In the news: AHA Advocates Diet Screening, Counseling. Vitamin B3 Shows Promise in Glaucoma

AHA: Routine Checkups Should Include Dietary Screening

A new scientific statement from the American Heart Association (AHA), recommends that a rapid diet-screening tool be incorporated into routine checkups(1).

“It is critical that diet quality be assessed and discussed at the point of care with clinicians and other members of the healthcare team to reduce the incidence and improve the management of diet-related chronic disease, especially cardiovascular disease,” the authors of the statement wrote.

The statement can be read online, open access: https://www.ahajournals.org/doi/10.1161/HCQ.0000000000000094.

According to the authors, poor dietary quality has ‘surpassed all other mortality risk factors, accounting for 11 million deaths and about 50% of cardiovascular deaths globally.”

Dietary screening or counseling is not usually part of routine medical visits. But the widespread use of electronic health records offers an unmet opportunity to provide evidence-based clinician-delivered dietary guidance using rapid diet screener tools.

The paper reviewed 15 such tools, pointing out their strengths and weaknesses. Three of them met the most “theoretical and practice-based criteria” for an optimal diet screening tool: the Mediterranean Screener (and variations), Rapid Eating Assessment for Participants (modified and shortened version) and Starting the Conversation Tool (modified version).

Flexibility is key, with the authors suggesting that clinicians discuss which tool would work best in their unique clinical workplace, and how it should be administered and by whom. These rapid diet screener tools can be used not just in primary care settings, but in relevant specialty care prevention settings as well.

Vitamin B3

Nicotinamide (aka niacinamide) is one of four major precursors of nicotinamide adenine dinucleotide or NAD+, the active form of vitamin B3. NAD+ is a critical co-enzyme in multiple metabolic processes and is key for mitochondrial health. Recent work suggests that serum levels of NAD+ are low in glaucoma patients, and nicotinamide has been shown to prevent age-related declines in NAD+.

Retinal ganglion cells endure significant metabolic stress in glaucoma but maintain the capacity to recover function. In preclinical models, nicotinamide supplementation has been shown to protect retinal ganglion cells. However, the potential of nicotin-amide in human glaucoma is unknown.

Recently, a double-blind, crossover, RCT led by the Center for Eye Research Australia, examined the effects of supplemental nicotinamide in 57 glaucoma patients(2).

In addition to their regular IOP-lowering treatments, participants received 6 weeks of 1.5 g/day of nicotinamide, then 6 weeks of 3.0 g/day followed by crossover. Visual function was measured using electroretinography, and perimetry. Participants were seen at baseline and during 6 weekly visits, where visual acuity, IOP and blood pressure were also measured, and a slit lamp exam administered.

PhNR Vmax improved in 23% of participants following nicotinamide vs 9% on placebo. Overall, Vmax improved by 14.8% on nicotinamide and 5.2% on placebo. Vmax ratio improved by 12.6% (P = .002) following nicotinamide; 3.6% on placebo. A trend for improved visual field mean deviation was observed with 27% improving ≥1 dB on nicotinamide and fewer deteriorating (4%) vs. placebo (P = .02).

The authors conclude that nicotinamide improved inner retinal function in glaucoma and indicate that further studies will elucidate the effects of long‐term supplementation.

References

1. Vadiveloo M, et al. Rapid Diet Assessment Screening Tools for Cardiovascular Disease Risk Reduction Across Healthcare Settings: A Scientific Statement from the American Heart Association. Circulation.Epub Aug, 2020.
2. Hui F, et al. Improvement in inner retinal function in glaucoma with nicotinamide supplementation: A cross-over randomized clinical trial. Clin Exp Ophthalmol. Epub July, 2020.