Hyperglycemia and Hypo-HDL-cholesterolemia 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

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 Korean-balanced 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.

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

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.