Lipid Research Group, School of Biomedical Sciences, University of New South Wales, Sydney, NSW, Australia
The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.
BMJ. 2023 Jan 18;380:e072909. doi: 10.1136/bmj-2022-072909.
To assess the prospective associations of circulating levels of omega 3 polyunsaturated fatty acid (n-3 PUFA) biomarkers (including plant derived α linolenic acid and seafood derived eicosapentaenoic acid, docosapentaenoic acid, and docosahexaenoic acid) with incident chronic kidney disease (CKD).
Pooled analysis.
A consortium of 19 studies from 12 countries identified up to May 2020.
Prospective studies with measured n-3 PUFA biomarker data and incident CKD based on estimated glomerular filtration rate.
Each participating cohort conducted de novo analysis with prespecified and consistent exposures, outcomes, covariates, and models. The results were pooled across cohorts using inverse variance weighted meta-analysis.
Primary outcome of incident CKD was defined as new onset estimated glomerular filtration rate <60 mL/min/1.73 m. In a sensitivity analysis, incident CKD was defined as new onset estimated glomerular filtration rate <60 mL/min/1.73 m and <75% of baseline rate.
25 570 participants were included in the primary outcome analysis and 4944 (19.3%) developed incident CKD during follow-up (weighted median 11.3 years). In multivariable adjusted models, higher levels of total seafood n-3 PUFAs were associated with a lower incident CKD risk (relative risk per interquintile range 0.92, 95% confidence interval 0.86 to 0.98; P=0.009, I=9.9%). In categorical analyses, participants with total seafood n-3 PUFA level in the highest fifth had 13% lower risk of incident CKD compared with those in the lowest fifth (0.87, 0.80 to 0.96; P=0.005, I=0.0%). Plant derived α linolenic acid levels were not associated with incident CKD (1.00, 0.94 to 1.06; P=0.94, I=5.8%). Similar results were obtained in the sensitivity analysis. The association appeared consistent across subgroups by age (≥60 <60 years), estimated glomerular filtration rate (60-89 ≥90 mL/min/1.73 m), hypertension, diabetes, and coronary heart disease at baseline.
Higher seafood derived n-3 PUFA levels were associated with lower risk of incident CKD, although this association was not found for plant derived n-3 PUFAs. These results support a favourable role for seafood derived n-3 PUFAs in preventing CKD.
评估循环中 omega-3 多不饱和脂肪酸（n-3 PUFA）生物标志物（包括植物来源的α-亚麻酸和海鲜来源的二十碳五烯酸、二十二碳五烯酸和二十二碳六烯酸）与新发慢性肾脏病（CKD）的前瞻性关联。
汇总分析。
一个由来自 12 个国家的 19 项研究组成的联盟，截至 2020 年 5 月确定。
前瞻性研究，具有测量的 n-3 PUFA 生物标志物数据和基于估计肾小球滤过率的新发 CKD。
每个参与队列都使用预先指定的和一致的暴露、结局、协变量和模型进行了新的分析。使用逆方差加权荟萃分析对队列进行汇总。
新发 CKD 的主要结局定义为新发生的估计肾小球滤过率<60 mL/min/1.73 m。在敏感性分析中，新发 CKD 的定义为新发生的估计肾小球滤过率<60 mL/min/1.73 m 和<基线率的 75%。
在主要结局分析中，共纳入 25570 名参与者，随访期间有 4944 名（19.3%）发生新发 CKD（加权中位数 11.3 年）。在多变量调整模型中，较高的总海鲜 n-3 PUFAs 水平与新发 CKD 风险降低相关（五分位间距每增加 1 个，相对风险为 0.92，95%置信区间为 0.86 至 0.98；P=0.009，I=9.9%）。在分类分析中，与最低五分位数相比，海鲜 n-3 PUFA 总水平处于最高五分位数的参与者新发 CKD 风险降低 13%（0.87，0.80 至 0.96；P=0.005，I=0.0%）。植物来源的α-亚麻酸水平与新发 CKD 无关（1.00，0.94 至 1.06；P=0.94，I=5.8%）。在敏感性分析中也得到了类似的结果。该关联在年龄（≥60 岁<60 岁）、估计肾小球滤过率（60-89 岁≥90 mL/min/1.73 m）、高血压、糖尿病和基线时的冠心病等亚组中似乎一致。
较高的海鲜源性 n-3 PUFA 水平与新发 CKD 风险降低相关，尽管这与植物源性 n-3 PUFAs 无关。这些结果支持海鲜源性 n-3 PUFAs 在预防 CKD 方面的有益作用。
Zotero 插件