PURPOSE. To investigate the association of macular pigment optical density (MPOD) with plasma lutein, zeaxanthin, and diet in an elderly population.METHODS. We conducted a population-based study, the Montrachet (Maculopathy Optic Nerve, nuTRition neurovAsCular, and HEarT disease) study, in subjects older than 75 years. The MPOD was measured by means of the two-wavelength autofluorescence technique. Plasma lutein and zeaxanthin were measured in fasting blood samples using HPLC. Food frequency consumption was assessed with self-reported food frequency questionnaires.RESULTS. Overall, 433 healthy participants (62.1% females) were included. Mean age was 82.0 +/- 3.6 years. Mean MPOD at 0.5 degrees eccentricity was 0.57 +/- 0.25 density units (DU) and was higher in women than in men (0.59 +/- 0.25 vs. 0.53 +/- 0.25, P = 0.017). The MPOD was lower in alcohol consumers than in non-alcohol consumers (0.55 +/- 0.25 vs. 0.61 +/- 0.25, P = 0.016). Median plasma lutein and zeaxanthin levels were 281.4 mu g/L and 20.0 mu g/L, respectively, and were higher in women (P = 0.010 and P = 0.003, respectively). The MPOD was positively correlated with plasma lutein and zeaxanthin (r = 0.10, P = 0.030 and r = 0.11, P = 0.027, respectively). A higher consumption of squash was associated with higher plasma lutein and zeaxanthin. Adjusting for confounders and diet revealed that MPOD was weakly associated with plasma lutein in nonsmokers (beta = 0.11, P = 0.021).CONCLUSIONS. This study suggests that plasma lutein is associated with MPOD after taking into account potential confounding factors in an elderly population.