Research Article: Relation Between Dietary Essential Fatty Acid Intake and Dry Eye Disease and Meibomian Gland Dysfunction in Postmenopausal Women

Date Published: May 15, 2018


Author(s): Jillian F. Ziemanski, Lynn R. Wolters, Lisa Jones-Jordan, Jason J. Nichols, Kelly K. Nichols.


To evaluate the relationship between omega-3 (n-3) and omega-6 (n-6) fatty acids with dry eye disease (DED) and meibomian gland dysfunction (MGD).

Cross-sectional study.

Postmenopausal women (n = 439) underwent a clinical evaluation and completed the Vio Food Frequency Questionnaire to estimate their dietary intake of n-3s and n-6s. Subjects were categorized into 2 binary classifications based on whether or not they had (1) DED and (2) MGD. Mean intake of dietary fatty acids was compared with 2-sample t tests. Univariate logistic regression models were used to estimate the odds ratios for each condition associated with each quintile of n-3s, n-6s, and n-6:n-3 ratios.

For DED vs non-DED, there were no significant differences in n-3 intake (1.95 ± 1.47 g vs 1.92 ± 1.24 g, P = .86), n-6 intake (15.58 ± 11.56 g vs 15.44 ± 10.61 g, P = .91), and n-6:n-3 (8.30 ± 2.57 vs 8.30 ± 2.57, P = .99). For MGD vs non-MGD, there were no significant differences in n-3 intake (1.87 ± 1.35 vs 1.96 ± 1.39, P = .61), n-6 intake (15.26 ± 11.85 vs 15.62 ± 10.93, P = .80), and n-6:n-3 (8.35 ± 2.94 vs 8.28 ± 2.42, P = .84). The odds ratios (OR) for DED did not differ significantly from 1.0 for n-3, n-6, or n-6:n-3. High n-3 consumption (OR = 0.22 [0.06–0.78]) and moderate n-6 consumption (OR = 0.37 [0.15–0.91]) were associated with a decreased frequency of MGD.

Dietary consumption of n-3s and n-6s showed no association with DED, but high n-3 consumption and moderate n-6 consumption were protective against MGD in this large sample of postmenopausal women.

Partial Text

A single-center, cross-sectional study was conducted in an academic setting to assess differences between dry eye and normal ocular health in postmenopausal women, particularly in relation to the structure and function of the meibomian glands. The study was conducted in accordance with the tenets of the Declaration of Helsinki, and the study protocol was approved by the Institutional Review Board at The Ohio State University. All subjects provided informed consent, and confidentiality was maintained in full compliance with the HIPAA Privacy Rule.

Four hundred thirty-nine subjects were enrolled in the Dry Eye in Menopause study (Figure 1). For this study, 116 individuals (26.4%) were excluded owing to baseline supplementation with any omega fatty acid supplements and 1 individual (0.2%) had incomplete supplement data, leaving 322 (73.3%) subjects eligible for the statistical analysis. Of these 322 subjects, 192 (59.6%) were categorized as meeting the definition for DED, while 130 (40.4%) were categorized as non-DED. For the MGD component, 3 of these same 322 subjects (0.9%) had incomplete data, leaving 319 (99.1%) available for analysis. Of these, 87 (27.3%) were classified as having MGD, while 232 (72.7%) were classified as non-MGD.

The aim of this analysis was to evaluate whether high n-3 and low n-6:n-3 dietary consumption are protective against DED and MGD in postmenopausal women. In this sample of 320 subjects, there was no observed increased or decreased frequency of DED relative to dietary intake of omega fatty acids, even among those with n-3 consumption, n-6 consumption, or n-6:n-3 ratios corresponding to high or low extremes. For MGD, however, high n-3 consumption and moderate n-6 consumption were associated with a decreased frequency of disease. There were no detected relations between n-6:n-3 ratios and MGD. Based on these results, n-3, n-6, and n-6:n-3 dietary consumption appear not to have an association with DED status in postmenopausal women, although dietary omega fatty acid consumption does seem to have some association with MGD status. This study did not assess the therapeutic value of n-3 supplementation in patients with these ocular surface conditions.




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