膳食镁摄入与慢性肾脏病发病的关系：前瞻性观察队列研究。

Association between dietary magnesium intake and incident chronic kidney disease: a prospective observational cohort study.

机构信息

Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea; Catholic Kwandong University International Saint Mary's Hospital, Seo-gu, Incheon, South Korea.

Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.

出版信息

Am J Clin Nutr. 2024 Oct;120(4):964-972. doi: 10.1016/j.ajcnut.2024.08.009. Epub 2024 Aug 18.

DOI:10.1016/j.ajcnut.2024.08.009

PMID:39163977

Abstract

BACKGROUND

Although serum magnesium deficiency is linked to higher cardiovascular disease risk, its association with chronic kidney disease (CKD) remains unclear.

OBJECTIVES

This study aimed to evaluate the relationship between dietary magnesium intake and CKD development in adults with clinically normal kidney function.

METHODS

The prospective observational cohort study evaluated 188,510 participants (median age, 57.0 y; female, 54.1%) from the UK Biobank. Dietary magnesium intake was assessed through a 24-h dietary recall questionnaire compromising a list of 206 foods and 32 beverages and categorized into quintiles. The primary outcome was incident CKD diagnosed through International Classification of Diseases-10 and Office of Population Censuses and Surveys 4 codes. Incident CKD, defined as estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m, was also assessed in a subcohort with creatinine follow-up data.

RESULTS

The median magnesium intake amount per person was 323.2 mg/d [interquartile range (IQR): 269.4-382.7 mg/d]. During 1,826,038.1 person-years of follow-up (median: 9.6 y; IQR: 9.3-10.3 y), CKD developed in 5,878 participants. The incidence of CKD was progressively higher in participants with lower magnesium intake (2.8%, 2.8%, 3.0%, 3.2%, and 3.7% in Q5-Q1, respectively). Cox regression analysis revealed that the hazard ratios (HRs) for incident CKD increased in a stepwise manner toward lower magnesium intake quintiles {adjusted HR (95% confidence interval [CI])-Q4: 0.97 (0.89, 1.06); Q3: 1.05 (0.96, 1.14); Q2: 1.12 (1.03, 1.21); Q1: 1.30 (1.20, 1.41)} relative to Q5 (P-linearity < 0.001). Similar results were observed with eGFR-defined CKD outcome [adjusted HR (95% CI)-Q4: 1.09 (0.92, 1.28); Q3: 1.15 (0.98, 1.35); Q2: 1.21 (1.03, 1.42); Q1: 1.41 (1.20, 1.65) relative to Q5; P-linearity < 0.001].

CONCLUSIONS

Lower dietary magnesium intake was associated with higher risk of incident CKD in adults with clinically normal kidney function. Further controlled studies are required to establish the potential benefit of adequate magnesium intake.

摘要

背景

尽管血清镁缺乏与更高的心血管疾病风险有关，但它与慢性肾脏病（CKD）的关系仍不清楚。

目的

本研究旨在评估在肾功能正常的成年人中，饮食镁摄入量与 CKD 发展之间的关系。

方法

这项前瞻性观察队列研究评估了来自英国生物库的 188510 名参与者（中位数年龄 57.0 岁；女性 54.1%）。通过 24 小时膳食回忆问卷评估饮食镁摄入量，该问卷包含 206 种食物和 32 种饮料清单，并分为五组。主要结局是通过国际疾病分类-10 和人口普查和调查局 4 代码诊断为 CKD 。在具有肌酐随访数据的亚队列中，还评估了定义为肾小球滤过率（eGFR）<60 mL/min/1.73 m 的 CKD 。

结果

每个人的平均镁摄入量为 323.2 mg/d[四分位数范围（IQR）：269.4-382.7 mg/d]。在 1826038.1 人年的随访期间（中位数：9.6 年；IQR：9.3-10.3 年），5878 名参与者发生了 CKD。镁摄入量较低的参与者的 CKD 发生率逐渐升高（Q5-Q1 分别为 2.8%、2.8%、3.0%、3.2%和 3.7%）。Cox 回归分析显示，随着镁摄入量逐渐减少，发生 CKD 的风险比（HRs）呈阶梯式上升{调整 HR（95%置信区间[CI]）-Q4：0.97（0.89，1.06）；Q3：1.05（0.96，1.14）；Q2：1.12（1.03，1.21）；Q1：1.30（1.20，1.41）}，与 Q5 相比（P-线性<0.001）。用 eGFR 定义的 CKD 结局也观察到了类似的结果[调整 HR（95%CI）-Q4：1.09（0.92，1.28）；Q3：1.15（0.98，1.35）；Q2：1.21（1.03，1.42）；Q1：1.41（1.20，1.65）与 Q5 相比；P-线性<0.001]。