Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, California, USA.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
Am J Nephrol. 2021;52(5):356-367. doi: 10.1159/000514754. Epub 2021 May 27.
The association between fruit and vegetable (FV) intake and the risk of end-stage kidney disease (ESKD) has not been examined in the general population and fully explored in chronic kidney disease (CKD). We prospectively evaluated this relationship in US representative sample of adults and evaluated consistency by the presence or absence, and severity, of CKD.
We used data from the Third National Health and Nutrition Examination Survey (1988-1994) linked with the US Renal Data System, including 14,725 adults aged ≥20 years and with follow-up for ESKD through 2008. Daily FV intake was ascertained using a food frequency questionnaire. We examined the association between selected categories of FV intake and ESKD using a Fine Gray competing risk model adjusting for sociodemographics, lifestyle, clinical and nutritional factors, estimated glomerular filtration rate, and albuminuria. We evaluated whether risk varied in individuals with severe versus any CKD.
230 participants (1.5%) developed ESKD during follow-up. In the adjusted model, compared to highest intake, those in lowest categories of FV intake had a higher risk of ESKD, for <2 times/day (1.45 [1.24-1.68], 2 to <3 times/day (1.40 [1.18-1.61]), 3 to <4 times/day (1.25 [1.04-1.46]), and 4 to <6 times/day (1.14 [0.97-1.31]). There was suggestion of heterogeneity (p for interaction = 0.03) with possible stronger inverse association in patients with CKD than those without CKD. After stratification, we obtained similar strong inverse association when we examined ESKD incidence across intake of FVs in participants with CKD stages 1-4 (n = 5,346) and specifically in those with CKD stages 3-4 (n = 1,084).
Low intake of FVs was associated with higher risk of ESKD in US adults with and without CKD, supporting an emerging body of literature on the potential benefits of plant-rich diets for prevention of ESKD.
水果和蔬菜（FV）摄入量与终末期肾病（ESKD）风险之间的关联尚未在普通人群中进行过检查，并且在慢性肾脏病（CKD）中也未得到充分探讨。我们前瞻性地评估了美国代表性成年人样本中这种关系，并通过存在或不存在以及 CKD 的严重程度来评估一致性。
我们使用了 1988-1994 年第三次国家健康和营养检查调查（NHANES III）的数据，该数据与美国肾脏数据系统相关联，包括 14725 名年龄≥20 岁的成年人，并通过 2008 年的 ESKD 随访。使用食物频率问卷确定每日 FV 摄入量。我们使用 Fine Gray 竞争风险模型，根据社会人口统计学，生活方式，临床和营养因素，估计肾小球滤过率和白蛋白尿，来检查选定的 FV 摄入量类别与 ESKD 之间的关联。我们评估了风险在患有严重 CKD 与任何 CKD 的个体中的差异。
在随访期间，有 230 名参与者（1.5%）发生了 ESKD。在调整后的模型中，与最高摄入量相比，FV 摄入量最低类别的参与者发生 ESKD 的风险更高，<2 次/天（1.45[1.24-1.68]），2-<3 次/天（1.40[1.18-1.61]），3-<4 次/天（1.25[1.04-1.46]），和 4-<6 次/天（1.14[0.97-1.31]）。存在异质性（p 交互=0.03）的迹象，可能在 CKD 患者中与在没有 CKD 的患者中具有更强的反比关系。分层后，我们在 CKD 1-4 期（n=5346）参与者的 FV 摄入量以及特别是 CKD 3-4 期（n=1084）参与者的 ESKD 发生率的整个范围内都获得了类似的强烈反比关系。
在美国患有和不患有 CKD 的成年人中，低 FV 摄入量与 ESKD 风险增加相关，这支持了植物性饮食对预防 ESKD 潜在益处的新兴文献。
