ISTANBUL, Turkey — A Mediterranean-like diet is associated with better renal function in people with chronic kidney disease. Adherence to the diet was also an independent predictor of mortality, according to a new study.

The results underscore the value of lifestyle and dietary patterns. "It's important to suggest to our kidney disease patients that they modify their lifestyles by increasing physical activity and adopting a healthier dietary pattern," Xiaoyan Huang, MD, who is a PhD student at the Karolinska Institute in Stockholm, Sweden, told Medscape Medical News. "The Mediterranean dietary pattern could be one choice. We don't know what the best diet is, but at least this is a good one."

The study grew out of Dr. Huang's PhD project. He studied linoleic acid in dialysis patients and found that the agent, which comes mainly from vegetable oils, is associated with both inflammation and better survival in dialysis patients.

The next thing to determine was whether linoleic acid is associated with mortality in the kidney disease population before dialysis. "It is better to study the whole dietary pattern rather than individual nutrients because when we consume linoleic acid, we also consume more fiber, vitamin C, vitamin E, and other nutrients," Dr. Huang said.

He presented the study results here at the European Renal Association-European Dialysis and Transplant Association 50th Congress.

Dr. Huang and colleagues followed 1110 Swedish men (mean age, 70 years), 506 of whom had a glomerular filtration rate below 60 mL/min per 1.73 m².

The researchers used 7-day dietary records to calculate a Mediterranean Diet Score, and categorized subjects as low, medium, and high adherents to the diet. Median follow-up was 9.9 years.

Less Kidney Disease

High adherents were 42% less likely to have kidney disease than low adherents (adjusted odds ratio, 0.58; 95% confidence interval, 0.38 - 0.87; = .04). Of those with chronic kidney disease, 33% died during the follow-up period.

The researchers found no significant difference in cardiometabolic risk factors (body mass index, waist circumference, blood pressure, blood lipids, glucose, insulin, inflammation, or albumin). However, a proportional hazards regression analysis revealed that high adherence was independently associated with a mortality risk that was 18% lower for every 2-point increase in Mediterranean Diet Score. For subjects with adequate dietary intake, the associations were stronger.

"We know that the Mediterranean diet prevents cardiovascular mortality in the general population; this shows that it may help in patients with chronic kidney disease," session moderator Bénédicte Stengel, MD, PhD, research director at INSERM in Paris, France, told Medscape Medical News.

Many risk factors for cardiovascular mortality are shared between the general population and individuals with kidney disease, but not all. "Some risk factors are not similar, so it is worth testing it," Dr. Stengel added.

Dr. Huang and Dr. Stengel have disclosed no relevant financial relationships.

European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) 50th Congress: Abstract SO028. Presented May 19, 2013.


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