In the news: Leafy Greens & Fish in Early AMD; Findings on Omega-3s & Bleeding

Eating Fish, Leafy Greens in Early Stages of AMD May Slow Progress to Severe Stages

Researchers from Harvard Medical School and University of Massachusetts Chan Medical School explored which nutritional factors might be important in the transition from early and intermediate AMD to more severe stages of the disease(1).

The investigators were motivated to explore this topic because transformations between different stages of AMD severity are not completely captured by traditional models with an endpoint of advanced AMD.

The findings, presented at the 2024 ARVO Annual Meeting in May, suggest that making healthy choices and consuming key nutrients in the early stages of AMD should be emphasized to delay progression to advanced stages.

The investigators used a 12-step severity scale to classify non-advanced eyes from AREDS participants. Eyes at baseline with early or intermediate AMD (severity scale 2-4 and scale 5-8 respectively) were included and monitored for progression to higher severity groups over a 5-year period.

Data from food frequency questionnaires were ranked into sex-specific 20% increments (quintiles) of servings per week for food and calorie-adjusted daily intake for nutrients.

Hazard ratios were adjusted for numerous factors such as age, sex, race, education, smoking status, caloric intake, multi-vitamin use; family history of AMD and genetic risk score (based on 12 genetic variants).

In the diet-only model, consuming green leafy vegetables (1.4 cups per week vs. none) resulted in a 25% reduction in progression risk (p=0.02), while eating fish (two 4oz. servings weekly vs. less than 2 servings), reduced risk by 21% (p=0.01).

In the nutrient-only model, lutein and zeaxanthin (2 mg/day vs. less than 2 mg) showed a 24% reduction in risk for progressing to a higher severity (p=0.02), while omega 3 intake (greater than 0.1 g daily vs. less) produced a 15% reduction.

The authors concluded that “It is important to emphasize healthy dietary choices and nutrient intake during the earlier transition stages of AMD to delay disease progression and advanced stages”.

Meta-Analysis Doesn’t Support Concerns of Increased Bleeding with fish oil Omega 3s.

The findings of a meta-analysis recently published in JAMA(2) do not support concerns that fish oil supplements may increase the risk of bleeding. The meta-analysis, which pooled data from 11 randomized controlled trials including over 120,500 patients, did not find an increased risk of bleeding, including fatal and central nervous system events. These findings are consistent with those of a 2017 systematic review on the topic.

The authors did note an increased relative risk only for those taking high-dose purified EPA (icosapent ethyl prescription medications such as Vascepa – a modified version of EPA found in fish oil). However, they indicated that the risk was very modest and the clinical significance of this finding “debatable”.

No overall increase in the risk of bleeding from omega 3 supplementation was found. Further, there was no difference in the incidence of serious bleeding (hemorrhagic stroke, intracranial bleeding events) among patients who did or did not receive omega‐3 PUFAs.

References

1. De D, Rosner B and Seddon JM. The role of nutritional factors in transitioning between early, mid and late stages of age-related macular degeneration. Invest Ophthalmol Vis Sci. 65((7):1348. ARVO Annual Meeting Abstract. June 2024
2. Javaid M, et al. Bleeding risk in patients receiving omega-3 polyunsaturated fatty acids: A systematic review and meta-analysis of randomized clinical trials. J Am Heart Assoc. 13::e032390, 2024.