Dietary intake and an atherogenic dietary pattern in relation to retinal vessel caliber 15-years later in the carotenoids in age-related eye disease study

Background & aims: The association between diet and retinal vessel caliber (RVC) has been under studied. One way diet can impact vascular health is through trimethylamine n-oxide (TMAO) production from the metabolism of choline. The TMAO dietary pattern (DP) is a diet pattern associated with plasma TMAO and choline. We evaluated the associations between food group intake and the TMAO-DP with RVC in postmenopausal women. Methods: Women (n = 398) from the Carotenoids in Age-Related Eye Disease Study (CAREDS) were included in this analysis [mean (SD) age = 65.3 (5.4) years]. Dietary data were collected from a food frequency questionnaire at baseline (2001–2004), and RVC measures were collected from fundus photographs at follow-up (2016–2019). Adjusted ANOVA and linear regression models were used to evaluate associations between the TMAO-DP and RVC. Associations between food groups and RVC were also evaluated. In an exploratory analysis, inverse probability of attrition weighting was used to account for potential selection bias from loss to follow-up in the cohort. Results: There was no association between the TMAO-DP and arterioles or venules. When applying inverse probability weights, those with higher TMAO-DP scores had narrower arterioles than those with lower scores [Q4 mean (SD) = 143.66 (1.92) μm, Q1 = 147.96 (1.94) μm; p = 0.02]. Some food groups were associated with RVC. For example, those with narrower arterioles consumed less starchy vegetables and fish. Conclusion: The intake of some food groups, but not the TMAO-DP, were associated with RVC measures 15 years later. This study may have been limited by survival bias.