健康的饮食模式与终末期肾病风险：新加坡华人健康研究
Healthful dietary patterns and risk of end-stage kidney disease: the Singapore Chinese Health Study.
作者信息
Geng Ting-Ting, Jafar Tazeen H, Neelakantan Nithya, Yuan Jian-Min, van Dam Rob M, Koh Woon-Puay
机构信息
Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
Health Services and Systems Research, Duke-NUS Medical School, Singapore.
出版信息
Am J Clin Nutr. 2021 Mar 11;113(3):675-683. doi: 10.1093/ajcn/nqaa348.
BACKGROUND
Although adherence to healthful dietary patterns has been associated with a lower risk of kidney function decline in Western populations, evidence in Asian populations remains scanty.
OBJECTIVES
We examined predefined dietary patterns, namely, the Alternate Healthy Eating Index-2010 (AHEI-2010), the Dietary Approaches to Stop Hypertension (DASH), and the alternate Mediterranean diet (aMED), in relation to risk of end-stage kidney disease (ESKD).
METHODS
We included 56,985 Chinese adults (aged 45-74 y) in the Singapore Chinese Health Study who were free of cancer, stroke, coronary artery disease, and ESKD at recruitment (1993-1998). Dietary pattern scores were calculated based on a validated 165-item FFQ. AHEI-2010 and aMED scores were modified by excluding the alcohol intake component because daily drinking has been associated with a higher risk of ESKD in our study population. We identified 1026 ESKD cases over a median follow-up of 17.5 y via linkage with the nationwide Singapore Renal Registry. Multivariable Cox regression models were used to compute HRs and their 95% CIs.
RESULTS
Higher scores of all 3 dietary patterns were associated with lower ESKD risk in a dose-dependent manner. Compared with the lowest quintiles, the multivariable-adjusted HRs (95% CIs) of ESKD were 0.75 (0.61, 0.92) for the highest quintile of AHEI-2010, 0.67 (0.54, 0.84) for DASH, and 0.73 (0.59, 0.91) for aMED (all P-trend ≤ 0.004). These inverse associations were stronger with increasing BMI (in kg/m2), and the HRs for the diet-ESKD association were lowest in the obese (BMI ≥ 27.5), followed by the overweight (BMI = 25 to <27.5) participants, compared with those in lower BMI categories; the P-interaction values between BMI and diet scores were 0.03 for AHEI-2010, 0.004 for aMED, and 0.06 for DASH.
CONCLUSIONS
Adherence to healthful dietary patterns was associated with a lower ESKD risk in an Asian population, especially in overweight or obese individuals.
背景
尽管坚持健康的饮食模式与西方人群肾功能下降风险较低有关，但亚洲人群的相关证据仍然不足。
目的
我们研究了预先定义的饮食模式，即2010年交替健康饮食指数（AHEI-2010）、终止高血压饮食方法（DASH）和替代地中海饮食（aMED）与终末期肾病（ESKD）风险的关系。
方法
我们纳入了新加坡华人健康研究中的56985名中国成年人（年龄45 - 74岁），这些人在招募时（1993 - 1998年）没有癌症、中风、冠状动脉疾病和ESKD。饮食模式得分基于一份经验证的165项食物频率问卷计算得出。由于在我们的研究人群中每日饮酒与ESKD风险较高相关，因此AHEI-2010和aMED得分通过排除酒精摄入量部分进行了调整。通过与全国性的新加坡肾脏登记处联动，我们在中位随访17.5年期间确定了1026例ESKD病例。使用多变量Cox回归模型计算风险比（HR）及其95%置信区间（CI）。
结果
所有3种饮食模式得分越高，ESKD风险越低，呈剂量依赖性。与最低五分位数相比，AHEI-2010最高五分位数的ESKD多变量调整后HR（95%CI）为0.75（0.61，0.92），DASH为0.67（0.54，0.84），aMED为0.73（0.59，0.91）（所有P趋势≤0.004）。随着体重指数（BMI，单位为kg/m²）增加，这些反向关联更强，与BMI较低类别的参与者相比，肥胖（BMI≥27.5）参与者中饮食与ESKD关联的HR最低，其次是超重（BMI = 25至<27.5）参与者；BMI与饮食得分之间的P交互作用值，AHEI-2010为0.03，aMED为0.004，DASH为0.06。
结论
在亚洲人群中，坚持健康的饮食模式与较低的ESKD风险相关，尤其是在超重或肥胖个体中。
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