J Korean Med Sci.  2021 Jun;36(23):e155. 10.3346/jkms.2021.36.e155.

Hyperglycemia and Hypo-HDLcholesterolemia Are Primary Risk Factors for Age-related Cataract, and a Korean-style Balanced Diet has a Negative Association, based on the Korean Genome and Epidemiology Study

• Jee D
• Park S

• KMID: 2516678
• DOI: http://doi.org/10.3346/jkms.2021.36.e155

Abstract

Background
The prevalence of cataracts is steadily increasing among the middle-aged and elderly worldwide. We hypothesized that adults aged > 50 years with age-related cataracts (ARCs) have an association with metabolic syndrome (MS) and its components, and MS has interactions with different dietary patterns and lifestyles that affect ARC risk. We examined the hypothesis using the Korean Genome and Epidemiology Study (KoGES; a large-scale hospital-based cohort study), which collected data between 2004–2013.
Methods
Participants ≥ 50 years old were classified as cases (1,972 ARC patients) and controls (38,290 healthy controls) based on a diagnosis of cataract by a physician. MS and its components were defined using WHO definitions for Asians. Dietary consumption was evaluated using a validated semi-quantitative food frequency questionnaire (SQFFQ), which contained 106 foods, and dietary patterns were analyzed by principal component analysis. After adjusting for potential covariates, logistic regression was used to investigate associations between MS and its components and between dietary patterns and a positive cataract history.
Results
ARC had a positive association with MS after 1.32-fold adjusting for age, sex, residence area, body mass index, and energy intake. Plasma glucose and HbA1c concentrations exhibited an increased ARC risk in the participants with MS by 1.50- and 1.92-fold and without MS by 1.35 and 1.88-fold, respectively. Serum high-density lipoprotein (HDL) concentrations were negatively associated with ARC risk only in the MS patients, but not without MS. However, blood pressure, abdominal obesity, and serum triglyceride concentrations did not associate with ARC risk regardless of MS. High intake of a Koreanbalanced diet (KBD) containing fermented food exhibited a negative association with ARC risk (OR = 0.81) only in the MS group. The fat and coffee intake had a negative association with ARC only in the non-MS group. Current- and former-smokers were positively associated with ARC risk.
Conclusion
Persons who have hyperglycemia and low-HDL-cholesterolemia had increased susceptibility of ARC prevalence. A KBD with a proper amount of fat (≥ 15%) is recommended, and smoking should be prohibited.

Keyword

Age-related Cataract; Metabolic Syndrome; Glucose Metabolism; Systolic Blood Pressure; Balanced Diet; Rice-main Diet

Figure

• 

  Fig. 1 ARC frequencies among participants according to the MS status.(A) ARC frequencies of participants consumed low- and high-Korean-balanced diet according to MS status. (B) ARC frequencies of participants who consumed low- and high-coffee intake according to MS status. (C) ARC frequencies of non-smokers and smokers according to MS status.ARC = Age-related cataracts, KBD = Korean-balanced diet, MS = metabolic syndrome.Interaction P value: Statistically significant differences of interaction term of MS and each parameter for ARC incidence using two-way analysis of covariance test with main effects (MS and lifestyle-related variables) and their interaction term after adjusting for covariates including age, sex, residence area, and body mass index, smoking status, income, education, steroid medicine intake, energy intake.Statistically significant differences of ARC frequencies between high and low groups were determined by χ2 test in non-MS and MS groups.*Significant differences of ARC incidences between low and high groups in the participants without MS (Non-MS) at P = 0.05 and *** at P < 0.001.+Significant differences of ARC incidences between low and high groups in the participants with MS.

Reference

1. Lee CM, Afshari NA. The global state of cataract blindness. Curr Opin Ophthalmol. 2017; 28(1):98–103. PMID: 27820750.

2. Prokofyeva E, Wegener A, Zrenner E. Cataract prevalence and prevention in Europe: a literature review. Acta Ophthalmol. 2013; 91(5):395–405. PMID: 22715900.

3. Rim TH, Kim MH, Kim WC, Kim TI, Kim EK. Cataract subtype risk factors identified from the Korea National Health and Nutrition Examination survey 2008–2010. BMC Ophthalmol. 2014; 14(1):4. PMID: 24410920.

4. Beebe DC, Holekamp NM, Shui YB. Oxidative damage and the prevention of age-related cataracts. Ophthalmic Res. 2010; 44(3):155–165. PMID: 20829639.

5. Liang YB, Friedman DS, Wong TY, Zhan SY, Sun LP, Wang JJ, et al. Prevalence and causes of low vision and blindness in a rural Chinese adult population: the Handan Eye Study. Ophthalmology. 2008; 115(11):1965–1972. PMID: 18684506.

6. Mundy KM, Nichols E, Lindsey J. Socioeconomic disparities in cataract prevalence, characteristics, and management. Semin Ophthalmol. 2016; 31(4):358–363. PMID: 27100947.

7. Nam GE, Han K, Ha SG, Han BD, Kim DH, Kim YH, et al. Relationship between socioeconomic and lifestyle factors and cataracts in Koreans: the Korea National Health and Nutrition Examination Survey 2008–2011. Eye (Lond). 2015; 29(7):913–920. PMID: 25976646.

8. Guo C, Wang Z, He P, Chen G, Zheng X. Prevalence, causes and social factors of visual impairment among Chinese adults: based on a national survey. Int J Environ Res Public Health. 2017; 14(9):E1034. PMID: 28885571.

9. Lindblad BE, Håkansson N, Philipson B, Wolk A. Alcohol consumption and risk of cataract extraction: a prospective cohort study of women. Ophthalmology. 2007; 114(4):680–685. PMID: 17173974.

10. Lu ZQ, Sun WH, Yan J, Jiang TX, Zhai SN, Li Y. Cigarette smoking, body mass index associated with the risks of age-related cataract in male patients in northeast China. Int J Ophthalmol. 2012; 5(3):317–322. PMID: 22773980.

11. Lindblad BE, Håkansson N, Wolk A. Smoking cessation and the risk of cataract: a prospective cohort study of cataract extraction among men. JAMA Ophthalmol. 2014; 132(3):253–257. PMID: 24385206.

12. Zheng Selin J, Rautiainen S, Lindblad BE, Morgenstern R, Wolk A. High-dose supplements of vitamins C and E, low-dose multivitamins, and the risk of age-related cataract: a population-based prospective cohort study of men. Am J Epidemiol. 2013; 177(6):548–555. PMID: 23420353.

13. Kim Y, Han BG. KoGES group. Cohort profile: the Korean Genome and Epidemiology Study (KoGES) consortium. Int J Epidemiol. 2017; 46(2):e20. PMID: 27085081.

14. Lim S, Jang HC, Lee HK, Kimm KC, Park C, Cho NH. A rural-urban comparison of the characteristics of the metabolic syndrome by gender in Korea: the Korean Health and Genome Study (KHGS). J Endocrinol Invest. 2006; 29(4):313–319. PMID: 16699297.

15. Liu M, Jin HS, Park S. Protein and fat intake interacts with the haplotype of PTPN11_rs11066325, RPH3A_rs886477, and OAS3_rs2072134 to modulate serum HDL concentrations in middle-aged people. Clin Nutr. 2020; 39(3):942–949. PMID: 31006500.

16. Kim Y, Han BG. KoGES group. Cohort profile: the Korean genome and epidemiology study (KoGES) consortium. Int J Epidemiol. 2017; 46(2):e20–20. PMID: 27085081.

17. Park S, Ham JO, Lee BK. Effects of total vitamin A, vitamin C, and fruit intake on risk for metabolic syndrome in Korean women and men. Nutrition. 2015; 31(1):111–118. PMID: 25466654.

18. Ahn Y, Kwon E, Shim JE, Park MK, Joo Y, Kimm K, et al. Validation and reproducibility of food frequency questionnaire for Korean genome epidemiologic study. Eur J Clin Nutr. 2007; 61(12):1435–1441. PMID: 17299477.

19. Steel RG, Torrie JH, Dickey DA. Principles and Procedures of Statistics: a Biological Approach. New York, NY, USA: McGraw-Hill;1997.

20. Kim JO, Mueller CW. Factor Analysis. Statistical Methods and Practical Issues. Thousand Oaks, CA, USA: Sage Publications;1978.

21. Park SJ, Lee JH, Kang SW, Hyon JY, Park KH. Cataract and cataract surgery: nationwide prevalence and clinical determinants. J Korean Med Sci. 2016; 31(6):963–971. PMID: 27247507.

22. Sabanayagam C, Wang JJ, Mitchell P, Tan AG, Tai ES, Aung T, et al. Metabolic syndrome components and age-related cataract: the Singapore Malay eye study. Invest Ophthalmol Vis Sci. 2011; 52(5):2397–2404. PMID: 21228391.

23. Park S, Kim T, Cho SI, Lee EH. Association between cataract and the degree of obesity. Optom Vis Sci. 2013; 90(9):1019–1027. PMID: 23811609.

24. Pizzol D, Veronese N, Quaglio G, Di Gennaro F, Deganello D, Stubbs B, et al. The association between diabetes and cataract among 42,469 community-dwelling adults in six low- and middle-income countries. Diabetes Res Clin Pract. 2019; 147:102–110. PMID: 30529577.

25. Becker C, Schneider C, Aballéa S, Bailey C, Bourne R, Jick S, et al. Cataract in patients with diabetes mellitus-incidence rates in the UK and risk factors. Eye (Lond). 2018; 32(6):1028–1035. PMID: 29386666.

26. Heydari B, Kazemi T, Zarban A, Ghahramani S. Correlation of cataract with serum lipids, glucose and antioxidant activities: a case-control study. West Indian Med J. 2012; 61(3):230–234. PMID: 23155978.

27. Li S, Li D, Zhang Y, Teng J, Shao M, Cao W. Association between serum lipids concentration and patients with age-related cataract in China: a cross-sectional, case-control study. BMJ Open. 2018; 8(4):e021496.

28. Yu X, Lyu D, Dong X, He J, Yao K. Hypertension and risk of cataract: a meta-analysis. PLoS One. 2014; 9(12):e114012. PMID: 25474403.

29. de Vries AC, Vermeer MA, Bloemendal H, Cohen LH. Pravastatin and simvastatin differently inhibit cholesterol biosynthesis in human lens. Invest Ophthalmol Vis Sci. 1993; 34(2):377–384. PMID: 8440592.

30. Stoll LL, McCormick ML, Denning GM, Weintraub NL. Antioxidant effects of statins. Drugs Today (Barc). 2004; 40(12):975–990. PMID: 15645009.

31. Hippisley-Cox J, Coupland C. Unintended effects of statins in men and women in England and Wales: population based cohort study using the QResearch database. BMJ. 2010; 340:c2197. PMID: 20488911.

32. Hermans MP, Ahn SA, Rousseau MF. Statin therapy and cataract in type 2 diabetes. Diabetes Metab. 2011; 37(2):139–143. PMID: 21145274.

33. Cheung N, Wong TY. Obesity and eye diseases. Surv Ophthalmol. 2007; 52(2):180–195. PMID: 17355856.

34. Tan JS, Wang JJ, Mitchell P. Influence of diabetes and cardiovascular disease on the long-term incidence of cataract: the Blue Mountains eye study. Ophthalmic Epidemiol. 2008; 15(5):317–327. PMID: 18850468.

35. Ghaem Maralani H, Tai BC, Wong TY, Tai ES, Li J, Wang JJ, et al. Metabolic syndrome and risk of age-related cataract over time: an analysis of interval-censored data using a random-effects model. Invest Ophthalmol Vis Sci. 2013; 54(1):641–646. PMID: 23258144.

36. Stevens VJ, Rouzer CA, Monnier VM, Cerami A. Diabetic cataract formation: potential role of glycosylation of lens crystallins. Proc Natl Acad Sci U S A. 1978; 75(6):2918–2922. PMID: 275862.

37. Pollreisz A, Schmidt-Erfurth U. Diabetic cataract-pathogenesis, epidemiology and treatment. J Ophthalmol. 2010; 2010:608751. PMID: 20634936.

38. Kinoshita JH. Pathways of glucose metabolism in the lens. Invest Ophthalmol. 1965; 4:619–628. PMID: 14340173.

39. Bunce GE, Kinoshita J, Horwitz J. Nutritional factors in cataract. Annu Rev Nutr. 1990; 10(1):233–254. PMID: 2200464.

40. Sedaghat F, Ghanavati M, Nezhad Hajian P, Hajishirazi S, Ehteshami M, Rashidkhani B. Nutrient patterns and risk of cataract: a case-control study. Int J Ophthalmol. 2017; 10(4):586–592. PMID: 28503432.

41. Ahn J, Kim NS, Lee BK, Park S. Carbohydrate intake exhibited a positive association with the risk of metabolic syndrome in both semi-quantitative food frequency questionnaires and 24-hour recall in women. J Korean Med Sci. 2017; 32(9):1474–1483. PMID: 28776343.

42. Park S, Ahn J, Lee BK. Very-low-fat diets may be associated with increased risk of metabolic syndrome in the adult population. Clin Nutr. 2016; 35(5):1159–1167. PMID: 26602244.

43. Park S, Ahn J, Kim NS, Lee BK. High carbohydrate diets are positively associated with the risk of metabolic syndrome irrespective to fatty acid composition in women: the KNHANES 2007–2014. Int J Food Sci Nutr. 2017; 68(4):479–487. PMID: 27822963.

44. Ahn J, Kim NS, Lee BK, Park S. Carbohydrate intake exhibited a positive association with the risk of metabolic syndrome in both semi-quantitative food frequency questionnaires and 24-hour recall in women. J Korean Med Sci. 2017; 32(9):1474–1483. PMID: 28776343.

45. Park S, Lee EH. Association between metabolic syndrome and age-related cataract. Int J Ophthalmol. 2015; 8(4):804–811. PMID: 26309883.