Departament de Bioquímica i Biotecnologia, Unitat de Nutrició, Universitat Rovira i Virgili, Reus, Spain.
Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain.
Am J Nephrol. 2021;52(1):45-58. doi: 10.1159/000513664. Epub 2021 Feb 8.
Large randomized trials testing the effect of a multifactorial weight-loss lifestyle intervention including Mediterranean diet (MedDiet) on renal function are lacking. Here, we evaluated the 1-year efficacy of an intensive weight-loss intervention with an energy-reduced MedDiet (erMedDiet) plus increased physical activity (PA) on renal function.
Randomized controlled "PREvención con DIeta MEDiterránea-Plus" (PREDIMED-Plus) trial is conducted in 23 Spanish centers comprising 208 primary care clinics. Overweight/obese (n = 6,719) adults aged 55-75 years with metabolic syndrome were randomly assigned (1:1) to an intensive weight-loss lifestyle intervention with an erMedDiet, PA promotion, and behavioral support (intervention) or usual-care advice to adhere to an energy-unrestricted MedDiet (control) between September 2013 and December 2016. The primary outcome was 1-year change in estimated glomerular filtration rate (eGFR). Secondary outcomes were changes in urine albumin-to-creatinine ratio (UACR), incidence of moderately/severely impaired eGFR (<60 mL/min/1.73 m2) and micro- to macroalbuminuria (UACR ≥30 mg/g), and reversion of moderately (45 to <60 mL/min/1.73 m2) to mildly impaired GFR (60 to <90 mL/min/1.73 m2) or micro- to macroalbuminuria.
After 1 year, eGFR declined by 0.66 and 1.25 mL/min/1.73 m2 in the intervention and control groups, respectively (mean difference, 0.58 mL/min/1.73 m2; 95% CI: 0.15-1.02). There were no between-group differences in mean UACR or micro- to macroalbuminuria changes. Moderately/severely impaired eGFR incidence and reversion of moderately to mildly impaired GFR were 40% lower (HR 0.60; 0.44-0.82) and 92% higher (HR 1.92; 1.35-2.73), respectively, in the intervention group.
The PREDIMED-Plus lifestyle intervention approach may preserve renal function and delay CKD progression in overweight/obese adults.
目前缺乏大规模随机试验来测试包括地中海饮食（MedDiet）在内的多因素减肥生活方式干预对肾功能的影响。在此，我们评估了能量减少的地中海饮食（erMedDiet）加体力活动（PA）增加的强化减肥干预对肾功能的 1 年疗效。
在西班牙 23 个中心的 208 个初级保健诊所中进行了随机对照的“预防地中海饮食加”（PREDIMED-Plus）试验。共有 6719 名年龄在 55-75 岁之间的超重/肥胖（BMI≥25）、代谢综合征成年人被随机分为强化减肥生活方式干预组（干预组）和常规护理组（对照组），干预组采用能量减少的地中海饮食、体力活动促进和行为支持，对照组接受坚持能量无限制的地中海饮食的常规护理。1 年的主要结局是估算肾小球滤过率（eGFR）的变化。次要结局包括尿白蛋白/肌酐比值（UACR）、中重度 eGFR 降低（<60 mL/min/1.73 m2）和微量白蛋白尿/大量白蛋白尿（UACR≥30 mg/g）的发生率，以及中度（45 至<60 mL/min/1.73 m2）到轻度 eGFR 降低（60 至<90 mL/min/1.73 m2）或微量白蛋白尿/大量白蛋白尿的逆转。
1 年后，干预组和对照组的 eGFR 分别下降了 0.66 和 1.25 mL/min/1.73 m2（平均差异，0.58 mL/min/1.73 m2；95%CI：0.15-1.02）。两组之间的平均 UACR 或微量白蛋白尿/大量白蛋白尿变化没有差异。中重度 eGFR 降低的发生率和中度至轻度 eGFR 降低的逆转率分别降低了 40%（HR 0.60；0.44-0.82）和 92%（HR 1.92；1.35-2.73）。
超重/肥胖成年人采用 PREDIMED-Plus 生活方式干预方法可能有助于保护肾功能和延缓慢性肾脏病进展。
