Background: The relationship between modifiable risk factors, such as diet and lifestyle, and glaucoma remains controversial. We analyse the effect of the Mediterranean lifestyle (ML) on glaucoma incidence in the “Seguimiento Universidad de Navarra” (SUN) Project. Methods: The SUN Healthy Lifestyle Score (SHLS) includes 10 healthy habits: never having smoked, moderate to high physical activity, Mediterranean diet adherence, moderate alcohol consumption, low television exposure, no binge drinking, short afternoon napping, meeting up with friends, working at least 40 h/wk, and low body mass index. The information was collected biennially through self-reported questionnaires. The relationship between new glaucoma cases and the SHLS was assessed by Cox regression using hazard ratios. Crude, multi-adjusted, and sensitivity analyses were performed. Results: During a median of 12 years of follow-up, 261 (1.42%) new cases of glaucoma were identified among 18,420 participants. After adjusting for potential confounders, participants in the healthiest SHLS category showed a significantly reduced risk of glaucoma compared to those in the lowest SHLS category (adjusted HR = 0.51, 95% CI = 0.28–0.93). For each point added to the SHLS, the risk of glaucoma relatively dropped 5%. Conclusions: Higher adherence to a ML, measured by the SHLS, was significantly associated with a lower risk of developing glaucoma. Based on our study, the ML is a protective factor for glaucoma incidence.

Purpose: To assess the association between carbohydrates (CH) intake and glaucoma incidence. Methods: 18,247 volunteer participants (183,067 person-years at risk) with 10-year of median follow-up were included in this prospective dynamic cohort. Baseline total CH intake (g/d) was categorised in quartiles and classified in nine different CH food sources. Self-reported diagnosis of glaucoma was collected at baseline and on biennial follow-up questionnaires. CH intake and glaucoma diagnosis were validated in a subsample of participants. We studied potential confounders and effect modificators, including diabetes. The relationship between CH intake and glaucoma incidence was analysed using multivariable Cox proportional hazards ratio (HR) models to adjust for potential confounding factors. Results: During 10 years of median follow-up, a total of 242 new cases of glaucoma were identified. Participants in the highest quartile of baseline CH intake had a significantly higher risk of glaucoma as compared to participants in the lowest quartile [HR 1.50 (95% Confidence interval (CI): 1.01–2.25), p for trend = 0.042]. None of the nine CH food groups was individually related to glaucoma. In stratified analyses, after excluding all cases of diabetes, the HR comparing extreme quartiles of CH intake was 1.77 (95% CI: 1.15–2.74). Conclusions: Our results suggest that a higher intake of total carbohydrates is associated with a higher risk of incident glaucoma. The total amount of CH, rather than the specific food sources of CH, seems to play a major role, and this association does not seem to be confounded or modified by diabetic status.

The relationship between healthy lifestyles, diet, and glaucoma remains controversial. In this study, we analyse the effect of Mediterranean Lifestyle (ML) on glaucoma incidence in the “Seguimiento Universidad de Navarra” (SUN) cohort. Participants (n=18 420) initially free of glaucoma were followed for a mean of 10.8 years. The SUN Healthy Lifestyle Score (SHLS) ranging from 0 to 10 points included 10 healthy habits: never having smoked, moderate to high physical activity (>20 MET-hour/week), Mediterranean diet (≥4/8 adherence points), moderate alcohol consumption (women, 0.1-5.0 g/d; men, 0.1-10.0 g/d), low television exposure (<2 h/day), no binge drinking (≤5 alcoholic drinks at any time), a short afternoon nap (<30 min/day), meeting up with friends (> 1 h/day), working at least 40 h/week and low body mass index (BMI≤22). Information is collected biennially through self-reported questionnaires. The relationship between new cases of glaucoma and the SHLS was assessed by logistic regression using a hazard ratio. Crude, multi-adjusted and sensitivity analysis were performed. During follow-up, we observed 261 (1.42%) new cases of glaucoma. After adjusting for potential confounders, participants in the healthiest category of SHLS (7-10 points) showed a significantly reduced risk of glaucoma compared to those in the lowest SHLS category (0-3 points) (adjusted HR=0.51, 95% CI=0.28-0.93). For each point added to the SHLS the risk of glaucoma relatively dropped by 5%. In conclusion, higher adherence to a ML, measured by the SHLS, was significantly associated with lower risk of developing glaucoma. The ML is a protective factor for glaucoma incidence.