Abstract
PURPOSETo 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).DESIGNCross-sectional study.METHODSPostmenopausal 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.RESULTSFor 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.CONCLUSIONSDietary 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.
Highlights
There is a growing body of literature aimed to investigate the effects of omega-3 (n-3) fatty acid supplementation as a treatment for ocular surface disease; inconclusive results are often reported, as reviewed previously.[6]
The study by Miljanovic and associates[9] was a pivotal investigation in nutrition and ocular surface disease, it was not designed to evaluate MEIBOMIAN GLAND dysfunction (MGD), to confirm the presence of MGD or D RY EYE DISEASE (DED) with a clinical examination, or to recruit postmenopausal women. The purpose of this analysis is to assess whether dietary consumption of n-3 and n-6 fatty acids, as well as the ratio between the two, is associated with an altered frequency of clinically confirmed DED or MGD in a large sample of postmenopausal women
All other clinical parameters showed no significant differences from the non-MGD group, which is consistent with expected values for at least stage 1 MGD, as discussed later
Summary
There is a growing body of literature aimed to investigate the effects of omega-3 (n-3) fatty acid supplementation as a treatment for ocular surface disease; inconclusive results are often reported, as reviewed previously.[6] Importantly though, this direction of research stems from a 2005 report of the Women’s Health Study,[7,8] stating that low dietary consumption, not supplementation, of omega-3s and high omega-6: omega-3 (n-6:n-3) ratios are associated with an increased incidence of self-reported dry eye disease.[9] The mechanism has not been fully elucidated, but there is theoretical evidence in support of DED mitigation owing to n-3’s anti-inflammatory properties.[10] Polyunsaturated fatty acids, such as n-3s and n-6s, yield prostaglandins and leukotrienes, both of which work through paracrine signaling to regulate inflammation and other physiologic processes.[10] The n-6 precursors primarily give rise to proinflammatory eicosanoids, while the n-3 precursors primarily lead to anti-inflammatory eicosanoids. The study by Miljanovic and associates[9] was a pivotal investigation in nutrition and ocular surface disease, it was not designed to evaluate MGD, to confirm the presence of MGD or DED with a clinical examination, or to recruit postmenopausal women. The purpose of this analysis is to assess whether dietary consumption of n-3 and n-6 fatty acids, as well as the ratio between the two, is associated with an altered frequency of clinically confirmed DED or MGD in a large sample of postmenopausal women
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