Consumption of whole grains, fruit and vegetables is not associated with indices of renal function in the population-based longitudinal Doetinchem study

Abstract

Emerging evidence suggests that diet and renal function are related. Little is known, however, about the association of consumption of whole grains, fruit and vegetables with urinary albumin:creatinine ratio (ACR) and changes in estimated glomerular filtration rate (eGFR). We investigated this in a population-based cohort aged 26-65 years. Data were from 3787 participants from the Doetinchem cohort study, who were examined ≥3 times, 5 years apart. Consumption of food groups was assessed at each round with a validated FFQ. GFR was estimated at each round from routinely measured cystatin C and creatinine using the Chronic Kidney Disease-Epidemiology (CKD-EPI) equation. ACR was measured at the last round. Generalised estimated equation models were performed to examine associations with changes in eGFR. Linear regression was used to examine associations with ACR. Adjustments were made for covariates related to lifestyle, biological factors and diet. Mean baseline eGFR was 104·5 (SD 13·7) and mean annual decline was −0·95 (SD 0·67) ml/min per 1·73 m 2 over a 15-year follow-up. A trend was observed towards slightly less annual decline in eGFR among those with higher consumption of whole grains (P = 0·06). This association, however, was attenuated and no longer significant in multivariate models (P = 0·29). Consumption of fruit and vegetables was not associated with changes in eGFR and urinary ACR. In conclusion, consumption of whole grains, fruit and vegetables is not associated with changes in eGFR and mean ACR. As this was the first longitudinal study into this association in the general population, and as results are only partially in line with related studies, further research is recommended.

A higher ratio of refined grain to whole grain is associated with a greater likelihood of chronic kidney disease: a population-based study

“…The Northern Manhattan Study (NOMAS) reported that a high vegetable intake (the main source of WG) was related to a significantly lower risk of incident eGFR <60 ml/min per 1•73 m 2 (43) . However, results from the Doetinchem Study (n 3787, 26-65 years) reported no link between WG intake, eGFR and mean ACR (18) , indicating that further research is needed to replicate these findings in other large populations. Discrepancies in these findings may be due to differences in study design.…”

“…However, there is a limited number of controversial evidence on the association between whole grain (WG) or refined grain (RG) and kidney function (17)(18)(19) . The Multi-Ethnic Study of Atherosclerosis (MESA) showed that higher consumption of WG was associated with lower albumin to creatinine ratio (ACR) (20) .…”

“…In contrast, the Framingham Heart Study found no association between consumption of WG, microalbuminuria and low estimated glomerular filtration rate (eGFR) (19) . Very recently, results from the population-based longitudinal Doetinchem study (n 3787, 26-65 years) reported no link between WG intake, eGFR and ACR (18) .…”

Dietary Patterns Based on Estimated Glomerular Filtration Rate and Kidney Function Decline in the General Population: The Lifelines Cohort Study

“…Diet is a modifiable factor that plays an important role in accelerated kidney function decline and incident chronic kidney disease (CKD) [1]. Previous studies predominantly focused on the effects of single nutrients, foods, or food groups in this context [2][3][4]. However, a dietary pattern-based approach may be more informative, as it provides a broader picture of food and nutrient intake [5].…”

Insulin resistance underlies the elevated cardiovascular risk associated with kidney disease and glomerular hyperfiltration

“…Glucagon involvement in the kidney hemodynamic response to animal protein and amino acid mix administration is further supported by the observation that carbohydrate meals (that inhibit glucagon release) do not increase RPF or GFR in normal subjects (Herber-Gast et al, 2017;Juraschek et al, 2013Juraschek et al, , 2016ter Wee et al, 1985). A systematic review and meta-analysis concludes that "weight reduction programs recommending high protein diets from animal sources should be handed with caution'' due to the more pronounced increase in GFR associated with high protein regimens compared to other dietary patterns in subjects without CKD (Schwingshackl and Hoffmann, 2014).…”