The Effects of Dietary Patterns on Urinary Albumin Excretion

Results of the Dietary Approaches to Stop Hypertension (DASH) Trial

David R Jacobs Jr, Myron D Gross, Lyn M Steffen, Michael W Steffes, Xinhua Yu, Laura P. Svetkey, Lawrence J. Appel, William M. Vollmer, George A. Bray, Thomas Moore, Paul R. Conlin, Frank Sacks

Research output: Contribution to journalArticle

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Abstract

Background: Dietary studies designed to decrease the urinary albumin excretion rate (AER) typically reduce protein by increasing lower protein plant foods and decreasing higher protein animal products. Study Design: We evaluated AER while increasing protein intake in the Dietary Approaches to Stop Hypertension (DASH) Trial (randomized, parallel group, 8 week controlled feeding). Setting & Participants: 378 individuals without diabetes with prehypertension or stage I hypertension. Intervention: The DASH diet, 18% energy from protein, emphasizes, among other features, low-fat dairy products; and the fruit/vegetable (FV) and control diets, each with 15% energy from protein. Outcome: AER. Measurements: We measured AER by using immunoassay and covariates at baseline and after 8 weeks. Results: Baseline AER had a geometric mean value of 4.0 ± 0.2 (SE) mg/24 h. In 285 participants with baseline AER less than 7 mg/24 h, AER was unchanged by diet treatment (geometric mean, 2.5 ± 0.2 mg/24 h in the control diet, 3.0 ± 0.2 mg/24 h in the FV diet, and 2.8 ± 0.2 mg/24 h in the DASH diet). Conversely, in 93 participants with baseline AER of 7 mg/24 h or greater, end-of-feeding AER was lower in the FV diet (6.6 ± 1.0 mg/24 h) than in the control (11.4 ± 1.8 mg/24 h; P = 0.01) or DASH diets (11.7 ± 1.6 mg/24 h; P = 0.005). The DASH and control diets were not different (P = 0.9). Limitations: Long-term AER change not studied. Conclusions: The decrease in AER after 8 weeks occurred in only those with high-normal baseline AER in the FV diet, in a pattern distinct from the blood pressure decrease. The DASH diet did not increase AER despite a 3% increase in energy from protein.

Original languageEnglish (US)
Pages (from-to)638-646
Number of pages9
JournalAmerican Journal of Kidney Diseases
Volume53
Issue number4
DOIs
StatePublished - Apr 1 2009

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Albumins
Hypertension
Diet
Vegetables
Fruit
Proteins
Prehypertension
Plant Proteins
Edible Plants
Dairy Products
Immunoassay
Fats
Blood Pressure

Keywords

  • Albumin excretion
  • phytochemical
  • protein
  • short term feeding

Cite this

The Effects of Dietary Patterns on Urinary Albumin Excretion : Results of the Dietary Approaches to Stop Hypertension (DASH) Trial. / Jacobs Jr, David R; Gross, Myron D; Steffen, Lyn M; Steffes, Michael W; Yu, Xinhua; Svetkey, Laura P.; Appel, Lawrence J.; Vollmer, William M.; Bray, George A.; Moore, Thomas; Conlin, Paul R.; Sacks, Frank.

In: American Journal of Kidney Diseases, Vol. 53, No. 4, 01.04.2009, p. 638-646.

Research output: Contribution to journalArticle

Jacobs Jr, David R ; Gross, Myron D ; Steffen, Lyn M ; Steffes, Michael W ; Yu, Xinhua ; Svetkey, Laura P. ; Appel, Lawrence J. ; Vollmer, William M. ; Bray, George A. ; Moore, Thomas ; Conlin, Paul R. ; Sacks, Frank. / The Effects of Dietary Patterns on Urinary Albumin Excretion : Results of the Dietary Approaches to Stop Hypertension (DASH) Trial. In: American Journal of Kidney Diseases. 2009 ; Vol. 53, No. 4. pp. 638-646.
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abstract = "Background: Dietary studies designed to decrease the urinary albumin excretion rate (AER) typically reduce protein by increasing lower protein plant foods and decreasing higher protein animal products. Study Design: We evaluated AER while increasing protein intake in the Dietary Approaches to Stop Hypertension (DASH) Trial (randomized, parallel group, 8 week controlled feeding). Setting & Participants: 378 individuals without diabetes with prehypertension or stage I hypertension. Intervention: The DASH diet, 18{\%} energy from protein, emphasizes, among other features, low-fat dairy products; and the fruit/vegetable (FV) and control diets, each with 15{\%} energy from protein. Outcome: AER. Measurements: We measured AER by using immunoassay and covariates at baseline and after 8 weeks. Results: Baseline AER had a geometric mean value of 4.0 ± 0.2 (SE) mg/24 h. In 285 participants with baseline AER less than 7 mg/24 h, AER was unchanged by diet treatment (geometric mean, 2.5 ± 0.2 mg/24 h in the control diet, 3.0 ± 0.2 mg/24 h in the FV diet, and 2.8 ± 0.2 mg/24 h in the DASH diet). Conversely, in 93 participants with baseline AER of 7 mg/24 h or greater, end-of-feeding AER was lower in the FV diet (6.6 ± 1.0 mg/24 h) than in the control (11.4 ± 1.8 mg/24 h; P = 0.01) or DASH diets (11.7 ± 1.6 mg/24 h; P = 0.005). The DASH and control diets were not different (P = 0.9). Limitations: Long-term AER change not studied. Conclusions: The decrease in AER after 8 weeks occurred in only those with high-normal baseline AER in the FV diet, in a pattern distinct from the blood pressure decrease. The DASH diet did not increase AER despite a 3{\%} increase in energy from protein.",
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AU - Steffes, Michael W

AU - Yu, Xinhua

AU - Svetkey, Laura P.

AU - Appel, Lawrence J.

AU - Vollmer, William M.

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AU - Moore, Thomas

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N2 - Background: Dietary studies designed to decrease the urinary albumin excretion rate (AER) typically reduce protein by increasing lower protein plant foods and decreasing higher protein animal products. Study Design: We evaluated AER while increasing protein intake in the Dietary Approaches to Stop Hypertension (DASH) Trial (randomized, parallel group, 8 week controlled feeding). Setting & Participants: 378 individuals without diabetes with prehypertension or stage I hypertension. Intervention: The DASH diet, 18% energy from protein, emphasizes, among other features, low-fat dairy products; and the fruit/vegetable (FV) and control diets, each with 15% energy from protein. Outcome: AER. Measurements: We measured AER by using immunoassay and covariates at baseline and after 8 weeks. Results: Baseline AER had a geometric mean value of 4.0 ± 0.2 (SE) mg/24 h. In 285 participants with baseline AER less than 7 mg/24 h, AER was unchanged by diet treatment (geometric mean, 2.5 ± 0.2 mg/24 h in the control diet, 3.0 ± 0.2 mg/24 h in the FV diet, and 2.8 ± 0.2 mg/24 h in the DASH diet). Conversely, in 93 participants with baseline AER of 7 mg/24 h or greater, end-of-feeding AER was lower in the FV diet (6.6 ± 1.0 mg/24 h) than in the control (11.4 ± 1.8 mg/24 h; P = 0.01) or DASH diets (11.7 ± 1.6 mg/24 h; P = 0.005). The DASH and control diets were not different (P = 0.9). Limitations: Long-term AER change not studied. Conclusions: The decrease in AER after 8 weeks occurred in only those with high-normal baseline AER in the FV diet, in a pattern distinct from the blood pressure decrease. The DASH diet did not increase AER despite a 3% increase in energy from protein.

AB - Background: Dietary studies designed to decrease the urinary albumin excretion rate (AER) typically reduce protein by increasing lower protein plant foods and decreasing higher protein animal products. Study Design: We evaluated AER while increasing protein intake in the Dietary Approaches to Stop Hypertension (DASH) Trial (randomized, parallel group, 8 week controlled feeding). Setting & Participants: 378 individuals without diabetes with prehypertension or stage I hypertension. Intervention: The DASH diet, 18% energy from protein, emphasizes, among other features, low-fat dairy products; and the fruit/vegetable (FV) and control diets, each with 15% energy from protein. Outcome: AER. Measurements: We measured AER by using immunoassay and covariates at baseline and after 8 weeks. Results: Baseline AER had a geometric mean value of 4.0 ± 0.2 (SE) mg/24 h. In 285 participants with baseline AER less than 7 mg/24 h, AER was unchanged by diet treatment (geometric mean, 2.5 ± 0.2 mg/24 h in the control diet, 3.0 ± 0.2 mg/24 h in the FV diet, and 2.8 ± 0.2 mg/24 h in the DASH diet). Conversely, in 93 participants with baseline AER of 7 mg/24 h or greater, end-of-feeding AER was lower in the FV diet (6.6 ± 1.0 mg/24 h) than in the control (11.4 ± 1.8 mg/24 h; P = 0.01) or DASH diets (11.7 ± 1.6 mg/24 h; P = 0.005). The DASH and control diets were not different (P = 0.9). Limitations: Long-term AER change not studied. Conclusions: The decrease in AER after 8 weeks occurred in only those with high-normal baseline AER in the FV diet, in a pattern distinct from the blood pressure decrease. The DASH diet did not increase AER despite a 3% increase in energy from protein.

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