Dietary patterns are linked to risk and outcomes in chronic kidney disease (CKD). Dietary intake varies by race, region and age. The relationship between a Dietary Approaches to Stop Hypertension (DASH) diet and CKD in elderly Koreans is unclear.
We conducted cross-sectional analyses of 2408 community-dwelling elderly participants from the Korean National Health and Nutrition Examination Survey (2011–2012). DASH dietary patterns for six nutrients (protein, fiber, calcium, potassium, total fat and sodium) were collected by 24 h recall. DASH-US (based on the US recommendations) and DASH-KQ (Korean quartile) scores were generated by summing the scores for the six nutrients. Multivariate logistic regression analysis was used to calculate odds ratio (OR) for the association between a DASH diet and CKD.
Mean subject age was 72.4±5.1 years, 13.9% had CKD and 23.8% had diabetes. Protein, fiber, calcium and potassium intake was lower in CKD than non-CKD participants. In multivariate logistic regression analysis adjusted for age, sex, body mass index, comorbid conditions and other factors, a high DASH score was associated with a low odds for CKD based on DASH-US (OR=0.78, 95% confidence interval (CI), 0.65–0.94, P=0.009) and DASH-KQ (OR=0.95, 95% CI, 0.91–0.99, P=0.022). In six nutrients of DASH diet, high fiber intake showed a low odds for CKD in the DASH-KQ model (P for trend=0.010).
Our findings suggest that higher adherence to a DASH diet and higher fiber intake are associated with lower odds of CKD in elderly Koreans. These results should be corroborated through longitudinal studies of the association between a DASH diet and high-fiber diet on the risk of developing CKD.
Subscribe to Journal
Get full journal access for 1 year
only $9.92 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Tax calculation will be finalised during checkout.
Rent or Buy article
Get time limited or full article access on ReadCube.
All prices are NET prices.
Levey AS, Coresh J . Chronic kidney disease. Lancet 2012; 379: 165–180.
Ash S, Campbell KL, Bogard J, Millichamp A . Nutrition prescription to achieve positive outcomes in chronic kidney disease: a systematic review. Nutrients 2014; 6: 416–451.
Lin J, Fung TT, Hu FB, Curhan GC . Association of dietary patterns with albuminuria and kidney function decline in older white women: a subgroup analysis from the Nurses' Health Study. Am J Kidney Dis 2011; 57: 245–254.
Chang A, Van Horn L, Jacobs DR Jr, Liu K, Muntner P, Newsome B et al. Lifestyle-related factors, obesity, and incident microalbuminuria: the CARDIA (Coronary Artery Risk Development in Young Adults) study. Am J Kidney Dis 2013; 62: 267–275.
Gutierrez OM, Muntner P, Rizk DV, McClellan WM, Warnock DG, Newby PK et al. Dietary patterns and risk of death and progression to ESRD in individuals with CKD: a cohort study. Am J Kidney Dis 2014; 64: 204–213.
Hu FB . Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin Lipidol 2002; 13: 3–9.
Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med 2001; 344: 3–10.
Salehi-Abargouei A, Maghsoudi Z, Shirani F, Azadbakht L . Effects of Dietary Approaches to Stop Hypertension (DASH)-style diet on fatal or nonfatal cardiovascular diseases—incidence: a systematic review and meta-analysis on observational prospective studies. Nutrition 2013; 29: 611–618.
Sacks FM, Campos H . Dietary therapy in hypertension. N Engl J Med 2010; 362: 2102–2112.
Ley SH, Hamdy O, Mohan V, Hu FB . Prevention and management of type 2 diabetes: dietary components and nutritional strategies. Lancet 2014; 383: 1999–2007.
Lim H, Kim SY, Wang Y, Lee SJ, Oh K, Sohn CY et al. Preservation of a traditional Korean dietary pattern and emergence of a fruit and dairy dietary pattern among adults in South Korea: secular transitions in dietary patterns of a prospective study from 1998 to 2010. Nutr Res 2014; 34: 760–770.
Oh C, No JK, Kim HS . Dietary pattern classifications with nutrient intake and body composition changes in Korean elderly. Nutr Res Pract 2014; 8: 192–197.
Flynn MA, Nolph GB, Baker AS, Krause G . Aging in humans: a continuous 20-year study of physiologic and dietary parameters. J Am Coll Nutr 1992; 11: 660–672.
Young VR . Energy requirements in the elderly. Nutr Rev 1992; 50: 95–101.
Lee SW, Kim YC, Oh SW, Koo HS, Na KY, Chae DW et al. Trends in the prevalence of chronic kidney disease, other chronic diseases and health-related behaviors in an adult Korean population: data from the Korean National Health and Nutrition Examination Survey (KNHANES). Nephrol Dial Transplant 2011; 26: 3975–3980.
Levin A, Stevens PE . Summary of KDIGO 2012 CKD Guideline: behind the scenes, need for guidance, and a framework for moving forward. Kidney Int 2014; 85: 49–61.
Mellen PB, Gao SK, Vitolins MZ, Goff DC Jr . Deteriorating dietary habits among adults with hypertension: DASH dietary accordance, NHANES 1988-1994 and 1999-2004. Arch Intern Med 2008; 168: 308–314.
Fung TT, Chiuve SE, McCullough ML, Rexrode KM, Logroscino G, Hu FB . Adherence to a DASH-style diet and risk of coronary heart disease and stroke in women. Arch Intern Med 2008; 168: 713–720.
Levitan EB, Wolk A, Mittleman MA . Consistency with the DASH diet and incidence of heart failure. Arch Intern Med 2009; 169: 851–857.
Appel LJ, Brands MW, Daniels SR, Karanja N, Elmer PJ, Sacks FM . Dietary approaches to prevent and treat hypertension: a scientific statement from the American Heart Association. Hypertension 2006; 47: 296–308.
Shirani F, Salehi-Abargouei A, Azadbakht L . Effects of Dietary Approaches to Stop Hypertension (DASH) diet on some risk for developing type 2 diabetes: a systematic review and meta-analysis on controlled clinical trials. Nutrition 2013; 29: 939–947.
Jacobs Jr DR, Gross MD, Steffen L, Steffes MW, Yu X, Svetkey LP et al. The effects of dietary patterns on urinary albumin excretion: results of the Dietary Approaches to Stop Hypertension (DASH) Trial. Am J Kidney Dis 2009; 53: 638–646.
Gopinath B, Harris DC, Flood VM, Burlutsky G, Brand-Miller J, Mitchell P . Carbohydrate nutrition is associated with the 5-year incidence of chronic kidney disease. J Nutr 2011; 141: 433–439.
Graudal NA, Galloe AM, Garred P . Effects of sodium restriction on blood pressure, renin, aldosterone, catecholamines, cholesterols, and triglyceride: a meta-analysis. JAMA 1998; 279: 1383–1391.
O'Donnell MJ, Mente A, Smyth A, Yusuf S . Salt intake and cardiovascular disease: why are the data inconsistent? Eur Heart J 2013; 34: 1034–1040.
Cuenca-Sanchez M, Navas-Carrillo D, Orenes-Pinero E . Controversies surrounding high-protein diet intake: satiating effect and kidney and bone health. Adv Nutr 2015; 6: 260–266.
Stolarz-Skrzypek K, Kuznetsova T, Thijs L, Tikhonoff V, Seidlerova J, Richart T et al. Fatal and nonfatal outcomes, incidence of hypertension, and blood pressure changes in relation to urinary sodium excretion. JAMA 2011; 305: 1777–1785.
Thomas MC, Moran J, Forsblom C, Harjutsalo V, Thorn L, Ahola A et al. The association between dietary sodium intake, ESRD, and all-cause mortality in patients with type 1 diabetes. Diabetes Care 2011; 34: 861–866.
Fan L, Tighiouart H, Levey AS, Beck GJ, Sarnak MJ . Urinary sodium excretion and kidney failure in nondiabetic chronic kidney disease. Kidney Int 2014; 86: 582–588.
Sharma S, McFann K, Chonchol M, de Boer IH, Kendrick J . Association between dietary sodium and potassium intake with chronic kidney disease in US adults: a cross-sectional study. Am J Nephrol 2013; 37: 526–533.
Barbaresko J, Koch M, Schulze MB, Nothlings U . Dietary pattern analysis and biomarkers of low-grade inflammation: a systematic literature review. Nutr Rev 2013; 71: 511–527.
Galland L . Diet and inflammation. Nutr Clin Pract 2010; 25: 634–640.
Odermatt A . The Western-style diet: a major risk factor for impaired kidney function and chronic kidney disease. Am J Physiol Renal Physiol 2011; 301: F919–F931.
Krishnamurthy VM, Wei G, Baird BC, Murtaugh M, Chonchol MB, Raphael KL et al. High dietary fiber intake is associated with decreased inflammation and all-cause mortality in patients with chronic kidney disease. Kidney Int 2012; 81: 300–306.
Diaz-Lopez A, Bullo M, Basora J, Martinez-Gonzalez MA, Guasch-Ferre M, Estruch R et al. Cross-sectional associations between macronutrient intake and chronic kidney disease in a population at high cardiovascular risk. Clin Nutr 2013; 32: 606–612.
Xu H, Huang X, Riserus U, Krishnamurthy VM, Cederholm T, Arnlov J et al. Dietary fiber, kidney function, inflammation, and mortality risk. Clin J Am Soc Nephrol 2014; 9: 2104–2110.
Gupta J, Mitra N, Kanetsky PA, Devaney J, Wing MR, Reilly M et al. Association between albuminuria, kidney function, and inflammatory biomarker profile in CKD in CRIC. Clin J Am Soc Nephrol 2012; 7: 1938–1946.
King DE, Egan BM, Woolson RF, Mainous AG 3rd, Al-Solaiman Y, Jesri A . Effect of a high-fiber diet vs a fiber-supplemented diet on C-reactive protein level. Arch Intern Med 2007; 167: 502–506.
Jones JM . Dietary fiber future directions: integrating new definitions and findings to inform nutrition research and communication. Adv Nutr 2013; 4: 8–15.
Song Y, Joung H . A traditional Korean dietary pattern and metabolic syndrome abnormalities. Nutr Metab Cardiovasc Dis 2012; 22: 456–462.
Lee KW, Cho MS . The traditional Korean dietary pattern is associated with decreased risk of metabolic syndrome: findings from the Korean National Health and Nutrition Examination Survey, 1998-2009. J Med Food 2014; 17: 43–56.
Lee HS, Lee SS, Hwang IY, Park YJ, Yoon SH, Han K et al. Prevalence, awareness, treatment and control of hypertension in adults with diagnosed diabetes: the Fourth Korea National Health and Nutrition Examination Survey (KNHANES IV). J Hum Hypertens 2013; 27: 381–387.
We thank the Korean National Health and Nutrition Examination Survey (KNHANES, https://knhanes.cdc.go.kr/knhanes/eng/index.do).
The authors declare no conflict of interest.
About this article
Cite this article
Lee, H., Lee, K., Hyun, Y. et al. DASH dietary pattern and chronic kidney disease in elderly Korean adults. Eur J Clin Nutr 71, 755–761 (2017). https://doi.org/10.1038/ejcn.2016.240
Dietary patterns and chronic kidney disease risk: a systematic review and updated meta-analysis of observational studies
Nutrition Journal (2021)
Dietary patterns associated with renal impairment in the Northern Ireland Cohort for the Longitudinal Study of Ageing (NICOLA)
European Journal of Nutrition (2021)
Nutrition & Metabolism (2018)
Dietary patterns and chronic kidney disease: a cross-sectional association in the Irish Nun Eye Study
Scientific Reports (2018)