以植物为基础的饮食与中青年早期慢性肾脏病标志物：来自年轻人冠状动脉风险发展 (CARDIA) 队列的研究结果。

A Plant-Centered Diet and Markers of Early Chronic Kidney Disease during Young to Middle Adulthood: Findings from the Coronary Artery Risk Development in Young Adults (CARDIA) Cohort.

机构信息

Department of Food Science and Nutrition, University of Minnesota-Twin Cities, St. Paul, MN, USA.

Division of Epidemiology and Community Health, University of Minnesota-Twin Cities, Minneapolis, MN, USA.

出版信息

J Nutr. 2021 Sep 4;151(9):2721-2730. doi: 10.1093/jn/nxab155.

DOI:10.1093/jn/nxab155

PMID:34087933

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8417917/

Abstract

BACKGROUND

Few studies have evaluated whether plant-centered diets prevent progression of early stage chronic kidney disease (CKD).

OBJECTIVES

We examined the association between plant-centered diet quality and early CKD markers.

METHODS

We prospectively examined 2869 black and white men and women in the Coronary Artery Risk Development in Young Adults Study free of diagnosed kidney failure in 2005-2006 [examination year 20 (Y20); mean age: 45.3 ± 3.6 y]. CKD marker changes from Y20 to 2015-2016 (Y30) were considered, including estimated glomerular filtration rate (eGFR; serum creatinine), urinary albumin-to-creatinine ratio (ACR), and both. Diet was assessed through interviewer-administered diet histories at Y0, Y7, and Y20, and plant-centered diet quality was quantified with the A Priori Diet Quality Score (APDQS). Linear regression models were used to examine the association of APDQS and subsequent 10-y changes in CKD markers.

RESULTS

After adjustment for sociodemographic, behavioral, and diet factors, we found that higher APDQS was related to less adverse changes in CKD markers in the subsequent 10-y period. Compared with the lowest APDQS quintile, the highest quintile was associated with an attenuated increase in lnACR (-0.25 mg/g; 95% CI: -0.37, -0.13 mg/g; P-trend < 0.001), whereas the highest quintile was associated with an attenuated decrease in eGFR (4.45 mL·min-1·1.73 m-2; 95% CI: 2.46, 6.43 mL·min-1·1.73 m-2). There was a 0.50 lower increase in combined CKD markers [ln(ACR) z score - eGFR z score] when comparing the extreme quintiles. Associations remained similar after further adjustment for hypertension, diabetes, and obesity as potential mediating factors. The attenuated worsening CKD marker changes associated with higher APDQS strengthened across increasing initial CKD category; those with the best diet and microalbuminuria in Y10-Y20 returned to high normal albuminuria (all P-interaction < 0.001).

CONCLUSIONS

Individuals who consumed plant-centered, high-quality diets were less likely to experience deterioration of kidney function through midlife, especially among participants with initial stage characterized as mild CKD.

摘要

背景

很少有研究评估以植物为中心的饮食是否能预防早期慢性肾脏病（CKD）的进展。

目的

我们研究了以植物为中心的饮食质量与早期 CKD 标志物之间的关系。

方法

我们前瞻性地研究了 2869 名黑人和白人男女，他们在 2005-2006 年（检查年份 20 岁，Y20）无诊断性肾衰竭[平均年龄：45.3±3.6 y]。考虑了从 Y20 到 2015-2016 年（Y30）的 CKD 标志物变化，包括估计肾小球滤过率（eGFR；血清肌酐）、尿白蛋白与肌酐比值（ACR）和两者。饮食通过在 Y0、Y7 和 Y20 时进行的访谈式饮食史进行评估，植物为中心的饮食质量用预先确定的饮食质量评分（APDQS）进行量化。线性回归模型用于研究 APDQS 与随后 10 年 CKD 标志物变化之间的关系。

结果

在调整了社会人口统计学、行为和饮食因素后，我们发现，APDQS 越高，随后 10 年的 CKD 标志物变化越不明显。与最低的 APDQS 五分位组相比，最高五分位组与 lnACR 增加幅度降低相关（-0.25 mg/g；95%CI：-0.37，-0.13 mg/g；P-trend<0.001），而最高五分位组与 eGFR 降低幅度降低相关（4.45 mL·min-1·1.73 m-2；95%CI：2.46，6.43 mL·min-1·1.73 m-2）。在比较极端五分位时，联合 CKD 标志物[ln（ACR）z 得分-eGFR z 得分]的增加减少了 0.50。当进一步调整高血压、糖尿病和肥胖作为潜在的中介因素时，关联仍然相似。与较高的 APDQS 相关的 CKD 标志物恶化减弱的趋势在不断增加的初始 CKD 类别中得到了加强；那些在 Y10-Y20 期间饮食最佳且微量白蛋白尿的人恢复到高正常白蛋白尿（所有 P-交互<0.001）。