Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia.
Department of Medicine, University of Otago, Christchurch, New Zealand.
Clin J Am Soc Nephrol. 2019 Oct 7;14(10):1441-1449. doi: 10.2215/CJN.00530119. Epub 2019 Sep 24.
Whether a healthy dietary pattern may prevent the incidence of developing CKD is unknown. This study evaluated the associations between dietary patterns and the incidence of CKD in adults and children.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This systematic review and meta-analysis identified potential studies through a systematic search of MEDLINE, Embase and references from eligible studies from database inception to February 2019. Eligible studies were prospective and retrospective cohort studies including adults and children without CKD, where the primary exposure was dietary patterns. To be eligible, studies had to report on the primary outcome, incidence of CKD (eGFR<60 ml/min per 1.73 m). Two authors independently extracted data, assessed risk of bias and evidence certainty using the Newcastle-Ottawa scale and GRADE.
Eighteen prospective cohort studies involving 630,108 adults (no children) with a mean follow-up of 10.4±7.4 years were eligible for analysis. Included studies had an overall low risk of bias. The evidence certainty was moderate for CKD incidence and low for eGFR decline (percentage drop from baseline or reduced by at least 3 ml/min per 1.73 m per year) and incident albuminuria. Healthy dietary patterns typically encouraged higher intakes of vegetables, fruit, legumes, nuts, whole grains, fish and low-fat dairy, and lower intakes of red and processed meats, sodium, and sugar-sweetened beverages. A healthy dietary pattern was associated with a lower incidence of CKD (odds ratio [OR] 0.70 (95% confidence interval [95% CI], 0.60 to 0.82); =51%; eight studies), and incidence of albuminuria (OR 0.77, [95% CI, 0.59 to 0.99]; =37%); four studies). There appeared to be no significant association between healthy dietary patterns and eGFR decline (OR 0.70 [95% CI, 0.49 to 1.01], =49%; four studies).
A healthy dietary pattern may prevent CKD and albuminuria.
健康的饮食模式是否可以预防慢性肾脏病（CKD）的发生尚不清楚。本研究评估了饮食模式与成年人和儿童 CKD 发病风险之间的关系。
设计、设置、参与者和测量：本系统评价和荟萃分析通过系统检索 MEDLINE、Embase 和从数据库建立到 2019 年 2 月符合条件的研究的参考文献，确定了潜在的研究。合格的研究是前瞻性和回顾性队列研究，包括没有 CKD 的成年人和儿童，主要暴露是饮食模式。符合条件的研究必须报告主要结局，即 CKD（eGFR<60 ml/min/1.73 m）的发病率。两名作者独立提取数据，使用纽卡斯尔-渥太华量表和 GRADE 评估偏倚风险和证据确定性。
纳入了 18 项前瞻性队列研究，共纳入 630108 名成年人（无儿童），平均随访 10.4±7.4 年。纳入的研究整体偏倚风险较低。CKD 发病率的证据确定性为中度，eGFR 下降（从基线下降的百分比或每年至少下降 3 ml/min/1.73 m）和白蛋白尿发生率的证据确定性为低。健康的饮食模式通常鼓励增加蔬菜、水果、豆类、坚果、全谷物、鱼和低脂乳制品的摄入，减少红肉和加工肉、钠和含糖饮料的摄入。健康的饮食模式与较低的 CKD 发病率（比值比 [OR] 0.70（95%置信区间 [95%CI]，0.60 至 0.82）；=51%；8 项研究）和白蛋白尿发病率（OR 0.77，[95%CI，0.59 至 0.99]；=37%；4 项研究）相关。健康的饮食模式与 eGFR 下降之间似乎没有显著关联（OR 0.70 [95%CI，0.49 至 1.01]，=49%；4 项研究）。
健康的饮食模式可能预防 CKD 和白蛋白尿。
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