Association of Dietary Flavonoid Intakes with End Stage Renal Disease: REasons for Geographic and Racial Differences in Stroke (REGARDS) Study Open Access

Abstract

Background

Flavonoids are bioactive polyphenols that are widely distributed in fruits, vegetables, tea, herbs, and many other commonly consumed plant-based foods and beverages. Observational studies and randomized controlled trials suggest that higher flavonoid intake is associated with lower risk of type 2 diabetes and hypertension, two major risk factors of End Stage Renal Disease (ESRD). Research on flavonoid intake and ESRD in large population cohort is lacking.

Objective

We examined the associations of habitual dietary flavonoid intake with incident ESRD and kidney function decline in the large biracial cohort REasons for Geographic and Racial Differences in Stroke (REGARDS) study.

Methods

We included 19,666 ESRD-free participants from the REGARDS study for analysis of incident ESRD and 10,214 ESRD-free participants for the analysis of substantial kidney function decline. Flavonoid intake was estimated by the linkage of a Block98 food frequency questionnaire with the USDA's Provisional Flavonoid Addendum and Proanthocyanidin Database. Incident ESRD was verified by United State Renal Data System through June 3, 2014. Substantial decline in renal function was defined as a composite of ≥30% decline in estimated glomerular filtration rate from baseline or onset of ESRD. Associations between tertiles of flavonoid intake and incident ESRD were estimated by using multivariable Cox proportional hazards models. Unconditional multivariable logistic regression models were constructed to assess the association between tertiles of flavonoid intake and substantial decline in renal function.

Results

A total of 186 participants developed incident ESRD over 8.3 years.  After adjustment for baseline renal measurements, socio-demographic, lifestyle, and dietary factors, isoflavone intake was inversely associated with incident ESRD (HRT3 vs. T1, 0.62; 95%CI, 0.40-0.95; ptrend = 0.04). Anthocyanidin intake was inversely but marginally significantly associated with incident ESRD (HRT3 vs. T1, 0.68; 95%CI, 0.43-1.06) and significantly associated with substantial decline in renal function (OR: 0.86; 95%CI: 0.76-0.98). Total flavonoid and other flavonoid subclass intakes were not associated with incident ESRD or substantial decline in renal function.

Conclusion

Higher reported intake of dietary isoflavone was associated with lower hazard of incident ESRD. There is some evidence that higher consumption of dietary anthocyanidins may be associated with slower kidney function decline.

Table of Contents

BACKGROUND................................................................................................................... 1

METHODS........................................................................................................................... 3

Study design and data collection......................................................................................... 3

Study population................................................................................................................ 4

Dietary assessment............................................................................................................. 4

Assessment of flavonoid intake........................................................................................... 5

Assessment of outcomes..................................................................................................... 5

Measurement of covariates................................................................................................. 6

Statistical analysis.............................................................................................................. 7

RESULTS............................................................................................................................. 9

DISCUSSION..................................................................................................................... 12

Strengths and limitations.................................................................................................. 14

Conclusion and future directions....................................................................................... 15

REFERENCES.................................................................................................................... 16

TABLES............................................................................................................................. 20

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	kidney function decline end stage renal disease REGARDS study chronic kidney disease flavonoid
Committee Chair / Thesis Advisor	Hartman, Terry, Emory University
Partnering Agencies	National or regional non-profit organization (e.g., American Cancer Society)

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