Greater adherence to healthful diet lowers ESKD risk

24 Mar 2021 byStephen Padilla
Greater adherence to healthful diet lowers ESKD risk

Adherence to healthful dietary patterns can help reduce the risk of end-stage kidney disease (ESKD) among Asians, particularly among those who are overweight or obese, according to the results of the Singapore Chinese Health Study.

The researchers examined the following predefined dietary patterns: the Alternate Healthy Eating Index-2010 (AHEI-2010), the Dietary Approaches to Stop Hypertension (DASH), and the alternate Mediterranean diet (aMED), in relation to risk of ESKD.

A total of 56,985 Chinese adults (aged 45–74 years) who were free of cancer, stroke, coronary artery disease, and ESKD at recruitment (1993–1998) were included in the analysis. Dietary pattern scores were calculated based on a validated 165-item food frequency questionnaire.

AHEI-2010 and aMED scores were modified by excluding the alcohol intake component because daily drinking has been associated with an increased risk of ESKD in the study population.

Over a median follow-up of 17.5 years, the researchers identified 1,026 ESKD cases via linkage with the nationwide Singapore Renal Registry. They used multivariable Cox regression models to compute hazard ratios (HRs) and their 95 percent confidence intervals (CIs).

Individuals with higher scores in any dietary pattern had a lower ESKD risk in a dose-dependent manner. Relative to the lowest quintiles, the multivariable-adjusted HRs of ESKD were as follows: 0.75 (95 percent CI, 0.61–0.92) for the highest quintile of AHEI-2010, 0.67 (95 percent CI, 0.54–0.84) for DASH, and 0.73 (95 percent CI, 0.59–0.91) for aMED (ptrend≤0.004 for all). [Am J Clin Nutr 2021;113:675-683]

The inverse associations between healthful dietary patterns and ESKD risk were more evident with increasing body mass index (BMI). The HRs for such associations were lowest in the obese (BMI ≥27.5 kg/m2), followed by the overweight (BMI 25 to <27.5 kg/m2), as compared with those in lower BMI categories (pinteraction=0.03 for AHEI-2010; p=0.004 for aMED; p=0.06 for DASH).

These findings were consistent with a 2017 investigation of 12,155 participants aged 45–64 years from the Atherosclerosis Risk in Communities (ARIC) Study. The results showed that higher adherence to healthful dietary patterns during middle age correlated with a lower risk of chronic kidney disease (CKD). [Am J Clin Nutr 2019;110:713-721]

Specifically, participants in the highest quintile of AHEI-2010 and aMED scores had a 20-percent and 13-percent reduced CKD risk compared with those in the lowest quintile.

A recent study involving 2,403 participants aged 21–74 years with estimated glomerular filtration rates of 20 to 70 mL/min/1.73m2 and dietary data in the Chronic Renal Insufficiency Cohort (CRIC) Study also support the findings of the current study.

The authors found that greater adherence to several healthful dietary patterns leads to a lower risk of CKD progression and all-cause mortality among people with CKD. They also suggested the need for a guidance to adopt healthy dietary patterns as a strategy for managing CKD. [Am J Kidney Dis 2021;77:235-244]