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Dietary inflammatory index and the aging kidney in older women: a 10-year prospective cohort study

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Abstract

Purpose

Chronic inflammation plays a role in the pathogenesis of age-related renal disease and the diet can moderate systemic inflammation. The primary objective of this study was to examine the associations between a dietary inflammatory index (DII®) score and renal function, the trajectory of renal function decline, and renal disease-related hospitalizations and/or mortality over 10 years.

Methods

The study was conducted in 1422 Western Australian women without prevalent chronic kidney disease and aged ≥ 70 years. Baseline dietary data, obtained from a validated food frequency questionnaire, were used to calculate a DII score for each individual.

Results

In this cohort, the mean [range] DII score was 0.19 [− 6.14 to 6.39]. A higher DII score was associated with poorer renal function at baseline and a greater renal function decline over 10 years; after multivariable adjustments, a one-unit higher DII score was associated with a 0.55 mL/min/1.73 m2 lower eGFR at baseline (p = 0.01) and a 0.06 mL/min/1.73 m2 greater annual decline in eGFR over 10 years (p = 0.05). Restricted cubic splines provide evidence of a non-linear association between baseline DII score and risk of a renal disease-related event. Compared to participants in the lowest quintile, those in the highest quintile of DII score were at a higher risk of experiencing a renal disease-related event (adjusted HR 2.06, 95% CI 0.97, 4.37).

Conclusion

Recommending an increased consumption of foods with a higher anti-inflammatory potential could form part of a multifaceted approach to reduce the risk of renal disease through diet and lifestyle changes.

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Acknowledgements

The authors wish to thank the staff at the Data Linkage Branch, Hospital Morbidity Data Collection and Registry of Births, Deaths and Marriages for their work on providing data for this study.

Funding

The study was supported by Kidney Health Australia grant S07 10, Healthway Health Promotion Foundation of Western Australia, Sir Charles Gairdner Hospital Research Advisory Committee Grant and by project grants 254,627, 303169 and 572604 from the National Health and Medical Research Council of Australia. The salary of JRL is supported by a National Health and Medical Research Council of Australia Career Development Fellowship (ID: 1107474). NPB is funded by a National Health and Medical Research Council Early Career Fellowship (Grant number APP1159914), Australia. The salary of JMH is supported by a National Health and Medical Research Council of Australia Senior Research Fellowship, Australia (Grant number APP1116937). WL is supported by the Raine/University of Western Australia clinical fellowship. NS and JRH were supported by the United States National Institute for Diabetes, Digestive and Kidney Diseases (grant no. R44DK103377). None of the funding agencies had any role in the conduct of the study; collection, management, analysis, or interpretation of the data; or preparation, review, or approval of the manuscript.

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Authors and Affiliations

  1. School of Medical and Health Sciences, Edith Cowan University, Perth, WA, 6009, Australia

    Nicola P. Bondonno, Lauren C. Blekkenhorst, Joshua R. Lewis & Jonathan M. Hodgson

  2. Medical School, University of Western Australia, Level 3 Medical Research Foundation Building, Rear 50 Murray Street, Perth, WA, 6000, Australia

    Nicola P. Bondonno, Lauren C. Blekkenhorst, Joshua R. Lewis, Jonathan M. Hodgson, Wai H. Lim & Richard L. Prince

  3. School of Public Health, Curtin University, Bentley, WA, 6102, Australia

    Anna L. Bird & Deborah A. Kerr

  4. School of Public Health, Sydney Medical School, Children’s Hospital at Westmead, Centre for Kidney Research, University of Sydney, Sydney, NSW, 2145, Australia

    Joshua R. Lewis & Germaine Wong

  5. Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA

    Nitin Shivappa & James R. Hébert

  6. Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA

    Nitin Shivappa & James R. Hébert

  7. Connecting Health Innovations LLC, Columbia, SC, 29201, USA

    Nitin Shivappa & James R. Hébert

  8. Centre for Epidemiology and Biostatistics, College of Medicine and Public Health, Flinders University, Adelaide, SA, 5042, Australia

    Richard J. Woodman

  9. Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, 6009, Australia

    Wai H. Lim

  10. Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, WA, 6009, Australia

    Richard L. Prince

Authors
  1. Nicola P. Bondonno
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  2. Lauren C. Blekkenhorst
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  3. Anna L. Bird
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  6. Nitin Shivappa
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  7. James R. Hébert
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  11. Wai H. Lim
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  12. Richard L. Prince
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Contributions

W.H.L., J.R.L., D.A.K., and R.L.P. were responsible for the project conception; J.R.L., R.L.P. collected the data; W.H.L., J.R.L., D.A.K., R.L.P., and J.M.H. developed the research plan; N.S. and J.R.H. contributed expertise and algorithms to calculate the DII scores and consulted on DII-related analyses. N.P.B. analyzed the data; N.P.B., L.C.B., and A.L.B. prepared the manuscript; all authors critically reviewed the manuscript.

Corresponding author

Correspondence to Nicola P. Bondonno.

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Conflict of interest

The authors declare no conflict of interest. Dr. James R. Hébert owns controlling interest in Connecting Health Innovations LLC (CHI), a company that has licensed the right to his invention of the dietary inflammatory index (DII®) from the University of South Carolina to develop computer and smart phone applications for patient counseling and dietary intervention in clinical settings. Dr. Nitin Shivappa is an employee of CHI.

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Bondonno, N.P., Blekkenhorst, L.C., Bird, A.L. et al. Dietary inflammatory index and the aging kidney in older women: a 10-year prospective cohort study. Eur J Nutr 59, 3201–3211 (2020). https://doi.org/10.1007/s00394-019-02160-9

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