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dc.contributor.authorKang, Jae Hee
dc.contributor.authorWillett, Walter C.
dc.contributor.authorRosner, Bernard Alfred
dc.contributor.authorBuys, Emmanuel
dc.contributor.authorWiggs, Janey Lee
dc.contributor.authorPasquale, Louis
dc.date.accessioned2017-10-05T20:14:20Z
dc.date.issued2016
dc.identifierQuick submit: 2017-06-01T20:31:25-0400
dc.identifier.citationKang, Jae H., Walter C. Willett, Bernard A. Rosner, Emmanuel Buys, Janey L. Wiggs, and Louis R. Pasquale. 2016. “Association of Dietary Nitrate Intake With Primary Open-Angle Glaucoma.” JAMA Ophthalmology 134 (3) (March 1): 294. doi:10.1001/jamaophthalmol.2015.5601.en_US
dc.identifier.issn2168-6165en_US
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:34060861
dc.description.abstractIMPORTANCE Nitric oxide signaling alterations in outflow facility and retinal blood flow autoregulation are implicated in primary open-angle glaucoma (POAG). Nitric oxide donation has emerged as a POAG therapeutic target. An exogenous source of nitric oxide is dietary nitrates. OBJECTIVE To evaluate the association between dietary nitrate intake, derived mainly from green leafy vegetables, and POAG. DESIGN, SETTING, AND PARTICIPANTS We followed up participants biennially in the prospective cohorts of the Nurses’ Health Study (63 893 women; 1984-2012) and the Health Professionals Follow-up Study (41 094 men; 1986-2012) at each 2-year risk period. Eligible participants were 40 years or older, were free of POAG, and reported eye examinations. EXPOSURES The primary exposure was dietary nitrate intake. Information on diet and potential confounders was updated with validated questionnaires. MAIN OUTCOMES AND MEASURES The main outcome was the incidence of POAG and POAG subtypes; 1483 cases were confirmed with medical records and classified into subtypes defined by intraocular pressure (IOP) (22 or <22 mm Hg) or by visual field (VF) loss pattern at diagnosis (peripheral loss only or early paracentral loss). Cohort-specific and pooled multivariable rate ratios (MVRRs) and 95% CIs were estimated. RESULTS During 1 678 713 person-years of follow-up, 1483 incident cases of POAG were identified. The mean (SD) age for the 1483 cases was 66.8 (8.3). Compared with the lowest quintile of dietary nitrate intake (quintile 1: approximately 80 mg/d), the pooled MVRR for the highest quintile (quintile 5: approximately 240 mg/d) was 0.79 (95% CI, 0.66-0.93; P for trend = .02). The dose response was stronger (P for heterogeneity = .01) for POAG with early paracentral VF loss (433 cases; quintile 5 vs quintile 1 MVRR = 0.56; 95% CI, 0.40-0.79; P for trend < .001) than for POAG with peripheral VF loss only (835 cases; quintile 5 vs quintile 1 MVRR = 0.85; 95% CI, 0.68-1.06; P for trend = .50). The association did not differ (P for heterogeneity = .75) by POAG subtypes defined by IOP (997 case patients with IOP 22 mm Hg: quintile 5 vs quintile 1 MVRR = 0.82; 95% CI, 0.67-1.01; P for trend = .11; 486 case patients with IOP <22 mm Hg: quintile 5 vs quintile 1 MVRR = 0.71; 95% CI, 0.53-0.96; P for trend = .12). Green leafy vegetables accounted for 56.7% of nitrate intake variation. Compared with consuming 0.31 servings per day, the MVRR for consuming 1.45 or more servings per day was 0.82 for all POAG (95% CI, 0.69-0.97; P for trend = .02) and 0.52 for POAG with paracentral VF loss (95% CI, 0.29-0.96; P for trend < .001).CONCLUSIONS AND RELEVANCE Higher dietary nitrate and green leafy vegetable intake was associated with a lower POAG risk, particularly POAG with early paracentral VF loss at diagnosis.en_US
dc.language.isoen_USen_US
dc.publisherAmerican Medical Association (AMA)en_US
dc.relation.isversionofdoi:10.1001/jamaophthalmol.2015.5601en_US
dc.relation.hasversionhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4966649/en_US
dash.licenseLAA
dc.titleAssociation of Dietary Nitrate Intake With Primary Open-Angle Glaucomaen_US
dc.typeJournal Articleen_US
dc.date.updated2017-06-02T00:30:03Z
dc.description.versionAccepted Manuscripten_US
dc.relation.journalJAMA Ophthalmologyen_US
dash.depositing.authorWillett, Walter C.
dc.date.available2016
dc.date.available2017-10-05T20:14:20Z
dc.identifier.doi10.1001/jamaophthalmol.2015.5601*
workflow.legacycommentscat.completeen_US
dash.contributor.affiliatedKang, Jae Hee
dash.contributor.affiliatedWiggs, Janey
dash.contributor.affiliatedPasquale, Louis
dash.contributor.affiliatedRosner, Bernard
dash.contributor.affiliatedBuys, Emmanuel
dash.contributor.affiliatedWillett, Walter


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