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Abstract
This study aims to establish the relation between the state of micronuterient in the body and diseases that affect the retina such as diabetic retinopathy and age related macular degeneration.
The study was done on a number of 60 subjects who attended the out patient clinic of the Research Institute of Ophthalmology looking for ocular medial care. These case were classified into three groups as follows. 20 subjects with no eye complications to serve as controls. 20 cases suffering from diabetic retinopathy. 20 cases suffering from age related macular degeneration. Cases were subjected to an overall clinical examination including the ophthalmological aspects. Anthropometric measurements were assessed. The food consumption pattern was estimated by dietary recall. The daily nutrient intake was calculated, using a computer program designed for this purpose. A blood sample was taken from each individual. This sample was used for estimation of blood hemoglobin and Glutathione peroxidase, plasma total protein, plasma albumin, serum iron, serum total iron binding capacity, serum copper, zinc, carotene and vitamin A (retinol). The data obtained from this study showed the following.
1- Cases suffering from diabetic retinopathy have higher body mass index and suffer from obesity.
2- The intake of energy in diabetic retinopathy patient exceeded the mean of ideal physiological requirement. While the intake of protein and fat was satisfactory. However, it was evidenced that patients have higher intake from saturated fat and most protein consumed was from plant origin which known to be deficient in some essential amino acids. These results support a role of obesity, quality of glycemic control and saturated fat as factors involved in DR development among these cases. 3- The dietary recall made to DR patients showed a marked low intake of each vitamin C and Vitamin A. Also having significantly low level of serum vitamin A and carotene. The two vitamins namely ascorbic acid and carotene are considered to be vitamins with antioxidant capabilities. It was suggested that the low intake of these vitamins is behind the development of DR. 4- The intake of zinc and copper was markedly low. The deficiency of zinc and copper is associated with low serum zinc and copper. Zinc and copper are known to play an important role in the normal metabolism of the retina and as minerals involved in free radical scavenging enzymes. This shows that Cu and zinc are factors involved in diabetic retinopathy development among these cases. 5- Activity of Glutathione peroxidase was increased as a response to react against the oxidative stress in diabetic retinopathy. Se is a necessary part of GSH –Px which serves as an antioxidant ,protecting cells from free radicals. 6- Age related macular degeneration cases have amore or less normal body mass index indicating that those cases don’t suffer from obesity 7- The intake of energy, protein and fat in AMD patient was satisfactory. This shows that energy and protein intake are not factors involved in AMD development among these cases.
8- The intake of vitamin C and vitamin A in patients suffering from AMD is markedly below normal physiological requirements. Also they have significantly low levels of serum vitamin A and carotene. It was suggested that the low intake of these vitamins is behind the development of AMD 9- There is a shortage of zinc and copper intake, the deficiency of zinc and copper is associated with low serum zinc and copper levels. Thus the deficiency of zinc and copper can be also a factor affecting AMD development 10- The level of Glutathione peroxidase in AMD patients was significantly lower than controls. This may confirm the role of Se deficiency as a factor contributing to the occurrence of AMD. 11- The dietary recall made to AMD patients showed that females have more nutrients intake than males. This study show that low vitamins and minerals intake and also higher consumption of saturated fat are factors possible to be behind the incidence or development of some retinal diseases such as AMD and DR. In order to avoid complications that associate these retinal diseases, the diet of those patients should be adjusted. A balanced diet should be provided that contain adequate calories and proteins that can satisfy the requirements under such condition. The diet should contain in particular vitamins with antioxidant characters such as vitamin E, C, -carotene and vitamin A. Minerals that are essential to the proper function of antioxidant enzymes should also be provided.