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It has been suggested that zeaxanthln and lutein be considered conditionally essential nutrients because low serum levels or low dietary intake are associated with low macular pigment density and increased risk of ARMD (Semba & Dagnelie 2003).

Epidemiological studies have also found an association between low serum carotenoid levels, including lutein and zeaxanthin levels, with all-cause mortality (De Waart et al 2001), the risk of inflammatory polyarthritis (Pattison et al 2005), breast cancer (Tamimi et al 2005), prostate cancer (Jian et al 2005), colon cancer (Nkondjock & Ghadirian 2004), cervical cancer (Garcia-Closas et al 2005, Kim et al 2004), human papilloma virus persistence (Garcia-Closas et al 2005), type 2 diabetes and impaired glucose metabolism (Coyne et al 2005), chronic cholestatic liver diseases (Floreani et al 2000), Alzheimer's disease and vascular dementia (Polidori et al 2004), and low fruit and vegetable consumption (Al-Delaimy et al 2005).

Carotenoids have also emerged as an excellent tissue marker for a diet rich in fruits and vegetables, and measurement of plasma and tissue carotenoids is considered to have an important role in defining optimal diets (Al-Delaimy et al 2005, Brevik et al 2004, Handelman 2001).

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