Dietary flavonoids are associated with longitudinal treatment outcomes in neovascular age-related macular degeneration

Author Identifier

Joshua Lewis

ORCID : 0000-0003-1003-8443

Nicola Bondonno

ORCID : 0000-0001-5905-444X

Catherine Bondonno

ORCID : 0000-0001-8509-439X

Jonathan Hodgson

ORCID : 0000-0001-6184-7764

Document Type

Journal Article

Publication Title

European Journal of Nutrition

PubMed ID





School of Medical and Health Sciences / Institute for Nutrition Research




Macular Disease Foundation Australia (MDFA)


Detaram, H. D., Liew, G., Lewis, J. R., Bondonno, N. P., Bondonno, C. P., Van Vu, K., . . . Gopinath, B. (2021). Dietary flavonoids are associated with longitudinal treatment outcomes in neovascular age-related macular degeneration. European Journal of Nutrition, 60(8), 4243-4250.


Purpose To assess whether dietary intake of flavonoids are associated with longitudinal treatment outcomes of patients with neovascular age-related macular degeneration (nAMD). Methods 547 participants with nAMD were recruited at baseline, 494 were followed-up after receiving 12 months of anti-vascular endothelial growth factor (anti-VEGF) therapy. Baseline dietary intake of flavonoids was determined using a validated food frequency questionnaire. At follow-up, presence of intra-retinal and sub-retinal fluid (IRF and SRF), retinal pigment epithelium detachment and measurements of central macular thickness (CMT) were recorded from optical coherence tomography scans. Visual acuity (VA) was documented using LogMAR charts. Results Participants in the first tertile of intake of the flavonol quercetin, and the flavan-3-ols epigallocatechin-3-gallate and epigallocatechin had significantly worse vision than participants in the third tertile—multivariable-adjusted least square (LS) mean VA: 14.68 vs. 19.53 (p = 0.04); 14.06 vs. 18.89 (p = 0.04); 13.86 vs. 18.86 (p = 0.03), respectively. Participants in the first compared to the third tertile of flavan-3-ol, epigallocatechin-3-gallate and epigallocatechin intake all had a twofold higher risk of IRF, multivariable-adjusted p trend of: 0.03, 0.01 and 0.02, respectively. The first vs. the third tertile of tea intake had significantly worse vision (LS mean VA: 13.49 vs. 19.04, p = 0.02), increased risk of IRF (OR 2.13, 95% CI 1.18–3.85) and greater mean CMT (279.59 μm vs. 256.52 μm, p = 0.04). Conclusions Higher intakes of dietary flavonoids, specifically flavonols and flavan-3-ols, could be associated with better long-term treatment outcomes in nAMD patients receiving anti-VEGF therapy. Confirmation of these associations in interventional studies could result in promising new therapeutic approaches to the treatment of nAMD.



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