Abstract
Abstract. Epidemiological studies show that adherence to healthy dietary patterns may be associated with a lower risk of decline in kidney function. However, existing evidence has not been quantitatively gathered. Pertinent observational studies investigating the association of adherence to a healthy dietary pattern, either priori-defined dietary pattern/indices or data-driven dietary patterns, with risk of kidney disease in the general population were identified by searching Medline and Scopus databases to May 28, 2018. A random-effects meta-analysis was applied. The analysis included eight prospective cohorts (5734 cases among 569,688 participants) and five cross-sectional studies (1955 cases among 16,614 participants). Higher adherence to a healthy dietary pattern (either priori-defined or data-driven dietary patterns) was associated with a 28% lower risk of kidney disease in the analysis of prospective cohort studies (RR = 0.72, 95 % CI = 0.58, 0.86; I2 = 71%, n = 8). A subgroup analysis based on definition of healthy dietary pattern resulted in significant inverse association only in the subgroup of Dietary Approaches to Stop Hypertension dietary pattern (RR: 0.74, 95 % CI: 0.54, 0.93; I2 = 73%, n = 5). A dose-response analysis indicated a monotonic inverse association between adherence to the Dietary Approaches to Stop Hypertension dietary pattern with risk of kidney disease. A 32% lower risk was observed in the analysis of cross-sectional studies (OR: 0.68, 95 % CI: 0.53, 0.83, I2 = 0%, n = 5). The findings suggest that higher adherence to a healthy dietary pattern is associated with a lower risk of kidney disease.
References
1 Chronic kidney disease: global dimension and perspectives. Lancet. 2013;382(9888):260–72.
2 Global prevalence of chronic kidney disease – a systematic review and meta-analysis. PLoS One. 2016;11(7):e0158765.
3 Breyer MDSusztak K editors. Developing treatments for chronic kidney disease in the 21st century. Semin Nephrol; 2016: Elsevier.
4 , Identification of patients and risk factors in chronic kidney disease – evaluating risk factors and therapeutic strategies. Nephrol Dial Transplant. 2001;16(suppl_7):57–60.
5 . The DASH diet for hypertension: Simon and Schuster; 2011.
6 . The effect of dietary approaches to stop hypertension (DASH) on serum inflammatory markers: a systematic review and meta-analysis of randomized trials. Clin Nutr. 2018;37(2):542–50.
7 . The effect of the mediterranean diet on hypertension: a systematic review and meta-analysis. J Nutr Educ Behav. 2016;48(1):42–53.e1.
8 . The association between dietary patterns and type 2 diabetes: a systematic review and meta-analysis of cohort studies. J Hum Nutr Diet. 2014;27(3):251–60.
9 . Consumption of a healthy dietary pattern results in significant reductions in C-reactive protein levels in adults: a meta-analysis. Nutr Res. 2016;36(5):391–401.
10 Vegetarian diet reduces the risk of hypertension independent of abdominal obesity and inflammation: a prospective study. J Hypertens. 2016;34(11):2164–71.
11 . The association between Dietary Approaches to Stop Hypertension and incidence of chronic kidney disease in adults: The Tehran Lipid and Glucose Study. Nephrol Dial Transplant. 2017;32:ii224-ii30.
12 . Dietary patterns and CKD progression. Blood Purif. 2016;41(1–3):117–22.
13 Lifestyle-related factors, obesity, and incident microalbuminuria: the CARDIA (Coronary Artery Risk Development in Young Adults) study. Am J Kidney Dis. 2013;62(2):267–75.
14 . Dietary Approaches to Stop Hypertension and risk of chronic kidney disease: A systematic review and meta-analysis of observational studies. Clin Nutr. 2019.
15 . Effect of diet protein restriction on progression of chronic kidney disease: A systematic review and meta-analysis. PLoS One. 2018;13(11).
16 . Dietary fibre intake in relation to the risk of incident chronic kidney disease. Br J Nutr. 2018;119(5):479–85.
17 . Effects of soy protein containing isoflavones in patients with chronic kidney disease: A systematic review and meta-analysis. Clin Nutr. 2016;35(1):117–24.
18 Association between probiotic and yogurt consumption and kidney disease: insights from NHANES. Nutr J. 2015;15(1):10.
19 . A higher ratio of refined grain to whole grain is associated with a greater likelihood of chronic kidney disease: a population-based study. Br J Nutr. 2019;121(11):1294–302.
20 . Dietary total antioxidant capacity and incidence of chronic kidney disease in subjects with dysglycemia: Tehran Lipid and Glucose Study. Eur J Nutr. 2018;57(7):2377–85.
21 . Low-protein diet for conservative management of chronic kidney disease: a systematic review and meta-analysis of controlled trials. J Cachexia Sarcopenia Muscle. 2018;9(2):235–45.
22 . Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin Lipidol. 2002;13(1):3–9.
23 . The effect of dietary approaches to stop hypertension (DASH) diet on weight and body composition in adults: a systematic review and meta-analysis of randomized controlled clinical trials. Obes Rev. 2016;17(5):442–54.
24 . Mediterranean diet and weight loss: meta-analysis of randomized controlled trials. Metab Syndr Relat Disord. 2011;9(1):1–12.
25 . Vegetarian diets and weight reduction: a meta-analysis of randomized controlled trials. J Gen Intern Med. 2016;31(1):109–16.
26 . Adherence to the Mediterranean diet is associated with reduced risk of incident chronic kidney diseases among Tehranian adults. Hypertens Res. 2017;40(1):96–102.
27 . A better diet quality is associated with a reduced likelihood of CKD in older adults. Nutr Metab Cardiovasc Dis. 2013;23(10):937–43.
28 Dietary patterns and risk of death and progression to ESRD in individuals with CKD: A cohort study. Am J Kidney Dis. 2014;64(2):204–13.
29 . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–9.
30 . Effect of duration of type I diabetes on the prevalence of stages of diabetic nephropathy defined by urinary albumin/creatinine ratio. J Am Soc Nephrol. 1996;7(6):930–7.
31 A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604–12.
32 The association between a Mediterranean-style diet and kidney function in the northern Manhattan study cohort. Clin J Am Soc Nephrol. 2014;9(11):1868–75.
33 DASH (Dietary Approaches to Stop Hypertension) diet and risk of subsequent kidney disease. Am J Kidney Dis. 2016;68(6):853–61.
34 Diet and major renal outcomes: a prospective cohort study. The NIH-AARP diet and health study. J Ren Nutr. 2016;26(5):288–98.
35 . Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25(9):603–5.
36 Perspective: NutriGrade: A scoring system to assess and judge the meta-evidence of randomized controlled trials and cohort studies in nutrition research. Adv Nutr. 2016;7(6):994–1004.
37 . Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3):177–88.
38 . Facilitating meta-analyses by deriving relative effect and precision estimates for alternative comparisons from a set of estimates presented by exposure level or disease category. Stat Med. 2008;27(7):954–70.
39 . Association of dietary patterns with albuminuria and kidney function decline in older white women: A subgroup analysis from the nurses’ health study. Am J Kidney Dis. 2011;57(2):245–54.
40 Dietary habits and risk of kidney function decline in an urban population. J Ren Nutr. 2017;27(1):16–25.
41 . Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557.
42 . Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34.
43 . Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994:1088–101.
44 . Meta-analysis of epidemiologic dose-response data. Epidemiology. 1993;218–28.
45 . Generalized least squares for trend estimation of summarized dose-response data. Stata J. 2006;6(1):40.
46 . Meta-analysis for linear and nonlinear dose-response relations: examples, an evaluation of approximations, and software. Am J Epidemiol. 2011;175(1):66–73.
47 . Dietary habits, poverty, and chronic kidney disease in an urban population. J Ren Nutr. 2015;25(2):103–10.
48 . Lifestyle factors and indices of kidney function in the framingham heart study. Am J Nephrol. 2015;41(4–5):267–74.
49 . DASH dietary pattern and chronic kidney disease in elderly Korean adults. Eur J Clin Nutr. 2017;71(6):755–61.
50 Dietary patterns and chronic kidney disease: A cross-sectional association in the Irish Nun Eye Study. Sci Rep. 2018;8(1).
51 . Association between dietary patterns, cadmium intake and chronic kidney disease among adults. Clin Nutr. 2018;37(1):276–84.
52 . Hypotensive peptides from milk proteins. J Nutr. 2004;134(4):980S–8S.
53 . Wholegrain cereals for coronary heart disease. Cochrane Database Syst Rev. 2007.
54 Resistant starch: promise for improving human health. Adv Nutr. 2013;4(6):587–601.
55 . Antioxidants in fruits and vegetables – the millennium’s health. Int J Food Sci Technol. 2001;36(7):703–25.
56 . Magnesium deficiency promotes a pro-atherogenic phenotype in cultured human endothelial cells via activation of NFkB. Biochim Biophys Acta Mol Basis Dis. 2010;1802(11):952–8.
57 . Clinical practice guidelines for nutrition in chronic renal failure. Am J Kidney Dis. 2000;35(2):S1–S140.
58 Cupisti AKalantar-Zadeh K editors. Management of natural and added dietary phosphorus burden in kidney disease. Semin Nephrol; 2013: Elsevier.
59 Vegetarian compared with meat dietary protein source and phosphorus homeostasis in chronic kidney disease. Clin J Am Soc Nephrol. 2010:CJN05040610.
60 Short-term effects of the DASH diet in adults with moderate chronic kidney disease: a pilot feeding study. Clin Kidney J. 2016;9(4):592–8.
61 The effects of dietary patterns on urinary albumin excretion: results of the Dietary Approaches to Stop Hypertension (DASH) Trial. Am J Kidney Dis. 2009;53(4):638–46.
62 . Superiority of salt restriction over diuretics in reducing renal hypertrophy and injury in uninephrectomized SHR. Am J Physiol Renal Physiol. 1990;258(6):F1675–F81.
63 . Nutritional therapy, phosphate control and renal protection. Nephron Clin Pract. 2014;126(1):1–7.
64 Comparative effects of different dietary approaches on blood pressure in hypertensive and pre-hypertensive patients: A systematic review and network meta-analysis. Crit Rev Food Sci Nutr. 2018:1–14.