Diet and Kidney Disease in High-Risk Individuals With Type 2 Diabetes Mellitus
Diet and Kidney Disease in High-Risk Individuals With Type 2 Diabetes Mellitus
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DOI：
10.1001/jamainternmed.2013.9051
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发表时间：
2013-10-14
影响因子：
39
通讯作者：
Oberbauer, Rainer
中科院分区：
文献类型：
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作者：
Dunkler, Daniela;Dehghan, Mahshid;Oberbauer, Rainer
2型糖尿病和相关的慢性肾脏病（CKD）已成为主要的公共卫生问题。关于饮食对2型糖尿病患者CKD发病率或进展的影响知之甚少。目的研究健康饮食、酒精、蛋白质和钠摄入量与2型糖尿病患者CKD发病率或进展之间的关系。正在进行的替米沙坦单药治疗和与雷米普利联合治疗全球终点试验中的所有6213例无大量白蛋白尿的2型糖尿病患者（ONTARGET）纳入本观察性研究。招募时间为2002年1月至2003年7月，前瞻性随访至2008年1月。主要结局和指标慢性肾脏疾病定义为随访5.5年时新发微量白蛋白尿或大量白蛋白尿或肾小球滤过率每年下降超过5%。我们使用改良的替代健康饮食指数（mAHEI）评估饮食。分析调整已知的风险因素，并竞争死亡的风险被认为是considered.Results随访5.5年后，31.7%的参与者发展慢性肾脏病和8.3%已经死亡。与mAHEI评分最不健康的三分位数参与者相比，最健康的三分位数参与者的CKD风险较低（调整后的比值比[OR]，0.74; 95%CI，0.64-0.84），死亡风险较低（OR，0.61; 95%CI，0.48-0.78）。每周食用超过3份水果的参与者与不经常食用这些食物的参与者相比，患CKD的风险较低。总蛋白和动物蛋白摄入量最低三分位数的参与者与最高三分位数的参与者相比，CKD风险增加（总蛋白OR，1.16; 95%CI，1.05-1.30）。钠摄入量与CKD无关。适量饮酒可降低慢性肾脏病的风险（OR，0.75; 95%CI，0.65-0.87）和死亡率（OR，0.69; 95%CI，0.53-0.89）。结论和相关性健康的饮食和适量饮酒可降低慢性肾脏病的发病率2型糖尿病患者中慢性肾脏病的发病率或进展。钠摄入量，在很大范围内，和正常的蛋白质摄入量与CKD无关。
IMPORTANCE Type 2 diabetes mellitus and associated chronic kidney disease (CKD) have become major public health problems. Little is known about the influence of diet on the incidence or progression of CKD among individuals with type 2 diabetes.OBJECTIVE To examine the association between (healthy) diet, alcohol, protein, and sodium intake, and incidence or progression of CKD among individuals with type 2 diabetes.DESIGN, SETTING, AND PARTICIPANTS All 6213 individuals with type 2 diabetes without macroalbuminuria from the Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial (ONTARGET) were included in this observational study. Recruitment spanned from January 2002 to July 2003, with prospective follow-up through January 2008.MAIN OUTCOMES AND MEASURES Chronic kidney disease was defined as new microalbuminuria or macroalbuminuria or glomerular filtration rate decline of more than 5% per year at 5.5 years of follow-up. We assessed diet using the modified Alternate Healthy Eating Index (mAHEI). The analyses were adjusted for known risk factors, and competing risk of death was considered.RESULTS After 5.5 years of follow-up, 31.7% of participants had developed CKD and 8.3% had died. Compared with participants in the least healthy tertile of mAHEI score, participants in the healthiest tertile had a lower risk of CKD (adjusted odds ratio [OR], 0.74; 95% CI, 0.64-0.84) and lower risk of mortality (OR, 0.61; 95% CI, 0.48-0.78). Participants consuming more than 3 servings of fruits per week had a lower risk of CKD compared with participants consuming these food items less frequently. Participants in the lowest tertile of total and animal protein intake had an increased risk of CKD compared with participants in the highest tertile (total protein OR, 1.16; 95% CI, 1.05-1.30). Sodium intake was not associated with CKD. Moderate alcohol intake reduced the risk of CKD (OR, 0.75; 95% CI, 0.65-0.87) and mortality (OR, 0.69; 95% CI, 0.53-0.89).CONCLUSIONS AND RELEVANCE A healthy diet and moderate intake of alcohol may decrease the incidence or progression of CKD among individuals with type 2 diabetes. Sodium intake, within a wide range, and normal protein intake are not associated with CKD.