Effect of glycemic index and carbohydrate intake on kidney function in healthy adults

Stephen P Juraschek, Alex R Chang, Lawrence J Appel, Cheryl A M Anderson, Deidra C Crews, Letitia Thomas, Jeanne Charleston, Edgar R Miller 3rd, Stephen P Juraschek, Alex R Chang, Lawrence J Appel, Cheryl A M Anderson, Deidra C Crews, Letitia Thomas, Jeanne Charleston, Edgar R Miller 3rd

Abstract

Background: Replacing carbohydrate with protein acutely increases glomerular filtration rate (GFR) but is associated with faster, long-term kidney disease progression. The effects of carbohydrate type (i.e. glycemic index, GI) on kidney function are unknown.

Methods: We conducted an ancillary study of a randomized, crossover feeding trial in overweight/obese adults without diabetes or kidney disease (N = 163). Participants were fed each of four healthy, DASH-like diets for 5 weeks, separated by 2-week washout periods. Weight was kept constant. The four diets were: high GI (GI ≥65) with high %carb (58 % kcal) (reference diet), low GI (≤45) with low %carb (40 % kcal), low GI with high %carb; and high GI with low %carb. Plasma was collected at baseline and after each feeding period. Study outcomes were cystatin C, β2-microglobulin (β2M), and estimated GFR based on cystatin C (eGFRcys).

Results: Mean (SD) age was 52 (11) years; 52 % were women; 50 % were black. At baseline, mean (SD) cystatin C, β2M, and eGFRcys were 0.8 (0.1) mg/L, 1.9 (0.4) mg/L, and 104 (16) mL/min/1.73 m(2). Compared to the high GI/high %carb diet, reducing GI, %carb, or both increased eGFRcys by 1.9 mL/min/1.73 m(2) (95 % CI: 1.1, 2.7; P < 0.001), 3.0 mL/min/1.73 m(2) (1.9, 4.0; P < 0.001), and 4.5 mL/min/1.73 m(2) (3.5, 5.4; P < 0.001), respectively. Increases in eGFRcys from reducing GI were significantly associated with increases in eGFRcys from reducing %carb (P < 0.001). Results for cystatin C and β2M reflected eGFRcys.

Conclusions: Reducing GI increased GFR. Reducing %carb by increasing calories from protein and fat, also increased GFR. Future studies on GI should examine the long-term effects of this increase in GFR on kidney injury markers and clinical outcomes.

Trial registration: Clinical Trials.gov, number: NCT00608049 (first registered January 23, 2008).

Keywords: Carbohydrate; Clinical trial; Creatinine; Cystatin C; Diet; Estimated glomerular filtration rate; Glycemic index; β2-microglobulin.

Figures

Fig. 1
Fig. 1
The effects (95 % confidence intervals) of reducing glycemic index (GI), reducing the proportion of carbohydrates (%carb), or reducing both GI and %carb on: a cystatin C (mg/L), b β2-microglobulin (mg/L), and c cystatin C-based estimated glomerular filtration rate (eGFRcys) (mL/min/1.73 m2) measured at the end of each feeding period. The reference diet was the high GI/high %carb diet

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