The Association Between Adherence to the Dutch Healthy Diet Index and Glaucoma Prevalence-The Maastricht Study

Objectives: To investigate the association between adherence to national nutritional guidelines (Dutch Healthy Diet Index [DHD-index]) and glaucoma prevalence and to explore whether this association changed after accounting for measured intraocular pressure (IOP). Methods: This cross-sectional study used baseline data 2010-2013 from The Maastricht Study, a population-based cohort in The Netherlands. Adults aged 40-75 years with implausible dietary intake were excluded. Dietary intake was evaluated using a validated food frequency questionnaire, and adherence was quantified by the DHD-index. All participants underwent ophthalmic examination including perimetry and IOP measurement. Logistic and linear regression models examined associations of DHD adherence with glaucoma prevalence and IOP. Additional exploratory analyses assessed whether the association with glaucoma was attenuated after accounting for measured IOP. Results: Among 5729 participants (mean age: 59.5 ± 8.7 years; 50.1% female), glaucoma prevalence was 9.7% (n = 558). Each 10-point increase in DHD-index score was associated with 12.5% lower odds of glaucoma prevalence (odds ratio [OR]: 0.88; 95% confidence interval [CI], 0.83 to 0.93) and lower IOP (β: -0.17; 95% CI, -0.25 to -0.09 mmHg). Individuals in the highest DHD adherence tertile had 38% lower odds of glaucoma than those in the lowest tertile (OR 0.62; 95% CI, 0.50 to 0.76). Additional adjustment for measured IOP yielded similar estimates. Conclusions: Higher adherence to the Dutch Healthy Diet was associated with a lower glaucoma prevalence. The association was only minimally attenuated after accounting for measured IOP. Longitudinal studies should examine whether adherence to national dietary guidelines is associated with glaucoma onset and progression.