Association Between Healthy Dietary Patterns and Chronic Kidney Disease in Patients with Diabetes: Findings from Korean National Health and Nutrition Examination Survey 2019-2021

Abstract

Background/Objectives: Although a healthy dietary pattern is a modifiable lifestyle factor in the prevention of chronic kidney disease (CKD), studies that investigate the association between a healthy diet and prevalent CKD in patients with diabetes, using the Korean Healthy Eating Index (KHEI), are lacking. Methods: This cross-sectional study included 1991 patients with diabetes from the eighth Korean National Health and Nutrition Examination Survey 2019-2021. A higher KHEI indicated healthier eating habits. CKD was defined as an estimated glomerular filtration rate < 60 mL/min/1.73 m(2) or urine albumin-creatinine ratio >= 30 mg/g. The risk of prevalent CKD was evaluated according to the median KHEI value using logistic regression analysis adjusted for various clinicodemographic characteristics. Each KHEI component score was compared between those with and those without CKD, using the Student's t-test. Results: Participants with a higher KHEI were older, with higher proportions of women, non-smokers, and non-alcoholics. A higher KHEI was significantly associated with a lower risk of prevalent CKD (adjusted odds ratio [aOR], 0.73 [0.58-0.93]). Subgroup analysis revealed stronger associations in those without hypertension status (aOR, 0.57 [0.37-0.87]) with at least high school education (aOR, 0.56 [0.38-0.81]). Moreover, patients with diabetes and CKD had significantly lower KHEI, particularly in the adequacy category components, including breakfast consumption, total fruit intake, and dairy product intake. Conclusions: A healthier dietary pattern was associated with a lower risk of prevalent CKD in patients with diabetes. Dietary intervention, which recommends the intake of breakfast, fruits, and dairy products, may be an effective strategy for CKD prevention.