Lifestyle-Related Factors, Obesity, and Incident Microalbuminuria: The CARDIA (Coronary Artery Risk Development in Young Adults) Study

Abstract

Background Modifiable lifestyle-related factors are associated with risk of coronary heart disease and may also influence kidney disease risk. Study Design Community-based prospective cohort study. Setting & Participants 2354 African-American and white participants ages 28–40 years, without baseline microalbuminuria or estimated glomerular filtration rate <60 ml/min/1.73 m2 recruited from four U.S. centers: Birmingham AL, Chicago IL, Minneapolis MN, and Oakland CA. Factors Current smoking, physical activity, fast food habits, obesity, and diet quality, which was based on 8 fundamental components of the Dietary Approaches to Stop Hypertension (DASH) diet, including increased intake of fruits, vegetables, low-fat dairy products, whole grains, nuts and legumes, and reduced intake of sodium, sugar sweetened beverages, and red and processed meats. Outcomes & Measurements Spot urine albumin-creatinine ratios (ACRs) were obtained at baseline (1995–96) and 3 5-year follow-up examinations (5, 10, and 15 years follow-up). Incident microalbuminuria was defined as presence of race and sex-adjusted ACR ≥25 mg/g at 2 or more of the successive follow-up examinations. Results Over the 15-year follow-up period, 77 individuals (3.3%) developed incident microalbuminuria. After multivariable adjustment, poor diet quality (OR, 2.0; 95% CI, 1.1–3.4) and obesity (OR, 1.9; 95% CI, 1.1–3.3) were significantly associated with microalbuminuria; current smoking (OR, 1.6; 95% CI, 0.9–2.8) was associated with microalbuminuria although the CI crossed 1.0. Neither low physical activity (OR, 1.0; 95% CI, 0.5–1.8) nor fast food consumption (OR, 1.2; 95% CI, 0.7–2.3) were associated with microalbuminuria. Compared to individuals with no unhealthy lifestyle-related factors (poor diet quality, current smoking and obesity), adjusted odds of incident microalbuminuria were 131%, 273%, and 634% higher for presence of 1 (OR, 2.3; 95% CI, 1.3–4.3), 2 (OR, 3.7; 95% CI, 1.8–7.7), and 3 (OR, 7.3; 95% CI, 2.1–26.1) unhealthy lifestyle-related factors. Limitations Self-reported dietary history and physical activity, low number of outcomes. Conclusions Consuming an unhealthy diet and obesity are associated with incident microalbuminuria.

Cumulative Incidence of Hypertension by 55 Years of Age in Blacks and Whites: The CARDIA Study

“…Height and weight were measured, and body mass index (BMI) was calculated as weight in kilograms divided by height in meters squared. Adherence to the Dietary Approaches to Stop Hypertension (DASH) diet was calculated using the methods described by Chang et al 12. Eight dietary components comprise the DASH adherence score.…”

Obesity and Kidney Disease: Hidden Consequences of the Epidemic

“…Higher BMI is associated with the presence 8 and development [9][10][11] of proteinuria in individuals without kidney disease. Furthermore, in numerous large population-based studies, higher BMI appears associated with the presence 8,12 and development of low estimated glomerular filtration rate (GFR), 9,10,13 with more rapid loss of estimated GFR over time, 14 and with the incidence of ESRD.…”

The Association between a Mediterranean-Style Diet and Kidney Function in the Northern Manhattan Study Cohort

“…There is mounting evidence that poor dietary patterns may lead to kidney disease (6,7). Until recently, dietary studies in CKD have focused mainly on protein intake, which have suggested a modest benefit with protein restriction (8,9).…”