Mikronährstoffe und ihre Bedeutung für das Auge – Wirkungsweise von Lutein/Zeaxanthin und Omega-3-Fettsäuren

 

 Buy Article Permissions and Reprints

Zusammenfassung

Mikronährstoffe spielen für die Funktion und für die Gesunderhaltung des Auges eine wichtige Rolle. Insbesondere Lutein, Zeaxanthin sowie Omega-3-Fettsäuren erfüllen dabei wichtige Funktionen: Lutein bildet zusammen mit Zeaxanthin das Makuläre Pigment, beide Carotinoide filtern den schädigenden blauen Lichtanteil des Sonnenlichts sowie das UV-Licht heraus, was zu verbessertem Kontrastsehen und verminderter Blendeempfindlichkeit führt. Weiterhin hat das Makulapigment antioxidative sowie antiinflammatorische Wirkungen. Omega-3-Fettsäuren besitzen ebenfalls antientzündliche Wirksamkeit und schützen umgewandelt in Neuroprotektin vor oxidativ bedingter Apoptose in der Retina. Zudem sind sie für die Fluidität und Versorgung der Photorezeptorenmembran verantwortlich. Diese Eigenschaften sind für die Prävention und Behandlung degenerativer Augenerkrankungen wie der altersbedingten Makuladegeneration bedeutsam. Ältere Menschen sind jedoch häufig nicht ausreichend mit Mikronährstoffen über die Ernährung versorgt. Da sich die Versorgung durch Ernährungsumstellung kaum verbessern lässt, ist eine zusätzliche Aufnahme in Form von Nahrungsergänzungsmitteln besonders in dieser Altersgruppe sinnvoll. Wissenschaftliche Studien belegen die positiven Effekte einer Supplementation mit Mikronährstoffen wie Lutein/Zeaxanthin, Vitamin C, Vitamin E, Zink und den Omega-3-Fettsäuren Docosahexaensäure und Eicoasapentaensäure (DHA und EPA). Die derzeit verfügbaren Nährstoffpräparate orientieren sich zum Teil noch an den Inhaltsstoffen der ARED-Studie (Age Related Eye Disease Study). Nach aktuellerer Studienlage sollten bei der Auswahl jedoch Formulierungen mit Lutein und Omega-3-Fettsäuren in physiologisch sinnvoller Dosierung ohne zusätzliches Beta-Carotin bevorzugt werden. 10 – 20 mg Lutein und Zeaxanthin stellen eine sichere Tages-Dosierung dar. In dem oben dargestellten Zusammenhang spielt Beta-Carotin für das Auge eine untergeordnete Rolle und ist in hoher Dosierung vor allem für Raucher kritisch für die Gesundheit. Die vorliegende Arbeit fasst die Funktionen der genannten Mikronährstoffe am Auge zusammen und kann Ophthalmologen bei der Beratung ihrer Patienten unterstützen.

Abstract

Micronutrients play an important role in function and health maintenance for the eye. Especially lutein, zeaxanthin and omega-3 fatty acids perform remarkable functions: lutein together with zeaxanthin forms the macular pigment, these carotenoids filter out the damaging blue light component from the sunlight as well as the ultraviolet light which leads to improved contrast sensitivity and less problems with screen glare. Furthermore, the macular pigment has antioxidant and anti-inflammatory effects. The omega-3 fatty acids also possess anti-inflammatory effects and, when converted into neuroprotectin, they protect against oxidative induced apoptosis in the retina. They are also responsible for the fluidity and supply to the photoreceptor membrane. These properties are important for the prevention and treatment of degenerative eye diseases like age-related macular degeneration. However, older people are often not sufficiently supplied of micronutrients in their diet. Because the supply of nutrients can hardly be achieved by dietary change, the additional intake in the form of food supplements is useful in this age group. Scientific studies have shown the positive effects of supplementation with micronutrients such as lutein/zeaxanthin, vitamin C, vitamin E, zinc and omega-3 fatty acids, docosahexaenoic acid and eicosapentaenoic acid (DHA and EPA). Currently available nutritional products are based in part on the ingredients of the ARED study (Age Related Eye Disease Study). According to more recent studies formulations containing lutein and omega-3 fatty acids in physiologically meaningful doses without additional beta-carotene should be preferred. 10 to 20 mg of lutein and zeaxanthin represent a safe daily dose Regarding to the context above, beta-carotene in high doses plays a minor role to the eye and is especially critical for the health of smokers. This paper summarises the functions of the presented micronutrients in the eye and can assist ophthalmologists in advising their patients.

Literatur

• 1 Wald G, Granit R, Hartline H K. Für ihre Entdeckung auf dem Gebiet der primären physiologischen und chemischen Sehvorgänge im Auge. Nobelpreis für Medizin 1967 http://www.nobelpreis.org
  Google Scholar
• 2 SanGiovanni J P et al. The relationship of dietary lipid intake and age-related macular degeneration in a case-control study: AREDS Report No. 20.  Arch Ophthalmol. 2007;  125 671-679
  Google Scholar
• 3 SanGiovanni J P, Chew E Y, Clemons T E et al. The Relationship of Dietary Carotenoid and Vitamin A, E, and C Intake With Age-Related Macular Degeneration in a Case-Control Study: AREDS Report No. 22.  Arch Ophthalmol. 2007;  125 (9) 1225-1232
  Google Scholar
• 4 SanGiovanni J P, Chew E Y, Agrón E et al. The relationship of dietary omega-3 long-chain polyunsaturated fatty acid intake with incident age-related macular degeneration: AREDS report no. 23.  Arch Ophthalmol. 2008;  126 (9) 1274-1279
  Google Scholar
• 5 SanGiovanni J P, Agrón E, Meleth A D et al. Omega-3 Long-chain polyunsaturated fatty acid intake and 12-y incidence of neovascular age-related macular degeneration and central geographic atrophy: AREDS report 30.  Am J Clin Nutr. 2009;  90 (6) 1601-1607
  Google Scholar
• 6 Richer S et al. LAST Studie.  Optometry. 2004;  75 (4) 216-230
  Google Scholar
• 7 Brinkmann C K, Rothenbühler S P, Wolf-Schnurrbusch U EK et al. Enhancement of Macular Pigment by Oral Lutein Supplemantation Study (EMPOLS): First Results. ARVO; 2009 , Poster 1708-A288
  Google Scholar
• 8 Wooten B R, Hammond B R. Macular pigment: influences on visual acuity and visibility.  Prog Retin Eye Res. 2002;  21 (2) 225-240
  Google Scholar
• 9 Olmedilla B, Granado F, Blanco I et al. Lutein, but not alpha-tocopherol, supplementation improves visual function in patients with age-related cataracts: a 2-y double-blind, placebo-controlled pilot study.  Nutrition. 2003;  19 (1) 21-24
  Google Scholar
• 10 Kvansakul J, Rodriguez-Carmona M, Edgar D F et al. Supplementation with the carotenoids lutein or zeaxanthin improves human visual performance.  Ophthalmic Physiol. 2006;  26 (4) 362-371
  Google Scholar
• 11 Neelam K et al. Psychophysical Function in Age-related Maculopathy.  Surv Ophthalmol. 2009;  54 (2) 167-210
  Google Scholar
• 12 Stringham J M, Hammond B R. Macular pigment and visual performance under glare conditions.  Optom Vis Sci. 2008;  85 (2) 82-88
  Google Scholar
• 13 Izumi-Nagai K, Nagai N, Ohgami K et al. Macular pigment lutein is antiinflammatory in preventing choroidal neovascularization.  Arter Thromb Vasc Biol. 2007;  27(12) 2555-2562
  Google Scholar
• 14 Jin X H, Ohgami K, Shiratori K et al. Inhibitory Effects of Lutein on Endotoxin-Induced Uveitis (EIU) in Lewis Rats.  Invest Ophthalmol Vis Sci. 2006;  47 2562-2568
  Google Scholar
• 15 Seddon J M, Ajani U A, Sperduto R D et al. Dietary carotenoids, vitamins A, C and E, and advanced age-related macular degeneration. Eye Disease Case-Control Study Group.  JAMA. 1994;  272 (18) 1413-1420
  Google Scholar
• 16 Sperduto R D et al. Antioxidant status and neovascular age-related macular degeneration. Eye Disease Case-Control Study Group.  Arch Ophtalmol. 1993;  111 104-109
  Google Scholar
• 17 Bone R A, Landrum J T, Mayne S T et al. Macular pigment in donor eyes with and without AMD: a case-control study.  Invest Ophtalmol Vis Sci. 2001;  42 235-240
  Google Scholar
• 18 Bernstein P S, Zhao D Y, Ermakov I V et al. Resonance Raman measurement of macular carotenoids in normal subjects and in age-related macular degeneration patients.  Ophtalmology. 2002;  109 1780-1787
  Google Scholar
• 19 Olmedilla B, Granado F, Blanco I et al. Lutein in patients with cataracts and age-related macular degeneration: a long-term supplementation study.  J Sci Food Agric. 2001;  81 904-909
  Google Scholar
• 20 Falsini B, Piccardi M, Larossi G et al. Influence of short-term antioxidant supplementation on macular function in age-related maculopathy: a pilot study including electrophysiologic assessment.  Ophtalmology. 2003;  110 51-60
  Google Scholar
• 21 Bone R A, Landrum J T, Dixon Z et al. Lutein and zeaxanthin in the eyes, serum and diet of human subjects.  Exp Eye Res. 2000;  71 239-245
  Google Scholar
• 22 Landrum J T, Bone R A, Joa H et al. A one year study of the macular pigment: the effect of 140 days of a lutein supplement.  Exp Eye Res. 1997;  65 (1) 57-62
  Google Scholar
• 23 Hammond B R, Johnson E J, Russell R M et al. Dietary modification of human macular pigment density.  Invest Ophtalmol Vis Sci. 1997;  38 (9) 1795-1801
  Google Scholar
• 24 Berendschol Jr T et al. Effekt einer Erhöhung der Luteinzufuhr durch Supplementierung.  Invest Ophtalmol Vis Sci. 2000;  41 3322-3326
  Google Scholar
• 25 Chakravarthy U, Beatty S, Stevenson M et al. Functional and Morphological Outcomes in the CARMA Clinical Trial.  Invest Ophthalmol Vis Sci. 2009;  50 E-Abstract 1257
  Google Scholar
• 26 Bone R A, Landrum J T, Mayne S T et al. Macular pigment in donor eyes with and without AMD: a case-control study.  Invest Ophthalmol Vis Sci. 2001;  42 235-420
  Google Scholar
• 27 Beatty S, Koh H H, Phil M et al. The role of oxidative stress in the pathogenesis of age-related macular degeneration.  Surv Ophthalmol. 2000;  45 115-134
  Google Scholar
• 28 Uauy R, Mena P, Rojas C. Essential fatty acids in early life: structural and functional role.  Proc Nutr Soc. 2000;  59 3-15
  Google Scholar
• 29 Rotstein N P, Pliti L E, German O L et al. Protective effect of docosahexaenoic acid on oxidative stress-induced apoptosis of retina photoreceptors.  Invest Ophthalmol Vis Sci. 2003;  44 (5) 2252-2259
  Google Scholar
• 30 SanGiovanni J P, Chew E Y. The role of omega-3 long-chain polyunsaturated fatty acids in health and disease of the retina.  Prog Retin Eye Res. 2005;  24 (1) 87-138
  Google Scholar
• 31 Connor K M, SanGiovanni J P, Lofqvist C et al. Increased dietary intake of Omega-3-polyunsaturated fatty acids reduces pathological retinal angiogenesis.  Nat Med. 2007;  13 (7) 868-873
  Google Scholar
• 32 Bazan N G. Omega-3 fatty acids, pro-inflammatory signaling and neuroprotection – Review.  Curr Opin Clin Nutr Metab Care. 2007;  10 (2) 136-41
  Google Scholar
• 33 Newman W P et al. Atherosclerosis in Alaska natives and non-natives.  Lancet. 1993;  341 1056-1057
  Google Scholar
• 34 Schmidt E B, Skou H A, Christensen J H et al. N-3 fatty acids from fish and coronary artery disease: implications for public health.  Public Health Nutr. 2000;  3 (1) 91-98
  Google Scholar
• 35 Hamazaki T, Urakaze M, Sawazaki S et al. Comparison of pulse velocity of the aorta between inhabitants of fishing and farming villages in Japan.  Atherosclerosis. 1988;  73 157-160
  Google Scholar
• 36 Sacks F M, Stone P H, Gibson C M et al. Controlled trial of fish oil for regression of human coronary atherosclerosis. HARP Research Group.  J Am Coll Cardiol. 1995;  25 1492-1498
  Google Scholar
• 37 Schacky, Angerer C P, Kothny W et al. The effect of dietary omega-3 fatty acids on coronary atherosclerosis: a randomized double-blind, placebo-controlled trial.  Ann Intern Med. 1999;  130 554-562
  Google Scholar
• 38 Rotstein N P, Politi L E, German O L et al. Protective effect of docosahexaenoic acid on oxidative stress-induced apoptosis of retina photoreceptors.  Invest ophthalmol Vis Sci. 2003;  44 (5) 252-259
  Google Scholar
• 39 Elner V M. Retinal pigment epithelial acid lipase activity and lipoprotein receptors: effects of dietary omega-3 fatty acids.  Trans Am Ophthalmol Soc. 2002;  100 301-338
  Google Scholar
• 40 Cleland L G, James M J, Proudman S M. Fish oil: what prescriber needs to know.  Arthr Res Ther. 2005;  8 202
  Google Scholar
• 41 SanGiovanni J P et al. The relationship of dietary lipid intake and age-related macular degeneration in a case-control study: AREDS Report No. 20.  Arch Ophthalmol. 2007;  125 671-679
  Google Scholar
• 42 Seddon J M, Ajani U A, Sperduto R D et al. Dietary carotenoids, vitamins A, C, and E, and advanced age-related macular degeneration. Eye Disease Case-Control Study Group.  JAMA. 1994;  272 (18) 1413-1420
  Google Scholar
• 43 Biesalski H K, Fürst P, Kasper H. et al .Ernährungsmedizin. Stuttgart: Thieme; 1999: 76
  Google Scholar
• 44 In: Referenzwerte für die Nährstoffzufuhr. Umschau Braus GmbH: 2008: 56.
  Google Scholar
• 45 Wolfram G, Freman D. Referenzwerte mit Gewähr – Richtwerte für die Fettzufuhr.  Ernährungs-Umschau. 2001;  8 274-283
  Google Scholar
• 46 In: Referenzwerte für die Nährstoffzufuhr. Umschau Braus GmbH (S. 55) (2008).
  Google Scholar
• 47 Hoyos C, Almqvist C, Garden F et al. Effect of omega 3 and omega 6 fatty acid intakes from diet and supplements on plasma fatty acid levels in the first 3 years of life.  Asia Pac J Clin Nutr. 2008;  17 (4) 552-557
  Google Scholar
• 48 Referenzwerte für die Nährstoffzufuhr 2008 Umschau Braus GmbH (S. 54). 
  Google Scholar
• 49 Alves-Rodrigues A, Shao A. The science behind lutein. Tox Letters 150 2004
  Google Scholar
• 50 EFSA Comment zu omega-3-fatty acids vom 19.1.2009. 
  Google Scholar
• 51 Calder P C. n-3 Polyunsaturated fatty acids and cytokine production in health and disease.  Ann Nutr Metab. 1997;  41 203-234
  Google Scholar
• 52 Stargrove M B. et al .Herb, Nutrient and Drug Interactions. Mosby Elsevier; 2008
  Google Scholar
• 53 Sijben J W, Calder P C. Differential immunomodulation with long-chain n-3 PUFA in health and chronic disease.  Proc Nutr Soc. 2007;  66 (2) 237-259
  Google Scholar
• 54 Lengyel I, Flinn J M, Peto T et al. High concentration of zinc in sub-retinal pigment epithelial deposits.  Exp Eye Res. 2007;  84 (4) 772-780
  Google Scholar
• 55 Age-Related Eye Disease Study Research Group . A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degeneration and vision loss: AREDS report no. 8.  Arch Ophthalmol. 2001;  119 (10) 1417-1436
  Google Scholar
• 56 The ATBC Cancer Prevention Study Group . The alpha-tocopherol, beta-carotene lung cancer prevention study: design, methods, participant characteristics, and compliance.  Ann Epidemiol. 1994;  4 (1) 1-10
  Google Scholar
• 57 Omenn G S, Goodman G E, Thornquist M D et al. Risk factors for lung cancer and for intervention effects in CARET, the Beta-Carotene and Retinol Efficacy Trial.  J Natl Cancer Inst. 1996;  88 (21) 1550-1559
  Google Scholar
• 58 Goodman G E, Thornquist M D, Balmes J et al. The Beta-Carotene and Retinol Efficacy Trial: incidence of lung cancer and cardiovascular disease mortality during 6-year follow-up after stopping beta-carotene and retinol supplements.  J Natl Cancer Inst. 2004;  96 (23) 1743-1750
  Google Scholar
• 59 Biesalski H K, Tinz J, Strobel M. The imprtance of beta-carotene as a source of vitamin A with special regard to pregnant and breastfeeding women.  Eur J Nutr. 2007;  46 (1) 1-20
  Google Scholar
• 60 Miller 3 rd E R, Pastor-Barriuso R, Dalal D et al. Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality.  Ann Intern Med. 2005;  142 (1) 37-46
  Google Scholar
• 61 Slatore C G, Littman A J, Au D H et al. Long-term use of supplemental multivitamins, vitamin C, vitamin E, and folate does not reduce the risk of lung cancer.  Am J Respir Crit Care Med. 2008;  177 (5) 524-530
  Google Scholar
• 62 http://www.crab.org/select/
• 63 Großklaus R, Henning K J. Vitamine für das Auge?.  Ophthalmologe. 2009;  106 521-526
  Google Scholar
• 64 Watzl B, Leitzmann C. Bioaktive Substanzen in Lebensmitteln. Stuttgart: Hippokrates Verlag; 2005: 27
  Google Scholar
• 65 Referenzwerte für Nährstoffzufuhr. 3. korrigierter Nachdruck der 1. Auflage Frankfurt/Main: Umschau Braus GmbH; 2008
  Google Scholar

Prof. Dr. Florian J. Schweigert

Institut für Ernährungswissenschaft, Universität Potsdam

Arthur-Scheunert-Allee 114 – 116

14558 Nuthetal

Phone: ++ 49/33 20 08 85 28/5 27

Fax: ++ 49/33 20 08 85 73

Email: fjschwei@uni-potsdam.de