Supplementary Material for: The Association of Dietary Patterns with Age-Related Macular Degeneration in a Multi-Ethnic Older Singaporean Population

Introduction: The associations of dietary patterns and age-related macular degeneration (AMD) have been reported using mostly Western and Japanese populations and evidence in multi-ethnic Asian populations, with potentially different dietary patterns, is lacking. In this study, we aimed to identify dietary patterns in a multi-ethnic older Singaporean population and examine their associations with AMD. Methods: This was a cross-sectional analysis of the Population Health and Eye Disease Profile in Elderly Singaporeans (PIONEER) study. Dietary intake was assessed using a 110-item interviewer-administered food frequency questionnaire validated in a Singaporean population. Presence and stage of AMD were categorized using fundus photographs and an established AMD classification. Dietary patterns were generated by applying exploratory factor analysis, and their associations with presence of AMD and stage of AMD were evaluated using adjusted logistic regression models and adjusted multinomial logistic regression models, respectively. Results: Of 1480 Chinese, Malay, and Indian individuals aged≥60 years (mean 71.3±7.7), age-standardized prevalence of any, early, and late AMD were 7.1%, 4.8%, and 2.2%. Three dietary patterns were generated: “Snacks, Fried Foods, and Refined Carbohydrates”; “Poultry, Meat and Fish”; and “Wholemeal Bread, Legumes and Nuts”. After adjusting for covariates, higher “Snacks, Fried Foods, and Refined Carbohydrates” pattern scores was associated with higher odds of any AMD (OR=1.41, 95%CI: 1.02-1.96) and early AMD (OR=1.63, 95%CI: 1.12-2.37). “Snacks, Fried Foods, and Refined Carbohydrates” pattern scores in the highest quartile were associated with higher odds of any AMD (OR=2.18, 95%CI: 1.01-4.72), compared to the lowest quartile. Conclusion: Only the “Snacks, Fried Foods, and Refined Carbohydrates” pattern was associated with AMD in this multi-ethnic older Singaporean population. These findings may inform the development of dietary guidelines in Singapore for more targeted AMD management, although prospective, longitudinal data are needed.