Association of dietary patterns with albuminuria and kidney function decline in older white women: a subgroup analysis from the Nurses' Health Study

Abstract

Background: Dietary patterns have been linked to such chronic diseases as cardiovascular disease, but sparse data currently are available for associations between dietary patterns and microalbuminuria or kidney function decline.

Study design: Subgroup analysis from a prospective observational cohort study.

Setting & participants: Female participants in the Nurses' Health Study who had dietary pattern data from food frequency questionnaires returned in 1984, 1986, 1990, 1994, and 1998 and urinary albumin-creatinine ratios from 2000 (n = 3,121); estimated glomerular filtration rate (eGFR) change between 1989 and 2000 was available for 3,071.

Predictor: Prudent (higher intake of fruits, vegetables, legumes, fish, poultry, and whole grains), Western (higher intake of red and processed meats, saturated fats, and sweets), and Dietary Approach to Stop Hypertension (DASH)-style dietary patterns (also greater intake of vegetables, fruits, and whole grains).

Outcomes & measurements: Microalbuminuria (albumin-creatinine ratio, 25-354 μg/mg) in 2000 and change in kidney function using eGFR between 1989 and 2000.

Results: After multivariable adjustment, the highest quartile of Western pattern score compared with the lowest quartile was associated directly with microalbuminuria (OR, 2.17; 95% CI, 1.18-3.66; P for trend = 0.01) and rapid eGFR decline ≥3 mL/min/1.73 m(2)/y (OR, 1.77; 95% CI, 1.03-3.03). Women in the top quartile of the DASH score had decreased risk of rapid eGFR decline (OR, 0.55; 95% CI, 0.38-0.80), but no association with microalbuminuria. These associations did not vary by diabetes status. The prudent dietary pattern was not associated with microalbuminuria or eGFR decline.

Limitations: Study cohort included primarily older white women and generalizability of results would benefit from validation in nonwhites and men.

Conclusions: A Western dietary pattern is associated with a significantly increased odds of microalbuminuria and rapid kidney function decrease, whereas a DASH-style dietary pattern may be protective against rapid eGFR decline.

Copyright © 2011 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

Inclusion and exclusion criteria for Nurses’ Health Study women in this analysis of dietary patterns with albuminuria and kidney function decline

Figure 2

Time-line of questionnaire and biological sample data collection in Nurses’ Health Study for these analyses. Questionnaires are administered every two years beginning in 1976 but only questionnaire data for non-dietary covariates from years used for this study (1990 and 2000) are shown. Food frequency questionnaires (FFQ’s) asking about diet over the previous 12 months were administered in 1984, 1986, 1990, 1994, and 1998. ACR = albumin-creatinine ratio. Reproduced from inted from Lin et al^28 with permisision of the American Society of Nephrology.