Highlight: Do our choices or our genes impact the development & progression of AMD?

You may have gotten an email yesterday about this post which said it was password protected.  I keep forgetting that putting a password on a page while it’s being developed doesn’t work to stop an early email.  Sorry!

Facebook group member Vickie Hoecherl (a link to her new Guest Author page below) has gone through the December 2017 article from the award-winning lecture by well-respected and widely-published Dr. Johanna M. Seddon and has shared with the group members some of the researcher’s quotes.   Click here for the full article “Macular Degeneration Epidemiology: Nature-Nurture, Lifestyle Factors, Genetic Risk, and Gene-Environment Interactions – The Weisenfeld Award Lecture”.


Do our choices impact the progression of AMD?  How much of our future is written in our genetic code

Note: If you see (), we’ve left out statistics from Dr. Seddon’s article. You can see them in the full article. Also, we’ve added topic headings to the researcher’s quotes. 
Nature vs. nurture

“Our analyses showed that a high proportion of AMD was attributable to genetics, with heritability ranging from 46% to 71%, depending on the stage of the disease. More advanced disease, as well as larger drusen and greater drusen area measuring 175 μm or larger were highly heritable, with estimates of 71%. The environmental influence on this disease is also notable (19% to 37%). Therefore, both nature and nurture were important in the development of AMD.”

Stop smoking

“The leading modifiable risk factor is cigarette smoking.”

Eat your greens, know your fats

“. . . . a higher frequency of intake of spinach or collard greens was associated with a substantially lower risk for AMD. Results suggested an 88% lower risk with higher intake, defined as eating a one-half cup serving at least five times per week. Other foods that are high in lutein and zeaxanthin include dark green leafy vegetables, kale, turnip greens, and collard greens.”

“High total fat intake was associated with almost a three-fold higher risk of progression and saturated and trans-unsaturated fats conferred over a 2-fold higher rate of progression from nonadvanced to advanced stages of AMD. Higher intake of omega-3 fats, which are found in high levels in fish and some nuts, reduced risk of progression to advanced AMD by 25% to 40%, particularly among participants with lower linoleic acid intake.”

Supplements weigh in

“Supplements containing vitamin C, E, zinc, as well as lutein and zeaxanthin are now recommended for individuals with intermediate-level AMD”

Get out the tape measure

“We also evaluated modifiable anthropometric factors, including BMI, waist circumference, and waist-to-hip ratio, in our prospective cohort. A BMI defined as obese (≥30) was significantly associated with a higher risk of progression to advanced stages of AMD (), as was the overweight classification (). A significant trend was observed for higher risk with higher BMI (). The highest tertile of waist circumference significantly increased risk of progression () compared with the lowest tertile. A higher waist-to-hip ratio also increased risk of progression (). In contrast, higher levels of physical activity tended to reduce risk of progression. ”

Genes effect on occurrence and progression

“Genes conferring AMD risk are not only related to the occurrence of AMD as found in case-control studies, but we also found they are important in determining the rate of progression of disease over time, from early and intermediate stages to advanced clinical phenotypes.”

Genes and diet can interplay

“We found the highest quintile of omega-3 intake was associated with a lower risk of progression to geographic atrophy, when compared with the lowest intake, and this beneficial effect was noted particularly among individuals who carried the homozygous risk genotype for ARMS2 (). No protective effect was observed for the ARMS2 homozygous nonrisk genotype. ”

“Additional gene-diet differences were observed with regard to high adherence to a Mediterranean diet (). High adherence reduced the risk of progression to advanced AMD, and specifically among those individuals carrying at least one nonrisk allele at CFH Y402H (). There was no effect of the Mediterranean diet on risk of progressing to advanced AMD among individuals carrying the CFH homozygous risk genotype (CC).”

“In our diet-gene evaluation of dietary folate, high consumption of dietary folate was significantly associated with a lower risk of progression (). We found a protective effect of higher folate intake against progression to geographic atrophy, particularly among individuals carrying the C3 R102G homozygous nonrisk genotype (). The beneficial effect of folate was not observed for those carrying at least one risk allele (G) at this locus.”

“We also recently reported that participants with the highest quintile of dietary vitamin D intake had a significantly lower risk of progression to advanced stages of AMD, and especially NV. This effect also may vary according to genotype.”


Read about Vickie’s journey with AMD

 

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Weighty Matters

I am dense. In more ways than one, but the way I am talking about is good. I have a fair amount of lean tissue (read muscle) that weighs more than fat. That means that I don’t flip out when a body mass index calculator says I am overweight.

Truthfully, I am just over the line at a BMI of 25.1. A healthy weight is reflected in a BMI below 25.

But who cares? The fact of the matter is, if you are reading these pages you or someone you care about has age-related macular degeneration. And another fact of the matter is higher BMIs are associated with progression of AMD.

Obesity is associated with a higher risk than ‘just’ being overweight. However, being overweight increases your risk pretty significantly. Reading the data from 2003 and generated by research by Seddon, Cote, Davis and Rosner, I discovered the risk ratios for both group as compared to skinny people are over 2 to 1. That means chubby people progress to advanced AMD twice as often as their skinny cousins.

And, of course, there is more. ‘Apples’ not only have more problems with diabetes and heart disease, they also have twice as great a chance of developing advanced AMD. Belly fat appears to be nasty business in all sorts of ways.

Gives me a new perspective on Santa Claus. With that “bowl full of jelly” around his middle, do you think he has heart problems, type 2 diabetes and AMD? Somebody should talk to him (and Mrs. Claus!) before Rudolph has to become a seeing-eye reindeer!

So, you know the drill. If you are carrying a little extra weight, you have heard it all before. Now there is one more reason to shed those pounds. You may not care about those potential bogeymen they threaten you with (those would be heart attacks or diabetes for example) but what about your sight? I suspect you are losing that NOW as in, as we speak now. What would you do to slow that process down?

Seddon et al (same article as above) found a 25% reduction in rate of disease progression when patients engaged in vigorous activity three times per week. Sort of sounds like exercise might help.

Those of you who are paying attention may be trying to add up some facts about me here. I have been an exercise nut since I was 25. However, I have a rapidly progressing case of AMD at 63. Obviously working out did not help me….or did it?

I have no clue. Maybe it was my crappy genes were totally resistant to any positive intervention. Maybe I would have developed this stuff at 58 or 59 if I had not exercised. No way of knowing.

What I do know is I am zealous about the benefits of exercise. Want to improve your physical and mental health? Want to meet great people and have fun? Exercise. Oh, and it just might help to postpone your advanced AMD. Never know. Continue reading “Weighty Matters”

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