**5. Conclusions**

We have performed a population-based study to assess the relationship between dietary intake of fatty acids and vitamin D and the prevalence of MGD among residents of Takushima Island, Japan. Our results sugges<sup>t</sup> that high intake of total fat, SFAs, oleic acid, and vitamin D may be inversely associated with the prevalence of MGD in Japanese individuals. No significant association was detected between the prevalence of MGD and either dietary intake of n-3 PUFAs or n-6 PUFAs or the n-6/n-3 PUFA ratio by multivariate logistic regression analysis. Further epidemiological studies are warranted to clarify dietary strategies for prevention of MGD.

**Author Contributions:** Conceptualization, R.A. and S.F.; formal analysis, S.F.; investigation, R.A., S.F., T.M., M.K., S.K., R.S., T.S., and N.M.; writing—original draft preparation, S.F.; writing—review and editing, R.A., and N.M.; supervision, N.M.; project administration, R.A.; software, S.S.; All authors have read and agreed to the published version of the manuscript.

**Funding:** This research received no external funding. It was financially supported by the Lid and Meibomian Gland Working Group.

**Institutional Review Board Statement:** The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board of Itoh Clinic (protocol code: IRIN201707-04, date of approval: 10th July 2017).

**Informed Consent Statement:** Informed consent was obtained from all subjects involved in the study.

**Data Availability Statement:** The data presented in this study are available on request from the corresponding author.

**Conflicts of Interest:** R.A. holds patents of a noninvasive meibography system (JP patent registration no. 5281846, U.S. patent publication no. 2011-0273550A1, and EP patent publication no. 2189108A1) and is a consultant for Inami Co., Kowa Co., and Topcon Japan. The remaining authors declare no conflict of interest.
