Healthful dietary patterns and risk of end-stage kidney disease: the Singapore Chinese Health Study

Abstract

Background: Although adherence to healthful dietary patterns has been associated with a lower risk of kidney function decline in Western populations, evidence in Asian populations remains scanty.

Objectives: We examined predefined dietary patterns, namely, the Alternate Healthy Eating Index-2010 (AHEI-2010), the Dietary Approaches to Stop Hypertension (DASH), and the alternate Mediterranean diet (aMED), in relation to risk of end-stage kidney disease (ESKD).

Methods: We included 56,985 Chinese adults (aged 45-74 y) in the Singapore Chinese Health Study who were free of cancer, stroke, coronary artery disease, and ESKD at recruitment (1993-1998). Dietary pattern scores were calculated based on a validated 165-item FFQ. AHEI-2010 and aMED scores were modified by excluding the alcohol intake component because daily drinking has been associated with a higher risk of ESKD in our study population. We identified 1026 ESKD cases over a median follow-up of 17.5 y via linkage with the nationwide Singapore Renal Registry. Multivariable Cox regression models were used to compute HRs and their 95% CIs.

Results: Higher scores of all 3 dietary patterns were associated with lower ESKD risk in a dose-dependent manner. Compared with the lowest quintiles, the multivariable-adjusted HRs (95% CIs) of ESKD were 0.75 (0.61, 0.92) for the highest quintile of AHEI-2010, 0.67 (0.54, 0.84) for DASH, and 0.73 (0.59, 0.91) for aMED (all P-trend ≤ 0.004). These inverse associations were stronger with increasing BMI (in kg/m2), and the HRs for the diet-ESKD association were lowest in the obese (BMI ≥ 27.5), followed by the overweight (BMI = 25 to <27.5) participants, compared with those in lower BMI categories; the P-interaction values between BMI and diet scores were 0.03 for AHEI-2010, 0.004 for aMED, and 0.06 for DASH.

Conclusions: Adherence to healthful dietary patterns was associated with a lower ESKD risk in an Asian population, especially in overweight or obese individuals.

Keywords: AHEI-2010; BMI; DASH; Mediterranean diet; Singapore Chinese Health Study; dietary patterns; end-stage kidney disease; nutritional epidemiology.

FIGURE 1

AHEI-2010, DASH, and aMED in relation to risk of ESKD across ordinal categories of increasing BMI (<23, 23 to <25, 25 to <27.5, and ≥27.5 kg/m²) (n = 56,985). HRs were adjusted for age, sex, dialect, education level, year of interview, hours per week of moderate activity, smoking status, total energy intake, coffee consumption, incense use, sleep duration, alcohol use, physician-diagnosed hypertension, and diabetes. AHEI-2010, Alternate Healthy Eating Index-2010; aMED, alternate Mediterranean diet; DASH, Dietary Approaches to Stop Hypertension; ESKD, end-stage kidney disease.

FIGURE 2

Relation between components of DASH and risk of end-stage kidney disease in the Singapore Chinese Health Study (n = 56,985). One serving of whole grains is 16 g; 1 serving of fruits is 1 medium piece; 1 serving of vegetables is 67 g; 1 serving of nuts is 28 g nuts or 1 tablespoon (16 g) of peanut butter and 1 serving of legumes is 1 medium-size tofu item; 1 serving of dairy is 250 mL or 1 cup of milk; 1 serving of fish is 90 g; 1 serving of red meat is either 113.4 g fresh meat or 42.5 g processed meat; 1 serving of SSBs/fruit juice is 1 glass of soda or 1 glass, packet, or typical local portion of fruit juice; percentage of energy excludes energy provided by alcohol. HRs were adjusted for the confounders in Model 2 and also mutually adjusted for other components of the DASH score. DASH, Dietary Approaches to Stop Hypertension; SSB, sugar-sweetened beverage.