Mediterranean diet may preserve kidney function better than low-fat for adults with CHD
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Adults with coronary heart disease who followed a Mediterranean diet preserved their kidney function better than those who followed a low-fat diet for 5 years, according to study data published in Clinical Nutrition.
“In persons suffering from coronary heart disease and, in combination with type 2 diabetes, the long-term consumption of a Mediterranean diet would be recommended to preserve kidney function,” Jose Lopez Miranda, MD, PhD, professor of internal medicine at the University of Cordoba and director of the internal medicine unit at Reina Sofia University Hospital in Spain, and Elena M. Yubero-Serrano, PhD, emerging researcher at the Maimonides Biomedical Research Institute of Cordoba, told Healio. “Besides the pharmacological treatment for these diseases, recommendation to follow this dietary model could reduce and delay kidney complications.”
Lopez Miranda, Yubero-Serrano and colleagues conducted a prospective, randomized, single-blind, controlled trial based on an intention-to-treat analysis with 1,002 adults aged 20 to 75 years with established CHD, no clinical events in the 6 months before enrollment, no other serious illness and a life expectancy of at least 5 years. Participants were recruited from Reina Sofia University Hospital and other centers in Spain from November 2009 to February 2012. In addition to conventional treatment for CHD, participants were randomly assigned to follow a Mediterranean diet with at least 35% of total calories from fat and no more than 50% of calories coming from carbohydrates; or a low-fat diet with at least 55% of calories coming from carbohydrates and less than 30% from fat. Participants were followed for 5 years. Kidney function was measure by determining the serum creatinine-based eGFR at baseline and 5 years. Participants were classified into a normal eGFR (n = 514), mildly impaired eGFR (n = 286) and a severely impaired eGFR (n = 53) group based on baseline values.
At 5 years, both the Mediterranean and low-fat diets were associated with a decline in eGFR. Participants following a Mediterranean diet had an eGFR decline rate that was 1.58 mL/min/1.73 m2 lower compared with those on the low-fat diet at 5 years (P = .033).
Adults with a mildly impaired eGFR at baseline on the Mediterranean diet had a 2.49 mL/min/1.73 m2 lower decline in eGFR compared with those in the low-fat group (P = .04). However, no differences in eGFR decline were observed between the two dietary patterns for participants with a normal or severely impaired eGFR at baseline.
Among adults with type 2 diabetes, those consuming a Mediterranean diet had an eGFR decline rate that was 2.07 mL/min/1.73 m2 lower compared with the low-fat diet at 5 years (P = .04), though both dietary patterns were associated with decreased eGFR compared with baseline.
In linear regression analysis, the baseline eGFR of participants was the biggest factor contributing to eGFR changes during the study period (beta = –6.082; P < .001). Other factors included sex (beta = –3.107; P = .001), the presence of diabetes (beta = –2.387; P = .001), allocation to the Mediterranean diet (beta = 1.474; P = .041) and age (beta = –0.153; P = .001).
“Given the bidirectional association between CHD and chronic kidney disease, our results present a dietary strategy as a clinical and therapeutic tool that could better reduce the high recurrence of cardiovascular and/or CKD complications in these patients through the consumption of a Mediterranean diet than a low-fat diet,” the researchers wrote.
Lopez Miranda and Yubero-Serrano said future research is focused on the potential molecular mechanisms and pathways associated with improved kidney function with a Mediterranean diet.
For more information:
Jose Lopez Miranda MD, PhD, can be reached at jlopezmir@uco.es.
Elena M. Yubero-Serrano, PhD, can be reached at elena.yubero@imibic.org.
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