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Editors Selection IGR 21-4

Risk Factors: Is glaucoma associated to niacin intake?

Comment by Dewang Angmo & Tanuj Dada on:

95813 Association between Daily Niacin Intake and Glaucoma: National Health and Nutrition Examination Survey, Taechameekietichai T; Taechameekietichai T; Chansangpetch S; Peerawaranun P et al., Nutrients, 2021; 13:

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Niacin a form of vitamin B3, is a precursor for coenzyme - nicotinamide adenine dinucleotide (NAD) which plays an important role in RGC mitochondrial energy production and preventing neurodegeneration.¹ Restoring NAD with its niacin precursor could provide a potential neuroprotective effect towards glaucoma.² Taechameekietichai et al. evaluated the relationship between dietary intake of niacin and glaucoma using the data from 5768 participants in the National Health and Nutrition Examination Survey (NHANES).³ Subjects aged > 40 years were included and Glaucoma diagnosis by self-report was utilized along with glaucoma diagnosis by fundus imaging and ISGEO criteria where available (n=4539). The authors reported a significant decrease in the crude odds of self-reported glaucoma in the third (OR 0.57, 95% Cl 0.43−0.76; p < 0.001) and fourth quartiles (OR 0.57, 95% Cl 0.37−0.90; p = 0.018) of daily niacin consumption, which equated to 21.01 to 28.22 mg/ day and greater than 28.22 mg/day, respectively. After adjusting for covariates, the odds of glaucoma based on fundus imaging remained significantly lower for niacin intake in the third (OR 0.49, 95% Cl 0.28−0.87; p = 0.016) and fourth (OR 0.48, 95% Cl 0.26−0.89; p = 0.022) quartile levels. The study concluded that a greater niacin intake may be associated with a lower chance of developing glaucoma.

Although this study is a large population based study, several limitations must be noted. Confounding factors like lifestyle could be associated with dietary intake and bioavailability would be different requiring serum evaluation. The consumption of niacin is based on last 24 hour recall while glaucoma is a chronic disease process. There is a possibility that recent consumption may be different from historical consumption due to change in dietary habits.

Retinal imaging & perimetry (frequency doubling technology) were carried out as part of the study, presumably after the survey data collection. In this process it is possible that a 'non-glaucomatous' individual by survey data might be glaucomatous as per the retinal imaging and perimetry assessment and vice versa. It would be useful to know the time lag between the survey and these examinations and the number of individuals with discordant outcomes by the survey vs clinical assessments and how such subjects were treated in the analysis.

The type and severity of glaucoma and correlations with niacin intake are lacking. The study has reported Standard Error with the continuous variables when in fact they should be reporting standard deviation.

Although a cause and effect relationship between niacin intake and glaucoma cannot be established from this observational study, it makes an important contribution in laying the foundation for performing future epidemiological cohort studies

Although a cause and effect relationship between niacin intake and glaucoma cannot be established from this observational study, it makes an important contribution in laying the foundation for performing future epidemiological cohort studies or trials with serum niacin assessment to evaluate the impact of niacin levels on RGC structure and function and to note the beneficial effects of niacin supplementation on glaucomatous optic neuropathy.

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