Antioxidant vitamin and mineral supplements for preventing age-related macular degeneration

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Abstract
Some observational studies have suggested that people who eat a diet rich in antioxidant vitamins (carotenoids, vitamins C and E) or minerals (selenium and zinc) may be less likely to develop age‐related macular degeneration (AMD). The aim of this review was to examine the evidence as to whether or not taking vitamin or mineral supplements prevents the development of AMD. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) in The Cochrane Library (2007, Issue 3), MEDLINE (1966 to August 2007), SIGLE (1980 to 2005/03), EMBASE (1980 to August 2007), National Research Register (NRR) (2007, Issue 3), AMED (1985 to January 2006) and PubMed (on 24 January 2006 covering last 60 days), reference lists of identified reports and the Science Citation Index. We contacted investigators and experts in the field for details of unpublished studies. We included all randomised trials comparing an antioxidant vitamin and/or mineral supplement (alone or in combination) to control. We included only studies where supplementation had been given for at least one year. Both review authors independently extracted data and assessed trial quality. Data were pooled using a fixed‐effect model. Three randomised controlled trials were included in this review (23,099 people randomised). These trials investigated alpha‐tocopherol and beta‐carotene supplements. There was no evidence that antioxidant vitamin supplementation prevented or delayed the onset of AMD. The pooled risk ratio for any age‐related maculopathy (ARM) was 1.04 (95% CI 0.92 to 1.18), for AMD (late ARM) was 1.03 (95% CI 0.74 to 1.43). Similar results were seen when the analyses were restricted to beta‐carotene and alpha‐tocopherol. There is no evidence to date that the general population should take antioxidant vitamin and mineral supplements to prevent or delay the onset of AMD. There are several large ongoing trials. People with AMD should see the related Cochrane review "Antioxidant vitamin and mineral supplements for slowing the progression of age‐related macular degeneration" written by the same author. 抗氧化維他命與礦物質補充劑對於預防老年性黃斑部退化變性 有些觀察性研究認為人們攝取大量的抗氧化維他命(類胡蘿蔔素，維他命C和E)或礦物質(硒和鋅)飲食也許較不可能發生老年性黃斑部退化變性(agerelated macular degeneration (AMD))。 這篇回顧的目的為評估是否攝取維他命或礦物質補充劑可以預防發生老年性黃斑部退化變性。 我們檢索考科藍圖書館中the Cochrane Central Register of Controlled Trials (CENTRAL) (其包含the Cochrane Eyes and Vision Group Trials Register)(2007, Issue 3)，MEDLINE (1966年至2007年八月)，SIGLE (1980年至2005年3月)，EMBASE (1980年至2007年八月)，National Research Register (2007, Issue 3)，AMED (1985年至2006年一月)及PubMed (於2006年1月24日，包含最後60天)，已確認報告的參考文獻及the Science Citation Index。我們接觸這個領域的調查者及專家以獲得尚未刊登研究的詳細資料。 我們納入所有關於抗氧化維他命及/或礦物質補充劑(單一或合併)相較於對照組的隨機試驗。我們只納入給予補充劑至少一年的研究。 兩名回顧作者分別摘錄資料並評估試驗品質。採用固定效果模型(fixedeffect model)加總資料。 這篇回顧納入三篇隨機對照試驗(隨機分配23,099名研究對象)。這些試驗評估alphatocopherol及betacarotene補充劑。沒有證據關於抗氧化劑維他命補充劑可以預防或延緩老年性黃斑部退化變性。任何老年性黃斑病變(agerelated maculopathy (ARM))其相對危險性為1.04(95% CI 0.92 to 1.18)，老年性黃斑部退化變性(晚期黃斑部病變)為1.03 (95% CI 0.74 to 1.43)。當限制分析betacarotene及alphatocopherol時發現有相似的結果。 至今沒有證據關於一般民眾應該攝取抗氧化維他命及礦物質補充劑以預防或延緩老年性黃斑部退化變性發作。有幾篇大型正在進行的試驗。有關老年性黃斑部退化變性可以參考相關的考科藍回顧“抗氧化維他命及礦物質補充劑用於延緩老年性黃斑部退化變性之進程”，其由相同的作者撰寫。 本摘要由高雄榮民總醫院金沁琳翻譯。 此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。 抗氧化維他命及礦物質補充劑用於預防發生老年性黃斑部退化變性。老年性黃斑部退化變性是一種影響視網膜(眼睛後方)中央區域的狀況。視網膜會隨著年齡退化且有些人會受損導致中央視覺喪失。有些研究認為大量攝取抗氧化維他命(類胡蘿蔔素，維他命C及E)或礦物質(硒及鋅)飲食也許較不可能發生老年性黃斑部退化變性。作者確認三篇大型的，高品質的隨機對照試驗，其於澳洲，芬蘭及美國研究維他命E及betacarotene補充劑之效果。這篇回顧沒有發現一般民眾應該攝取抗氧化維他命或礦物質補充劑以延緩發作老年性黃斑部退化變性之證據。期盼正在進行中試驗的研究結果。

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