Relation Between Dietary Essential Fatty Acid Intake and Dry Eye Disease and Meibomian Gland Dysfunction in Postmenopausal Women

Abstract

Purpose: To evaluate the relationship between omega-3 (n-3) and omega-6 (n-6) fatty acids with dry eye disease (DED) and meibomian gland dysfunction (MGD).

Design: Cross-sectional study.

Methods: Postmenopausal women (n = 439) underwent a clinical evaluation and completed the Vio Food Frequency Questionnaire to estimate their dietary intake of n-3s and n-6s. Subjects were categorized into 2 binary classifications based on whether or not they had (1) DED and (2) MGD. Mean intake of dietary fatty acids was compared with 2-sample t tests. Univariate logistic regression models were used to estimate the odds ratios for each condition associated with each quintile of n-3s, n-6s, and n-6:n-3 ratios.

Results: For DED vs non-DED, there were no significant differences in n-3 intake (1.95 ± 1.47 g vs 1.92 ± 1.24 g, P = .86), n-6 intake (15.58 ± 11.56 g vs 15.44 ± 10.61 g, P = .91), and n-6:n-3 (8.30 ± 2.57 vs 8.30 ± 2.57, P = .99). For MGD vs non-MGD, there were no significant differences in n-3 intake (1.87 ± 1.35 vs 1.96 ± 1.39, P = .61), n-6 intake (15.26 ± 11.85 vs 15.62 ± 10.93, P = .80), and n-6:n-3 (8.35 ± 2.94 vs 8.28 ± 2.42, P = .84). The odds ratios (OR) for DED did not differ significantly from 1.0 for n-3, n-6, or n-6:n-3. High n-3 consumption (OR = 0.22 [0.06-0.78]) and moderate n-6 consumption (OR = 0.37 [0.15-0.91]) were associated with a decreased frequency of MGD.

Conclusions: Dietary consumption of n-3s and n-6s showed no association with DED, but high n-3 consumption and moderate n-6 consumption were protective against MGD in this large sample of postmenopausal women.

FIGURE 1

Enrollment flow chart. A total of 439 postmenopausal women were enrolled in the Dry Eye in Menopause study, but 117 were excluded from this analysis owing to baseline omega fatty acid supplementation (n = 116) or incomplete data (n = 1). Of the 322 women in the DED/non-DED analysis, 192 met the criteria to be diagnosed with DED, while 130 did not. Of the same 322 women in the MGD/non-MGD analysis, 3 were excluded owing to incomplete data. Of the 319 remaining, 87 met the criteria to be diagnosed with MGD, while 232 did not. DED = dry eye disease; MGD = meibomian gland dysfunction.

FIGURE 2

Odds ratio plot of dry eye disease and meibomian gland dysfunction with respect to omega-3 fatty acid consumption in postmenopausal women. Model 1 controlled for age, race, body mass index, total dietary fat intake, and presence or absence of an eye examination in the previous 12 months. Model 2 controlled for systemic hypertension, diabetes mellitus, and arthritis, in addition to the variables controlled for in Model 1. DED = dry eye disease; MGD = meibomian gland dysfunction.

FIGURE 3

Odds ratio plot of dry eye disease and meibomian gland dysfunction with respect to omega-6 fatty acid consumption in postmenopausal women. Model 1 controlled for age, race, body mass index, total dietary fat intake, and presence or absence of an eye examination in the previous 12 months. Model 2 controlled for systemic hypertension, diabetes mellitus, and arthritis, in addition to the variables controlled for in Model 1. DED = dry eye disease; MGD = meibomian gland dysfunction.

FIGURE 4

Odds ratio plot of dry eye disease and meibomian gland dysfunction with respect to omega-6:omega-3 fatty acid consumption in postmenopausal women. Model 1 controlled for age, race, body mass index, total dietary fat intake, and presence or absence of an eye examination in the previous 12 months. Model 2 controlled for systemic hypertension, diabetes mellitus, and arthritis, in addition to the variables controlled for in Model 1. DED = dry eye disease; MGD = meibomian gland dysfunction.