The association of Mediterranean and DASH diets with mortality in adults on hemodialysis: The DIET-HD multinational cohort study

Valeria M. Saglimbene, Germaine Wong, Jonathan C. Craig, Marinella Ruospo, Suetonia C. Palmer, Katrina Campbell, Vanessa Garcia-Larsen, Patrizia Natale, Armando Teixeira-Pinto, Juan Jesus Carrero, Peter Stenvinkel, Letizia Gargano, Angelo M. Murgo, David W. Johnson, Marcello Tonelli, Rubén Gelfman, Eduardo Celia, Tevfik Ecder, Amparo G. Bernat, Domingo Del CastilloDelia Timofte, Marietta Török, Anna Bednarek-Skublewska, Jan Duława, Paul Stroumza, Susanne Hoischen, Martin Hansis, Elisabeth Fabricius, Paolo Felaco, Charlotta Wollheim, Jörgen Hegbrant, Giovanni F.M. Strippoli

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10 Citations (Scopus)

Abstract

Background: Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets associate with lower cardiovascular and all-cause mortality in the general population, but the benefits for patients on hemodialysis are uncertain. Methods: Mediterranean and DASH diet scores were derived from the GA2LEN Food Frequency Questionnaire within the DIET-HD Study, a multinational cohort study of 9757 adults on hemodialysis. We conducted adjusted Cox regression analyses clustered by country to evaluate the association between diet score tertiles and all-cause and cardiovascular mortality (the lowest tertile was the reference category). Results: During the median 2.7-year follow-up, 2087 deaths (829 cardiovascular deaths) occurred. The adjusted hazard ratios (95% confidence intervals) for the middle and highest Mediterranean diet score tertiles were 1.20 (1.01 to 1.41) and 1.14 (0.90 to 1.43), respectively, for cardiovascular mortality and 1.10 (0.99 to 1.22) and 1.01 (0.88 to 1.17), respectively, for all-cause mortality. Corresponding estimates for the same DASH diet score tertiles were 1.01 (0.85 to 1.21) and 1.19 (0.99 to 1.43), respectively, for cardiovascular mortality and 1.03 (0.92 to 1.15) and 1.00 (0.89 to 1.12), respectively, for all-cause mortality. The association between DASH diet score and all-cause death was modified by age (P=0.03); adjusted hazard ratios for the middle and highest DASH diet score tertiles were 1.02 (0.81 to 1.29) and 0.70 (0.53 to 0.94), respectively, for younger patients (#60 years old) and 1.05 (0.93 to 1.19) and 1.08 (0.95 to 1.23), respectively, for older patients. Conclusions: Mediterranean and DASH diets did not associate with cardiovascular or total mortality in hemodialysis.

Original languageEnglish
Pages (from-to)1741-1751
Number of pages11
JournalJournal of The American Society of Nephrology
Volume29
Issue number6
DOIs
Publication statusPublished - Jun 2018
Externally publishedYes

Keywords

  • Dietary patterns
  • Mediterranean diet
  • DASH diet
  • Mortality
  • Hemodialysis
  • End-stage kidney disease

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    Saglimbene, V. M., Wong, G., Craig, J. C., Ruospo, M., Palmer, S. C., Campbell, K., Garcia-Larsen, V., Natale, P., Teixeira-Pinto, A., Carrero, J. J., Stenvinkel, P., Gargano, L., Murgo, A. M., Johnson, D. W., Tonelli, M., Gelfman, R., Celia, E., Ecder, T., Bernat, A. G., ... Strippoli, G. F. M. (2018). The association of Mediterranean and DASH diets with mortality in adults on hemodialysis: The DIET-HD multinational cohort study. Journal of The American Society of Nephrology, 29(6), 1741-1751. https://doi.org/10.1681/ASN.2018010008