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Title: Dietary guideline adherence index and kidney measures in the framingham heart study

Author
item MA, JIANTAO - National Heart, Lung And Blood Institute(NHLBI, NIH)
item JACQUES, PAUL - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item HWANG, SHIH-JEN - National Heart, Lung And Blood Institute(NHLBI, NIH)
item TROY, LISA - University Of Massachusetts
item MCKEOWN, NICOLA - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item CHU, AUDREY - National Heart, Lung And Blood Institute(NHLBI, NIH)
item FOX, CAROLINE - National Heart, Lung And Blood Institute(NHLBI, NIH)

Submitted to: American Journal of Kidney Diseases
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/12/2016
Publication Date: 5/31/2016
Citation: Ma, J., Jacques, P.F., Hwang, S., Troy, L.M., McKeown, N.M., Chu, A.Y., Fox, C.S. 2016. Dietary guideline adherence index and kidney measures in the framingham heart study. American Journal of Kidney Diseases. doi: 10.1053/j.ajkd.2016.04.015.

Interpretive Summary: Chronic kidney disease (CKD) reflects damage of kidney structure and decline in kidney function. The prevalence of CKD has increased during the past decades, and it is estimated that 13% of the American adult population currently has CKD. CKD elevates the risk for kidney failure and cardiovascular disease. Several observational studies have examined the relationship of kidney function and a variety of dietary components, such as protein, saturated fat, sodium, whole grains, and added sugars. These studies often compared higher intake with lower intake of a particular dietary component and suggest that dietary factors are important for CKD prevention. We previously demonstrated that an overall healthy diet, represented by a higher Dietary Guidelines for Americans Adherence Index (DGAI) score, was associated with better kidney function or lower risk for CKD over 7 years of follow-up in the Framingham Heart Study. The DGAI represents adherence to the Dietary Guidelines for Americans. It consists of 20 individual components, which were constructed based on key dietary recommendations for individual food groups or nutrients in the 2005 Dietary Guidelines for Americans. Therefore, it is uncertain which specific DGAI components were driving our previous finding. Thus, the aim of this study was to examine the prospective association between individual DGAI components and change in kidney measurements, estimated glomerular filtration rate (eGFR,) and urinary albumin to creatinine ratio (UACR.) No observational studies have directly considered the dietary guidelines when examining the prospective association between dietary intake and kidney measures. We examined participants who attended examinations 7 (1998-2001) and 8 (2005-2008) in the Framingham Offspring Cohort. Our primary outcome was the development of low estimated glomerular filtration rate (eGFR) over a 7 year follow-up after exclusion of prevalent low eGFR at baseline. Low eGFR was defined as eGFR <60 mL/min/1.73 m2. Among 1,822 participants (mean age, 59.4 years; 54.6% women,) 181 incident cases of low eGFR were identified. After adjustment for potential confounders, compared to optimal adherence to meat and legume recommendations, low adherence was associated with approximately 3-fold higher likelihood of incident low eGFR; low adherence to dairy product recommendations was also associated with 2-fold higher likelihood of low eGFR compared to optimal adherence. In addition, low adherence to the meat and legume and dairy recommendations was associated with rapid eGFR decline, and low adherence to dairy product recommendations was also associated incident albuminuria. The present study suggests that adherence to the Dietary Guidelines for Americans is of crucial importance for maintaining healthy kidney function and for the primary prevention of CKD.

Technical Abstract: BACKGROUND: No observational studies have directly considered dietary guidelines when examining the prospective association between dietary intake and kidney measures. STUDY DESIGN: Prospective cohort study. SETTING & PARTICIPANTS: We examined participants who attended examinations 7 (1998-2001) and 8 (2005-2008) in the Framingham Offspring Cohort. PREDICTORS: Individual components of Dietary Guidelines for Americans Adherence Index (DGAI) that reflect adherence to key dietary recommendations based on the 2005 guideline. OUTCOMES & MEASURES: The primary outcome was incident low estimated glomerular filtration rate (eGFR) at follow-up after exclusion of prevalent low eGFR at baseline. Low eGFR was defined as serum creatinine-based eGFR<60mL/min/1.73m2. RESULTS: Among 1,822 participants (mean age, 59.4 years; 54.6% women), 181 incident cases of low eGFR were identified. After adjustment for potential confounders, compared to optimal adherence to meat and legume recommendations, low adherence was associated with higher odds of incident low eGFR (P for trend = 0.01); ORs in the lowest and intermediate adherence categories were 2.98 (95% CI, 1.13-7.92) and 1.65 (95% CI, 1.02-2.66), respectively. Low adherence to dairy product recommendations was also associated with higher odds of incident low eGFR compared to optimal adherence (P for trend = 0.03); ORs in the lowest and intermediate adherence categories were 1.98 (95% CI, 1.03-3.82) and 1.59 (95% CI, 0.81-3.11), respectively. In addition, low adherence to meat and legume recommendations was associated with rapid eGFR decline (P for trend = 0.01), and low adherence to dairy product recommendations was associated with rapid eGFR decline (P for trend = 0.01) and incident albuminuria (P for trend = 0.03). LIMITATIONS: The DGAI was developed based on the 2005 Dietary Guidelines for Americans. CONCLUSIONS: Better adherence to dietary recommendations for both meat and legumes and dairy products was associated with lower risk for developing adverse kidney measures.