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Abstract: PO2421

Diet Quality and Kidney Outcomes in Adolescent and Adult American Indians: The Strong Heart Family Study

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention


  • Mokiao, Reya H., Seattle Children's Hospital, Seattle, Washington, United States
  • Fretts, Amanda M., University of Washington, Seattle, Washington, United States
  • Deen, Jason F., Seattle Children's Hospital, Seattle, Washington, United States
  • Umans, Jason G., MedStar Health Research Institute, Hyattsville, Maryland, United States

The burden of chronic and end stage kidney disease (CKD and ESKD), is exceedingly high amongst American Indians (AIs). We sought to examine the relationship of diet quality, a modifiable risk factor, and kidney outcomes in AI adolescents and adults, hypothesizing that poorer quality diets would be associated with incident albuminuria and accelerated eGFR decline in this population.


This is a secondary analysis of data from the Strong Heart Family Study, a longitudinal study of cardiovascular disease and its risk factors among AIs from Arizona, North and South Dakota, and Oklahoma (n=1721, mean age 39 +/- 16 years, 16% adolescents aged 14-21 years, 61% female, 28% with hypertension, 13% with diabetes, 52% with obesity, 4% with CKD at baseline). Participants completed two exams (baseline: 2001-2003; follow-up: 2007-2009). The primary exposure (at baseline) was the Alternative Healthy Eating Index (AHEI), a measure of diet quality on a 110-point scale (assessed using a 119-item Block food frequency questionnaire). The primary outcomes (at follow-up) were: 1) incident albuminuria (albumin to creatinine ratio 30mg/g); 2) eGFR decline of 30%. Generalized estimating equations were used to examine the association of AHEI (in quartiles) with incident albuminuria and eGFR decline.


In total, 9.9% (5.6% of adolescents) had incident albuminuria and 5.6% of participants (9.2% of adolescents) had eGFR decline of 30%. Median AHEI for the poorest diet quartile was 34 compared to 55 for the healthiest diet quartile, each 10-20 points lower than AHEI scores from studies of the general population. The unadjusted odds ratio (OR) for incident albuminuria comparing extreme quartiles of diet quality (poorest versus healthiest [reference] quartiles) was 1.32 (95%CI 0.92, 1.89). After adjustment for baseline diabetes, eGFR and age, the OR for incident albuminuria was 1.79 (95% CI 1.24, 2.58). There were no significant unadjusted or adjusted associations of diet quality with eGFR decline.


These preliminary results suggest an association of diet quality and incident albuminuria in AI. Given the high burden of CKD in this population, further research is required to determine whether interventions to improve diet quality may improve kidney outcomes.


  • NIDDK Support