Smyth Andrew, Griffin Matthew, Yusuf Salim, Mann Johannes F E, Reddan Donal, Canavan Michelle, Newell John, O'Donnell Martin
Health Research Board Clinical Research Facility Galway, National University of Ireland, Galway, Ireland; Department of Nephrology, Galway University Hospitals, Galway, Ireland; Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
Health Research Board Clinical Research Facility Galway, National University of Ireland, Galway, Ireland; Department of Nephrology, Galway University Hospitals, Galway, Ireland.
J Ren Nutr. 2016 Sep;26(5):288-98. doi: 10.1053/j.jrn.2016.01.016. Epub 2016 Mar 12.
Chronic kidney disease (CKD) is prevalent and associated with significant morbidity and mortality. Dietary modification may be an approach to reducing CKD.
In this prospective cohort study, we evaluated the association between diet quality, sodium and potassium intakes, and major renal outcomes. A total of 544,635 community-dwelling adults, aged 51 to 70 years, living in 6 states and 2 urban areas in the United States, from the National Institutes of Health-American Association of Retired Persons Diet and Health Study. Using a food frequency questionnaire completed at baseline, we assessed diet quality using the Alternate Healthy Eating Index (AHEI), Healthy Eating Index (HEI), Mediterranean Diet Score (MDS), Recommended Food Score, and Dietary Approaches to Stop Hypertension (DASH) scores. This was also used to estimate daily sodium and potassium intakes.
Multivariable adjusted competing risks regression calculated sub-hazard ratios (sHRs) for a composite of death due to a renal cause and dialysis, with death due to a nonrenal cause as the competing event.
During a mean of 14.3-year follow-up, a total of 4,848 participants died from a renal cause or initiated dialysis. Four diet quality scores (AHEI, HEI, MDS, and DASH) were significantly associated with the composite renal outcome; the Recommended Food Score was not. Compared to the lowest score quintile, the highest quintiles of AHEI (sHR 0.71; 95% confidence interval [CI] 0.65-0.79), HEI (sHR 0.82; 95% CI 0.74-0.91), MDS (sHR 0.84; 95% CI 0.74-0.95), and DASH (sHR 0.85; 95% CI 0.77-0.94) were associated with a reduced hazard of the composite. The highest sodium quintile (sHR 1.17; 95% CI 1.02-1.33 for sodium intake > 3.6 g/day) was associated with an increased hazard, whereas the highest potassium quintile (sHR 0.83 [0.73-0.95]) with a reduced hazard.
Our findings support an association between healthy dietary patterns and reduced risk of major renal outcomes and provide observational evidence to inform dietary guideline recommendations for CKD prevention.
慢性肾脏病（CKD）很常见，且与显著的发病率和死亡率相关。饮食调整可能是降低CKD的一种方法。
在这项前瞻性队列研究中，我们评估了饮食质量、钠和钾摄入量与主要肾脏结局之间的关联。共有544,635名年龄在51至70岁之间、居住在美国6个州和2个城市地区的社区居民参与了美国国立卫生研究院-美国退休人员协会饮食与健康研究。我们使用基线时填写的食物频率问卷，通过替代健康饮食指数（AHEI）、健康饮食指数（HEI）、地中海饮食评分（MDS）、推荐食物评分和终止高血压膳食方法（DASH）评分来评估饮食质量。这也用于估计每日钠和钾的摄入量。
多变量调整的竞争风险回归计算了因肾脏原因死亡和透析的复合结局的亚风险比（sHRs），以非肾脏原因死亡作为竞争事件。
在平均14.3年的随访期间，共有4848名参与者死于肾脏原因或开始透析。四种饮食质量评分（AHEI、HEI、MDS和DASH）与复合肾脏结局显著相关；推荐食物评分则不然。与最低评分五分位数相比，AHEI（sHR 0.71；95%置信区间[CI] 0.65 - 0.79）、HEI（sHR 0.82；95% CI 0.74 - 0.91）、MDS（sHR 0.84；95% CI 0.74 - 0.95）和DASH（sHR 0.85；95% CI 0.77 - 0.94）的最高五分位数与复合结局风险降低相关。钠摄入量最高的五分位数（钠摄入量>3.6克/天，sHR 1.17；95% CI 1.02 - 1.33）与风险增加相关，而钾摄入量最高的五分位数（sHR 0.83 [0.73 - 0.95]）与风险降低相关。
我们的研究结果支持健康饮食模式与降低主要肾脏结局风险之间的关联，并为预防CKD的饮食指南建议提供了观察性证据。
