Dietary Guideline Adherence Index and Kidney Measures in the Framingham Heart Study.
BACKGROUND
No observational studies have directly considered dietary guidelines when examining the prospective association between dietary intake and kidney measures.


METHODS
Prospective cohort study.


METHODS
We examined participants who attended examinations 7 (1998-2001) and 8 (2005-2008) in the Framingham Offspring Cohort.


METHODS
Individual components of Dietary Guidelines for Americans Adherence Index (DGAI) that reflect adherence to key dietary recommendations based on the 2005 guideline.


METHODS
The primary outcome was incident low estimated glomerular filtration rate (eGFR) at follow-up after exclusion of prevalent low eGFR at baseline. Low eGFR was defined as serum creatinine-based eGFR<60mL/min/1.73m2.


RESULTS
Among 1,822 participants (mean age, 59.4 years; 54.6% women), 181 incident cases of low eGFR were identified. After adjustment for potential confounders, compared to optimal adherence to meat and legume recommendations, low adherence was associated with higher odds of incident low eGFR (P for trend = 0.01); ORs in the lowest and intermediate adherence categories were 2.98 (95% CI, 1.13-7.92) and 1.65 (95% CI, 1.02-2.66), respectively. Low adherence to dairy product recommendations was also associated with higher odds of incident low eGFR compared to optimal adherence (P for trend = 0.03); ORs in the lowest and intermediate adherence categories were 1.98 (95% CI, 1.03-3.82) and 1.59 (95% CI, 0.81-3.11), respectively. In addition, low adherence to meat and legume recommendations was associated with rapid eGFR decline (P for trend = 0.01), and low adherence to dairy product recommendations was associated with rapid eGFR decline (P for trend = 0.01) and incident albuminuria (P for trend = 0.03).


CONCLUSIONS
The DGAI was developed based on the 2005 Dietary Guidelines for Americans.


CONCLUSIONS
Better adherence to dietary recommendations for both meat and legumes and dairy products was associated with lower risk for developing adverse kidney measures.
National Heart, Lung, and Blood Institute's Framingham Heart Study and Population Sciences Branch, Framingham, MA.
Jiantao
J
Ma
Nutritional Epidemiology Program, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA.
Paul F
PF
Jacques
National Heart, Lung, and Blood Institute's Framingham Heart Study and Population Sciences Branch, Framingham, MA.
Shih-Jen
SJ
Hwang
Department of Nutrition, University of Massachusetts, Amherst, MA.
Lisa M
LM
Troy
Nutritional Epidemiology Program, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA.
Nicola M
NM
McKeown
National Heart, Lung, and Blood Institute's Framingham Heart Study and Population Sciences Branch, Framingham, MA.
Audrey Y
AY
Chu
National Heart, Lung, and Blood Institute's Framingham Heart Study and Population Sciences Branch, Framingham, MA. Electronic address: foxca@nhlbi.nih.gov.
Caroline S
CS
Fox
D002318:Cardiovascular Diseases / Q000453:epidemiology; D004032:Diet; D016021:Epidemiologic Studies; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000517:prevention & control*
Dietary Guidelines for Americans Adherence Index (DGAI); Framingham Heart Study Offspring Cohort; albuminuria; dairy products; diet; estimated glomerular filtration rate (eGFR); incident low eGFR; kidney disease progression; meat and legumes; modifiable risk factor; rapid eGFR decline; renal function; urinary albumin-creatinine ratio (UACR)