Rationale & Objective: A diet rich in vegetables and fruit can lower blood pressure and may reduce cardiovascular risk. However, the association between this dietary pattern and incident chronic kidney disease in the general population is unknown. Study Design: A community-based prospective cohort study. Setting & Participants: 9,229 study participants with normal kidney function from the Korean Genome and Epidemiology Study database. Predictors: Daily consumption of nonfermented and fermented vegetables and fruit classified into tertiles based on a validated semiquantitative food-frequency questionnaire. Outcomes: Incident occurrence of estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2, incident proteinuria (≥1+ by dipstick test), and repeated measures of estimated net endogenous acid production. Analytical Approach: Multivariable cause-specific hazards model to assess the association of vegetable and fruit intake with incident chronic kidney disease. Results: During a mean follow-up of 8.2 years, 1,741 (21.9/1,000 person-years [PY]) participants developed eGFRs < 60 mL/min/1.73 m2. Incident eGFR < 60 mL/min/1.73 m2 occurred less frequently with higher intake of nonfermented vegetables, occurring at rates of 22.8/1,000 PY, 22.7/1,000 PY, and 20.1/1,000 PY for the lowest, middle, and highest tertiles, respectively; P for trend < 0.001. The incidence of proteinuria was also lower in the middle and highest tertiles. In a multivariable cause-specific hazards model, the highest tertile of nonfermented vegetable intake was associated with 14% lower risk for incident eGFR < 60 mL/min/1.73 m2 than the lowest tertile. The highest tertile was also associated with 32% lower risk for proteinuria than the lowest tertile. There were no associations of fermented vegetable and fruit intake with incidence of eGFR < 60 mL/min/1.73 m2. However, the highest tertiles of both fermented vegetable and fruit intake were associated with 14% and 45% lower risks for incident proteinuria compared with the lowest tertiles (both P < 0.001). During follow-up, estimated net endogenous acid production increased in the lowest tertile of intake of nonfermented or fermented vegetables and fruit, whereas it decreased in the highest tertile. Limitations: Self-reported dietary intake, single ethnicity population. Conclusions: A diet rich in vegetables and fruit may reduce the risk for kidney disease.
Bibliographical noteFunding Information:
Jong Hyun Jhee, MD, Youn Kyung Kee, MD, Jung Tak Park, MD, PhD, Tae-Ik Chang, MD, PhD, Ea Wha Kang, MD, PhD, Tae-Hyun Yoo, MD, PhD, Shin-Wook Kang, MD, PhD, and Seung Hyeok Han, MD, PhD. Research idea and study design: JHJ, SHH; data acquisition: JHJ; data analysis/interpretation: JHJ, YKK; statistical analysis: JHJ, YKK; supervision or mentorship: JTP, T-IC, EWK, T-HY, S-WK, SHH. Each author contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved. This research was supported by a grant from the Ministry for Health and Welfare, Republic of Korea. The epidemiologic data used in this study were obtained from KoGES (4851-302) of the Korea Centers for Disease Control and Prevention, Republic of Korea. This study was also supported by a research grant from Inha University Hospital. The funders of this study had no role in the study design; data collection, analysis, or interpretation; writing of the report; or the decision to submit the report for publication. The authors declare that they have no relevant financial interests. Received September 5, 2018. Evaluated by 2 external peer reviewers, with direct editorial input from a Statistics/Methods Editor, an Associate Editor, and the Editor-in-Chief. Accepted in revised form February 11, 2019.
This research was supported by a grant from the Ministry for Health and Welfare, Republic of Korea. The epidemiologic data used in this study were obtained from KoGES (4851-302) of the Korea Centers for Disease Control and Prevention, Republic of Korea. This study was also supported by a research grant from Inha University Hospital. The funders of this study had no role in the study design; data collection, analysis, or interpretation; writing of the report; or the decision to submit the report for publication.
© 2019 National Kidney Foundation, Inc.
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