Adherence to a Mediterranean diet and its association with age-related macular degeneration. The Coimbra Eye Study–Report 4

•Association between age-related macular degeneration (AMD) and adherence to the Mediterranean diet.•High adherence to the Mediterranean diet is a protective factor for AMD.•Effect of diet is driven by an increased consumption of vegetables and fruits/nuts.•Regular physical activity is a protective factor for AMD. This study aimed to characterize the association of lifestyle and nutritional risk profiles with age-related macular degeneration (AMD) in two subpopulations with differing AMD prevalence. This case-control study (n = 1992) included 768 patients with AMD and 1224 age- and sex-matched participants without AMD with a single visit at a primary health care unit. Enrolled participants completed a validated lifestyle and food frequency questionnaire. A score to measure adherence to the Mediterranean diet (mediSCORE; Range, 0–9) was constructed from individual food intakes, which were further analyzed by conversion to nutrient consumption. Higher adherence to the Mediterranean diet (mediSCORE ≥6) was significantly associated with no AMD (odds ratio [OR] = 0.73; P = 0.009). The subpopulation with lower AMD prevalence presented significantly higher adherence to the Mediterranean diet in relation to all individual food groups that comprised the mediSCORE (P