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Elshoff D, Mehta P, Ziouzenkova O. Chronic Kidney Disease Diets for Kidney Failure Prevention: Insights from the IL-11 Paradigm. Nutrients 2024; 16:1342. [PMID: 38732588 PMCID: PMC11085624 DOI: 10.3390/nu16091342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/24/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
Nearly every fifth adult in the United States and many older adults worldwide are affected by chronic kidney disease (CKD), which can progress to kidney failure requiring invasive kidney replacement therapy. In this review, we briefly examine the pathophysiology of CKD and discuss emerging mechanisms involving the physiological resolution of kidney injury by transforming growth factor beta 1 (TGFβ1) and interleukin-11 (IL-11), as well as the pathological consequences of IL-11 overproduction, which misguides repair processes, ultimately culminating in CKD. Taking these mechanisms into account, we offer an overview of the efficacy of plant-dominant dietary patterns in preventing and managing CKD, while also addressing their limitations in terms of restoring kidney function or preventing kidney failure. In conclusion, this paper outlines novel regeneration strategies aimed at developing a reno-regenerative diet to inhibit IL-11 and promote repair mechanisms in kidneys affected by CKD.
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Affiliation(s)
- Denise Elshoff
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH 43210, USA;
- Department of Human Sciences, The Ohio State University, Columbus, OH 43210, USA;
| | - Priyanka Mehta
- Department of Human Sciences, The Ohio State University, Columbus, OH 43210, USA;
| | - Ouliana Ziouzenkova
- Department of Human Sciences, The Ohio State University, Columbus, OH 43210, USA;
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Mirzababaei A, Abaj F, Hajishizari S, Bahrampour N, Noori S, Barekzai AM, Hosseininasab D, Clark CCT, Mirzaei K. The association of dietary approaches to stop hypertension (DASH) with the odds of diabetic nephropathy and metabolic markers in women: a case-control study. BMC Womens Health 2023; 23:63. [PMID: 36782160 PMCID: PMC9926721 DOI: 10.1186/s12905-022-02140-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/20/2022] [Indexed: 02/15/2023] Open
Abstract
OBJECTIVES Epidemiologic studies have reported that diet is associated with diabetes and its complications through different pathways. We sought to examine the associations between the Dietary Approaches to Stop Hypertension (DASH) diet and the odds of diabetic nephropathy (DN) developing in Iranian women with existing type 2 diabetes. METHODS In this case-control study, 105 women with DN and 105 controls, matched for age and diabetes duration, were selected from the Kowsar Diabetes Clinic in Semnan, Iran. DASH, estimated using dietary intake, was assessed using a validated and reliable food frequency questionnaire with 147 items. Anthropometric measurements were assessed for all subjects. Logistic regression was performed to examine the association between DASH and the odds of developing DN. RESULTS After controlling for potential confounders, subjects in the highest intake of DASH diet adherence have 84% lower odds of DN, compared to those with the lowest intake (OR = 0.16, 95% CI = 0.07-0.34, P < 0.001). Among DASH diet subcategories, intakes of vegetables (80%), fruits (88%), nuts and legumes (87%), and low-fat dairy (73%) decreased the risk of DN after adjustment for confounders (P < 0.001). CONCLUSIONS This study showed that the DASH diet is associated with lower odds of DN development in women with type 2 diabetes.
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Affiliation(s)
- Atieh Mirzababaei
- grid.411705.60000 0001 0166 0922Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O. Box 14155-6117, Tehran, Iran
| | - Faezeh Abaj
- grid.411705.60000 0001 0166 0922Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O. Box 14155-6117, Tehran, Iran
| | - Sara Hajishizari
- grid.411705.60000 0001 0166 0922Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O. Box 14155-6117, Tehran, Iran
| | - Niki Bahrampour
- grid.411463.50000 0001 0706 2472Department of Nutrition, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Sahar Noori
- grid.411463.50000 0001 0706 2472Department of Nutrition, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Ahmad Mujtaba Barekzai
- grid.411705.60000 0001 0166 0922Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O. Box 14155-6117, Tehran, Iran
| | - Dorsa Hosseininasab
- grid.411463.50000 0001 0706 2472Department of Nutrition, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Cain C. T. Clark
- grid.8096.70000000106754565Centre for Intelligent Healthcare, Coventry University, Coventry, CV1 5FB UK
| | - Khadijeh Mirzaei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O. Box 14155-6117, Tehran, Iran. .,Food Microbiology Research Center, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
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Tantisattamo E, Kalantar-Zadeh K. Paradigm shift in lifestyle modification for solitary kidney after donor nephrectomy. Curr Opin Nephrol Hypertens 2023; 32:67-75. [PMID: 36444664 DOI: 10.1097/MNH.0000000000000853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Living donor kidney transplantation potentially leads to long-term complications including chronic kidney disease, end-stage kidney disease, elevated blood pressure, and pregnancy-associated hypertension. Given living donors generally do not have underlying medical conditions, lifestyle modifications, particularly dietary interventions may prevent those complications and improve their health outcomes. RECENT FINDINGS Glomerular hyperfiltration occurs as physiologic adaptation during an initial postdonor nephrectomy period. In the long-term, these adaptations may become pathologic consequences resulting from hyperfiltration-mediated kidney injury and ultimately secondary focal segmental glomerulosclerosis in the solitary kidney. Dietary interventions to slow a decline in kidney function include low protein intake of <0.8 g/kg/day and low sodium consumption of 2-4 g/day as well as certain health dietary patterns. There is no evidence regarding the quantity and quality of protein that can be recommended for living kidney donors and the same for sodium. Plant Dominant (PLADO) diets, Dietary Approaches to Stop Hypertension (DASH), Mediterranean, and vegetarian diets may be favorable for living kidney donors with solitary kidney but the evidence is still lacking. SUMMARY Although dietary interventions may provide benefits and kidney health for living kidney donors, further studies including clinical trials are required to incorporate them into clinical practice guidelines.
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Ozaki S, Yamamoto R, Shinzawa M, Tomi R, Yoshimura R, Nakanishi K, Nishida M, Nagatomo I, Kudo T, Yamauchi-Takihara K, Isaka Y, Moriyama T. Vegetable Preference and Prediction of Proteinuria: A Retrospective Cohort Study. Ann Nutr Metab 2021; 77:337-343. [PMID: 34700317 DOI: 10.1159/000520044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 10/02/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Little information is available about the association between vegetable preference and chronic kidney disease. METHODS This retrospective cohort study included 10,819 university workers in Japan who underwent their annual health checkups between January 2005 and March 2013. According to a question "Do you like vegetables"? with 3 possible answers of "I like vegetables," "I like vegetables somewhat," or "I dislike vegetables," 2,831, 2,249, and 104 male workers and 3,902, 1,648, and 85 female workers were classified into the "like," "somewhat," and "dislike" groups, respectively. An association between vegetable preference and incidence of proteinuria (dipstick urinary protein ≥1+) was assessed using Cox proportional-hazards models adjusted for clinically relevant factors. RESULTS During the median observational period of 5.0 years, the incidence of proteinuria was observed in 650 (12.7%) male and 789 (14.1%) female workers. Among male workers, the "dislike" group had a significantly higher risk of proteinuria (multivariable-adjusted hazard ratio of "like," "somewhat," and "dislike" groups: 1.00 [reference], 1.05 [0.90-1.23], and 1.59 [1.01-2.50], respectively). Among female workers, vegetable preference was associated with the incidence of proteinuria in a dose-dependent manner (1.00 [reference], 1.20 [1.04-1.40], 1.95 [1.26-3.02], respectively). CONCLUSION "Do you like vegetables"? was a clinically useful tool to identify subjects vulnerable to proteinuria.
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Affiliation(s)
- Shingo Ozaki
- Department of Nephrology, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Ryohei Yamamoto
- Department of Nephrology, Graduate School of Medicine, Osaka University, Suita, Japan.,Health and Counseling Center, Osaka University, Toyonaka, Japan.,Health Promotion and Regulation, Department of Health Promotion Medicine, Osaka University Graduate School of Medicine, Toyonaka, Japan
| | - Maki Shinzawa
- Department of Nephrology, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Ryohei Tomi
- Department of Nephrology, Graduate School of Medicine, Osaka University, Suita, Japan
| | | | - Kaori Nakanishi
- Health and Counseling Center, Osaka University, Toyonaka, Japan
| | - Makoto Nishida
- Health and Counseling Center, Osaka University, Toyonaka, Japan
| | - Izumi Nagatomo
- Health and Counseling Center, Osaka University, Toyonaka, Japan
| | - Takashi Kudo
- Health and Counseling Center, Osaka University, Toyonaka, Japan
| | | | - Yoshitaka Isaka
- Department of Nephrology, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Toshiki Moriyama
- Department of Nephrology, Graduate School of Medicine, Osaka University, Suita, Japan.,Health and Counseling Center, Osaka University, Toyonaka, Japan.,Health Promotion and Regulation, Department of Health Promotion Medicine, Osaka University Graduate School of Medicine, Toyonaka, Japan
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Choi Y, Steffen LM, Chu H, Duprez DA, Gallaher DD, Shikany JM, Schreiner PJ, Shroff GR, Jacobs DR. A Plant-Centered Diet and Markers of Early Chronic Kidney Disease during Young to Middle Adulthood: Findings from the Coronary Artery Risk Development in Young Adults (CARDIA) Cohort. J Nutr 2021; 151:2721-2730. [PMID: 34087933 PMCID: PMC8417917 DOI: 10.1093/jn/nxab155] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 04/13/2021] [Accepted: 04/28/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Few studies have evaluated whether plant-centered diets prevent progression of early stage chronic kidney disease (CKD). OBJECTIVES We examined the association between plant-centered diet quality and early CKD markers. METHODS We prospectively examined 2869 black and white men and women in the Coronary Artery Risk Development in Young Adults Study free of diagnosed kidney failure in 2005-2006 [examination year 20 (Y20); mean age: 45.3 ± 3.6 y]. CKD marker changes from Y20 to 2015-2016 (Y30) were considered, including estimated glomerular filtration rate (eGFR; serum creatinine), urinary albumin-to-creatinine ratio (ACR), and both. Diet was assessed through interviewer-administered diet histories at Y0, Y7, and Y20, and plant-centered diet quality was quantified with the A Priori Diet Quality Score (APDQS). Linear regression models were used to examine the association of APDQS and subsequent 10-y changes in CKD markers. RESULTS After adjustment for sociodemographic, behavioral, and diet factors, we found that higher APDQS was related to less adverse changes in CKD markers in the subsequent 10-y period. Compared with the lowest APDQS quintile, the highest quintile was associated with an attenuated increase in lnACR (-0.25 mg/g; 95% CI: -0.37, -0.13 mg/g; P-trend < 0.001), whereas the highest quintile was associated with an attenuated decrease in eGFR (4.45 mL·min-1·1.73 m-2; 95% CI: 2.46, 6.43 mL·min-1·1.73 m-2). There was a 0.50 lower increase in combined CKD markers [ln(ACR) z score - eGFR z score] when comparing the extreme quintiles. Associations remained similar after further adjustment for hypertension, diabetes, and obesity as potential mediating factors. The attenuated worsening CKD marker changes associated with higher APDQS strengthened across increasing initial CKD category; those with the best diet and microalbuminuria in Y10-Y20 returned to high normal albuminuria (all P-interaction < 0.001). CONCLUSIONS Individuals who consumed plant-centered, high-quality diets were less likely to experience deterioration of kidney function through midlife, especially among participants with initial stage characterized as mild CKD.
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Affiliation(s)
- Yuni Choi
- Department of Food Science and Nutrition, University of Minnesota–Twin Cities, St. Paul, MN, USA
| | - Lyn M Steffen
- Division of Epidemiology and Community Health, University of Minnesota–Twin Cities, Minneapolis, MN, USA
| | - Haitao Chu
- Division of Biostatistics, University of Minnesota–Twin Cities, Minneapolis, MN, USA
| | - Daniel A Duprez
- Cardiovascular Division, Department of Medicine, University of Minnesota–Twin Cities, Minneapolis, MN, USA
| | - Daniel D Gallaher
- Department of Food Science and Nutrition, University of Minnesota–Twin Cities, St. Paul, MN, USA
| | - James M Shikany
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, University of Minnesota–Twin Cities, Minneapolis, MN, USA
| | - Gautam R Shroff
- Division of Cardiology, Department of Medicine, Hennepin Healthcare and University of Minnesota–Twin Cities, Minneapolis, MN, USA
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Soltani S, Jayedi A. Adherence to healthy dietary pattern and risk of kidney disease: a systematic review and meta-analysis of observational studies. INT J VITAM NUTR RES 2020; 92:267-279. [PMID: 32138628 DOI: 10.1024/0300-9831/a000647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Epidemiological studies show that adherence to healthy dietary patterns may be associated with a lower risk of decline in kidney function. However, existing evidence has not been quantitatively gathered. Pertinent observational studies investigating the association of adherence to a healthy dietary pattern, either priori-defined dietary pattern/indices or data-driven dietary patterns, with risk of kidney disease in the general population were identified by searching Medline and Scopus databases to May 28, 2018. A random-effects meta-analysis was applied. The analysis included eight prospective cohorts (5734 cases among 569,688 participants) and five cross-sectional studies (1955 cases among 16,614 participants). Higher adherence to a healthy dietary pattern (either priori-defined or data-driven dietary patterns) was associated with a 28% lower risk of kidney disease in the analysis of prospective cohort studies (RR = 0.72, 95 % CI = 0.58, 0.86; I2 = %71, n = 8). A subgroup analysis based on definition of healthy dietary pattern resulted in significant inverse association only in the subgroup of Dietary Approaches to Stop Hypertension dietary pattern (RR: 0.74, 95 % CI: 0.54, 0.93; I2 = 73%, n = 5). A dose-response analysis indicated a monotonic inverse association between adherence to the Dietary Approaches to Stop Hypertension dietary pattern with risk of kidney disease. A 32% lower risk was observed in the analysis of cross-sectional studies (OR: 0.68, 95 %CI: 0.53, 0.83, I2 = 0%, n = 5). The findings suggest that higher adherence to a healthy dietary pattern is associated with a lower risk of kidney disease.
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Affiliation(s)
- Sepideh Soltani
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Ahmad Jayedi
- Food Safety Research Center (salt), Semnan University of Medical Sciences, Semnan, Iran.,Department of Community Nutrition, School of Nutritional Science and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
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Abbasi R, Bakhshimoghaddam F, Alizadeh M. Major dietary patterns in relation to preeclampsia among Iranian pregnant women: a case-control study. J Matern Fetal Neonatal Med 2019; 34:3529-3536. [PMID: 31736380 DOI: 10.1080/14767058.2019.1686474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: Preeclampsia is a pregnancy disorder that increases the risk of prenatal and maternal complications. Therefore, prevention of preeclampsia requires identifying its preventable risk factors such as dietary patterns.Objective: This study aimed to investigate the relationship between the major dietary patterns and preeclampsia.Study design: In this case-control study, the dietary patterns of a total of 510 pregnant women were investigated. Data on their dietary intake, sociodemographics, and daily physical activity levels were collected using a 198 item semi-quantitative food frequency questionnaire, a sociodemographic questionnaire, and a physical activity questionnaire, respectively. To identify the major dietary patterns and to model the relationship between dietary patterns and preeclampsia, factor analysis and unconditional logistic regression were employed, respectively. The three major dietary patterns identified were as follows: healthy dietary pattern (i.e. high in fruits, low-fat dairy, dried fruits, nuts, vegetables, fruit juice, liquid oil, and tomatoes), western dietary pattern (i.e. high in red meat, processed meat, fried potatoes, and pickles), and Iranian traditional dietary pattern (i.e. high in eggs, potatoes, and legumes).Results: After adjustment for confounding factors, we found that with an increase in the healthy dietary pattern score, the odds of preeclampsia were reduced to 87.5% (OR = 0.125, 95%CI: 0.070-0.221, p < .001); with an increase in the western dietary pattern score, the odds of preeclampsia were increased 5.99 times (OR = 5.99, 95%CI: 3.414-10.53, p < .001); and with an increase in the Iranian traditional dietary pattern score, the odds of preeclampsia were reduced to 81.7% (OR = 0.183, 95%CI: 0.109-0.308, p < .001).Conclusion: The findings showed that the western dietary pattern had a direct relationship and the healthy and Iranian traditional patterns had a reverse relationship with preeclampsia.
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Affiliation(s)
- Reza Abbasi
- Department of Nutrition, Faculty of Medicine, Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran
| | - Farnush Bakhshimoghaddam
- Department of Nutrition, Faculty of Medicine, Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran
| | - Mohammad Alizadeh
- Department of Nutrition, Faculty of Medicine, Food and Beverages Safety Research Center, Urmia University of Medical Sciences, Urmia, Iran
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Yuzbashian E, Asghari G, Mirmiran P, Amouzegar-Bahambari P, Azizi F. Adherence to low-sodium Dietary Approaches to Stop Hypertension-style diet may decrease the risk of incident chronic kidney disease among high-risk patients: a secondary prevention in prospective cohort study. Nephrol Dial Transplant 2019; 33:1159-1168. [PMID: 29361057 DOI: 10.1093/ndt/gfx352] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 10/30/2017] [Indexed: 02/03/2023] Open
Abstract
Background Considering the fact that subjects with dysglycemia, dyslipidemia or high blood pressure are at high risk for chronic kidney disease (CKD), long-term adherence to the Dietary Approaches to Stop Hypertension (DASH)-style diet may contribute to the prevention of CKD. This study, examined the association between adherence to the low-sodium DASH-style diet and incident CKD among high-risk adults over 3 years of follow-up. Methods In this prospective cohort study (followed up for 3 years, 2012-15), we selected 1100 subjects with dysglycemia, 2715 with dyslipidemia and 2089 with high blood pressure, all of whom were free of CKD at baseline (2009-11) in a subgroup of the Tehran Lipid and Glucose Study. The low-sodium DASH-style diet was designed based on eight foods and nutrients using a food frequency questionnaire. Estimated glomerular filtration rate (eGFR) was calculated and CKD was defined as eGFR <60 mL/min/1.73 m2. Results After 3 years of follow-up, among subjects with dysglycemia, dyslipidemia or high blood pressure, the rate of incident CKD was ∼16%. In multivariable-adjusted analyses for participants in the highest compared with the lowest quartile of the low-sodium DASH-style diet score, the odds ratio was 0.58 [95% confidence interval (CI) 0.36-0.92] for subjects with dysglycemia, 0.64 (95% CI 0.48-0.87) for subjects with dyslipidemia and 0.62 (95% CI 0.44-0.87) for subjects with high blood pressure. Conclusions Higher adherence to the low-sodium DASH-style diet might be associated with a lower risk of incident CKD among high-risk adults, highlighting the importance of adherence to the low-sodium DASH-style diet in substantially reducing both the occurrence of CKD and the burden imposed by it in the future.
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Affiliation(s)
- Emad Yuzbashian
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Golaleh Asghari
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvin Mirmiran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pegah Amouzegar-Bahambari
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Kim H, Caulfield LE, Garcia-Larsen V, Steffen LM, Grams ME, Coresh J, Rebholz CM. Plant-Based Diets and Incident CKD and Kidney Function. Clin J Am Soc Nephrol 2019; 14:682-691. [PMID: 31023928 PMCID: PMC6500948 DOI: 10.2215/cjn.12391018] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 02/20/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND OBJECTIVES The association between plant-based diets, incident CKD, and kidney function decline has not been examined in the general population. We prospectively investigated this relationship in a population-based study, and evaluated if risk varied by different types of plant-based diets. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Analyses were conducted in a sample of 14,686 middle-aged adults enrolled in the Atherosclerosis Risk in Communities study. Diets were characterized using four plant-based diet indices. In the overall plant-based diet index, all plant foods were positively scored; in the healthy plant-based diet index, only healthful plant foods were positively scored; in the provegetarian diet, selected plant foods were positively scored. In the less healthy plant-based diet index, only less healthful plant foods were positively scored. All indices negatively scored animal foods. We used Cox proportional hazards models to study the association with incident CKD and linear mixed models to examine decline in eGFR, adjusting for confounders. RESULTS During a median follow-up of 24 years, 4343 incident CKD cases occurred. Higher adherence to a healthy plant-based diet (HR comparing quintile 5 versus quintile 1 [HRQ5 versus Q1], 0.86; 95% confidence interval [95% CI], 0.78 to 0.96; P for trend =0.001) and a provegetarian diet (HRQ5 versus Q1, 0.90; 95% CI, 0.82 to 0.99; P for trend =0.03) were associated with a lower risk of CKD, whereas higher adherence to a less healthy plant-based diet (HRQ5 versus Q1, 1.11; 95% CI, 1.01 to 1.21; P for trend =0.04) was associated with an elevated risk. Higher adherence to an overall plant-based diet and a healthy plant-based diet was associated with slower eGFR decline. The proportion of CKD attributable to lower adherence to healthy plant-based diets was 4.1% (95% CI, 0.6% to 8.3%). CONCLUSIONS Higher adherence to healthy plant-based diets and a vegetarian diet was associated with favorable kidney disease outcomes.
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Affiliation(s)
- Hyunju Kim
- Center for Human Nutrition and
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland; and
| | | | | | - Lyn M. Steffen
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Morgan E. Grams
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland; and
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland; and
| | - Casey M. Rebholz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland; and
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Kramer HJ, Townsend RR, Griffin K, Flynn JT, Weiner DE, Rocco MV, Choi MJ, Weir MR, Chang TI, Agarwal R, Beddhu S. KDOQI US Commentary on the 2017 ACC/AHA Hypertension Guideline. Am J Kidney Dis 2019; 73:437-458. [PMID: 30905361 PMCID: PMC6740329 DOI: 10.1053/j.ajkd.2019.01.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 01/08/2019] [Indexed: 02/07/2023]
Abstract
Hypertension is a modifiable risk factor for cardiovascular morbidity and mortality and reduction of elevated blood pressure (BP) remains an important intervention for slowing kidney disease progression. Over the past decade, the most appropriate BP target for initiation and titration of BP-lowering medications has been an area of intense research and debate within the clinical community. In 2017, the American College of Cardiology and the American Heart Association (ACC/AHA) in conjunction with several other professional societies released new hypertension guidelines based on data from a systematic review of clinical trials and observational data. While many of the recommendations in the ACC/AHA hypertension guideline are relevant to nephrology practice, BP targets and management strategies for patients receiving dialysis are not discussed. This Kidney Disease Outcomes Quality Initiative (KDOQI) commentary focuses largely on recommendations from the ACC/AHA hypertension guidelines that are pertinent to individuals at risk of chronic kidney disease or with non-dialysis-dependent chronic kidney disease. This KDOQI commentary also includes a brief discussion of the consensus statement regarding hypertension diagnosis and management for adults receiving maintenance dialysis published by the European Renal and Cardiovascular Medicine Working Group of the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) and the Hypertension and the Kidney working group of the European Society of Hypertension. Overall, we support the vast majority of the ACC/AHA recommendations and highlight select areas in which best diagnosis and treatment options remain controversial.
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Affiliation(s)
- Holly J Kramer
- Department of Public Health Sciences, Loyola University Chicago Stritch School of Medicine, Maywood; Department of Medicine, Loyola University Chicago Stritch School of Medicine, Maywood; Hines VA Medical Center, Hines, IL.
| | - Raymond R Townsend
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Karen Griffin
- Department of Medicine, Loyola University Chicago Stritch School of Medicine, Maywood; Hines VA Medical Center, Hines, IL
| | - Joseph T Flynn
- Department of Pediatrics, University of Washington School of Medicine, Seattle WA
| | | | - Michael V Rocco
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Michael J Choi
- Department of Medicine, Johns Hopkins School of Medicine
| | - Matthew R Weir
- Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Tara I Chang
- Department of Medicine, Stanford Medical School, Palo Alto, CA
| | - Rajiv Agarwal
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
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Kim HW, Park JT, Yoo TH, Lee J, Chung W, Lee KB, Chae DW, Ahn C, Kang SW, Choi KH, Han SH. Urinary Potassium Excretion and Progression of CKD. Clin J Am Soc Nephrol 2019; 14:330-340. [PMID: 30765533 PMCID: PMC6419276 DOI: 10.2215/cjn.07820618] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 11/12/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Data on whether low or high urinary potassium excretion is associated with poor kidney outcome have been conflicting. The aim of this study was to clarify the association between urinary potassium excretion and CKD progression. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We investigated the relationship between lower urinary potassium excretion and CKD progression and compared three urinary potassium indices among 1821 patients from the Korean Cohort Study for Outcome in Patients with CKD. Urinary potassium excretion was determined using spot urinary potassium-to-creatinine ratio, spot urinary potassium concentration, and 24-hour urinary potassium excretion. Patients were categorized into four groups according to quartiles of each urinary potassium excretion metric. The study end point was a composite of a ≥50% decrease in eGFR from baseline values and ESKD. RESULTS During 5326 person-years of follow-up, the primary outcome occurred in 392 (22%) patients. In a multivariable cause-specific hazard model, lower urinary potassium-to-creatinine ratio was associated with higher risk of CKD progression (adjusted hazard ratio, 1.47; 95% confidence interval, 1.01 to 2.12) comparing the lowest quartile with the highest quartile. Sensitivity analyses with other potassium metrics also showed consistent results in 855 patients who completed 24-hour urinary collections: adjusted hazard ratios comparing the lowest quartile with the highest quartile were 3.05 (95% confidence interval, 1.54 to 6.04) for 24-hour urinary potassium excretion, 1.95 (95% confidence interval, 1.05 to 3.62) for spot urinary potassium-to-creatinine ratio, and 3.79 (95% confidence interval, 1.51 to 9.51) for spot urinary potassium concentration. CONCLUSIONS Low urinary potassium excretion is associated with progression of CKD.
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Affiliation(s)
- Hyung Woo Kim
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Korea
| | - Jung Tak Park
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Korea
| | - Tae-Hyun Yoo
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Korea
| | - Joongyub Lee
- Department of Prevention and Management, School of Medicine, Inha University, Incheon, Korea
| | - Wookyung Chung
- Department of Internal Medicine, Gachon University, Gil Hospital, Incheon, Korea
| | - Kyu-Beck Lee
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea; and
| | - Dong-Wan Chae
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Curie Ahn
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Korea
| | - Kyu Hun Choi
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Korea
| | - Seung Hyeok Han
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Korea
| | - on behalf of the KNOW-CKD Study Investigators
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Korea
- Department of Prevention and Management, School of Medicine, Inha University, Incheon, Korea
- Department of Internal Medicine, Gachon University, Gil Hospital, Incheon, Korea
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea; and
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Carvalho CM, Gross LA, de Azevedo MJ, Viana LV. Dietary Fiber Intake (Supplemental or Dietary Pattern Rich in Fiber) and Diabetic Kidney Disease: A Systematic Review of Clinical Trials. Nutrients 2019; 11:E347. [PMID: 30736343 DOI: 10.3390/nu11020347] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 01/22/2019] [Accepted: 01/30/2019] [Indexed: 12/18/2022] Open
Abstract
Fiber intake is associated with better glycemic control being an important nonpharmacologicaltreatment for diabetes (DM). We hypothesize that a dietary fiber intake can bringbenefits to diabetic kidney disease (DKD), improving renal outcomes. This systematic review aimedto evaluate the effect of dietary fiber (supplemental or dietary pattern rich in fiber) on DKD. Wesearched six databases to identify clinical trials that reported fiber intake and renal outcomes(albuminuria, proteinuria, estimated glomerular filtration rate (eGFR) dialysis) in patients with DM.From 1814 studies, 48 papers were fully evaluated. In the end, seven trials (161 patients, aged 58.3years, 49% females) were included. The studies were organized into three categories (vegetarian,Dietary Approaches to Stop Hypertension (DASH) diet, and fiber supplement), two evaluatedsupplements and five dietary patterns. Vegetarian diet reduced albuminuria in three trials, two inpatients with type 1 DM and one in patients with type 2 DM; and one study demonstrated a change inthe eGFR in type 1 DM. The individual quality of the studies was low/uncertain. A vegetarian dietarypattern may have a beneficial effect on these renal outcomes. However, the individual effect of theintake of fiber on DKD not was possible to be evaluated.
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13
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Song AY, Crews DC, Ephraim PL, Han D, Greer RC, Boyér LL, Ameling J, Gayles DJ, Sneed V, Carson KA, Albert M, Liu Y, Cooper LA, Boulware LE. Sociodemographic and Kidney Disease Correlates of Nutrient Intakes Among Urban African Americans With Uncontrolled Hypertension. J Ren Nutr 2019; 29:399-406. [PMID: 30709714 DOI: 10.1053/j.jrn.2018.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 11/18/2018] [Accepted: 12/12/2018] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE The objective of this study was to determine the association between sociodemographic factors and intakes of 4 nutrients and associations between intakes and markers of kidney disease to identify opportunities to improve outcomes among clinically high-risk African Americans. DESIGN AND METHODS We conducted a cross-sectional study of baseline data from the Achieving Blood Pressure Control Together study, a randomized controlled trial of 159 African Americans (117 females) with uncontrolled hypertension in Baltimore MD. To determine the association between sociodemographic factors and nutrient intakes, we constructed linear and logistic regression models. Using logistic regression, we determined the association between below-median nutrient intakes and kidney disease. Our outcomes of interest were daily intakes of vitamin C, magnesium, dietary fiber, and potassium as estimated by the Block Fruit-Vegetable-Fiber Screener and kidney disease defined as estimated glomerular filtration rate <60 mL/min per 1.73 m2 or urinary albumin-to-creatinine ratio >=30 mg/g. SETTING AND SUBJECTS Baseline data from the Achieving Blood Pressure Control Together study, a randomized controlled trial of 159 African Americans (117 females) with uncontrolled hypertension, were obtained. METHODS To determine the association between sociodemographic factors and nutrient intakes, we constructed linear and logistic regression models. Using logistic regression, we determined the association between below-median nutrient intakes and kidney disease. MAIN OUTCOME MEASURES Our outcomes of interest were daily intakes of vitamin C, magnesium, dietary fiber, and potassium as estimated by the Block Fruit-Vegetable-Fiber Screener and kidney disease defined as estimated glomerular filtration rate <60 mL/min per 1.73 m2 or urinary albumin-to-creatinine ratio ≥30 mg/g. RESULTS Overall, compared to Institute of Medicine recommendations, participants had lower intakes of magnesium, fiber, and potassium but higher vitamin C intakes. For females, sociodemographic factors that significantly associated with lower intake of the 4 nutrients were older age, obesity, lower health numeracy, and lesser educational attainment. For males, none of the sociodemographic factors were significantly associated with nutrient intakes. Below-median intake was significantly associated with albumin-to-creatinine ratio ≥30 (adjusted odds ratio [95% confidence interval]: 3.4 [1.5, 7.8] for vitamin C; 3.6 [1.6, 8.4] for magnesium; 2.9 [1.3, 6.5] for fiber; 3.6 [1.6, 8.4] for potassium), but not with estimated glomerular filtration rate <60. CONCLUSION African Americans with uncontrolled hypertension may have low intakes of important nutrients, which could increase their risk of chronic kidney disease. Tailored dietary interventions for African Americans at high risk for chronic kidney disease may be warranted.
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Affiliation(s)
- Annie Y Song
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Deidra C Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland; Johns Hopkins Center for Health Equity, Johns Hopkins Medical Institutions, Baltimore, Maryland.
| | - Patti L Ephraim
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Dingfen Han
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Raquel C Greer
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland; Johns Hopkins Center for Health Equity, Johns Hopkins Medical Institutions, Baltimore, Maryland; Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - LaPricia Lewis Boyér
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Jessica Ameling
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Debra J Gayles
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Valerie Sneed
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland; Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kathryn A Carson
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland; Johns Hopkins Center for Health Equity, Johns Hopkins Medical Institutions, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael Albert
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yang Liu
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Lisa A Cooper
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland; Johns Hopkins Center for Health Equity, Johns Hopkins Medical Institutions, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - L Ebony Boulware
- Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina
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Kramer H, Jimenez EY, Brommage D, Vassalotti J, Montgomery E, Steiber A, Schofield M. Medical Nutrition Therapy for Patients with Non-Dialysis-Dependent Chronic Kidney Disease: Barriers and Solutions. J Acad Nutr Diet 2018; 118:1958-1965. [PMID: 30076072 DOI: 10.1016/j.jand.2018.05.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 05/25/2018] [Indexed: 01/11/2023]
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15
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Van Elswyk ME, Weatherford CA, McNeill SH. A Systematic Review of Renal Health in Healthy Individuals Associated with Protein Intake above the US Recommended Daily Allowance in Randomized Controlled Trials and Observational Studies. Adv Nutr 2018; 9:404-418. [PMID: 30032227 PMCID: PMC6054213 DOI: 10.1093/advances/nmy026] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 10/10/2017] [Accepted: 03/27/2018] [Indexed: 12/21/2022] Open
Abstract
A systematic review was used to identify randomized controlled trials (RCTs) and observational epidemiologic studies (OBSs) that examined protein intake consistent with either the US RDA (0.8 g/kg or 10-15% of energy) or a higher protein intake (≥20% but <35% of energy or ≥10% higher than a comparison intake) and reported measures of kidney function. Studies (n = 26) of healthy, free-living adults (>18 y old) with or without metabolic disease risk factors were included. Studies of subjects with overt disease, such as chronic kidney, end-stage renal disease, cancer, or organ transplant, were excluded. The most commonly reported variable was glomerular filtration rate (GFR), with 13 RCTs comparing GFRs obtained with normal and higher protein intakes. Most (n = 8), but not all (n = 5), RCTs reported significantly higher GFRs in response to increased protein intake, and all rates were consistent with normal kidney function in healthy adults. The evidence from the current review is limited and inconsistent with regard to the role of protein intake and the risk of kidney stones. Increased protein intake had little or no effect on blood markers of kidney function. Evidence reported here suggests that protein intake above the US RDA has no adverse effect on blood pressure. All included studies were of moderate to high risk of bias and, with the exception of 2 included cohorts, were limited in duration (i.e. <6 mo). Data in the current review are insufficient to determine if increased protein intake from a particular source, i.e., plant or animal, influences kidney health outcomes. These data further indicate that, at least in the short term, higher protein intake within the range of recommended intakes for protein is consistent with normal kidney function in healthy individuals.
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16
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Wen J, Hao J, Zhang Y, Liang Y, Li S, Wang F, Duan X, Yang X, Cao K, Wang B, Lu X, Wang N. Fresh fruit consumption and risk of incident albuminuria among rural Chinese adults: A village-based prospective cohort study. PLoS One 2018; 13:e0197917. [PMID: 29795700 PMCID: PMC5967721 DOI: 10.1371/journal.pone.0197917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 05/10/2018] [Indexed: 01/12/2023] Open
Abstract
Background Recent studies showed that increased fresh fruit consumption is significantly associated with lower risks of diabetes, hypertension, and cardiovascular disease (CVD); other studies suggested that albuminuria is associated with diabetes, hypertension, and CVD. Therefore, we hypothesized that lower fresh fruit consumption is associated with higher risk of incident albuminuria among Chinese adults in rural areas, where fresh fruit consumption level is very low and prevalence of albuminuria is high. Methods We tested the hypothesis in a village-based cohort study of 3574 participants aged ≥ 30 years from the Handan Eye Study conducted from 2006 to 2013. Albuminuria was defined as urinary albumin-to-creatinine ratio ≥ 30 mg/g. Results Overall, 35.4% of the participants never or rarely consumed fresh fruits, and 33.9, 21.6, and 9.1% consumed fresh fruits 1–3 times/month, 1–2 times/week, and ≥ 3 times/week, respectively. During a median follow-up period of 5.6 years, albuminuria developed in 17.6% (n = 629) of the participants. Compared with participants who consumed fresh fruits ≥ 3 times/week, the multivariable adjustment odds ratios (ORs) for incident albuminuria associated with fruit consumption 1–2 times/week, 1–3 times/month, and no or rare consumption were 1.58 (95% confidence intervals (CI), 1.05–2.40), 1.74 (95% CI, 1.17–2.58), and 1.78 (95% CI, 1.20–2.64), respectively. After excluding participants with diabetes, the association remained significant. Conclusions Lower fresh fruit consumption was significantly associated with higher risk of incident albuminuria, and fresh fruit consumption frequency could be an essential intervention target to prevent albuminuria in rural China.
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Affiliation(s)
- Jiangping Wen
- Department of Laboratory Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jie Hao
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Eye Institute, Beijing, China
| | - Ye Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yuanbo Liang
- Clinical and Epidemiological Research Center, the Affiliated Eye Hospital of Wenzhou Medical University, Wenzhou, China
| | - Sizhen Li
- Nanjing Aier Eye Hospital, Nanjing, China
| | - Fenghua Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xinrong Duan
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xiaohui Yang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Eye Institute, Beijing, China
| | - Kai Cao
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Eye Institute, Beijing, China
| | - Bingsong Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Eye Institute, Beijing, China
| | - Xinxin Lu
- Department of Laboratory Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- * E-mail: (NW); (XL)
| | - Ningli Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Eye Institute, Beijing, China
- * E-mail: (NW); (XL)
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17
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Vervloet MG, van Ballegooijen AJ. Prevention and treatment of hyperphosphatemia in chronic kidney disease. Kidney Int 2018; 93:1060-1072. [PMID: 29580635 DOI: 10.1016/j.kint.2017.11.036] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 11/21/2017] [Accepted: 11/27/2017] [Indexed: 12/20/2022]
Abstract
Hyperphosphatemia has consistently been shown to be associated with dismal outcome in a wide variety of populations, particularly in chronic kidney disease (CKD). Compelling evidence from basic and animal studies elucidated a range of mechanisms by which phosphate may exert its pathological effects and motivated interventions to treat hyperphosphatemia. These interventions consisted of dietary modifications and phosphate binders. However, the beneficial effects of these treatment methods on hard clinical outcomes have not been convincingly demonstrated in prospective clinical trials. In addition, exposure to high amounts of dietary phosphate may exert untoward actions even in the absence of overt hyperphosphatemia. Based on this concept, it has been proposed that the same interventions used in CKD patients with normal phosphate concentrations be used in the presence of hyperphosphatemia to prevent rise of phosphate concentration and as an early intervention for cardiovascular risk. This review describes conceptual models of phosphate toxicity, summarizes the evidence base for treatment and prevention of hyperphosphatemia, and identifies important knowledge gaps in the field.
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Affiliation(s)
- Marc G Vervloet
- Department of Nephrology, Amsterdam Cardiovascular Sciences, VU University Medical Center, Amsterdam, the Netherlands.
| | - Adriana J van Ballegooijen
- Department of Nephrology, Amsterdam Cardiovascular Sciences, VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, Amsterdam Public Health Institute, VU University Medical Center, Amsterdam, the Netherlands
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18
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Tyson CC, Barnhart H, Sapp S, Poon V, Lin PH, Svetkey LP. Ambulatory blood pressure in the dash diet trial: Effects of race and albuminuria. J Clin Hypertens (Greenwich) 2018; 20:308-314. [PMID: 29384243 DOI: 10.1111/jch.13170] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 10/05/2017] [Accepted: 10/20/2017] [Indexed: 12/27/2022]
Abstract
We evaluated whether low-grade albuminuria or black race modulates ambulatory blood pressure (BP) or nocturnal BP response to the DASH diet. Among 202 adults enrolled in the DASH multicenter trial who were fed the DASH or control diet for 8 weeks, reductions in 24-hour daytime and nighttime SBP and DBP were significantly larger for DASH compared to control. Median changes in nocturnal BP dipping were not significant. Compared to urine albumin excretion of <7 mg/d, ≥7 mg/d was associated with larger significant median reductions in 24-hour SBP (-7.3 vs -3.1 mm Hg), all measures of DBP (24-hour: -5.9 vs -1.8 mm Hg; daytime: -9.9 vs -4.0 mm Hg; nighttime -9.0 vs -2.0 mm Hg), and with increased nocturnal SBP dipping (2.3% vs -0.5%). Black race was associated with larger median reduction in 24-hour SBP only (-5.5 vs -2.4 mm Hg). This analysis suggests greater effect of DASH on ambulatory BP in the presence of low-grade albuminuria.
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Affiliation(s)
- Crystal C Tyson
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | | | - Shelly Sapp
- Duke Clinical Research Institute, Durham, NC, USA
| | - Victor Poon
- Duke Clinical Research Institute, Durham, NC, USA
| | - Pao-Hwa Lin
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.,Sarah W. Stedman Nutrition & Metabolism Center, Duke University, Durham, NC, USA
| | - Laura P Svetkey
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.,Sarah W. Stedman Nutrition & Metabolism Center, Duke University, Durham, NC, USA
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19
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Buscail C, Sabate JM, Bouchoucha M, Kesse-Guyot E, Hercberg S, Benamouzig R, Julia C. Western Dietary Pattern Is Associated with Irritable Bowel Syndrome in the French NutriNet Cohort. Nutrients 2017; 9:nu9090986. [PMID: 28880222 PMCID: PMC5622746 DOI: 10.3390/nu9090986] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 08/09/2017] [Accepted: 08/15/2017] [Indexed: 12/13/2022] Open
Abstract
Background: Diet appears to play a key role in the pathogenesis of the irritable bowel syndrome (IBS). Some dietary patterns (DP) could increase the risk of triggering or worsening IBS symptoms. This cross-sectional study aimed to assess the association between a posteriori derived DP and IBS in a large French population, the web-based NutriNet-Santé cohort. Methods: Study population included participants of the NutriNet-Santé study who completed a questionnaire based on Rome III criteria assessing IBS. A principal component analysis (PCA) was performed to identify major DPs based on 29 food groups' consumption. Associations between DP quintiles and IBS were investigated with multivariable logistic regressions. Results: 44,350 participants were included, with 2423 (5.5%) presenting IBS. Three major DP were extracted using PCA, "healthy," "western," and "traditional." After adjustments on confounders, the "western" DP was positively associated with IBS (OR Q5 vs. Q1 = 1.38, 95% CI 1.19-1.61, p trend < 0.0001) and the "traditional" DP was positively associated with IBS in women (OR Q5 vs. Q1 = 1.29 95% CI 1.08-1.54, p trend = 0.001). Conclusions: In this study, a "western" DP-highly correlated with the consumption of fatty and sugary products and snacks-was associated with a moderate increased risk of IBS.
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Affiliation(s)
- Camille Buscail
- Université Paris 13, Sorbonne Paris Cité, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre de Recherche en Epidémiologie et Biostatistiques (CRESS), Inserm 1153, Inra U1125, Cnam, COMUE Sorbonne Paris Cité, F-93017 Bobigny, France.
- Département de Santé Publique, Hôpital Avicenne (AP-HP), F-93017 Bobigny, France.
| | - Jean-Marc Sabate
- Service d' Hépato-Gastro-Entérologie, Hôpital Avicenne (AP-HP), F-93017 Bobigny, France.
| | - Michel Bouchoucha
- Service d' Hépato-Gastro-Entérologie, Hôpital Avicenne (AP-HP), F-93017 Bobigny, France.
| | - Emmanuelle Kesse-Guyot
- Université Paris 13, Sorbonne Paris Cité, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre de Recherche en Epidémiologie et Biostatistiques (CRESS), Inserm 1153, Inra U1125, Cnam, COMUE Sorbonne Paris Cité, F-93017 Bobigny, France.
| | - Serge Hercberg
- Université Paris 13, Sorbonne Paris Cité, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre de Recherche en Epidémiologie et Biostatistiques (CRESS), Inserm 1153, Inra U1125, Cnam, COMUE Sorbonne Paris Cité, F-93017 Bobigny, France.
- Département de Santé Publique, Hôpital Avicenne (AP-HP), F-93017 Bobigny, France.
| | - Robert Benamouzig
- Service d' Hépato-Gastro-Entérologie, Hôpital Avicenne (AP-HP), F-93017 Bobigny, France.
| | - Chantal Julia
- Université Paris 13, Sorbonne Paris Cité, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre de Recherche en Epidémiologie et Biostatistiques (CRESS), Inserm 1153, Inra U1125, Cnam, COMUE Sorbonne Paris Cité, F-93017 Bobigny, France.
- Département de Santé Publique, Hôpital Avicenne (AP-HP), F-93017 Bobigny, France.
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20
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Ko GJ, Kalantar-Zadeh K, Goldstein-Fuchs J, Rhee CM. Dietary Approaches in the Management of Diabetic Patients with Kidney Disease. Nutrients 2017; 9:E824. [PMID: 28758978 DOI: 10.3390/nu9080824] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 07/22/2017] [Accepted: 07/25/2017] [Indexed: 12/13/2022] Open
Abstract
Chronic kidney disease (CKD) is one of the most prevalent complications of diabetes, and patients with diabetic kidney disease (DKD) have a substantially higher risk of cardiovascular disease and death compared to their non-diabetic CKD counterparts. In addition to pharmacologic management strategies, nutritional and dietary interventions in DKD are an essential aspect of management with the potential for ameliorating kidney function decline and preventing the development of other end-organ complications. Among DKD patients with non-dialysis dependent CKD, expert panels recommend lower dietary protein intake of 0.8 g/kg of body weight/day, while higher dietary protein intake (>1.2 g/kg of body weight/day) is advised among diabetic end-stage renal disease patients receiving maintenance dialysis to counteract protein catabolism, dialysate amino acid and protein losses, and protein-energy wasting. Carbohydrates from sugars should be limited to less than 10% of energy intake, and it is also suggested that higher polyunsaturated and monounsaturated fat consumption in lieu of saturated fatty acids, trans-fat, and cholesterol are associated with more favorable outcomes. While guidelines recommend dietary sodium restriction to less than 1.5–2.3 g/day, excessively low sodium intake may be associated with hyponatremia as well as impaired glucose metabolism and insulin sensitivity. As patients with advanced DKD progressing to end-stage renal disease may be prone to the “burnt-out diabetes” phenomenon (i.e., spontaneous resolution of hypoglycemia and frequent hypoglycemic episodes), further studies in this population are particularly needed to determine the safety and efficacy of dietary restrictions in this population.
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21
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Kramer H. Kidney Disease and the Westernization and Industrialization of Food. Am J Kidney Dis 2017; 70:111-121. [DOI: 10.1053/j.ajkd.2016.11.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 11/01/2016] [Indexed: 01/12/2023]
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Abstract
Although phosphorus is an essential nutrient required for multiple physiological functions, recent research raises concerns that high phosphorus intake could have detrimental effects on health. Phosphorus is abundant in the food supply of developed countries, occurring naturally in protein-rich foods and as an additive in processed foods. High phosphorus intake can cause vascular and renal calcification, renal tubular injury, and premature death in multiple animal models. Small studies in human suggest that high phosphorus intake may result in positive phosphorus balance and correlate with renal calcification and albuminuria. Although serum phosphorus is strongly associated with cardiovascular disease, progression of kidney disease, and death, limited data exist linking high phosphorus intake directly to adverse clinical outcomes. Further prospective studies are needed to determine whether phosphorus intake is a modifiable risk factor for kidney disease.
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Affiliation(s)
- Alex R Chang
- Kidney Health Research Institute, Geisinger Health System, Danville, Pennsylvania 17822; .,Department of Epidemiology and Health Services Research, Geisinger Health System, Geisinger Health System, Danville, Pennsylvania 17822
| | - Cheryl Anderson
- Division of Preventive Medicine, School of Medicine, University of California, San Diego, La Jolla, California 92093
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Kelly JT, Palmer SC, Wai SN, Ruospo M, Carrero JJ, Campbell KL, Strippoli GFM. Healthy Dietary Patterns and Risk of Mortality and ESRD in CKD: A Meta-Analysis of Cohort Studies. Clin J Am Soc Nephrol 2017; 12:272-279. [PMID: 27932391 PMCID: PMC5293335 DOI: 10.2215/cjn.06190616] [Citation(s) in RCA: 167] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 10/19/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Patients with CKD are advised to follow dietary recommendations that restrict individual nutrients. Emerging evidence indicates overall eating patterns may better predict clinical outcomes, however, current data on dietary patterns in kidney disease are limited. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This systematic review aimed to evaluate the association between dietary patterns and mortality or ESRD among adults with CKD. Medline, Embase, and reference lists were systematically searched up to November 24, 2015 by two independent review authors. Eligible studies were longitudinal cohort studies reporting the association of dietary patterns with mortality, cardiovascular events, or ESRD. RESULTS A total of seven studies involving 15,285 participants were included. Healthy dietary patterns were generally higher in fruit and vegetables, fish, legumes, cereals, whole grains, and fiber, and lower in red meat, salt, and refined sugars. In six studies, healthy dietary patterns were consistently associated with lower mortality (3983 events; adjusted relative risk, 0.73; 95% confidence interval, 0.63 to 0.83; risk difference of 46 fewer (29-63 fewer) events per 1000 people over 5 years). There was no statistically significant association between healthy dietary patterns and risk of ESRD (1027 events; adjusted relative risk, 1.04; 95% confidence interval, 0.68 to 1.40). CONCLUSIONS Healthy dietary patterns are associated with lower mortality in people with kidney disease. Interventions to support adherence to increased fruit and vegetable, fish, legume, whole grain, and fiber intake, and reduced red meat, sodium, and refined sugar intake could be effective tools to lower mortality in people with kidney disease.
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Affiliation(s)
- Jaimon T. Kelly
- Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia
| | - Suetonia C. Palmer
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Shu Ning Wai
- Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia
| | - Marinella Ruospo
- Department of Translational Medicine, University of Eastern Piedmont Amedeo Avogadro, Alessandria, Italy
- Diaverum Academy, Lund, Sweden
| | - Juan-Jesus Carrero
- Division of Renal Medicine, Department of Clinical Science, Intervention and technology, Karolinska Institutet, Huddinge, Sweden
| | - Katrina L. Campbell
- Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia
| | - Giovanni F. M. Strippoli
- Diaverum Academy, Lund, Sweden
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy. Diaverum Academy, Sweden; and
- Sydney School of Public Health, University of Sydney, New South Wales, Australia
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Lee SJ, Lee SY, Sung SA, Chin HJ, Lee SW. Low Rice Intake Is Associated with Proteinuria in Participants of Korea National Health and Nutrition Examination Survey. PLoS One 2017; 12:e0170198. [PMID: 28081248 DOI: 10.1371/journal.pone.0170198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 01/02/2017] [Indexed: 11/19/2022] Open
Abstract
Little is known about the risk factors of proteinuria in the Asian population. On the basis of the association between rice intake patterns and chronic diseases, we hypothesized that rice intake patterns are associated with proteinuria in the Asian population. Data, including data regarding rice intake frequency and dipstick urinalysis results, from the Korea National Health and Nutrition Examination Survey in 1998, 2001, 2005, and 2007 were analyzed. The study involved 19,824 participants who were older than 20 years of age. Low rice intake was defined as consumption of rice ≤ 1 time/day. Proteinuria was defined as dipstick urinalysis protein ≥ 1 positive. Among the 19,824 participants, the prevalence of low rice intake and proteinuria were 17.3% and 2.9%, respectively. The low rice intake group showed a higher rate of proteinuria than the non-low rice intake group did (3.8% vs. 2.7%, P < 0.001). In multivariate logistic regression analysis, the odds ratio (OR) of low rice intake for proteinuria was 1.54 (95% confidence interval (CI): 1.25-1.89; P < 0.001). Low rice intake was also independently associated with high blood pressure (OR: 1.43, 95% CI: 1.31-1.56; P < 0.001) and diabetes (OR: 1.43, 95% CI: 1.27-1.62; P < 0.001). In conclusion, low rice intake was found to be independently associated with proteinuria in the Asian population, which might have been affected by the associations of low rice intake with high blood pressure and diabetes. Future prospective studies are needed to confirm the results of this study.
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Lee HS, Lee KB, Hyun YY, Chang Y, Ryu S, Choi Y. DASH dietary pattern and chronic kidney disease in elderly Korean adults. Eur J Clin Nutr 2017; 71:755-61. [PMID: 27966569 DOI: 10.1038/ejcn.2016.240] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 04/05/2016] [Accepted: 05/03/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND/OBJECTIVES Dietary patterns are linked to risk and outcomes in chronic kidney disease (CKD). Dietary intake varies by race, region and age. The relationship between a Dietary Approaches to Stop Hypertension (DASH) diet and CKD in elderly Koreans is unclear. SUBJECTS/METHODS We conducted cross-sectional analyses of 2408 community-dwelling elderly participants from the Korean National Health and Nutrition Examination Survey (2011-2012). DASH dietary patterns for six nutrients (protein, fiber, calcium, potassium, total fat and sodium) were collected by 24 h recall. DASH-US (based on the US recommendations) and DASH-KQ (Korean quartile) scores were generated by summing the scores for the six nutrients. Multivariate logistic regression analysis was used to calculate odds ratio (OR) for the association between a DASH diet and CKD. RESULTS Mean subject age was 72.4±5.1 years, 13.9% had CKD and 23.8% had diabetes. Protein, fiber, calcium and potassium intake was lower in CKD than non-CKD participants. In multivariate logistic regression analysis adjusted for age, sex, body mass index, comorbid conditions and other factors, a high DASH score was associated with a low odds for CKD based on DASH-US (OR=0.78, 95% confidence interval (CI), 0.65-0.94, P=0.009) and DASH-KQ (OR=0.95, 95% CI, 0.91-0.99, P=0.022). In six nutrients of DASH diet, high fiber intake showed a low odds for CKD in the DASH-KQ model (P for trend=0.010). CONCLUSIONS Our findings suggest that higher adherence to a DASH diet and higher fiber intake are associated with lower odds of CKD in elderly Koreans. These results should be corroborated through longitudinal studies of the association between a DASH diet and high-fiber diet on the risk of developing CKD.
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Wai SN, Kelly JT, Johnson DW, Campbell KL. Dietary Patterns and Clinical Outcomes in Chronic Kidney Disease: The CKD.QLD Nutrition Study. J Ren Nutr 2016; 27:175-182. [PMID: 27939593 DOI: 10.1053/j.jrn.2016.10.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 10/09/2016] [Accepted: 10/19/2016] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Emerging evidence suggests that dietary patterns are associated with survival in people with chronic kidney disease (CKD). This study evaluated the relationship between dietary habits and renal-related clinical outcomes in an established CKD cohort. DESIGN Prospective cohort study. SETTING Three outpatient nephrology clinics in Queensland, Australia. SUBJECTS A total of 145 adult patients with Stage 3 or 4 CKD (estimated glomerular filtration rate 15-59 mL/minute/1.73 m2). INTERVENTION Dietary intake was measured using 24-hour recall and the HeartWise Dietary Habits Questionnaire (DHQ), which evaluates 10 components of dietary patterns in relation to cooking habits and intake of food groups. MAIN OUTCOME MEASURE The primary outcome was a composite end point of all-cause mortality, commencement of dialysis, and doubling of serum creatinine. Secondary outcome was all-cause mortality alone. Multivariate cox regression analyses calculated hazard ratios (HRs) for associations between DHQ domains and occurrence of composite outcome and adjusted for confounders, including comorbidities and renal function. RESULTS Over a median follow-up of 36 months, 32% (n = 47) reached the composite end point, of which 21% died (n = 30). Increasing DHQ score was associated with a lower risk of the composite end point with increasing intake of fruits and vegetables (HR: 0.61; 95% CI, 0.39-0.94) and limiting alcohol consumption (HR, 0.79; 95% CI: 0.65-0.96). For the secondary outcome of all-cause mortality, there was a significant association with adequate intake of fruits and vegetables (HR: 0.35; 95% CI, 0.15-0.83). CONCLUSION Healthy dietary patterns consisting of adequate fruits and vegetables and limited alcohol consumption are associated with a delay in CKD progression and improved survival in patients with Stage 3 or 4 CKD.
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Affiliation(s)
- Shu Ning Wai
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Jaimon T Kelly
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia; School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Katrina L Campbell
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia; School of Medicine, University of Queensland, Brisbane, Queensland, Australia; Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
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Ravera A, Carubelli V, Sciatti E, Bonadei I, Gorga E, Cani D, Vizzardi E, Metra M, Lombardi C. Nutrition and Cardiovascular Disease: Finding the Perfect Recipe for Cardiovascular Health. Nutrients 2016; 8:E363. [PMID: 27314382 DOI: 10.3390/nu8060363] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/05/2016] [Accepted: 05/23/2016] [Indexed: 02/07/2023] Open
Abstract
The increasing burden of cardiovascular disease (CVD) despite the progress in management entails the need of more effective preventive and curative strategies. As dietary-associated risk is the most important behavioral factor influencing global health, it appears the best target in the challenge against CVD. Although for many years, since the formulation of the cholesterol hypothesis, a nutrient-based approach was attempted for CVD prevention and treatment, in recent years a dietary-based approach resulted more effective in reducing cardiovascular risk worldwide. After the publication of randomized trials on the remarkable effects of the Mediterranean diet and the Dietary Approach to Stop Hypertension (DASH) diet on CVD, new efforts were put on research about the effects of complex dietary interventions on CVD. The purpose of this paper is to review the evidence on dietary interventions in the prevention and disease modification of CVD, focusing on coronary artery disease and heart failure, the main disease responsible for the enormous toll taken by CVD worldwide.
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Abstract
PURPOSE OF REVIEW Given scientific and public debate about optimal diet to prevent cardiovascular disease, and interest in diet and other chronic diseases, we propose that following a few simple dietary principles would reduce chronic disease incidence. RECENT FINDINGS Nutrition research has been criticized for focusing on individual nutrients and foods, treated like drug therapy. With a few important exceptions, clinical trials of supplemental nutrients have not shown benefit. Although highly specific nutrition information is elusive, diet patterns have provided consistent answers, important for public health. Observational cohort studies have found that some dietary patterns are reported with high reliability over long periods and predict future cardiovascular and other inflammatory-related diseases. Two randomized clinical trials confirmed this finding. There are many common features of Mediterranean and prudent diets, particularly the plant-centered aspect, coupled with variety of foods eaten. A dietary pattern characterized by high fruit, vegetable, legume, whole grain, nut, berry, seed, and fish intakes, and possibly by intakes of dairy, coffee, tea, chocolate, and alcohol (not in excess), but low meat and detrimentally processed foods is associated with reduced incidence of cardiovascular disease and rates of noncardiovascular, noncancer chronic inflammatory-related mortality. SUMMARY A plant-centered diet may be broadly recommended.
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Affiliation(s)
- David R Jacobs
- aDivision of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA bSchool of Health Sciences, University of Wollongong, Wollongong, NSW, Australia
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Abstract
African Americans suffer disproportionately from advanced and progressive chronic kidney disease (CKD). Socioeconomic factors are believed to play an important role in this disparity, and likely influence African Americans' increased risk of CKD through multiple pathways. Low socioeconomic status (SES) may contribute to racial disparities in CKD because of the greater prevalence of poverty, for example, among African Americans as compared with whites. However, low SES has a stronger relation with CKD among African Americans than among whites, underscoring that the context and magnitude of socioeconomic influences on CKD outcomes varies between these populations. These socioeconomic influences may produce new or potentiate existing racial differences in biology. This review discusses what is known about the role of SES in explaining racial disparities in CKD, highlights several knowledge gaps in this area, and suggests future directions toward the elimination of disparities in CKD.
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Affiliation(s)
- Deidra C Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD.
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Chang A, Batch BC, McGuire HL, Vollmer WM, Svetkey LP, Tyson CC, Sanguankeo A, Anderson C, Houston J, Appel LJ. Association of a reduction in central obesity and phosphorus intake with changes in urinary albumin excretion: the PREMIER study. Am J Kidney Dis 2013; 62:900-7. [PMID: 23810691 DOI: 10.1053/j.ajkd.2013.04.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 04/25/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Excess adiposity and dietary factors may be important determinants of urinary albumin excretion (UAE). STUDY DESIGN Observational analysis of PREMIER, a randomized trial designed to lower blood pressure using behavioral interventions (counseling on weight loss, healthy diet, and exercise). SETTING & PARTICIPANTS 481 participants with normal kidney function who provided adequate 24-hour urine collections at baseline and 6 months. PREDICTORS Change in waist circumference; 24-hour urine sodium, potassium, and phosphorus excretion; and protein intake estimated from urea nitrogen. OUTCOMES & MEASUREMENTS The primary outcome was change in log-transformed 24-hour UAE over 6 months. RESULTS After 6 months, the proportion of individuals with UAE ≥10 mg/d decreased from 18.7% to 12.7% (P < 0.001). Changes in mean waist circumference (-4.2 ± 6.6 [SD] cm), 24-hour excretion of sodium (-28.2 ± 71.7 mmol/d), potassium (+8.4 ± 27.8 mmol/d), phosphorus (-27.7 ± 314.1 mg/d), and protein intake (-1.7 ± 19.4 g/d) were observed. After adjustment for relevant covariates, the following variables were associated significantly with reduction in ln(UAE) in separate models: decrease in waist circumference (P = 0.001), decrease in 24-hour urine phosphorus excretion (P < 0.001), and decrease in protein intake (P = 0.01). In a multivariable model including these 3 predictors, decreases in waist circumference (P = 0.002) and 24-hour urine phosphorus excretion (P = 0.03), but not change in protein intake (P = 0.5), remained associated significantly with reduction in ln(UAE). These associations remained significant even after adjustment for changes in blood pressure and insulin resistance. Baseline UAE and metabolic syndrome modified the relationship of waist circumference with ln(UAE); specifically, individuals with higher UAE and baseline metabolic syndrome experienced greater reductions in ln(UAE) from decreases in waist circumference. LIMITATIONS Observational study with potential for confounding. CONCLUSIONS In adults with normal kidney function, decreases in waist circumference and 24-hour urine phosphorus excretion are associated with reductions in UAE. These findings support the rationale for clinical trials to determine whether reducing dietary phosphorus intake or waist circumference could prevent chronic kidney disease or slow its progression.
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Affiliation(s)
- Alex Chang
- Division of Nephrology, Johns Hopkins University, Baltimore, MD; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD.
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Chang A, Van Horn L, Jacobs DR, Liu K, Muntner P, Newsome B, Shoham DA, Durazo-Arvizu R, Bibbins-Domingo K, Reis J, Kramer H. Lifestyle-related factors, obesity, and incident microalbuminuria: the CARDIA (Coronary Artery Risk Development in Young Adults) study. Am J Kidney Dis 2013; 62:267-75. [PMID: 23601954 DOI: 10.1053/j.ajkd.2013.02.363] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 02/05/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND Modifiable lifestyle-related factors are associated with risk of coronary heart disease and may also influence kidney disease risk. STUDY DESIGN Community-based prospective cohort study. SETTING & PARTICIPANTS 2,354 African American and white participants aged 28-40 years without baseline microalbuminuria or estimated glomerular filtration rate <60 mL/min/1.73 m² recruited from 4 US centers: Birmingham, AL; Chicago, IL; Minneapolis, MN; and Oakland, CA. FACTORS Current smoking, physical activity, fast food habits, obesity, and diet quality, which was based on 8 fundamental components of the Dietary Approaches to Stop Hypertension (DASH) diet, including increased intake of fruits, vegetables, low-fat dairy products, whole grains, and nuts and legumes and reduced intake of sodium, sugar-sweetened beverages, and red and processed meats. OUTCOMES & MEASUREMENTS Spot urine albumin-creatinine ratios were obtained at baseline (1995-1996) and three 5-year follow-up examinations (5, 10, and 15 years' follow-up). Incident microalbuminuria was defined as the presence of age- and sex-adjusted albumin-creatinine ratio ≥25 mg/g at 2 or more of the successive follow-up examinations. RESULTS During the 15-year follow-up, 77 (3.3%) individuals developed incident microalbuminuria. After multivariable adjustment, poor diet quality (OR, 2.0; 95% CI, 1.1-3.4) and obesity (OR, 1.9; 95% CI, 1.1-3.3) were associated significantly with microalbuminuria; current smoking (OR, 1.6; 95% CI, 0.9-2.8) was associated with microalbuminuria, although the CI crossed 1.0. Neither low physical activity (OR, 1.0; 95% CI, 0.5-1.8) nor fast food consumption (OR, 1.2; 95% CI, 0.7-2.3) was associated with microalbuminuria. Compared with individuals with no unhealthy lifestyle-related factors (poor diet quality, current smoking, and obesity), adjusted odds of incident microalbuminuria were 131%, 273%, and 634% higher for the presence of 1 (OR, 2.3; 95% CI, 1.3-4.3), 2 (OR, 3.7; 95% CI, 1.8-7.7), and 3 (OR, 7.3; 95% CI, 2.1-26.1) unhealthy lifestyle-related factors. LIMITATIONS Self-reported dietary history and physical activity, low number of outcomes. CONCLUSIONS Consuming an unhealthy diet and obesity are associated with incident microalbuminuria.
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Affiliation(s)
- Alex Chang
- Division of Nephrology, Johns Hopkins University, Baltimore, MD 21205, USA.
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Dall'Alba V, Silva FM, Antonio JP, Steemburgo T, Royer CP, Almeida JC, Gross JL, Azevedo MJ. Improvement of the metabolic syndrome profile by soluble fibre - guar gum - in patients with type 2 diabetes: a randomised clinical trial. Br J Nutr. 2013;110:1601-1610. [PMID: 23551992 DOI: 10.1017/s0007114513001025] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A diet rich in fibre seems to protect against the metabolic syndrome (MetS), but there is scarce information about the role of fibre intake in patients with the MetS and diabetes. The aim of the present study was to evaluate the effects of soluble fibre from partially hydrolysed guar gum (PHGG) on the MetS and cardiovascular risk factors in patients with type 2 diabetes. In the present randomised controlled clinical trial, forty-four patients with type 2 diabetes (males 38·6 %, age 62 (SD 9) years, diabetes duration 14·2 (SD 9·6) years) and the MetS underwent clinical, laboratory and dietary evaluations at baseline, 4 and 6 weeks. All patients followed their usual diet and the intervention group (n 23) received an additional 10 g/d of PHGG. In the intervention group, waist circumference (WC), glycated Hb (HbA1c), 24 h urinary albumin excretion (UAE) and serum trans-fatty acids (FA) were reduced in comparison with baseline after 4 and 6 weeks: WC 103·5 (SD 9·5) to 102·1 (SD 10) to 102·3 (SD 9·7) cm; HbA1c 6·88 (SD 0·99) to 6·64 (SD 0·94) to 6·57 (SD 0·84) %; 24 h UAE 6·8 (interquartile range 3·0-17·5) to 4·5 (interquartile range 3·0-10·5) to 6·2 (interquartile range 3·0-9·5) mg; trans-FA 71 (interquartile range 46-137) to 67 (interquartile range 48-98) to 57 (interquartile range 30-110) mg/l (P< 0·05 for all). The only change in the control group was weight reduction: 77·0 (SD 13·5) to 76·2 (SD 13·3) to 76·1 (SD 13·4) kg (P= 0·005). Other MetS components (blood pressure, TAG, HDL-cholesterol, fasting plasma glucose), total and LDL-cholesterol, C-reactive protein and endothelin-1 did not change in either group. In patients with type 2 diabetes and the MetS, the addition of PHGG to the usual diet improved cardiovascular and metabolic profiles by reducing WC, HbA1c, UAE and trans-FA.
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Kramer H. Dietary patterns, calories, and kidney disease. Adv Chronic Kidney Dis 2013; 20:135-40. [PMID: 23439372 DOI: 10.1053/j.ackd.2012.12.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 11/20/2012] [Accepted: 12/10/2012] [Indexed: 12/17/2022]
Abstract
Specific nutritional factors that mediate obesity or CKD remain very difficult to quantify in any population. That being said, several macronutrients, including protein intake, have been examined as risk factors for CKD progression. Given the correlation of micro- and macronutrients within a particular diet and the consistency of an individual's dietary habits over time for most individuals, dietary patterns may have a greater impact on CKD risk and progression. This review focuses on dietary patterns and their association with CKD. To date, studies examining dietary patterns and CKD risk remain very limited, and more studies are needed. However, the follow-up period may need to be fairly long to detect any association. Caloric intake itself may also affect CKD risk. This may be due to the influence of caloric intake on sirtuin1, which modulates adiponectin gene expression and nitric oxide bioavailability.
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Chen H, Wang Y, Ma L, Zhao J, Li Y, Li M. Long-term high animal protein diet reduces body weight gain and insulin secretion in diet-induced obese rats. J Sci Food Agric 2012; 92:2638-2643. [PMID: 22495763 DOI: 10.1002/jsfa.5679] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2011] [Revised: 02/21/2012] [Accepted: 02/23/2012] [Indexed: 05/31/2023]
Abstract
BACKGROUND The effects of a high protein diet on insulin secretion and glucose metabolism have been quite controversial. The aim of this study was to evaluate the effects of long-term isocaloric high animal protein intake on insulin secretion in diet-induced obese rats. RESULTS After the experimental period (24 weeks), the high-fat diet-induced obese rats that were fed isocaloric high-protein diets (HP) had lower body weight gain (P < 0.01) and lower visceral fat (P < 0.05) than normal protein (NP) rats. Fasting plasma glucagon-like peptide-1 (GLP-1) was also reduced significantly (P < 0.05), as well as serum insulin levels at 5 min and 10 min by intravenous insulin releasing test. In addition, insulin mRNA and pancreatic duodenal homeodomain-1 (PDX-1), GLP-1 protein expression were both markedly lower in HP rats (P < 0.05), while PDX-1 mRNA in HP rats had no difference from NP rats. CONCLUSION These results suggest that long-term isocaloric high animal protein intake reduces the acute insulin response in obese rats and the decrease of insulin is associated with both reduced weight gain and inhibition of PDX-1 expression. GLP-1 might be a negative feedback for the balance of energy metabolism secondary to changes of body weight and visceral fat.
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Affiliation(s)
- Haiyan Chen
- Department of Endocrinology, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
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Teunissen-Beekman KFM, Dopheide J, Geleijnse JM, Bakker SJL, Brink EJ, de Leeuw PW, van Baak MA. Protein supplementation lowers blood pressure in overweight adults: effect of dietary proteins on blood pressure (PROPRES), a randomized trial. Am J Clin Nutr 2012; 95:966-71. [PMID: 22357725 DOI: 10.3945/ajcn.111.029116] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Dietary protein intake may help to manage blood pressure (BP) and prevent complications associated with elevated BP. OBJECTIVE The objective of this study was to determine whether 4 wk of increased protein intake (∼25% compared with ∼15% of energy intake that isoenergetically replaces carbohydrate intake) lowers office and daytime BP compared with increased carbohydrate intake. DESIGN A randomized, double-blind, parallel study compared consumption of 3 × 20 g protein/d (20% pea, 20% soy, 30% egg, and 30% milk-protein isolate) with 3 × 20 g maltodextrin/d. Protein or maltodextrin were isoenergetically substituted for a sugar-sweetened drink. Primary outcomes were office and daytime BP. A total of 99 men and women [age range: 20-70 y; BMI (in kg/m²): 25-35] with untreated elevated BP (BP ≥130/85 and <160/100 mm Hg) were randomly assigned. Ninety-four completers (51 subjects in the maltodextrin group, 43 subjects in the protein group) were included in the analyses. RESULTS Office systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 4.9 ± 1.7 mm Hg (P = 0.005) and 2.7 ± 1.3 mm Hg (P = 0.05) lower, respectively, in the protein group. Daytime SBP was 4.6 ± 1.7 mm Hg lower in the protein group (P = 0.006), whereas daytime DBP did not differ between groups (P = 0.37). Urinary sodium excretion was higher in the maltodextrin group (P = 0.004). CONCLUSION Increased protein intake, at the expense of maltodextrin, lowers BP in overweight adults with upper-range prehypertension and grade 1 hypertension. This trial was registered at www.trialregister.nl as NTR 1362.
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Current Opinion in Lipidology. Current world literature. Curr Opin Lipidol 2010; 21:84-8. [PMID: 20101119 DOI: 10.1097/MOL.0b013e32833592e7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rahman M, Smith MC. Effects of Dietary Modification on Albumin Excretion Rate. Am J Kidney Dis 2009; 53:576-8. [DOI: 10.1053/j.ajkd.2009.01.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Accepted: 01/27/2009] [Indexed: 11/11/2022]
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