The Effects of Dietary Patterns on Urinary Albumin Excretion: Results of the Dietary Approaches to Stop Hypertension (DASH) Trial
Received 30 May 2008; accepted 23 October 2008. published online 27 January 2009.
Refers to article:
Effects of Dietary Modification on Albumin Excretion Rate
Mahboob Rahman, Michael C. Smith
American Journal of Kidney Diseases
April 2009 (Vol. 53, Issue 4, Pages 576-578) Full Text |
Full-Text PDF (118 KB)
Background
Dietary studies designed to decrease the urinary albumin excretion rate (AER) typically reduce protein by increasing lower protein plant foods and decreasing higher protein animal products.
Study Design
We evaluated AER while increasing protein intake in the Dietary Approaches to Stop Hypertension (DASH) Trial (randomized, parallel group, 8 week controlled feeding).
Setting & Participants
378 individuals without diabetes with prehypertension or stage I hypertension.
Intervention
The DASH diet, 18% energy from protein, emphasizes, among other features, low-fat dairy products; and the fruit/vegetable (FV) and control diets, each with 15% energy from protein.
Outcome
AER.
Measurements
We measured AER by using immunoassay and covariates at baseline and after 8 weeks.
Results
Baseline AER had a geometric mean value of 4.0 ± 0.2 (SE) mg/24 h. In 285 participants with baseline AER less than 7 mg/24 h, AER was unchanged by diet treatment (geometric mean, 2.5 ± 0.2 mg/24 h in the control diet, 3.0 ± 0.2 mg/24 h in the FV diet, and 2.8 ± 0.2 mg/24 h in the DASH diet). Conversely, in 93 participants with baseline AER of 7 mg/24 h or greater, end-of-feeding AER was lower in the FV diet (6.6 ± 1.0 mg/24 h) than in the control (11.4 ± 1.8 mg/24 h; P = 0.01) or DASH diets (11.7 ± 1.6 mg/24 h; P = 0.005). The DASH and control diets were not different (P = 0.9).
Limitations
Long-term AER change not studied.
Conclusions
The decrease in AER after 8 weeks occurred in only those with high-normal baseline AER in the FV diet, in a pattern distinct from the blood pressure decrease. The DASH diet did not increase AER despite a 3% increase in energy from protein.
1Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
2Department of Nutrition, University of Oslo, Oslo, Norway
3Department of Laboratory Medicine and Pathology, School of Public Health, University of Minnesota, Minneapolis, MN
4Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, MN
5Department of Medicine, Duke Hypertension Center, and Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, NC
6Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD
7Kaiser Permanente Center for Health Research, Portland, OR
8Pennington Biomedical Research Center, part of the Louisiana State University System, Baton Rouge, LA
9Office of Clinical Research, Boston University Medical Center, Brigham & Women's Hospital and Harvard Medical School, Boston, MA
10Department of Nutrition, Harvard School of Public Health, and Channing Laboratory, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA
Address correspondence to David R. Jacobs Jr, PhD, University of Minnesota, Division of Epidemiology and Community Health, School of Public Health, 1300 South 2nd St, Ste 300, Minneapolis, MN 55454
ABSTRACT