Dietary patterns and risk of incident chronic kidney disease: The Atherosclerosis Risk in Communities study

Emily A. Hu, Lyn M. Steffen, Morgan E. Grams, Deidra C. Crews, Josef Coresh, Lawrence J. Appel, Casey M. Rebholz

Research output: Contribution to journalArticlepeer-review

39 Scopus citations


BACKGROUND: Adherence to healthy dietary patterns, measured by the Healthy Eating Index (HEI), Alternative Healthy Eating Index (AHEI), and alternate Mediterranean diet (aMed) scores, is associated with a reduced risk of cardiovascular disease. The association between these scores and chronic kidney disease (CKD) is undetermined.

OBJECTIVE: We aimed to estimate the association between the HEI, AHEI, and aMed scores and risk of incident CKD.

METHODS: We conducted a prospective analysis in 12,155 participants aged 45-64 y from the Atherosclerosis Risk in Communities (ARIC) Study. We calculated HEI-2015, AHEI-2010, and aMed scores for each participant and categorized them into quintiles of each dietary score. Incident CKD was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2 accompanied by ≥25% decline in estimated glomerular filtration rate, a kidney disease-related hospitalization or death, or end-stage renal disease. We used cause-specific hazard models to estimate risk of CKD from the quintile of the dietary score through to 31 December 2017.

RESULTS: There were 3980 cases of incident CKD over a median follow-up of 24 y. Participants who had higher adherence to the HEI-2015, AHEI-2010, and aMed scores were more likely to be female, have higher educational attainment, higher income level, be nonsmokers, more physically active, and diabetic compared with participants who scored lower. All 3 dietary scores were associated with lower CKD risk (P-trend < 0.001). Participants who were in the highest quintile of HEI-2015 score had a 17% lower risk of CKD (HR: 0.83; 95% CI: 0.74, 0.92) compared with participants in the lowest quintile. Those in quintile 5 of AHEI-2010 and aMed scores, respectively, had a 20% and 13% lower risk of CKD compared with those in quintile 1.

CONCLUSION: Higher adherence to healthy dietary patterns during middle age was associated with lower risk of CKD.

Original languageEnglish (US)
Pages (from-to)713-721
Number of pages9
JournalAmerican Journal of Clinical Nutrition
Issue number3
StatePublished - Sep 1 2019

Bibliographical note

Funding Information:
EAH is supported by a grant from the NIH/National Heart, Lung, and Blood Institute (training grant T32 HL007024). CMR is supported by a mentored research scientist development award from the National Institute of Diabetes and Digestive and Kidney Diseases (K01 DK107782) and a grant from the National Heart, Lung, and Blood Institute (R21 HL143089). The Atherosclerosis Risk in Communities (ARIC) Study has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute, NIH, and Department of Health and Human Services (HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700004I, HHSN268201700005I).

Publisher Copyright:
Copyright © American Society for Nutrition 2019.


  • AHEI
  • ARIC
  • DASH
  • HEI
  • Mediterranean
  • dietary patterns
  • dietary scores
  • kidney disease
  • renal disease

PubMed: MeSH publication types

  • Journal Article


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