膳食脂肪与碳水的比例,或影响慢性肾病的发生发展
  • 纳入9226人,中位随访11.4年,期间记录了778例慢性肾病(CKD);
  • 膳食脂肪/膳食碳水(F/C)比例最低的三分位人群,其估算肾小球滤过率的下降速度更快;
  • 校正多混杂因素后,蛋白质摄入>1g/kg体重/天时,F/C比例最低的三分位(<16.1%)的CKD风险显著升高;
  • 4年期间维持低F/C比例膳食(<16.1%)的人,其后续CKD进展风险比维持更高F/C比例膳食的人显著升高70%;
  • F/C比例与CKD风险呈非线性关系,在<16.1%时随F/C比例降低CKD风险迅速升高。
主编推荐语
mildbreeze
高蛋白摄入与肾脏高滤过和更快的肾功能下降有关,但其他的宏量营养素——碳水化合物和脂肪与慢性肾病(CKD)之间的关系仍不确定。Clinical Nutrition近期发表一项韩国的人群研究,发现当膳食脂肪/膳食碳水化合物的比例较低时,普通人群的肾功能下降更快、患CKD的风险更高。因此,该研究提出为了预防CKD,应注意优化膳食结构,避免过多的碳水化合物和过少的脂肪。
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Clinical Nutrition [IF:7.324]

Relationship between carbohydrate-to-fat intake ratio and the development of chronic kidney disease: A community-based prospective cohort study

碳水化合物/脂肪摄入量的比例与慢性肾脏疾病进展的关系:一项基于社区的前瞻性队列研究

10.1016/j.clnu.2021.09.001

2021-09-09, Article

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Background & aims: It is well-known that high protein intake is associated with renal hyperfiltration and faster renal function decline, but the association of other macronutrients, carbohydrate and fat, with development of chronic kidney disease (CKD) is still inconclusive. Therefore, we aimed to examine the relationship between fat-to-carbohydrate intake ratio (F/C ratio) and incident CKD.
Methods: We included 9226 subjects from the Korean Genome and Epidemiology Study. The subjects were divided into two groups depending on 1 g protein intake per ideal body weight per day. Primary exposure was the F/C ratio defined as calorie intake of fat/calorie intake of fat and carbohydrate. The primary outcome was the development of CKD, which was defined as an estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m2 and/or proteinuria (≥1+).
Results: During a median follow-up duration of 11.4 years, 778 (8.4%) CKD events occurred. Subjects in the lowest F/C ratio tertile had faster eGFR decline rate than other tertiles. In multivariable Cox analysis, a significantly higher CKD risk was observed in the lowest tertile when protein intake > 1 g/kg/day (hazard ratio [HR] for T1 (<16.1%) vs. T3 (>21.5%), 1.38; 95% confidence interval [CI], 1.03–1.84; P = 0.031). In sensitivity analysis, subjects maintained low F/C ratio diet (<16.1%) during 4 years showed higher risk of subsequent CKD development than those maintained high F/C ratio diet (≥16.1%; HR, 1.70; 95% CI, 1.10–2.63; P = 0.018). In cubic spline analysis, CKD risk was sharply increased in F/C ratio <16.1%, but the risk was nearly constant in F/C ratio ≥16.1%.
Conclusions: A diet with a low F/C ratio was associated with increased risk of CKD in the general population. Therefore, it is necessary to limit excessive high carbohydrate and low fat intake to prevent CKD development in this population.

First Authors:
Hyoshik Kim

Correspondence Authors:
Hyoungnae Kim

All Authors:
Hyoshik Kim,Haekyung Lee,Soon Hyo Kwon,Jin Seok Jeon,Hyunjin Noh,Dong Cheol Han,Hyoungnae Kim

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