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

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.

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  • Authors+Show Affiliations

    ,

    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.

    ,

    Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL.

    ,

    Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.

    ,

    Department of Epidemiology, Emory University, Atlanta, GA; Department of Medicine, Emory University, Atlanta, GA.

    ,

    Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.

    ,

    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.

    Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL.

    Source

    MeSH

    Aged
    Cohort Studies
    Disease Progression
    Feeding Behavior
    Female
    Follow-Up Studies
    Humans
    Kidney Failure, Chronic
    Male
    Middle Aged
    Population Surveillance
    Prospective Studies
    Renal Insufficiency, Chronic
    Risk Factors

    Pub Type(s)

    Journal Article
    Observational Study
    Research Support, N.I.H., Extramural

    Language

    eng

    PubMed ID

    24679894

    Citation

    TY - JOUR T1 - Dietary patterns and risk of death and progression to ESRD in individuals with CKD: a cohort study. AU - Gutiérrez,Orlando M, AU - Muntner,Paul, AU - Rizk,Dana V, AU - McClellan,William M, AU - Warnock,David G, AU - Newby,P K, AU - Judd,Suzanne E, Y1 - 2014/03/27/ PY - 2013/10/10/received PY - 2014/02/04/accepted PY - 2014/4/1/entrez PY - 2014/4/1/pubmed PY - 2014/9/23/medline KW - Dietary pattern KW - chronic kidney disease (CKD) KW - disease progression KW - kidney failure KW - modifiable risk factor KW - mortality risk KW - nutrition SP - 204 EP - 13 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am. J. Kidney Dis. VL - 64 IS - 2 N2 - 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. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/24679894/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(14)00593-9 ER -