Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL.
Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL.
Am J Kidney Dis. 2014 Aug;64(2):204-13. doi: 10.1053/j.ajkd.2014.02.013. Epub 2014 Mar 27.
Nutrition is linked strongly with health outcomes in chronic kidney disease (CKD). However, few studies have examined relationships between dietary patterns and health outcomes in persons with CKD.
Observational cohort study.
SETTING & PARTICIPANTS: 3,972 participants with CKD (defined as estimated glomerular filtration rate < 60 mL/min/1.73 m2 or albumin-creatinine ratio ≥ 30 mg/g at baseline) from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study, a prospective cohort study of 30,239 black and white adults at least 45 years of age.
5 empirically derived dietary patterns identified by factor analysis: "convenience" (Chinese and Mexican foods, pizza, and other mixed dishes), "plant-based" (fruits and vegetables), "sweets/fats" (sugary foods), "Southern" (fried foods, organ meats, and sweetened beverages), and "alcohol/salads" (alcohol, green-leafy vegetables, and salad dressing).
All-cause mortality and end-stage renal disease (ESRD).
816 deaths and 141 ESRD events were observed over approximately 6 years of follow-up. There were no statistically significant associations of convenience, sweets/fats, or alcohol/salads pattern scores with all-cause mortality after multivariable adjustment. In Cox regression models adjusted for sociodemographic factors, energy intake, comorbid conditions, and baseline kidney function, higher plant-based pattern scores (indicating greater consistency with the pattern) were associated with lower risk of mortality (HR comparing fourth to first quartile, 0.77; 95% CI, 0.61-0.97), whereas higher Southern pattern scores were associated with greater risk of mortality (HR comparing fourth to first quartile, 1.51; 95% CI, 1.19-1.92). There were no associations of dietary patterns with incident ESRD in multivariable-adjusted models.
Missing dietary pattern data, potential residual confounding from lifestyle factors.
A Southern dietary pattern rich in processed and fried foods was associated independently with mortality in persons with CKD. In contrast, a diet rich in fruits and vegetables appeared to be protective.
营养与慢性肾脏病（CKD）的健康结果密切相关。然而，很少有研究调查饮食模式与 CKD 患者健康结果之间的关系。
观察性队列研究。
3972 名 CKD 患者（定义为肾小球滤过率估计值<60 mL/min/1.73 m2 或基线时白蛋白-肌酐比≥30 mg/g）来自 Reasons for Geographic and Racial Differences in Stroke（REGARDS）研究，这是一项针对至少 45 岁的 30239 名黑人和白人成年人的前瞻性队列研究。
通过因子分析确定的 5 种经验性饮食模式：“方便”（中式和墨西哥食物、披萨和其他混合菜肴）、“植物性”（水果和蔬菜）、“甜食/脂肪”（含糖食物）、“南方”（油炸食品、器官肉和加糖饮料）和“酒精/沙拉”（酒精、绿叶蔬菜和沙拉酱）。
在大约 6 年的随访期间，观察到 816 例死亡和 141 例终末期肾病（ESRD）事件。在多变量调整后，方便、甜食/脂肪或酒精/沙拉模式评分与全因死亡率之间没有统计学上显著的关联。在调整了社会人口因素、能量摄入、合并症和基线肾功能的 Cox 回归模型中，更高的植物性模式评分（表明与模式的一致性更高）与较低的死亡率风险相关（比较第四四分位数与第一四分位数的 HR，0.77；95%CI，0.61-0.97），而更高的南方模式评分与更高的死亡率风险相关（比较第四四分位数与第一四分位数的 HR，1.51；95%CI，1.19-1.92）。在多变量调整模型中，饮食模式与 ESRD 事件之间没有关联。
饮食模式数据缺失，生活方式因素可能存在残余混杂。
富含加工和油炸食品的南方饮食模式与 CKD 患者的死亡率独立相关。相比之下，富含水果和蔬菜的饮食似乎具有保护作用。
