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. 2020 May 21;4(6):nzaa088.
doi: 10.1093/cdn/nzaa088. eCollection 2020 Jun.

A Healthy Beverage Score and Risk of Chronic Kidney Disease Progression, Incident Cardiovascular Disease, and All-Cause Mortality in the Chronic Renal Insufficiency Cohort

Emily A Hu  1 , Cheryl A M Anderson  2 , Deidra C Crews  3 , Katherine T Mills  4 , Jiang He  4 , Haochang Shou  5 , Jonathon J Taliercio  6 , Madhumita J Mohanty  7 , Zeenat Bhat  7 , Josef Coresh  1 , Lawrence J Appel  3 , Casey M Rebholz  1 ; CRIC Study Investigators
Affiliations

A Healthy Beverage Score and Risk of Chronic Kidney Disease Progression, Incident Cardiovascular Disease, and All-Cause Mortality in the Chronic Renal Insufficiency Cohort

Emily A Hu et al. Curr Dev Nutr. .

Abstract

Background: Beverages are a source of calories and other bioactive constituents but are an understudied aspect of the diet. Different beverages have varying effects on health outcomes.

Objectives: We created the Healthy Beverage Score (HBS) to characterize participants' beverage patterns and examined its association with chronic kidney disease (CKD) progression, incident cardiovascular disease (CVD), and all-cause mortality among individuals with CKD.

Methods: We conducted a prospective analysis of 2283 adults aged 21-74 y with a baseline estimated glomerular filtration rate of 20-70 mL · min-1 · 1.73 m-2 from the Chronic Renal Insufficiency Cohort. Diet was assessed using a 124-item FFQ at visit 1 (2003-2008). The HBS, ranging from 7 to 28 possible points, consisted of 7 components, each scored from 1 to 4 based on rank distribution by quartile, except alcohol, which was based on sex-specific cutoffs. Participants were given more points for higher consumption of low-fat milk and of coffee/tea, for moderate alcohol, and for lower consumption of 100% fruit juice, whole-fat milk, artificially sweetened beverages, and sugar-sweetened beverages. CKD progression, incident CVD, and mortality were ascertained through January 2018. We conducted multivariable Cox proportional hazards models.

Results: There were 815 cases of CKD progression, 285 cases of incident CVD, and 725 deaths over a maximum of 14 y of follow-up. Compared with participants in the lowest tertile of the HBS, participants in the highest tertile had a 25% lower likelihood of CKD progression (HR: 0.75; 95% CI: 0.63, 0.89; P-trend = 0.001) and a 17% lower likelihood of all-cause mortality (HR: 0.83; 95% CI: 0.69, 1.00; P-trend = 0.04) after adjusting for sociodemographic, clinical, and dietary factors. There was no significant trend for incident CVD.

Conclusions: Among individuals with CKD, a healthier beverage pattern was inversely associated with CKD progression and all-cause mortality. Beverage intake may be an important modifiable target in preventing adverse outcomes for individuals with CKD.

Keywords: CRIC; all-cause mortality; cardiovascular disease; chronic kidney disease progression; healthy beverages.

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Figures

FIGURE 1
FIGURE 1
Risk of chronic kidney disease progression (A), incident CVD (B), and all-cause mortality (C) by individual components of the HBS per 1 point higher. Cox proportional hazards models were used to estimate HRs and 95% CIs. Models were adjusted for age, sex, race, clinical site, education, income level, baseline estimated glomerular filtration rate, urinary protein, total energy intake, smoking status, physical activity, BMI, diabetes mellitus, CVD, systolic blood pressure, HDL cholesterol, angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker use, Healthy Eating Index-2015 score, and all other components of the HBS. Alcohol was modeled as moderate drinkers compared with heavy or never drinkers. Sample size for analyses of incident CVD was 1578 participants; 705 participants with a history of CVD at baseline were excluded. ASB, artificially sweetened beverage; CVD, cardiovascular disease; HBS, Healthy Beverage Score; SSB, sugar-sweetened beverage.
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