Rebholz Casey M, Crews Deidra C, Grams Morgan E, Steffen Lyn M, Levey Andrew S, Miller Edgar R, Appel Lawrence J, Coresh Josef
Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD; Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD.
Am J Kidney Dis. 2016 Dec;68(6):853-861. doi: 10.1053/j.ajkd.2016.05.019. Epub 2016 Aug 9.
There are established guidelines for recommended dietary intake for hypertension treatment and cardiovascular disease prevention. Evidence is lacking for effective dietary patterns for kidney disease prevention.
Prospective cohort study.
SETTING & PARTICIPANTS: Atherosclerosis Risk in Communities (ARIC) Study participants with baseline estimated glomerular filtration rate (eGFR) ≥ 60mL/min/1.73m (N=14,882).
The Dietary Approaches to Stop Hypertension (DASH) diet score was calculated based on self-reported dietary intake of red and processed meat, sweetened beverages, sodium, fruits, vegetables, whole grains, nuts and legumes, and low-fat dairy products, averaged over 2 visits.
Cases were ascertained based on the development of eGFRs<60mL/min/1.73m accompanied by ≥25% eGFR decline from baseline, an International Classification of Diseases, Ninth/Tenth Revision code for a kidney disease-related hospitalization or death, or end-stage renal disease from baseline through 2012.
3,720 participants developed kidney disease during a median follow-up of 23 years. Participants with a DASH diet score in the lowest tertile were 16% more likely to develop kidney disease than those with the highest score tertile (HR, 1.16; 95% CI, 1.07-1.26; P for trend < 0.001), after adjusting for sociodemographics, smoking status, physical activity, total caloric intake, baseline eGFR, overweight/obese status, diabetes status, hypertension status, systolic blood pressure, and antihypertensive medication use. Of the individual components of the DASH diet score, high red and processed meat intake was adversely associated with kidney disease and high nuts, legumes, and low-fat dairy products intake was associated with reduced risk for kidney disease.
Potential measurement error due to self-reported dietary intake and lack of data for albuminuria.
Consuming a DASH-style diet was associated with lower risk for kidney disease independent of demographic characteristics, established kidney risk factors, and baseline kidney function. Healthful dietary patterns such as the DASH diet may be beneficial for kidney disease prevention.
已有关于高血压治疗和心血管疾病预防的推荐饮食摄入量指南。但缺乏预防肾脏疾病的有效饮食模式的证据。
前瞻性队列研究。
社区动脉粥样硬化风险（ARIC）研究中基线估计肾小球滤过率（eGFR）≥60mL/（min·1.73m²）的参与者（N = 14882）。
基于两次访视期间自我报告的红肉、加工肉、甜味饮料、钠、水果、蔬菜、全谷物、坚果和豆类以及低脂乳制品的饮食摄入量计算出终止高血压膳食方法（DASH）饮食评分。
根据eGFR<60mL/（min·1.73m²）且eGFR较基线下降≥25%、国际疾病分类第九/十版中与肾脏疾病相关的住院或死亡编码、或从基线到2012年的终末期肾病来确定病例。
在中位随访23年期间，3720名参与者患上了肾脏疾病。在调整了社会人口统计学、吸烟状况、身体活动、总热量摄入、基线eGFR、超重/肥胖状况、糖尿病状况、高血压状况、收缩压和抗高血压药物使用情况后，DASH饮食评分处于最低三分位数的参与者患肾脏疾病的可能性比评分处于最高三分位数的参与者高16%（风险比，1.16；95%置信区间，1.07 - 1.26；趋势P值<0.001）。在DASH饮食评分的各个组成部分中，红肉和加工肉摄入量高与肾脏疾病呈负相关，坚果、豆类和低脂乳制品摄入量高与肾脏疾病风险降低相关。
由于自我报告的饮食摄入量可能存在测量误差，且缺乏蛋白尿数据。
食用DASH式饮食与较低的肾脏疾病风险相关，独立于人口统计学特征、既定的肾脏风险因素和基线肾功能。像DASH饮食这样的健康饮食模式可能对预防肾脏疾病有益。
