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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Clinical Nutrition".

Deadline for manuscript submissions: closed (5 June 2025) | Viewed by 13232

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Special Issue Editor

Prof. Dr. Rufino Silva

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Guest Editor

1. University Clinic of Ophthalmology, Faculty of Medicine, University of Coimbra (FMUC), 3000-354 Coimbra, Portugal
2. Department of Ophthalmology, Unidade Local de Saude de Coimbra, Coimbra, Portugal
3. Association for Innovation and Biomedical Research in Light and Image (AIBILI), Coimbra, Portugal
4. Clinical and Academic Centre of Coimbra, Coimbra, Portugal
Interests: age-related macular degeneration; diabetic retinopathy; epidemiology; genetics; mediterranean diet; lifestyle; metabolomics; imaging; biomarkers

Special Issue Information

Dear Colleagues,

Vision loss due to age-related macular degeneration and diabetic retinopathy can be devastating to the individual due to its detrimental impact on the quality of life. These two conditions are the leading causes of vision loss and blindness in adults in developed countries. Dry eye syndrome can affect people of all ages, but it is more common in older adults and can be associated with several factors. There is increasing evidence to support that the impact of AMD, diabetic retinopathy and dry eye can, to some extent, be mitigated by addressing modifiable risk factors such as diet and lifestyle.

Dietary modification and nutritional supplementation for the prevention and treatment of these conditions have attracted considerable scientific attention. It is well known that for individuals with diabetes, maintaining stable blood sugar levels through diet and lifestyle measures is crucial in preventing and treating diabetic retinopathy. A large body of scientific evidence supports the role of supplements and diet rich in antioxidants, such as vitamins C and E, zinc, lutein, zeaxanthin and omega-3 fatty acids, in reducing the risk of AMD or slowing its progression. Research on the role of diet and supplements in treating other conditions such as cataracts, glaucoma and dry eye has received increasing attention in recent years.

I warmly welcome short communications, original research articles and review articles related to this topic.

Prof. Dr. Rufino Silva
Guest Editor

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Keywords

diet
Mediterranean diet
nutrients
eye diseases
supplements
age-related macular degeneration
diabetic retinopathy
dry eye disease
cataract
glaucoma
vitamins
antioxidants

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Published Papers (6 papers)

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Research

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12 pages, 1047 KiB

Open AccessArticle

From Vineyard to Vision: Efficacy of Maltodextrinated Grape Pomace Extract (MaGPE) Nutraceutical Formulation in Patients with Diabetic Retinopathy

by Elisabetta Schiano, Sabrina Vaccaro, Vincenzo Scorcia, Adriano Carnevali, Massimiliano Borselli, Domenico Chisari, Fabrizia Guerra, Fortuna Iannuzzo, Gian Carlo Tenore, Giuseppe Giannaccare and Ettore Novellino

Nutrients 2024, 16(17), 2850; https://doi.org/10.3390/nu16172850 - 26 Aug 2024

Cited by 4 | Viewed by 2003

Abstract

Despite recent advances, pharmacological treatments of diabetic retinopathy (DR) do not directly address the underlying oxidative stress. This study evaluates the efficacy of a nutraceutical formulation based on maltodextrinated grape pomace extract (MaGPE), an oxidative stress inhibitor, in managing DR. A 6-month, randomized, placebo-controlled clinical trial involving 99 patients with mild to moderate non-proliferative DR was conducted. The MaGPE group showed improvement in best-corrected visual acuity (BCVA) values at T3 (p < 0.001) and T6 (p < 0.01), a reduction in CRT (at T3 and T6, both p < 0.0001) and a stabilization of vascular perfusion percentage, with slight increases at T3 and T6 (+3.0% and +2.7% at T3 and T6, respectively, compared to baseline). Additionally, the levels of reactive oxygen metabolite derivatives (dROMs) decreased from 1100.6 ± 430.1 UCARR at T0 to 974.8 ± 390.2 UCARR at T3 and further to 930.6 ± 310.3 UCARR at T6 (p < 0.05 vs. T0). Similarly, oxidized low-density lipoprotein (oxLDL) levels decreased from 953.9 ± 212.4 µEq/L at T0 to 867.0 ± 209.5 µEq/L at T3 and markedly to 735.0 ± 213.7 µEq/L at T6 (p < 0.0001 vs. T0). These findings suggest that MaGPE supplementation effectively reduces retinal swelling and oxidative stress, contributing to improved visual outcomes in DR patients. Full article

(This article belongs to the Special Issue Diet and Supplements in the Prevention and Treatment of Eye Diseases)

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Review

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17 pages, 258 KiB

Open AccessReview

Nutrient-Driven Antioxidant Interventions for Prevention of Age-Related and Diabetic Cataracts

by Rosa Giglio, Serena Milan, Leandro Inferrera, Daniele Tognetto, Fabiana D’Esposito, Federico Visalli, Caterina Gagliano and Marco Zeppieri

Nutrients 2025, 17(11), 1885; https://doi.org/10.3390/nu17111885 - 30 May 2025

Viewed by 222

Abstract

Cataract formation remains a significant cause of global visual impairment. Increasing attention has been directed toward antioxidant-based interventions as potential non-surgical strategies to delay or prevent cataractogenesis, particularly in the age-related and diabetic contexts. This review summarizes recent preclinical evidence on nutritional antioxidants for the prevention of age-related and diabetic cataracts. Agents such as trimetazidine, Moringa oleifera stem extract, ginsenoside Rg1, lanosterol nanoparticles, β-casomorphin-7, and cerium oxide-based nanotherapies have been shown to mitigate oxidative damage, modulate redox signaling pathways, and preserve lens clarity. Advances in drug delivery, including topical formulations, nanoparticle carriers, and intravitreal injections, have been proposed to overcome the anatomical and pharmacokinetic barriers associated with the avascular lens. The new data support ongoing translational research to maximize the clinical use of antioxidants and highlight their therapeutic potential in the prevention of age-related and diabetic cataracts. Full article

(This article belongs to the Special Issue Diet and Supplements in the Prevention and Treatment of Eye Diseases)

23 pages, 766 KiB

Open AccessReview

Nutritional Genomics: Implications for Age-Related Macular Degeneration

by Inês Figueiredo, Cláudia Farinha, Patrícia Barreto, Rita Coimbra, Pedro Pereira, João Pedro Marques, Isabel Pires, Maria Luz Cachulo and Rufino Silva

Nutrients 2024, 16(23), 4124; https://doi.org/10.3390/nu16234124 - 28 Nov 2024

Cited by 1 | Viewed by 2160

Abstract

Background: Age-related macular degeneration (AMD) is a leading cause of vision loss in older individuals, driven by a multifactorial etiology involving genetic, environmental, and dietary factors. Nutritional genomics, which studies gene-nutrient interactions, has emerged as a promising field for AMD prevention and management. Genetic predispositions, such as variants in CFH, C3, C2/CFB, APOE, and oxidative stress pathways, significantly affect the risk and progression of AMD. Methods: This narrative review synthesizes findings from randomized controlled trials and recent advances in nutritional genomics research. It examines the interplay between genetic predispositions and dietary interventions, exploring how personalized nutritional strategies can optimize AMD management. Results and Discussion: The AREDS and AREDS2 trials demonstrated that supplements, including vitamins C, E, zinc, copper, lutein, and zeaxanthin, can reduce the progression to advanced AMD. Nutritional interventions tailored to genetic profiles show promise: CFH risk alleles may enhance zinc supplementation’s anti-inflammatory effects, while APOE variants influence the response to omega-3 fatty acids. Adjusting carotenoid intake, such as lutein and zeaxanthin, based on genetic susceptibility exemplifies emerging precision nutritional approaches. Ongoing research seeks to integrate nutrigenomic testing into clinical settings, enabling clinicians to tailor interventions to individual genetic profiles. Conclusions: Further studies are needed to assess the long-term effects of personalized interventions, investigate additional genetic variants, and develop tools for clinical implementation of nutrigenomics. Advancing these strategies holds the potential to improve patient outcomes, optimize AMD management, and pave the way for precision nutrition in ophthalmology. Full article

(This article belongs to the Special Issue Diet and Supplements in the Prevention and Treatment of Eye Diseases)

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11 pages, 453 KiB

Open AccessReview

NAD+ and Niacin Supplementation as Possible Treatments for Glaucoma and Age-Related Macular Degeneration: A Narrative Review

by Mohamed R. Gemae, Mario D. Bassi, Patrick Wang, Eric K. Chin and David R.P. Almeida

Nutrients 2024, 16(16), 2795; https://doi.org/10.3390/nu16162795 - 21 Aug 2024

Cited by 2 | Viewed by 3907

Abstract

Glaucoma and age-related macular degeneration (AMD) are progressive retinal diseases characterized by increased oxidative stress, inflammation, and mitochondrial dysfunction. This review investigates the potential therapeutic benefits of NAD+ and niacin supplementation in managing glaucoma and AMD. A literature search was conducted encompassing keywords such as “niacin”, “NAD”, “glaucoma”, “AMD”, and “therapeutics”. NAD+ depletion is associated with increased oxidative stress and mitochondrial dysfunction in glaucoma and AMD. Niacin, a precursor to NAD+, has shown promise in replenishing NAD+ levels, improving choroidal blood flow, and reducing oxidative damage. Animal studies in glaucoma models indicate that nicotinamide (NAM) supplementation preserves RGC density and function. Large-scale population-based studies indicate an inverse correlation between niacin intake and glaucoma prevalence, suggesting a preventative role. Randomized controlled trials assessing niacin supplementation showed significant improvements in visual field sensitivity and inner retinal function, with a dose-dependent relationship. In AMD, nicotinamide supplementation may improve rod cell function and protect against oxidative stress-induced damage. Cross-sectional studies reveal that individuals with AMD have a lower dietary intake of niacin. Further studies suggest niacin’s role in improving choroidal blood flow and dilating retinal arterioles, potentially mitigating ischemic damage and oxidative stress in AMD. Beyond current management strategies, NAD+ and niacin supplementation may offer novel therapeutic avenues for glaucoma and AMD. Further research is warranted to elucidate their efficacy and safety in clinical settings. Full article

(This article belongs to the Special Issue Diet and Supplements in the Prevention and Treatment of Eye Diseases)

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21 pages, 2919 KiB

Open AccessSystematic Review

Mediterranean Diet on Development and Progression of Age-Related Macular Degeneration: Systematic Review and Meta-Analysis of Observational Studies

by Pedro Marques-Couto, Inês Coelho-Costa, Renato Ferreira-da-Silva, José Paulo Andrade and Ângela Carneiro

Nutrients 2025, 17(6), 1037; https://doi.org/10.3390/nu17061037 - 15 Mar 2025

Viewed by 1284

Abstract

Introduction: Age-related macular degeneration (AMD) is a leading cause of vision impairment. A Mediterranean diet (MD) has been suggested to provide protective effects against AMD development and progression due to its antioxidant and anti-inflammatory properties. However, inconsistencies in findings across observational studies have been reported. This systematic review and meta-analysis aim to synthesize the existing evidence on the relationship between adherence to the MD and AMD development or progression. Methods: A systematic search was conducted using MEDLINE (via PubMed), Web of Science, and SCOPUS, following PRISMA guidelines. Observational studies assessing MD adherence in relation to AMD risk or progression were included. Meta-analyses were performed separately for each study design using odds ratios (ORs) for cross-sectional and case–control studies and hazard ratios (HRs) for prospective cohort studies. Heterogeneity was assessed using the I² statistic, and publication bias was evaluated via funnel plots. Results: Eight studies were included: two cross-sectional, three case–control, and three prospective cohort studies. The meta-analysis of cross-sectional studies (pooled OR = 0.96; 95% CI: 0.83–1.11; p = 0.6243; I² = 0%) found no significant association between MD adherence and AMD. However, the weight distribution was highly imbalanced, limiting interpretability. Meta-analyses of case–control and prospective cohort studies demonstrated a significant protective effect of MD adherence: case–control studies showed a 34% reduction in the odds of AMD progression (OR = 0.66; 95% CI: 0.54–0.81; p < 0.0001; I² = 41.5%), while prospective cohort studies indicated a 23% reduced risk of AMD progression (HR = 0.77; 95% CI: 0.67–0.88; p < 0.0001; I² = 0%). Conclusions: This systematic review and meta-analysis suggest an inverse association between adherence to the MD and AMD progression, particularly in case–control and prospective cohort studies. Despite the small number of included studies, these findings highlight the potential role of diet in AMD management. Future research should focus on larger, well-controlled prospective studies with standardized dietary assessments. Key Points: 1. Higher adherence to the MD is associated with a reduced risk of AMD progression, with meta-analyses of case–control and prospective cohort studies showing 34% lower odds (OR = 0.66) and 23% reduced risk (HR = 0.77) of disease progression, respectively. 2. No significant association was found in cross-sectional studies (OR = 0.96; 95% CI: 0.83–1.11), likely due to methodological limitations and the challenge of establishing a temporal relationship between diet and AMD progression. 3. Despite the limited number of studies, findings suggest a potential role of diet in AMD management. Future research should prioritize larger, well-controlled prospective studies with standardized dietary assessments. Full article

(This article belongs to the Special Issue Diet and Supplements in the Prevention and Treatment of Eye Diseases)

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13 pages, 2175 KiB

Open AccessSystematic Review

Systematic Review and Meta-Analysis on the Association Between Daily Niacin Intake and Glaucoma

by Constantin Alin Nicola, Maria Cristina Marinescu, Anne Marie Firan, Mihaela Simona Naidin, Radu Constantin Ciuluvica, Maria Magdalena Rosu, Andreea-Daniela Meca, Maria Bogdan and Adina Turcu-Stiolica

Nutrients 2024, 16(21), 3604; https://doi.org/10.3390/nu16213604 - 23 Oct 2024

Viewed by 2744

Abstract

Background: Glaucoma is a progressive optic neuropathy, characterised by a complex pathophysiology, with mitochondrial dysfunction playing a significant role in the cellular damage and apoptosis of ganglion cells. Niacin is a precursor to several molecules acting as coenzymes in the mitochondrial production of ATP, in DNA repair and in the reduction of reactive oxygen species. The objective of this systematic review is to assess the impact of daily niacin intake on glaucoma. Methods: Case–control and cohort studies regarding niacin and glaucoma, indexed in PubMed, Web of Science, Cochrane and Scopus, were included. Other study methodologies, studies regarding niacin in other ocular disease or other nutrients in glaucoma were excluded. Bias was assessed using the Newcastle–Ottawa Scale. The study protocol was registered in the PROSPERO database (no. CRD42024578889). Results: Five case–control studies were included. In the pooled analysis, a significantly higher proportion of patients with high niacin consumption was found in the group without glaucoma compared to those with glaucoma as defined by ISGEO criteria (p-value < 0.00001; OR = 0.66, 95% CI 0.55–0.79) or as defined by retinal imaging (p-value = 0.02; OR = 0.63, 95% CI 0.43–0.94). Conclusions: Daily dietary intake of niacin is significantly lower in patients with glaucoma compared to the general population. Given different average daily intakes of niacin in these populations, different glaucoma definitions and several confounding variables which weaken the associations, large sample, standardised randomised controlled trials are needed to confirm the potential benefits of niacin in glaucoma. Full article

(This article belongs to the Special Issue Diet and Supplements in the Prevention and Treatment of Eye Diseases)

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