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Editors Selection IGR 16-3

Miscellaneous: Niacin Intake and Glaucoma

Comment by Jost Jonas on:

108165 Associations Between Niacin Intake and Glaucoma in the National Health and Nutrition Examination Survey, Lee SY; Tseng VL; Kitayama K; Kitayama K et al., Journal of Glaucoma, 2023; 32: 443-450

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In a large cross-sectional study consisting of more than 5000 adult participants of the 2005- 2008 National Health and Nutrition Examination Survey (NHANES) and including 55 (1.0%) patients with glaucoma, Lee and colleagues reported on an inverse relationship between a higher niacin intake and a lower glaucoma prevalence. The NHANES is a survey of the U.S. civilian, noninstitutionalized population and was conducted by the US National Center for Health Statistics. Dietary niacin intake was assessed based on two 24-hour dietary recall interviews, and glaucoma was defined by regrading optic disc images. The multivariable regression analysis was adjusted for age, sex, ethnic background, education level, income, body mass index, smoking status, alcohol use, cardiovascular disease, diabetes mellitus, daily energy intake, vitamin B2 and B6 consumption, and macular degeneration. Using niacin intake as a continuous variable, each additional one mg of dietary niacin intake was associated with 6% lower odds of glaucoma in adjusted analyses (odds ratio (OR): 0.94; 95%CI: 0.90, 0.98). When analyzed in quartiles, however, the highest quartile of dietary niacin intake did not correlate significantly with the glaucoma risk in partially or fully adjusted models (fully adjusted OR: 0.30, 95%CI: 0.05, 1.93). In a similar manner, when assessed as a binary variable, a higher dietary niacin intake was not significantly associated with the glaucoma risk in partially or fully adjusted models (fully adjusted OR: 0.61; 95%CI: 0.30, 1.23). Stratified by sex, niacin intake as a binary variable was significantly associated with a lower glaucoma risk only in women (OR: 0.35; 95%CI: 0.14, 0.90), but not among men (OR: 1.12: 95%CI: 0.32, 2.31). Besides the limitation in the general statistical significance of the results, other limitations of the study were listed by the authors, such as that the study only assessed dietary niacin intake while supplementary niacin was not recorded; that niacin for the therapy of hyperlipidemia was excluded; that tryptophan, albeit the possibility of its endogenous transformation into niacin, was not included as a variable; that the glaucoma diagnosis might have been inaccurate in some circumstances since only optic disc images were available (e.g., the glaucoma prevalence was relatively low in the present study as compared to previous several population-based studies); that glaucoma was not differentiated into open-angle glaucoma versus angle-closure glaucoma and that intraocular pressure was not included into the analysis; and that the study as a cross-sectional investigation could not assess causality. In conclusion, future studies may further evaluate the potential association between niacin intake and glaucoma to further corroborate the findings and conclusions made in the present study.

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