Dietary patterns and risk of incident chronic kidney disease: the Atherosclerosis Risk in Communities study

Abstract

Background: Adherence to healthy dietary patterns, measured by the Healthy Eating Index (HEI), Alternative Healthy Eating Index (AHEI), and alternate Mediterranean diet (aMed) scores, is associated with a reduced risk of cardiovascular disease. The association between these scores and chronic kidney disease (CKD) is undetermined.

Objective: We aimed to estimate the association between the HEI, AHEI, and aMed scores and risk of incident CKD.

Methods: We conducted a prospective analysis in 12,155 participants aged 45-64 y from the Atherosclerosis Risk in Communities (ARIC) Study. We calculated HEI-2015, AHEI-2010, and aMed scores for each participant and categorized them into quintiles of each dietary score. Incident CKD was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2 accompanied by ≥25% decline in estimated glomerular filtration rate, a kidney disease-related hospitalization or death, or end-stage renal disease. We used cause-specific hazard models to estimate risk of CKD from the quintile of the dietary score through to 31 December 2017.

Results: There were 3980 cases of incident CKD over a median follow-up of 24 y. Participants who had higher adherence to the HEI-2015, AHEI-2010, and aMed scores were more likely to be female, have higher educational attainment, higher income level, be nonsmokers, more physically active, and diabetic compared with participants who scored lower. All 3 dietary scores were associated with lower CKD risk (P-trend < 0.001). Participants who were in the highest quintile of HEI-2015 score had a 17% lower risk of CKD (HR: 0.83; 95% CI: 0.74, 0.92) compared with participants in the lowest quintile. Those in quintile 5 of AHEI-2010 and aMed scores, respectively, had a 20% and 13% lower risk of CKD compared with those in quintile 1.

Conclusion: Higher adherence to healthy dietary patterns during middle age was associated with lower risk of CKD.

Keywords: AHEI; ARIC; DASH; HEI; Mediterranean; dietary patterns; dietary scores; kidney disease; renal disease.

FIGURE 1

Restricted cubic spline plot of adjusted HRs for incident chronic kidney disease by dietary score. (A) HEI-2015; (B) AHEI-2010; (C) aMed diet. Adjusted for age, sex, race-center, total energy intake, education level, income, estimated glomerular filtration rate, physical activity, smoking status, pack-years, BMI, diabetes, systolic blood pressure, antihypertensive medication use, and HDL cholesterol. Histogram displays the distribution of study participants according to scores for each dietary pattern. Solid line represents the adjusted HR (on logarithmic scale) and dashed lines represent the 95% CI from a cause-specific hazard model. Note: knots placed at 61, 67, 72, 76, and 82 for HEI-2015; 37, 45, 51, 57, and 67 for AHEI-2010; and 2, 4, and 6 for aMed. AHEI, Alternative Healthy Eating Index; aMed, alternate Mediterranean diet; HEI, Healthy Eating Index.

FIGURE 2

HR (on logarithmic scale) of incident kidney disease comparing the highest with the lowest quintile of individual component consumption. (A) HEI-2015; (B) AHEI-2010; (C) aMed diet. Values are HRs (95% CIs) derived from cause-specific hazard models. Adjusted for age, sex, race-center, total energy intake, education level, income, estimated glomerular filtration rate, physical activity, smoking status, pack-years, BMI, diabetes, systolic blood pressure, antihypertensive medication use, HDL cholesterol, and all other factors of each dietary score. AHEI, Alternative Healthy Eating Index; aMed, alternate Mediterranean diet; HEI, Healthy Eating Index; SSB, sugar-sweetened beverage.