Background/objectives To assess the long-term association between low-carbohydrate dietary patterns and incident primary open-angle glaucoma (POAG), and POAG subtypes defined by highest untreated intraocular pressure (IOP) and by pattern of visual field (VF) loss at diagnosis. Subjects/methods We followed 185,638 participants of three large US prospective cohorts biennially (1976–2016, 1986–2016 and 1991–2017). Deciles of three low-carbohydrate-diet scores were calculated to represent adherence to diets lower in carbohydrate and higher in protein and fat from any source, animal sources or plant sources. We confirmed POAG cases ( n = 2112) by medical record review and used Cox proportional hazards models to estimate multivariable-adjusted relative risks (MVRRs) and 95% confidence intervals (CIs). Results There was no association between the three types of low-carbohydrate-diet scores and POAG: the MVRR for POAG in the highest vs. lowest deciles was 1.13 (95% CI, 0.91–1.39; P trend = 0.40) for the overall score; 1.10 (95% CI, 0.89–1.35; P trend = 0.38) for the animal score and 0.96 (95% CI, 0.79–1.18; P trend = 0.88) for the vegetable score. No differential associations by IOP level was found ( P heterogeneity ≥ 0.06). However, the vegetable score showed a suggestive inverse association with early paracentral VF loss (highest vs. lowest decile MVRR = 0.78 [95% CI, 0.55–1.10]; P trend = 0.12) but not with peripheral VF loss only (MVRR = 1.09 [95% CI, 0.83–1.44]; P trend = 0.14; P heterogeneity = 0.03). Conclusions Low-carbohydrate diets were not associated with risk of POAG. Our data suggested that higher consumption of fat and protein from vegetable sources substituting for carbohydrates was associated with lower risk of the POAG subtype with initial paracentral VF loss.

中文翻译：

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低碳水化合物饮食评分和原发性开角型青光眼的风险：来自三个美国队列的数据


背景/目标 评估低碳水化合物饮食模式与原发性开角型青光眼 (POAG) 之间的长期关联，以及根据未经治疗的最高眼压 (IOP) 和视野 (VF) 丧失模式定义的 POAG 亚型诊断。对象/方法 我们每两年（1976-2016、1986-2016 和 1991-2017）对美国三个大型前瞻性队列的 185,638 名参与者进行跟踪。计算了三个低碳水化合物饮食分数的十分之一，以代表对任何来源（动物来源或植物来源）的碳水化合物含量较低且蛋白质和脂肪含量较高的饮食的坚持。我们通过病历审查确认了 POAG 病例（n = 2112），并使用 Cox 比例风险模型来估计多变量调整相对风险 (MVRR) 和 95% 置信区间 (CI)。结果 三种低碳水化合物饮食评分与 POAG 之间没有关联：最高十分位数与最低十分位数中 POAG 的 MVRR 总体评分为 1.13（95% CI，0.91–1.39；P 趋势 = 0.40） ;动物评分为 1.10（95% CI，0.89–1.35；P 趋势 = 0.38），蔬菜评分为 0.96（95% CI，0.79–1.18；P 趋势 = 0.88）。未发现 IOP 水平存在差异关联（P 异质性≥ 0.06）。然而，蔬菜评分显示出与早期旁中心室颤丧失呈负相关（最高与最低十分位数 MVRR = 0.78 [95% CI，0.55–1.10]；P 趋势 = 0.12），但仅与外周室颤丧失不相关（MVRR = 1.09） [95% CI，0.83–1.44]；P 趋势 = 0.14；P 异质性 = 0.03）。结论 低碳水化合物饮食与 POAG 风险无关。我们的数据表明，用蔬菜来源的脂肪和蛋白质代替碳水化合物的摄入量较高，与初始旁中心室颤丧失的 POAG 亚型风险较低相关。