Kwon Yu-Jin, Joo Young Su, Yun Hae-Ryong, Lim Li Rang, Yang Juyeon, Lee Hye Sun, Kim Hyung-Mi, Lee Hyangkyu, Lee Jung Eun, Lee Ji-Won
Department of Family Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea.
Division of Nephrology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea.
Front Nutr. 2024 Sep 4;11:1463502. doi: 10.3389/fnut.2024.1463502. eCollection 2024.
Emerging evidence highlights the potential advantages of the Mediterranean diet (MD) in preserving kidney function and slowing chronic kidney disease (CKD) progression. However, interventional studies on the MD are scarce in East Asian populations.
This randomized crossover trial aimed to assess the safety and short-term impact of the Mediterranean Proper Optimal Balance (MEDi-POB) diet in Korean patients with stage 3-4 CKD. Kidney function was assessed using the estimated glomerular filtration rate, which was calculated using the CKD Epidemiology Collaboration equation. Fifty patients with CKD were randomly assigned to two groups, each starting with a different 4-week intervention, followed by a 4-week washout period, followed by a switch to the other 4-week intervention. During the MEDi-POB intervention, patients received home delivery of meals twice daily, 5 days a week, while the control intervention comprised a conventional diet. Forty-six patients successfully completed the entire 12-week trial. Paired -tests were conducted to assess mean differences between the two groups. A linear mixed model was used to adjust for sequence and period.
Dietary fat, fiber, and niacin intake were significantly higher following the MEDi-POB diet than following the control diet ( = 0.001 for fat, < 0.001 for fiber, and = 0.007 for niacin). The MEDi-POB diet also yielded slightly increased total CO levels ( = 0.043), indicating effective management of metabolic acidosis. Conversely, sodium and copper intake were significantly lower with the MEDi-POB diet ( = 0.032 and = 0.037, respectively). Caloric intake increased, but body mass index slightly decreased from baseline after consuming the MEDi-POB diet. Dietary potassium intake exhibited a non-significant increase ( = 0.053), and no significant changes in serum ( = 0.883) and urine potassium levels ( = 0.087) occurred. Kidney function remained well-preserved following the MEDi-POB diet.
These results indicate that the MEDi-POB diet is safe even in patients with advanced CKD, as it does not adversely affect serum and urine potassium levels and helps maintain kidney function.
新出现的证据凸显了地中海饮食（MD）在保护肾功能和减缓慢性肾脏病（CKD）进展方面的潜在优势。然而，针对东亚人群的地中海饮食干预研究较少。
这项随机交叉试验旨在评估地中海适宜最佳平衡（MEDi-POB）饮食对韩国3-4期CKD患者的安全性和短期影响。使用估计肾小球滤过率评估肾功能，该指标通过CKD流行病学协作组方程计算得出。50例CKD患者被随机分为两组，每组先进行为期4周的不同干预，随后是4周的洗脱期，之后转换为另一为期4周的干预。在MEDi-POB干预期间，患者每周5天每天两次接受送餐上门服务，而对照干预采用传统饮食。46例患者成功完成了整个12周的试验。采用配对t检验评估两组之间的平均差异。使用线性混合模型对序列和时期进行调整。
与对照饮食相比，MEDi-POB饮食后的膳食脂肪、纤维和烟酸摄入量显著更高（脂肪P = 0.001，纤维P < 0.001，烟酸P = 0.007）。MEDi-POB饮食还使总二氧化碳水平略有升高（P = 0.043），表明对代谢性酸中毒进行了有效管理。相反，MEDi-POB饮食的钠和铜摄入量显著降低（分别为P = 0.032和P = 0.037）。热量摄入增加，但食用MEDi-POB饮食后体重指数较基线略有下降。膳食钾摄入量呈非显著性增加（P = 0.053），血清（P = 0.883）和尿钾水平无显著变化（P = 0.087）。MEDi-POB饮食后肾功能保持良好。
这些结果表明，MEDi-POB饮食即使对晚期CKD患者也是安全的，因为它不会对血清和尿钾水平产生不利影响，并有助于维持肾功能。
