Mediterranean Diet, Kidney Function, and Mortality in Men... : Clinical Journal of the American Society of Nephrology (original) (raw)

Original Articles

Mediterranean Diet, Kidney Function, and Mortality in Men with CKD

Huang, Xiaoyan*; Jiménez-Moleón, José Juan†; Lindholm, Bengt*; Cederholm, Tommy‡; Ärnlöv, Johan§,‖; Risérus, Ulf‡; Sjögren, Per‡; Carrero, Juan Jesús*,¶

*Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention, and Technology and

¶Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden;

†Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, Granada, Spain;

‡Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism and

§Department of Public Health and Caring Sciences, Section of Geriatrics, Uppsala University, Uppsala, Sweden; and

‖School of Health and Social Studies, Dalarna University, Falun, Sweden

Correspondence: Dr. Xiaoyan Huang, Divisions of Renal Medicine and Baxter Novum, Karolinska University Hospital at Huddinge K56, Karolinska Institutet, SE-14186, Stockholm, Sweden. Email: [email protected]

Received February 12, 2013

Accepted April 30, 2013

Online date: June 06, 2013

Abstract

Background and objectives

Adherence to a Mediterranean diet may link to a better preserved kidney function in the community as well as a favorable cardiometabolic profile and reduced mortality risk in individuals with manifest CKD.

Design, setting, participants, & measurements

Dietary habits were determined by 7-day dietary records in a population-based cohort of 1110 Swedish men (age 70 years) from 1991 to 1995, 506 of whom were considered to have CKD because of a GFR<60 ml/min per 1.73 m2. A Mediterranean Diet Score was calculated, and participants were categorized as having low, medium, or high adherence. Adequate dietary reporters were identified with Goldberg cutoffs (_n_=597). Deaths were registered during a median follow-up of 9.9 years.

Results

Compared with low adherents, medium and high adherents were 23% and 42% less likely to have CKD, respectively (adjusted odds ratio [95% confidence interval]=0.77 [0.57 to 1.05] and 0.58 [0.38 to 0.87], respectively, P for trend=0.04). Among those individuals with CKD, phosphate intake and net endogenous acid production were progressively lower across increasing adherence groups. No differences were observed regarding other cardiometabolic risk factors across adherence groups. As many as 168 (33%) CKD individuals died during follow-up. Compared with low adherents, proportional hazards regression associated medium and high adherents to a 25% and 23% lower mortality risk, respectively (adjusted hazard ratio [95% confidence interval]=0.75 [0.52 to 1.06] and 0.77 [0.44 to 1.36], respectively, P for trend=0.10). Sensitivity analyses showed significant and stronger associations when only adequate dietary reporters were considered.

Conclusions

Adherence to a Mediterranean dietary pattern is associated with lower likelihood of CKD in elderly men. A greater adherence to this diet independently predicted survival in those patients with manifest CKD. Clinical trials are warranted to test the hypothesis that following such a diet could improve outcomes (independent of other healthy lifestyles) in CKD patients.