Association of Intake of Whole Grains with Health Outcomes in the Chronic Renal Insufficiency Cohort Study.

IF 8.5 1区医学 Q1 UROLOGY & NEPHROLOGY Clinical Journal of the American Society of Nephrology Pub Date : 2024-08-14 DOI:10.2215/CJN.0000000000000538

Dillon Winkelman, Julie Smith-Gagen, Casey M Rebholz, Orlando M Gutierrez, David E St-Jules

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Abstract

Background: Patients with chronic kidney disease (CKD) are encouraged to choose refined grains instead of whole grains as part of the low-phosphorus diet for managing chronic kidney disease-mineral and bone disorders (CKD-MBD). However, there is no direct evidence indicating that limiting whole grains has a beneficial impact on CKD outcomes.

Methods: This study analyzed Chronic Renal Insufficiency Cohort data in two ways, namely cross-sectional examination of CKD-MBD biomarkers and prospective examination of health outcomes. A total of 4,067 (cross-sectional) and 4,331 (prospective) participants were included. The primary exposure was reported intake of whole grains (analyzed as servings/day, servings/1,000kcal, and refined grain servings/whole grain servings). CKD-MBD biomarkers included serum phosphorus, fibroblast growth factor-23, parathyroid hormone, calcitriol, and calcium. Outcomes included cardiovascular events, kidney failure, and all-cause mortality.

Results: In adjusted models, reported intake of whole grains was associated with higher phosphorus intake and serum phosphorus when assessed crudely (serving/day), but not when analyzed in relation to energy. Higher intake of refined grain relative to whole grains was associated (all models) with higher risk of kidney failure (Model 4: 1.01, 95% CI 1.00 to 1.02; P=0.01, all-cause mortality (Model 4: 1.01, 95% CI 1.00 to 1.01; P=0.01), and cardiovasulcar disease except for the fully adjusted model. Higher dietary density was associated with lower mortality in models adjusted for demographic and clinical factors including kidney function, but not in the fully adjusted model that futher adjusted for dietary factors.

Conclusion: Intake of whole grains was not associated with CKD-MBD biomarkers. Intake of whole grains in relation to refined grains was associated with lower risk of cardiovascular disease, kidney failure, and mortality. The results of this study put into question the long-standing practice of restricting whole grains in patients with chronic kidney disease.

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慢性肾功能不全队列研究中全谷物摄入量与健康结果的关系

背景：人们鼓励慢性肾脏病（CKD）患者选择精制谷物而非全谷物，作为控制慢性肾脏病-矿物质和骨骼疾病（CKD-MBD）的低磷饮食的一部分。然而，目前还没有直接证据表明限制全谷物会对慢性肾脏病的治疗结果产生有利影响：本研究通过两种方式分析了慢性肾功能不全队列数据，即横断面 CKD-MBD 生物标志物检查和前瞻性健康结果检查。共纳入了 4067 名（横断面）和 4331 名（前瞻性）参与者。主要暴露指标是报告的全谷物摄入量（以份数/天、份数/1,000 千卡和精制谷物份数/全谷物份数进行分析）。CKD-MBD生物标志物包括血清磷、成纤维细胞生长因子-23、甲状旁腺激素、降钙素三醇和钙。结果包括心血管事件、肾衰竭和全因死亡率：在调整后的模型中，当粗略评估（份/天）时，报告的全谷物摄入量与较高的磷摄入量和血清磷相关，但当分析与能量的关系时，则不相关。与全谷物相比，精制谷物摄入量越高，肾衰竭风险越高（模型 4：1.01，95% CI 1.00 至 1.02；P=0.01），全因死亡率越高（模型 4：1.01，95% CI 1.00 至 1.01；P=0.01），心血管疾病风险越高（完全调整模型除外）。在根据包括肾功能在内的人口统计学和临床因素进行调整的模型中，较高的膳食密度与较低的死亡率相关，但在根据膳食因素进行进一步调整的完全调整模型中，较高的膳食密度与较低的死亡率无关：结论：全谷物摄入量与慢性肾脏病-骨髓增生异常综合征生物标志物无关。与精制谷物相比，全谷物的摄入与较低的心血管疾病、肾衰竭和死亡风险有关。这项研究的结果对长期以来限制慢性肾病患者摄入全谷物的做法提出了质疑。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Journal of the American Society of Nephrology 医学-泌尿学与肾脏学

CiteScore

12.20

自引率

3.10%

发文量

514

审稿时长

3-6 weeks

期刊介绍： The Clinical Journal of the American Society of Nephrology strives to establish itself as the foremost authority in communicating and influencing advances in clinical nephrology by (1) swiftly and effectively disseminating pivotal developments in clinical and translational research in nephrology, encompassing innovations in research methods and care delivery; (2) providing context for these advances in relation to future research directions and patient care; and (3) becoming a key voice on issues with potential implications for the clinical practice of nephrology, particularly within the United States. Original manuscript topics cover a range of areas, including Acid/Base and Electrolyte Disorders, Acute Kidney Injury and ICU Nephrology, Chronic Kidney Disease, Clinical Nephrology, Cystic Kidney Disease, Diabetes and the Kidney, Genetics, Geriatric and Palliative Nephrology, Glomerular and Tubulointerstitial Diseases, Hypertension, Maintenance Dialysis, Mineral Metabolism, Nephrolithiasis, and Transplantation.