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A Diet Rich in Vegetables and Fruit and Incident CKD: A Community-Based Prospective Cohort Study.
Am J Kidney Dis. 2019 10; 74(4):491-500.AJ

Abstract

RATIONALE & OBJECTIVE

A diet rich in vegetables and fruit can lower blood pressure and may reduce cardiovascular risk. However, the association between this dietary pattern and incident chronic kidney disease in the general population is unknown.

STUDY DESIGN

A community-based prospective cohort study.

SETTING & PARTICIPANTS

9,229 study participants with normal kidney function from the Korean Genome and Epidemiology Study database.

PREDICTORS

Daily consumption of nonfermented and fermented vegetables and fruit classified into tertiles based on a validated semiquantitative food-frequency questionnaire.

OUTCOMES

Incident occurrence of estimated glomerular filtration rate (eGFR) < 60mL/min/1.73m2, incident proteinuria (≥1+ by dipstick test), and repeated measures of estimated net endogenous acid production.

ANALYTICAL APPROACH

Multivariable cause-specific hazards model to assess the association of vegetable and fruit intake with incident chronic kidney disease.

RESULTS

During a mean follow-up of 8.2 years, 1,741 (21.9/1,000 person-years [PY]) participants developed eGFRs < 60mL/min/1.73m2. Incident eGFR < 60mL/min/1.73m2 occurred less frequently with higher intake of nonfermented vegetables, occurring at rates of 22.8/1,000 PY, 22.7/1,000 PY, and 20.1/1,000 PY for the lowest, middle, and highest tertiles, respectively; P for trend < 0.001. The incidence of proteinuria was also lower in the middle and highest tertiles. In a multivariable cause-specific hazards model, the highest tertile of nonfermented vegetable intake was associated with 14% lower risk for incident eGFR < 60mL/min/1.73m2 than the lowest tertile. The highest tertile was also associated with 32% lower risk for proteinuria than the lowest tertile. There were no associations of fermented vegetable and fruit intake with incidence of eGFR < 60mL/min/1.73m2. However, the highest tertiles of both fermented vegetable and fruit intake were associated with 14% and 45% lower risks for incident proteinuria compared with the lowest tertiles (both P < 0.001). During follow-up, estimated net endogenous acid production increased in the lowest tertile of intake of nonfermented or fermented vegetables and fruit, whereas it decreased in the highest tertile.

LIMITATIONS

Self-reported dietary intake, single ethnicity population.

CONCLUSIONS

A diet rich in vegetables and fruit may reduce the risk for kidney disease.

Authors+Show Affiliations

Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon; Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University.Department of Internal Medicine, Hangang Sacred Heart Hospital, Hallym University, Seoul.Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University.Department of Internal Medicine, National Health Insurance Corporation Medical Center, Ilsan Hospital, Goyang si, Gyeonggi-do.Department of Internal Medicine, National Health Insurance Corporation Medical Center, Ilsan Hospital, Goyang si, Gyeonggi-do.Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University.Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University; Department of Internal Medicine, College of Medicine, Severance Biomedical Science Institute, Brain Korea 21 PLUS, Yonsei University, Seoul, Republic of Korea.Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University. Electronic address: hansh@yuhs.ac.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31040089

Citation

Jhee, Jong Hyun, et al. "A Diet Rich in Vegetables and Fruit and Incident CKD: a Community-Based Prospective Cohort Study." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 74, no. 4, 2019, pp. 491-500.
Jhee JH, Kee YK, Park JT, et al. A Diet Rich in Vegetables and Fruit and Incident CKD: A Community-Based Prospective Cohort Study. Am J Kidney Dis. 2019;74(4):491-500.
Jhee, J. H., Kee, Y. K., Park, J. T., Chang, T. I., Kang, E. W., Yoo, T. H., Kang, S. W., & Han, S. H. (2019). A Diet Rich in Vegetables and Fruit and Incident CKD: A Community-Based Prospective Cohort Study. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 74(4), 491-500. https://doi.org/10.1053/j.ajkd.2019.02.023
Jhee JH, et al. A Diet Rich in Vegetables and Fruit and Incident CKD: a Community-Based Prospective Cohort Study. Am J Kidney Dis. 2019;74(4):491-500. PubMed PMID: 31040089.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Diet Rich in Vegetables and Fruit and Incident CKD: A Community-Based Prospective Cohort Study. AU - Jhee,Jong Hyun, AU - Kee,Youn Kyung, AU - Park,Jung Tak, AU - Chang,Tae-Ik, AU - Kang,Ea Wha, AU - Yoo,Tae-Hyun, AU - Kang,Shin-Wook, AU - Han,Seung Hyeok, Y1 - 2019/04/27/ PY - 2018/09/05/received PY - 2019/02/11/accepted PY - 2019/5/2/pubmed PY - 2020/4/1/medline PY - 2019/5/2/entrez KW - Vegetable KW - chronic kidney disease (CKD) KW - diet KW - eating patterns KW - estimated glomerular filtration rate (eGFR) KW - fermented vegetable KW - food choices KW - fruit KW - incident CKD KW - modifiable risk factor KW - non-fermented vegetable KW - proteinuria KW - reduced eGFR SP - 491 EP - 500 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 74 IS - 4 N2 - RATIONALE & OBJECTIVE: A diet rich in vegetables and fruit can lower blood pressure and may reduce cardiovascular risk. However, the association between this dietary pattern and incident chronic kidney disease in the general population is unknown. STUDY DESIGN: A community-based prospective cohort study. SETTING & PARTICIPANTS: 9,229 study participants with normal kidney function from the Korean Genome and Epidemiology Study database. PREDICTORS: Daily consumption of nonfermented and fermented vegetables and fruit classified into tertiles based on a validated semiquantitative food-frequency questionnaire. OUTCOMES: Incident occurrence of estimated glomerular filtration rate (eGFR) < 60mL/min/1.73m2, incident proteinuria (≥1+ by dipstick test), and repeated measures of estimated net endogenous acid production. ANALYTICAL APPROACH: Multivariable cause-specific hazards model to assess the association of vegetable and fruit intake with incident chronic kidney disease. RESULTS: During a mean follow-up of 8.2 years, 1,741 (21.9/1,000 person-years [PY]) participants developed eGFRs < 60mL/min/1.73m2. Incident eGFR < 60mL/min/1.73m2 occurred less frequently with higher intake of nonfermented vegetables, occurring at rates of 22.8/1,000 PY, 22.7/1,000 PY, and 20.1/1,000 PY for the lowest, middle, and highest tertiles, respectively; P for trend < 0.001. The incidence of proteinuria was also lower in the middle and highest tertiles. In a multivariable cause-specific hazards model, the highest tertile of nonfermented vegetable intake was associated with 14% lower risk for incident eGFR < 60mL/min/1.73m2 than the lowest tertile. The highest tertile was also associated with 32% lower risk for proteinuria than the lowest tertile. There were no associations of fermented vegetable and fruit intake with incidence of eGFR < 60mL/min/1.73m2. However, the highest tertiles of both fermented vegetable and fruit intake were associated with 14% and 45% lower risks for incident proteinuria compared with the lowest tertiles (both P < 0.001). During follow-up, estimated net endogenous acid production increased in the lowest tertile of intake of nonfermented or fermented vegetables and fruit, whereas it decreased in the highest tertile. LIMITATIONS: Self-reported dietary intake, single ethnicity population. CONCLUSIONS: A diet rich in vegetables and fruit may reduce the risk for kidney disease. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/31040089/A_Diet_Rich_in_Vegetables_and_Fruit_and_Incident_CKD:_A Community_Based_Prospective_Cohort_Study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(19)30662-6 DB - PRIME DP - Unbound Medicine ER -