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Am J Kidney Dis. 2014 Aug;64(2):204-13. doi: 10.1053/j.ajkd.2014.02.013. Epub 2014 Mar 27.

Dietary patterns and risk of death and progression to ESRD in individuals with CKD: a cohort study.

Author information

1
Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL. Electronic address: ogutierr@uab.edu.
2
Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL.
3
Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.
4
Department of Epidemiology, Emory University, Atlanta, GA; Department of Medicine, Emory University, Atlanta, GA.
5
Department of Pediatrics, Boston University School of Medicine, Boston, MA; Program in Graduate Medical Nutrition Sciences, Boston University School of Medicine, Boston, MA; Department of Epidemiology, Boston University School of Public Health, Boston, MA; Program in Gastronomy, Culinary Arts, and Wine Studies, Boston University Metropolitan College, Boston, MA.
6
Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL.

Abstract

BACKGROUND:

Nutrition is linked strongly with health outcomes in chronic kidney disease (CKD). However, few studies have examined relationships between dietary patterns and health outcomes in persons with CKD.

STUDY DESIGN:

Observational cohort study.

SETTING & PARTICIPANTS:

3,972 participants with CKD (defined as estimated glomerular filtration rate < 60 mL/min/1.73 m2 or albumin-creatinine ratio ≥ 30 mg/g at baseline) from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study, a prospective cohort study of 30,239 black and white adults at least 45 years of age.

PREDICTORS:

5 empirically derived dietary patterns identified by factor analysis: "convenience" (Chinese and Mexican foods, pizza, and other mixed dishes), "plant-based" (fruits and vegetables), "sweets/fats" (sugary foods), "Southern" (fried foods, organ meats, and sweetened beverages), and "alcohol/salads" (alcohol, green-leafy vegetables, and salad dressing).

OUTCOMES:

All-cause mortality and end-stage renal disease (ESRD).

RESULTS:

816 deaths and 141 ESRD events were observed over approximately 6 years of follow-up. There were no statistically significant associations of convenience, sweets/fats, or alcohol/salads pattern scores with all-cause mortality after multivariable adjustment. In Cox regression models adjusted for sociodemographic factors, energy intake, comorbid conditions, and baseline kidney function, higher plant-based pattern scores (indicating greater consistency with the pattern) were associated with lower risk of mortality (HR comparing fourth to first quartile, 0.77; 95% CI, 0.61-0.97), whereas higher Southern pattern scores were associated with greater risk of mortality (HR comparing fourth to first quartile, 1.51; 95% CI, 1.19-1.92). There were no associations of dietary patterns with incident ESRD in multivariable-adjusted models.

LIMITATIONS:

Missing dietary pattern data, potential residual confounding from lifestyle factors.

CONCLUSIONS:

A Southern dietary pattern rich in processed and fried foods was associated independently with mortality in persons with CKD. In contrast, a diet rich in fruits and vegetables appeared to be protective.

KEYWORDS:

Dietary pattern; chronic kidney disease (CKD); disease progression; kidney failure; modifiable risk factor; mortality risk; nutrition

PMID:
24679894
PMCID:
PMC4111976
DOI:
10.1053/j.ajkd.2014.02.013
[Indexed for MEDLINE]
Free PMC Article

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