Association between Dietary Mineral Intake and Chronic Kidney Disease: The Health Examinees (HEXA) Study

Abstract

Few studies have explored the association between mineral intake and chronic kidney disease (CKD). A cross-sectional analysis investigated the association between mineral intake (calcium, phosphorus, sodium, potassium, iron, and zinc) and CKD using the Health Examinee (HEXA) cohort of the Korean Genome and Epidemiologic Study (KoGES). For 159,711 participants, mineral intake was assessed by a food frequency questionnaire. CKD was defined as an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73 m2. Dietary intake of each mineral was divided into quartiles and the quartile including recommended dietary allowance (RDA) or adequate intake (AI) of each mineral was used as a reference. We assessed the association between the quartile of mineral intakes and CKD using polytomous logistic regression models. The lowest quartiles of phosphorus (≤663.68 mg/day, odds ratio [OR] = 1.64, 95% confidence interval [CI]: 1.25–2.15), potassium (≤1567.53 mg/day, OR = 1.87, 95% CI: 1.27–2.75), iron (≤6.93 mg/day, OR = 1.53, 95% CI: 1.17–2.01), and zinc (≤5.86 mg/day, OR = 1.52, 95% CI: 1.02–2.26) were associated with higher odds for advanced CKD compared with the references. The present study suggests that an inadequate intake of some minerals may be associated with CKD occurrence in the general population. Due to the reverse causation issue in this cross-sectional study design, further longitudinal prospective studies are needed in order to prove the results.

The DASH Diet and Cardiometabolic Health and Chronic Kidney Disease: A Narrative Review of the Evidence in East Asian Countries

“…A prospective cohort study in South Korean adults with impaired kidney function found that a higher potassium intake was associated with a decreased risk of CKD development and less estimated glomerular filtration rate (eGFR) decline, but only in participants with hypertension [ 60 ]. These findings are corroborated by a cross-sectional study from South Korea, which found that low potassium intake was associated with increased odds of advanced stage CKD, though only in participants with hypertension [ 61 ]. Phosphorus, though not included in the DASH diet guidelines, is another mineral that may be higher in this diet due to increased intakes of dairy, whole grains, and lean protein sources.…”

“…Phosphorus, though not included in the DASH diet guidelines, is another mineral that may be higher in this diet due to increased intakes of dairy, whole grains, and lean protein sources. The same cross-sectional study from South Korea also examined phosphorus intake and similarly found that lower phosphorus intake was associated with increased risk of advanced stage CKD in participants with hypertension [ 61 ]. It should be noted that dietary guidance typically recommends that patients with CKD reduce their intakes of potassium and phosphorus in order to avoid CKD progression and further complications.…”

Dietary Micronutrients and Risk of Chronic Kidney Disease: A Cohort Study with 12 Year Follow-Up

“…In the general population, low phosphorus intake means very low protein intake, i.e., malnutrition, which increases morbidity and mortality [ 20 ]. In our previous study, we also reported that low phosphorus intake (<664 mg; 1st quartile) increased the prevalence likelihood of CKD relative to 2nd quartile (664–844 mg) [ 10 ]. Low phosphorus intake may reflect that the main food of Koreans is rice and vegetables seasoned with salt and an eating habit of consuming less animal meat and dairy products.…”

“…The subjects were questioned by well-trained interviewers regarding their sociodemographic status, lifestyle (smoking, alcohol consumption, and physical activity), anthropometric measurements, and personal and family medical history. All samples were immediately sent to the Korean National Biobank; the reliability of each biomarker analysis has been previously published [ 10 ]. Blood and urine samples were collected in a serum separator tube (SST), and a two-ethylene ediaminetetra acetic acid (EDTA) tube, along with a 10 mL midstream urine sample.…”

“…It has been reported in three studies that higher intake of certain antioxidant vitamins or healthy diet (e.g., Mediterranean diet) may improve kidney function or reduce CKD [ 7 , 8 , 9 ]. Despite epidemiologic evidence, the associations of dietary minerals and vitamins with the development of CKD have not been universally defined, and the results for each micronutrient have been inconsistent because most studies either used the cross-sectional study design or focused on patients on dialysis [ 7 , 10 ]. In particular, it is not clear how much to eat to prevent CKD, and what is the appropriate intake, which is defined as the minimum risk for developing CKD.…”