPLC analysis. Measurements were made using a standardized protocol by the psychophysical method of heterochromatic flicker photometry (HFP) during CAREDS study visits conducted from 2001 to 2004. This protocol, described in detail previously, 20, 33 had high test-retest reliability (r = 0.9) and participant response. T-tests, ANCOVA, and Chi-Square tests were performed to assess the statistical significance of potential covariates	Women in the group with high dietary levels of lutein and zeaxanthin had a 23% lower prevalence of nuclear cataract (age-adjusted odds ratio, 0.77; 95% confidence interval, 0.62–0.96) compared with those with low levels.). Women in the highest quintile category of diet or serum levels of lutein and zeaxanthin as compared with those in the lowest quintile category were 32% less likely to have nuclear cataract (multivariable-adjusted odds ratio, 0.68; 95% confidence interval, 0.48–0.97; P for trend = 0.04; and multivariable-adjusted odds ratio, 0.68; 95% confidence interval, 0.47–0.98; P for trend = 0.01, respectively).	Moderate
Pastor-Valero et al. (99)	Case-control study	To Investigate the association of antioxidant vitamins and minerals and risk of cataract in a Mediterranean population	-	Cases with cataract (343) and 334 age/sex frequency-matched controls aged 55 to 74 y were selected from an ophthalmic outreach clinic	Participants were interviewed about their diet using a Food Frequency Questionnaire, and other information on potential confounders, such as smoking, alcohol, and education. Blood samples were analyzed by a colorimetric method for vitamin C and by reversed-phase HLPC for other blood antioxidants	Blood levels of vitamin C above 49 micromol/L were associated with a 64% reduced odds for cataract (P < 0.0001). Dietary intake of vitamins C, E and selenium were marginally associated with decreased odds (P = 0.09, P = 0.09, P = 0.07, respectively), whereas moderately high levels of blood lycopene (>0.30 micromol/L) were associated with a 46% increased odds of cataract (P = 0.04). results strengthen the evidence for a protective role for vitamin C on the aging lens as this effect was seen in a population characterized by high vitamin C intakes	Moderate
Ghanavati et al. (100)	case-control study	To evaluate and compare healthy eating index among the patients with cataract and healthy individual	–	97 patients with cataract and 198 healthy people (as a control group)	Individuals were selected by the convenience sampling method and the food frequency questionnaire (FFQ) was completed for them. At first, HEI was calculated and then the HEI scores were compared in cataract patients and healthy individuals.	The analysis of FFQ showed that the scores of vegetables (7.81 vs. 10), nutritional variation (5.5 vs. 7) and sodium (2 vs. 6) groups (P < 0.001) were significantly lower among the patients with cataract than the healthy individuals. Also this significant difference was observed in the scores of total HEI and fruits (respectively 73.26 vs.79.30 and 7.1 vs. 9.8) (P < 0.01). On the other hand, the scores of saturated fatty acids (10 vs. 9; P = 0.02), total fat (8 vs. 7; P = 0.004) and cereals (10 vs. 10; P < 0.001) were higher among the patients with cataract than the healthy individuals. In addition, after adjusting the confounding factors the results showed that the HEI high score was associated with reducing the risk of coming down with cataract (OR = 0.18, CI: 95%, P < 0.001, 0.08–0.41).	Moderate
Sedaghat et al. (101)	case-control study	To assess the relation between nutrient patterns and cataract risk	–	97 cataract patients and 198 matched controls.	Dietary consumption was collected through a valid food frequency questionnaire (FFQ). Nutrient patterns were detected by applying factor analysis. Unconditional logistic regression models were used to estimate odds ratio (ORs) and 95%Cis. They identified 5 main nutrient patterns: -Pattern 1: included niacin, thiamin, carbohydrates, protein, zinc, vitamin B6 and sodium (sodium pattern) -Pattern 2: characterized by oleic acid, monounsaturated fats, polyunsaturated fats, linoleic acid, trans fatty acid, linolenic acid, vitamin E and saturated fats (fatty acid pattern). -Pattern 3: factor represented high intake of vitamin B12, vitamin D, cholesterol and calcium (mixed pattern) -Pattern 4: high in intake of beta and alpha carotene, vitamin A and vitamin C (antioxidant pattern). - Pattern 5: pattern loaded heavily on docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) (omega-3 pattern)	In crude and multivariate analysis, the sodium pattern was associated with increased risk of cataract (OR = 1.97, 95%CI: 1.09–3.96). The fatty acid pattern elevated the risk of cataract (OR = 1.94, 95%CI: 1.1–3.86). Antioxidant pattern was associated with a significant 79% reduced risk (2nd category compared with the 1st). Omega-3 pattern was significantly negatively associated with risk of cataract (P = 0.04).	Moderate
Minassian et al. (102)	case-control study	To investigate the association between cataract and clinical manifestations concearning hydratation	24 months	1,364 patients, 881 males, 483 females. Divided in cataract and non-cataract group depending on ophthalmic diagnosis	All patients aged 30 to 69 attending the eye unit during the study period were systematically tested and examined to assess visual acuity and central lens opacities. Generalities and antropometry were assessed. All patient underwent an interview about past risk factor and past diseases concearning hydratation.	The results strongly confirm the findings from the first study and indicate thatan estimated 38% of blinding cataract may be attributable to repeated de-hydrational crises resulting from severe life threatening diarrhoeal disease and/or heatstroke. The risk of blinding cataract was strongly related to level of exposure to de-hydrational crises in a consistent and dose-dependent manner, thus indicating a causal association.	Moderate