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 chronic diseases such as cardiovascular disease, but sparse data are currently available on associations between dietary patterns and microalbuminuria or kidney function decline. Study Design Subgroup analysis from a prospective observational cohort study Setting and Participants Female participants in the Nurses’ Health Study who had dietary patterns data from food frequency questionnaires returned in 1984, 1986, 1990, 1994, and 1998 and urinary albumin-creatinine ratios (ACR) from the year 2000 (n=3121); estimated glomerular filtration rate (eGFR) change between 1989 and 2000 was available in 3071. 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 and Measurements Microalbuminuria (albumin-to-creatinine ratio 25 to 354 mcg/mg) in 2000 and change in kidney function by eGFR between 1989 and 2000. Results After multivariable adjustment, the highest quartile of Western pattern score compared to the lowest quartile was directly associated with microalbuminuria (OR, 2.17; 95% CI, 1.18 to 3.66; p-for trend=0.01) and rapid eGFR decline of ≥3 ml/min/1.73 m2 per year (OR, 1.77; 95% CI, 1.03 to 3.03). Women in the top quartile of the DASH score had decreased risk for rapid eGFR decline (OR, 0.55; 95% CI, 0.38 to 0.80), but had no association with microalbuminuria. These associations did not vary with 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 non-whites and men. Conclusions A Western dietary pattern is associated with a significantly elevated risk for microalbuminuria and rapid kidney function decline whereas a DASH-style dietary pattern may be protective against rapid eGFR decline.