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Cited by 144Chronic Kidney Disease and DiabetesNutritional Studies and DietSodium Intake and Health

Diet and Kidney Disease in High-Risk Individuals With Type 2 Diabetes Mellitus

Dunkler, Daniela·2013·JAMA Internal Medicine
DOI 10.1001/jamainternmed.2013.9051
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Abstract

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. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00153101.

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Authors
Dunkler, D.
Affiliations
Population Health Research Institute (CA)
Corresponding author
Dunkler, Daniela
ORCID
Dunkler, Daniela
Venue
JAMA Internal Medicine
Publisher
American Medical Association (AMA)
Published
2013-08-12
Volume
173
Issue
18
Pages
1682-92
ISSN
2168-6106 (ISSN-L)
DOI
10.1001/jamainternmed.2013.9051
OpenAlex
W2108088034
Cited by
144
References
36
Citations by year
2026: 1 · 2025: 6 · 2024: 10 · 2023: 14 · 2022: 3 · 2021: 7 · 2020: 13 · 2019: 15 · 2018: 11 · 2017: 12 · 2016: 18 · 2015: 13 · 2014: 19 · 2013: 2
FWCI
13.02
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
Topics
  • Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
Keywords
type 2 diabetes, chronic kidney disease, diet, healthy eating, Alternative Healthy Eating Index, microalbuminuria, macroalbuminuria, protein intake, animal protein, sodium intake, alcohol consumption, fruits, mortality, glomerular filtration rate decline, ONTARGET trial, renal risk factors, disease progression, competing risk of death, competing risks
MeSH terms
Telmisartan, Aged, Angiotensin-Converting Enzyme Inhibitors, Benzimidazoles, Benzoates, Diabetes Mellitus, Type 2, Diet, Dose-Response Relationship, Drug, Drug Therapy, Combination, Feeding Behavior, Female, Follow-Up Studies, Glomerular Filtration Rate, Humans, Male, Middle Aged, Prospective Studies, Risk Factors, Time Factors, Global Health, Incidence, Ramipril, Disease Progression, Renal Insufficiency, Chronic

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