Lutein is a type of xanthophyll often used in treatment or prevention of eye diseases. In this case as well, more research is eagerly awaited. Therefore, based on the most recent findings, this review will focus on lutein properties, dietary sources, usual intake, efficacy in human health, and toxicity. However, there are still conflicting data that need to be elucidated by randomized clinical trials with large cohorts of general population. After 40 weeks, no clinical effects; only minimal improvement in mfEGR. The Lutein Antioxidant Supplementation Trial (LAST) included 90 individuals with atrophic AMD and demonstrated a significant beneficial effect of L supplementation (10 mg/d), either alone or in combination with other antioxidants, for nearly 1 year [12]; in particular, it was observed that L enhanced MPOD, also improving VA and CS [12]. Power R., Coen R.F., Beatty S., Mulcahy R., Moran R., Stack J., Howard A.N., Nolan J.M. Another experiment carried out on mice demonstrated that L prevented arsenic-induced hepatotoxicity via reduced ROS production and lipid peroxidation [78]. reported that uveal structures account for about 50% of total eye carotenoids and 30% of total eye L [52]; this is the basis for the possible beneficial effects that L may have in the ciliary body and in the iris. Lutein is a xanthophyll, i.e., an oxygenated carotenoid that all mammalians, humans included, derive from their diet because they are unable to synthesize carotenoids [11]. suggested that L uptake in the retina may be mediated by a specific transporter, namely scavenger class B type 1 [53], thus explaining the massive build-up of L in the eye. We reviewed the literature on the evidence for the health effects of L, including its usual intake with different diets, adequate doses, and safety of supplementation, with specific reference to eye diseases. Vishwanathan R., Kuchan M.J., Sen S., Johnson E.J. Abdel-Aal E.-S.M., Akhtar H., Zaheer K., Ali R. Dietary sources of lutein and zeaxanthin carotenoids and their role in eye health. The structure of L is similar to that of other carotenoids, with a skeleton made up of 40 carbon atoms, organized into eight isoprene units [45], as shown in Figure 1. In mice, L was able to reverse the loss of nigral dopaminergic neurons by reducing oxidative stress and improving mitochondrial dysfunction [146]. After 1 year, both G1 and G2 showed significantly increased MPOD, VA and CS. Chen J., Smith L.E. One study that looked at more than 100,000 people from 1984 to 2010 found that a higher intake of bioavailable lutein and zeaxanthin was associated with a lower long-term risk of developing advanced age-related macular degeneration. According to a more recent study, L supplementation (20 mg/d for 3 months, followed by 10 mg/d for another 3 months) significantly increased MPOD by about 28% compared to placebo in 126 participants with AMD [14]. Vu H.T., Robman L., Hodge A., McCarty C.A., Taylor H.R. Le Marchand L., Hankin J.H., Bach F., Kolonel L.N., Wilkens L.R., Stacewicz-Sapuntzakis M., Bowen P.E., Beecher G.R., Laudon F., Baque P., et al. Identification and quantitation of carotenoids and their metabolites in the tissues of the human eye. Functional foods and their role in cancer prevention and health promotion: a comprehensive review. Lutein supplements contain a natural substance classified as a carotenoida group of plant pigments with antioxidant effects. RCT, participants with bilateral drusen or AMD in 1 eye (3335 eyes analyzed); 3 groups: G1 (1114 eyes); G2 (1104 eyes); G3 (1117 eyes). Liu R., Wang T., Zhang B., Qin L., Wu C., Li Q., Ma L. Lutein and zeaxanthin supplementation and association with visual function in age-related macular degeneration. No difference between G2 vs. G3. Recent data also demonstrated that L is effective in improving memory [139] or other measures of cognitive function, such as spatial memory and reasoning ability [140]. Positive correlation between MPOD increase, VA and CS. Weikel K.A., Garber C., Baburins A., Taylor A. Nutritional modulation of cataract. Lutein. European Food Safety Authority Scientific opinion on the re-evaluation of lutein [e 161b] as a food additive. observed a significant reduction (19%) in the risk of cataract in the highest quintile of L intake compared with the lowest quintile [20]. In particular, an association was observed between chronic intake of supplements also containing L and an increased risk of lung cancer, mainly non-small cell lung cancer [208]. Content is reviewed before publication and upon substantial updates. Snodderly D.M., Auran J.D., Delori F.C. Higher L circulating levels have been correlated with better cognitive ability scores, as measured by the Wechsler scale [134], and it has been proposed that an increased parahippocampal cortex volume may account for these results. The influence of cigarette smoking on circulating concentrations of antioxidant micronutrients. official website and that any information you provide is encrypted Young A.J., Lowe G.M. CS significantly increased in both G2 and G3, but much more in G3. Ho L., van Leeuwen R., Witteman J.C., van Duijn C.M., Uitterlinden A.G., Hofman A., de Jong P.T., Vingerling J.R., Klaver C.C. In rats fed with high fat diet, Qiu et al. Secondary analyses of the effects of lutein/zeaxanthin on age-related macular degeneration progression: AREDS2 report No. The presence of L has also been demonstrated in peripheral regions of the fovea [49], but its content decreases in the central region where Z is prevalent [49] by a 2:1 ratio [50]. Berrow E.J., Bartlett H.E., Eperjesi F., Gibson J.M. Conversely, other studies were consistent with a linear dose-response pattern for L efficacy [37,38], supported by a meta-analysis of 8 RCTs [33], suggesting that the higher the L intake, the better the outcome. Age-Related Eye Disease Study 2 Research Group Lutein + zeaxanthin and omega-3 fatty acids for age-related macular degeneration: The Age-Related Eye Disease Study 2 [AREDS2] randomized clinical trial. In mice, L significantly stimulated bone formation and inhibited bone reabsorption through its regulatory activity on NF-B [188]. Serum carotenoids and tocopherols and incidence of age-related nuclear cataract. In particular, it was also shown that L was ineffective in reducing the risk of developing AMD [29,30] and in slowing progression to late AMD [27,92]. We definitely need more data, and carefully conducted RCTs evidence on this issue consisting of prospective clinical studies that use data obtained from database of patients who had been prescribed lutein to slow the progression of cataract. Subczynski W.K., Wisniewska A., Widomska J. reported a dose-dependent inverse association between non-alcoholic fatty liver disease risk and serum carotenoid levels, including L [43]; in particular, they observed a 44% lower risk in the highest vs. lowest quintile. Nolan J.M., Loughman J., Akkali M.C., Stack J., Scanlon G., Davison P., Beatty S. The impact of macular pigment augmentation on visual performance in normal subjects: COMPASS. Moeller S.M., Voland R., Tinker L., Blodi B.A., Klein M.L., Gehrs K.M., Johnson E.J., Snodderly D.M., Wallace R.B., Chappell R.J., et al. Fiedor J., Burda K. Potential role of carotenoids as antioxidants in human health and disease. Overall, it seems that the amount of L intake, including by supplementation, may partly counter inflammatory processes and favor human health, but inconsistencies still remain. Liu T., Liu W.H., Zhao J.S., Meng F.Z., Wang H. Lutein protects against -amyloid peptide-induced oxidative stress in cerebrovascular endothelial cells through modulation of Nrf-2 and NF-b. Antioxidant and prooxidant properties of carotenoids. No significant differences in MPOD accumulation between G1 and G2. Institute of Medicine (US) Panel on Dietary Antioxidants and Related Compounds . Zhang P.C., Wu C.R., Wang Z.L., Wang L.Y., Han Y., Sun S.L., Li Q.S., Ma L. Effect of lutein supplementation on visual function in nonproliferative diabetic retinopathy. Most studies have focused on lutein (L), a carotenoid with a strong antioxidant effect in vitro [9] that has been associated with a reduced risk of age-related diseases [10]. The Atherosclerosis Risk in Communities (ARIC) study showed that L intake was not associated with DR in spite of the marked antioxidant properties [126]. Many studies in humans have also provided evidence for a beneficial role of L supplementation, lowering the blood concentrations of inflammatory cytokines, while favoring the secretion of anti-inflammatory cytokines [39]. Effect of supplemental lutein and zeaxanthin on serum, macular pigmentation, and visual performance in patients with early age-related macular degeneration. Significant improvement in VA and CS after 2 years. Lutein might have an important role even in other diseases. Secondary outcomes in a clinical trial of carotenoids with coantioxidants versus placebo in early age-related macular degeneration. Lutein intake at the age of 1 year and cardiometabolic health at the age of 6 years: The Generation R Study. FOIA After 1 year, significant improvement in MPOD, CS and glare sensitivity vs. placebo. Age-Related Eye Disease Study 2 (AREDS2) Research Group. Inflammation and its resolution as determinants of acute coronary syndromes. AMD: age-related macular degeneration; AREDS: age-related eye disease study (formulation: vit. observed that L significantly decreased circulating cholesterol serum levels and hepatic cholesterol and triglycerides [185]. No effect in reducing progression to advanced AMD. Muriach M., Bosch-Morell F., Arnal E., Alexander G., Blomhoff R., Romero F.J. Lutein prevents the effect of high glucose levels on immune system cells in vivo and in vitro. Read our, Study Highlights the Safest Supplements to Slow Age-Related Macular Degeneration, All-Natural Strategies to Prevent Cataracts, How Age-Related Macular Degeneration Is Treated, 15 Anti-Inflammatory Foods You Should Be Eating, Vitamin C: Uses, Side Effects, Dosage, and Interactions, Why Your Body Needs Folate and How to Get Enough. Zamroziewicz M.K., Paul E.J., Zwilling C.E., Johnson E.J., Kuchan M.J., Cohen N.J., Barbey A.K. Ge X.X., Xing M.Y., Yu L.F., Shen P. Carotenoid intake and esophageal cancer risk: A meta-analysis. Associations between age-related nuclear cataract and lutein and zeaxanthin in the diet and serum in the Carotenoids in the Age-Related Eye Disease Study, an Ancillary Study of the Womens Health Initiative. Location of macular xanthophylls in the most vulnerable regions of photoreceptor outer-segment membranes. Leermakers et al. Li S., Ding Y., Niu Q., Xu S., Pang L., Ma R., Jing M., Feng G., Tang J.X., Zhang Q., et al. The effects of a lutein-based supplement on objective and subjective measures of retinal and visual function in eyes with age-related maculopathyA randomised controlled trial. Aghajanpour M, Nazer MR, Obeidavi Z, Akbari M, Ezati P, Kor NM. However, an important chemical difference with functional implications is the presence of two oxygen atoms inside the structure [46], thus making L a polar carotenoid which is classified as a xanthophyll, namely an oxygenated carotenoid. A.S. collected and analyzed references concerning the cardiovascular aspects, revised and approved the final version. Karppi J., Laukkanen J.A., Kurl S. Plasma lutein and zeaxanthin and the risk of age-related nuclear cataract among the elderly Finnish population. Lutein and atherosclerosis: Belfast versus Toulouse revisited. S.B. Chong E.W., Wong T.Y., Kreis A.J., Simpson J.A., Guymer R.H. Dietary antioxidants and primary prevention of age related macular degeneration: Systematic review and meta-analysis. Gastric acidity influences the blood response to a beta-carotene dose in humans. Orlistat, a drug that inhibits lipase activity, has proven to decrease L absorption [67] to an extent similar to that of impaired activity of pancreatic enzymes [68], as in the case of in vitro measurements relative to patients with cystic fibrosis [69] or, to a lesser extent, with smoking [70] and alcohol consumption [71]. Beatty S., Chakravarthy U., Nolan J.M., Muldrew K.A., Woodside J.V., Denny F., Stevenson M.R. Lyle et al. However, there is probably too little evidence to conclude on this issue [186]. Lutein improves visual function in some patients with retinal degeneration: A pilot study via the Internet. It is called the "eye vitamin" since it is found in the human eye, specifically within the macula and retina. By clicking Accept All Cookies, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts. The new PMC design is here! and M.L.P. Xanthophylls and alpha-tocopherol decrease UVB-induced lipid peroxidation and stress signaling in human lens epithelial cells. Safety assessment of lutein and zeaxanthin (Lutemax 2020): Subchronic toxicity and mutagenicity studies. In summary, there is some evidence that L is a CV protective factor, however, definitive data from RCTs are still missing. In particular, in over 30,000 participants Brown et al. In some cases,the product may deliver doses that differ from the specified amount for each herb. Memorial Sloan-Kettering Cancer Center, "About Herbs: Lutein". Rock C.L., Swendseid M.E. After 1 year, MPOD increased in all groups; the significant improvement in CS was much more effective in G3. Reinterpretation of the results of a pooled analysis of dietary carotenoid intake and breast cancer risk by using the interval collapsing method. Johnson E.J., Vishwanathan R., Johnson M.A., Hausman D.B., Davey A., Scott T.M., Green R.C., Miller L.S., Gearing M., Woodard J., et al. Korobelnik J.F., Rougier M.B., Delyfer M.N., Bron A., Merle B.M.J., Savel H., Chne G., Delcourt C., Creuzot-Garcher C. Effect of Dietary Supplementation with Lutein, Zeaxanthin, and -3 on Macular Pigment: A Randomized Clinical Trial. Zheng et al. Probable benefits of increasing folic acid intakes. Health effects of carotenoids during pregnancy and lactation. Significant improvement in VA after 6 months. Satia J.A., Littman A., Slatore C.G., Galanko J.A., White E. Long-term use of beta-carotene, retinol, lycopene, and lutein supplements and lung cancer risk: Results from the Vitamins and Lifestyle (VITAL) study. At present, there are too many uncertainties about the anti-cancer action of L, but data are sufficient to pursue this research line. Nutrients and bioactives in green leafy vegetables and cognitive decline: Prospective study. Intervention trial, participants with AMD (45); 3 groups: G1 (15); G2 (15)]; G3 (15). observed a positive correlation between L and blood concentrations of activin-A in infants [135], a neuroprotection marker [136,137]. Retinopathy of prematurity. Amengual J., Lobo G.P., Golczak M., Li H.N., Klimova T., Hoppel C.L., Wyss A., Palczewski K., von Lintig J. will also be available for a limited time. However, it seems premature to claim that L exerts a protective effect on skin. Relationship between serum and brain carotenoids, -tocopherol, and retinol concentrations and cognitive performance in the oldest old from the Georgia Centenarian Study. Spectrosc. As reported above, mammalians are not able to synthesize carotenoids which therefore need to be introduced with food [11]. Although these data have been obtained mostly from observational studies, they conclude that the risk for coronary disease and stroke is lower in the highest tertile for L intake compared to the lowest. In a case-control study including 421 individuals with neovascular AMD and 615 controls, it was found that the odds ratio (OR) of developing AMD was 0.3 when the highest quintile of L serum concentrations was compared with the lowest quintile, hypothesizing a negative relationship between L levels and AMD risk [103]. [193]. Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. HHS Vulnerability Disclosure, Help The Carotenoids with Co-antioxidants in Age-Related Maculopathy (CARMA) study demonstrated that L (12 mg/d for 2 years) improved VA in 433 patients with early AMD [15]. United States Department of Agriculture, Agricultural Research Service . Lutein has been demonstrated to exert an extremely potent antioxidant action by quenching singlet oxygen and scavenging free radicals [9,72], although it seems to be less potent than Z [9]. Studies performed both in animals [198,199] and in-vitro [199] clearly demonstrated that the use of L is safe as no mutagenic or teratogenic effect was observed. The EFSA additionally set an upper limit for L-enriched milk for infants, establishing a maximum L supplementation of 250 g/L [205]. Leermakers E.T., Darweesh S.K., Baena C.P., Moreira E.M., Melo van Lent D., Tielemans M.J., Muka T., Vitezova A., Chowdhury R., Bramer W.M., et al. Cho E., Hankinson S.E., Rosner B., Willett W.C., Colditz G.A. Lind M., Hayes A., Caprnda M., Petrovic D., Rodrigo L., Kruzliak P., Zulli A. Inducible nitric oxide synthase: Good or bad? Both animal and in vitro studies demonstrated that some carotenoids are compounds with antioxidant activity [5,6]. After 3 years, all the groups showed a significant increase in MPOD but no effects in reducing progression to advanced AMD or improving VA. CS significantly increased, mainly in G3. No improvement in VA, but VA decreased on placebo. Lutein is found mainly in the inner plexiform layer and in Henles fiber layer [47] but it can also be found in Mller cells [48]. Cathy Wong is a nutritionist and wellness expert. Intervention trial, participants with AMD (67); 3 groups with different dosages. Nevertheless, although L does not seem to be toxic, some side effects have been reported. Wang M.X., Jiao J.H., Li Z.Y., Liu R.R., Shi Q., Ma L. Lutein supplementation reduces plasma lipid peroxidation and C-reactive protein in healthy nonsmokers. A European multicentre, placebo-controlled supplementation study with alpha-tocopherol, carotene-rich palm oil, lutein or lycopene: Analysis of serum responses. Significant VA enhancement not before 24 months. Qiu X., Gao D.H., Xiang X., Xiong Y.F., Zhu T.S., Liu L.G., Sun X.F., Hao L.P. Ameliorative effects of lutein on non-alcoholic fatty liver disease in rats. Lutein and zeaxanthin supplementation in preterm infants to prevent retinopathy of prematurity: A randomized controlled study. ); ti.obinu@inisehcram.oiluig (G.M. A large body of evidence suggests that a diet rich in antioxidants, which have an anti-inflammatory role [1,2], may contribute to reducing the burden of chronic diseases [3]. After 12 weeks, no effect in improving VA and glare sensitivity. Carotid-wall intima-media thickness and cardiovascular events. Preliminary identification of the human macular pigment. No effect in improving VA. Other factors influencing atherosclerosis and CV risk, like lipid peroxidation and C-reactive protein serum concentrations, were shown to be reduced following L supplementation [160]. The site is secure. The lower MPOD at baseline, the greater the improvement. In this study other formulations were also investigated. However, an accurate survey performed by the EFSA concluded that data were insufficient to consider that L supplementation is associated with such negative events [197]. Bone R.A., Landrum J.T., Hime G.W., Cains A., Zamor J. Stereochemistry of the human macular carotenoids. Interesting results have also come from several meta-analyses investigating the potential of L as an anti-cancer compound. Lorenzoni F., Giampietri M., Ferri G., Lunardi S., Madrigali V., Battini L., Boldrini A., Ghirri P. Lutein administration to pregnant women with gestational diabetes mellitus is associated to a decrease of oxidative stress in newborns. The food matrix of spinach is a limiting factor in determining the bioavailability of beta-carotene and to a lesser extent of lutein in humans. about navigating our updated article layout. Dawczynski J., Jentsch S., Schweitzer D., Hammer M., Lang G.E., Strobel J. Adackapara C.A., Sunness J.S., Dibernardo C.W., Melia B.M., Dagnelie G. Prevalence of cystoid macular edema and stability in oct retinal thickness in eyes with retinitis pigmentosa during a 48-week lutein trial. Only a subgroup of 13 participants had an effective increase both in serum levels of L and MPOD. Wu J, Cho E, Willett WC, Sastry SM, Schaumberg DA. Bone R.A., Landrum J.T., Friedes L.M., Gomez C.M., Kilburn M.D., Menendez E., Vidal I., Wang W. Distribution of lutein and zeaxanthin stereoisomers in the human retina. Before Mono- and diglycerides improve lutein absorption in healthy adults: A randomised, double-blind, cross-over, single-dose study. Enhanced resistance to oxidation of low density lipoproteins and decreased lipid peroxide formation during beta-carotene supplementation in cystic fibrosis. concluded that L might be useful in cataract treatment [124]. Sato et al. Antioxidant micronutrients and the risk of renal cell carcinoma in the Womens Health Initiative cohort. Carotenoid intake and head and neck cancer: A pooled analysis in the International Head and Neck Cancer Epidemiology Consortium. Similar results were obtained in vitro, where L was effective in increasing bone formation, preventing bone loss, and decreasing the interleukin-1-dependent differentiation of osteoclasts [189]. RCT, participants with AMD (14); treatment group (8) vs. no treatment (6). However, a recent meta-analysis by the same authors that included studies enrolling more than 350,000 participants concluded that L consumption is associated with better CV health [170]. An RCT conducted on 144 patients with subclinical atherosclerosis demonstrated that L significantly decreased the carotid intima-media thickness [164], which is an established CV risk factor [165]. Lutein is naturally abundant and available in fruit, cereals, and vegetables, and it is also present in egg yolk [4], as seen in Table 1, where its bioavailability is higher than in any other food [81]. Lutein supplements are typically used in alternative medicine for eye diseases, such as cataracts and macular degeneration. Renzi-Hammond L.M., Bovier E.R., Fletcher L.M., Miller L.S., Mewborn C.M., Lindbergh C.A., Baxter J.H., Hammond B.R. government site. prospectively reported that dietary factors associated with L intake slow down age-related cognitive decline [147]. [145] reported that L stimulates the in-vitro differentiation of human stem cells into neural progenitors, a noteworthy effect that might protect against specific types of dementia as Alzheimers disease. Intake of lutein and zeaxanthin differ with age, sex, and ethnicity. Observational studies have confirmed the possible beneficial effects of L intake on total hip bone mineral density in men [42], supporting a positive role on bone health [190]. Morris M.C., Wang Y., Barnes L.L., Bennett D.A., Dawson-Hughes B., Booth S.L. More than 20 years ago Seddon et al. Some skin yellowing was a side effect in people with moderate age-related macular degeneration (AMD) taking high amounts of lutein over multiple years. suggested that L plasma levels were inversely associated with circulating levels of oxidized LDL [161], whereas low circulating levels of L were associated with an increased risk of developing atrial fibrillation [162]. A prospective study of carotenoid intake and risk of cataract extraction in US men. Prospective study of lutein/zeaxanthin intake and risk of age-related macular degeneration. To date, no study reported toxicity, either in acute or during chronic L supplementation [197]. Effect of beta-carotene supplementation on the concentrations and distribution of carotenoids, vitamin E, vitamin A, and cholesterol in plasma lipoprotein and non-lipoprotein fractions in healthy older women. Bone R.A., Landrum J.T., Tarsis S.L. Genetic factors are thought to influence the risk of AMD, in particular mutations involving genes encoding complement factor H (CFH). A mitochondrial enzyme degrades carotenoids and protects against oxidative stress. Kijlstra A., Tian Y., Kelly E.R., Berendschot T.T. In other cases, the product may be contaminated with other substances such as metals. A prospective study of carotenoid and vitamin A intakes and risk of cataract extraction in US women. A one year study of the macular pigment: The effect of 140 days of a lutein supplement. The study's findings also suggest that lutein supplements may help treat vision problems brought on by long-term exposure to light from computer screens., A 2018 review of research concluded that there are many studies supporting lutein beneficial effects on eye health. After 48 weeks, both G3 and G4 effectively increased MPOD; CS only improved on G3. Slattery M.L., Benson J., Curtin K., Ma K.N., Schaeffer D., Potter J.D. Once ingested, L is absorbed by the mucosa of the small bowel and bound to chylomicrons; then, it is secreted into lymph and reaches the liver [56]. Bone R.A., Landrum J.T., Fernandez L., Tarsis S.L. Changes following supplementation with lutein and zeaxanthin in retinal function in eyes with early age-related macular degeneration: A randomised, double-blind, placebo-controlled trial. and transmitted securely. In older women, Johnson et al. Cao et al. Chen J., Jiang W., Shao L., Zhong D., Wu Y., Cai J. Murray I.J., Makridaki M., van der Veen R.L., Carden D., Parry N.R., Berendschot T.T. A few observational studies have found a significant correlation between high L plasma concentrations and a low risk for developing cataract [112,113,114,115], and a negative association has also been reported between daily L intake and the risk of cataract, especially nuclear cataract [17,18,19,20,21]. Intervention trial, participants with dry AMD [. Huang J., Lu M.S., Fang Y.J., Xu M., Huang W.Q., Pan Z.Z., Chen Y.M., Zhang C.X. Besides this specific effect, any research on possible side effects of lutein is slim. E: 400 UI; beta carotene: 15 mg; zinc: 80 mg; copper: 2 mg); CS: contrast sensitivity; DHA: docosahexaenoic acid; EPA: eicosapentaenoic acid; L: lutein; mfEGR: multifocal electroretinogram; MPOD: macular pigment optical density; MZ: meso-zeaxanthin; RCT: randomized controlled trial; VA: visual acuity; Z: zeaxanthin. Lutein and zeaxanthin intakes and risk of age-related macular degeneration and cataracts: An evaluation using the Food and Drug Administrations evidence-based review system for health claims. In order to analyze the effect of adding L (10 mg/d) and Z (2 mg/d) to the original formulation [vitamin C (500 mg), vitamin E (400 IU), beta-carotene (15 mg), zinc (80 mg), and copper (2 mg)], the AREDS2 study included more than 4000 individuals at risk of developing late AMD. Bjrklund G., Chirumbolo S. Role of oxidative stress and antioxidants in daily nutrition and human health. Homocysteine Studies Collaboration Homocysteine and risk of ischemic heart disease and stroke: A meta-analysis. RCT, healthy participants (121); intervention group (61) vs. placebo (60), Intervention group: formulation containing L 12 mg + Z 1 mg. After 1 year, significant effect on MPOD but no improvement in VA, CS, glare disability, recovery from photostress. Furthermore, most of the results available at present were obtained from clinical trials lasting less than 1 year. Long term effects of lutein, zeaxanthin and omega-3-LCPUFAs supplementation on optical density of macular pigment in AMD patients: The LUTEGA study. Vishwanathan R., Iannaccone A., Scott T.M., Kritchevsky S.B., Jennings B.J., Carboni G., Forma G., Satterfield S., Harris T., Johnson K.C., et al. suggested that higher plasma L concentrations were associated with low risk of preeclampsia [195]. Snodderly D.M., Brown P.K., Delori F.C., Auran J.D. Johnson E.J., Maras J.E., Rasmussen H.M., Tucker K.L. Picone S., Ritieni A., Fabiano A., Graziani G., Paolillo P., Livolti G., Galvano F., Gazzolo D. Lutein levels in arterial cord blood correlate with neuroprotein activin A in healthy preterm and term newborns: A trophic role for lutein? Ribaya-Mercado J.D., Ordovas J.M., Russell R.M. These authors also found that L improved insulin sensitivity by acting on the expression of key factors involved in hepatic signaling, such as sirtuin-1 and PPAR-. Clevidence B.A., Bieri J.G. Dietary intake of lutein and diabetic retinopathy in the Atherosclerosis Risk in Communities Study (ARIC), Bahrami H., Melia M., Dagnelie G. Lutein supplementation in retinitis pigmentosa: PC-based vision assessment in a randomized double-masked placebo-controlled clinical trial [NCT00029289]. Fujimura S., Ueda K., Nomura Y., Yanagi Y. A lutein-enriched diet prevents cholesterol accumulation and decreases oxidized LDL and inflammatory cytokines in the aorta of guinea pigs.

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