title: Mediterranean diet, kidney function, and mortality in men with CKD.
abstract: OBJECTIVE
  Adherence to a Mediterranean diet may link to a better preserved kidney function in the community as well as a favorable cardiometabolic profile and reduced mortality risk in individuals with manifest CKD.
  
  
  METHODS
  Dietary habits were determined by 7-day dietary records in a population-based cohort of 1110 Swedish men (age 70 years) from 1991 to 1995, 506 of whom were considered to have CKD because of a GFR<60 ml/min per 1.73 m(2). A Mediterranean Diet Score was calculated, and participants were categorized as having low, medium, or high adherence. Adequate dietary reporters were identified with Goldberg cutoffs (n=597). Deaths were registered during a median follow-up of 9.9 years.
  
  
  RESULTS
  Compared with low adherents, medium and high adherents were 23% and 42% less likely to have CKD, respectively (adjusted odds ratio [95% confidence interval]=0.77 [0.57 to 1.05] and 0.58 [0.38 to 0.87], respectively, P for trend=0.04). Among those individuals with CKD, phosphate intake and net endogenous acid production were progressively lower across increasing adherence groups. No differences were observed regarding other cardiometabolic risk factors across adherence groups. As many as 168 (33%) CKD individuals died during follow-up. Compared with low adherents, proportional hazards regression associated medium and high adherents to a 25% and 23% lower mortality risk, respectively (adjusted hazard ratio [95% confidence interval]=0.75 [0.52 to 1.06] and 0.77 [0.44 to 1.36], respectively, P for trend=0.10). Sensitivity analyses showed significant and stronger associations when only adequate dietary reporters were considered.
  
  
  CONCLUSIONS
  Adherence to a Mediterranean dietary pattern is associated with lower likelihood of CKD in elderly men. A greater adherence to this diet independently predicted survival in those patients with manifest CKD. Clinical trials are warranted to test the hypothesis that following such a diet could improve outcomes (independent of other healthy lifestyles) in CKD patients.
authors.affiliation: Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention, and Technology, Stockholm, Sweden. xiaoyan.huang@ki.se
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Huang
authors.forename: José Juan
authors.initials: JJ
authors.lastname: Jiménez-Moleón
authors.forename: Bengt
authors.initials: B
authors.lastname: Lindholm
authors.forename: Tommy
authors.initials: T
authors.lastname: Cederholm
authors.forename: Johan
authors.initials: J
authors.lastname: Arnlöv
authors.forename: Ulf
authors.initials: U
authors.lastname: Risérus
authors.forename: Per
authors.initials: P
authors.lastname: Sjögren
authors.forename: Juan Jesús
authors.initials: JJ
authors.lastname: Carrero
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D038441:Diet, Mediterranean; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000502:physiology*; D008297:Male; D010349:Patient Compliance; D051436:Renal Insufficiency, Chronic / Q000178:diet therapy / Q000453:epidemiology / Q000401:mortality* / Q000503:physiopathology*; D015996:Survival Rate; D013548:Sweden / Q000453:epidemiology