Healthy diet, moderate alcohol may be associated with decreased risk of CKD in diabetes patients

Eating a healthy diet and drinking a moderate amount of alcohol may be associated with decreased risk or progression of chronic kidney disease (CKD) in patients with type 2 diabetes mellitus, according to a report published by JAMA Internal Medicine, a JAMA Network publication.

Type 2 diabetes and associated CKD have become major public health problems. However, little is known about the long-term effect of diet on the incidence and progression of early-stage diabetic CKD, according to the study background.

Daniela Dunkler, Ph.D., of McMaster University, Ontario, Canada, and colleagues examined the association of a healthy diet, alcohol, protein and sodium intake with incident or progression of CKD among patients with type 2 diabetes. All 6,213 patients with type 2 diabetes in the ONTARGET trial were included in the observational study.

The study results indicate that 31.7 percent of patients developed CKD and 8.3 percent of patients died after 5.5 years of follow-up. Compared with patients in the least healthy scoring group on an index that assessed diet quality, patients in the healthiest group had a lower risk of CKD (adjusted odds ratio [OR], 0.74) and lower risk of mortality (OR, 0.61). Patients who ate more than three servings of fruits per week had a lower risk of CKD compared with patients who ate fruit less frequently. Patients in the lowest group of total and animal protein intake had an increased risk of CKD compared with patients in the highest group. Sodium intake was not associated with CKD, while moderate alcohol intake reduced the risk of CKD (OR, 0.75) and mortality (OR, 0.69).

"A healthy diet and moderate intake of alcohol may decrease the incidence or progression of CKD among individuals with type 2 diabetes. Sodium intake, within a wide range, and normal protein intake are not associated with CKD," the study concludes.
(JAMA Intern Med. Published online August 12, 2013. doi:10.1001/jamainternmed.2013.9051. Available pre-embargo to the media at http://media.jamanetwork.com.)

Editor's Note: The ONTARGET trial was sponsored by Boehringer-Ingelheim. The observational study presented herein was funded by SysKid. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Commentary: Moving Dietary Management of Diabetes Forward

In a related commentary, Holly Kramer, M.D., M.P.H., of Loyola University Chicago, Maywood, Ill., and Alex Chang, M.D., M.S., of Johns Hopkins University, Baltimore, write: "Patients with both type 2 diabetes and kidney disease may be frustrated by the numerous dietary restrictions that are recommended by their health care team."

"Patients may even ask 'what can I eat?' Perhaps the best dietary advice we can give to patients with type 2 diabetes and kidney disease is the same as the advice for those who want to avoid chronic kidney disease, and the same advice for preventing and treating hypertension, and the same dietary advice for everyone: eat a diet rich in fruits and vegetables, low-fat dairy products, and whole grains while minimizing saturated and total fat," they conclude.

Source: McMaster University