Abstract P293: The Effect of Diet Beverage Intake on Measures of Diabetes Control: A Pilot Study

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Andrew Odegaard ◽  
Kristin Hirahatake
Keyword(s):  
Kidney Function ◽  
Water Intake ◽  
Diet Quality ◽  
Repeated Measures ◽  
Crossover Trial ◽  
Healthy Eating Index ◽  
Bottled Water ◽  
Diabetes Control ◽  
Health Concern ◽  
Habitual Diet

Introduction: Diet beverages are calorie free beverages sweetened with non-nutritive sweeteners (NNS). People with diabetes are at high macro and microvascular risk and are the highest per capita consumers of diet beverages as they tend to consume them directly in place of sugar sweetened beverages. This behavior has been endorsed by dietetic and scientific organizations; and diet beverages are marketed synonymously with better health, suitable for weight loss, and thus advantageous for diabetes control. The underlying public health concern is the lack of data to support or refute this concept. To begin addressing this evidence gap we carried out a randomized, two period crossover trial testing the effect of habitual diet beverage intake compared to habitual bottled water intake (avoidance of all NNS) on clinical markers of diabetes control and potential mechanistic pathways. Hypothesis: Habitual diet beverage intake will raise glycemia, lower kidney function, and lower diet quality compared to water intake. Methods: We carried out a randomized, two period crossover trial of 12 adults with type 2 diabetes who were being treated with oral medications and were free of other major chronic disease. In two separate 4 week periods with a washout period between them, participants were randomized to consume 24 oz. a day of a diet beverage (DB) of choice in 1 period and 24 oz. a day of bottled water (H2O) in the other while maintaining usual lifestyle habits and diabetes treatment regimens across periods. The primary outcome was change in glycemia (fructosamine). Secondary outcomes were kidney function (eGFR via serum creatinine) and diet quality (healthy eating index score, HEI-2010). All clinical measures were collected by standardized protocol and laboratory measurement. Diet was assessed by 3 random 24 hour recalls each period (1 weekend, 2 weekday) using a web based automated self-administered platform and diet quality was calculated by estimating the HEI-2010. Mixed-model repeated measures linear regression was used to analyze the continuous outcomes data. Results: 10 women and 2 men, mean (SD) age 58.3 (7.9) years with mean (SD) HbA1c % of 7.1 (1.4) at baseline were randomized and completed the study. Glycemia (fructosamine) was reduced, mean (SE) of -3.9 (3.2) umol/L during the H2O period and increased 0.6 (3.2) umol/L during the DB period, p=0.36. The results for kidney function (eGFR) were: H2O: -0.4 (3.7) v. DB: -2.3 (-3.7) mL/min/1.73m 2 , p=0.72. Diet quality was lower during the DB period relative to the H2O period (58.0 v. 61.5, p=0.25). Conclusion: Although the magnitude and precision of the treatment effects limits the inference, these results suggest the need for larger and longer trials to more definitively test this hypothesis and inform the role diet beverages may have in diabetes control.

scholarly journals Diet quality associated peripheral blood DNA methylation signatures

2020 ◽  
Vol 79 (OCE2) ◽  
Author(s):  
Jiantao Ma ◽  
Casey Rebholz ◽  
Kim Braun ◽  
Lindsay Reynolds ◽  
Stella Aslibekyan ◽  
...  
Keyword(s):  
Dna Methylation ◽  
Diet Quality ◽  
Peripheral Blood ◽  
Molecular Mechanisms ◽  
Healthy Eating Index ◽  
European Ancestry ◽  
P Value ◽  
Primary Analysis ◽  
Habitual Diet ◽  
Methylation Patterns

AbstractLeukocyte DNA methylation patterns associated with habitual diet may reveal molecular mechanisms involved in the pathogenesis of diet-related chronic diseases and highlight targets for prevention and treatment. We aimed to examine peripheral blood derived leukocyte DNA methylation signatures associated with diet quality. We meta-analyzed epigenome-wide associations between diet quality and DNA methylation levels at over 400,000 cytosine-guanine dinucleotides (CpGs). We conducted analysis primarily in 6,662 European ancestry (EA) participants and secondarily in a group additionally including 3,062 participants of non-European ancestry from five population-based cohort studies. DNA methylation profiles were measured in whole blood, CD4 + T-cells, or CD14 + monocytes. We used food frequency questionnaires to assess habitual intake and constructed two diet quality scores: the Mediterranean-style diet score (MDS) and Alternative Healthy Eating Index (AHEI). Our primary analysis identified 32 diet-associated CpGs, 12 CpGs for MDS and 24 CpGs for AHEI (at FDR < 0.05, corresponding p-values = 1.2×10-6 and 3.1×10-6, respectively) in EA participants. Four of these CpGs were associated with both MDS and AHEI. In addition, Mendelian randomization analysis indicated that seven diet-associated CpGs were causally linked to at least one of the CVD risk factors. For example, hypermethylation of cg11250194 (FADS2), which was associated with higher diet quality scores, was also associated with lower fasting triglycerides concentrations (p-value = 1.5×10-14) and higher high-density lipoprotein cholesterol concentrations (p-value = 1.7×10-8). Transethnic meta-analysis identified nine additional CpGs associated with diet quality (either MDS or AHEI) at FDR < 0.05. Overall quality of habitual diet was associated with differential peripheral leukocyte DNA methylation levels of 32 CpGs in EA participants. The diet-associated CpGs may serve as biomarkers and targets for preventive measures in CVD health. Future studies are warranted to examine diet-associated DNA methylation patterns in larger, ethnically diverse study samples.

scholarly journals Yogurt Consumption Is Associated with Better Dietary Intake and Diet Quality in School-aged Children (P18-112-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Yong Zhu ◽  
Jessica Smith ◽  
Valerie Benoit ◽  
Neha Jain ◽  
Vipra Vanage ◽  
...  
Keyword(s):  
Dietary Intake ◽  
Diet Quality ◽  
The United States ◽  
Healthy Eating Index ◽  
Health Concern ◽  
School Aged Children ◽  
Funding Sources ◽  
Health And Nutrition ◽  
Calcium Magnesium ◽  
Total Fat

Abstract Objectives To assess associations between yogurt consumption and dietary intake as well as diet quality in school-aged children in the United States. Methods A total of 3709 children aged 6–12 years from the National Health and Nutrition Examination Survey 2011–2012, 2013–2014 and 2015–2016 were included in the study. Day 1 dietary data were used to determine yogurt consumption status, energy and nutrient intake. Healthy Eating Index 2015 (HEI-2015) was used as a measure of diet quality. Multiple linear regression analyses for surveys were conducted to estimate associations between yogurt consumption and dietary intake, as well as diet quality, adjusting for sociodemographic characteristics. Results About 9% of children aged 6–12 years were yogurt eaters. Compared to non-eaters, children who reported yogurt consumption had significantly higher intake of calcium, magnesium, phosphorus, potassium, total sugar and carbohydrate, as well as significantly less intake of total fat and sodium (P < 0.05 for all). There were no significant differences on intake of added sugar and total energy intake. HEI-2015 total score, as well as sub scores for greens and beans, whole fruit, dairy, and sodium were significantly higher in yogurt eaters than non-eaters (P < 0.05 for all). Conclusions Consumption of yogurt is associated with increased intake of several key vitamins and minerals, including nutrients of public health concern such as calcium and potassium, in school-aged children. Yogurt consumption is also associated with better diet quality in this population. Funding Sources The study was funded by General Mills, Inc.

scholarly journals Hydration Status: Influence of Exercise and Diet Quality

2017 ◽  
Vol 13 (4) ◽  
pp. 414-423
Author(s):  
Ismael San Mauro Martín ◽  
Elena Garicano Vilar ◽  
Denisse Aracely Romo Orozco ◽  
Paula Mendive Dubourdieu ◽  
Victor Paredes Barato ◽  
...  
Keyword(s):  
Physical Exercise ◽  
Water Intake ◽  
Diet Quality ◽  
Fluid Intake ◽  
Healthy Eating Index ◽  
Hydration Status ◽  
Total Water ◽  
Essential Components ◽  
Significant Difference ◽  
Total Water Intake

Physical activity, adherence to a healthy diet, and healthy beverage pattern are considered essential components of a healthy lifestyle. We aimed to evaluate the associations between physical exercise, diet quality, and total fluid intake, along with fluid recommendations compliance in a sample of adults. Data on fluid intake from different types of beverages were collected in a cross-sectional study, in 1161 men and women between 18 and 65 years of age, using a fluid-specific diary. Exercise was evaluated with a self-reported questionnaire, and quality of diet was assessed using the Healthy Eating Index-2010 (HEI). Mean volume of water consumed was 1497.5 mL for men, 1309.5 mL for women. A total of 37.4% did not follow the recommendations of the European Food Safety Agency for total water intake. There was a statistically significant difference ( P = .002) between total water intake and follow-up of recommendations, as well as for sex ( P < .001). Mean HEI-2010 score was 65.21. There were no statistically significant differences ( P = .301) in HEI index among better or worse hydration. Sport variables had influence on milliliters of water consumed ( P < .001). Participants who engaged in more physical exercise exhibit a healthier pattern of fluid intake. Healthy individuals with the highest scores for HEI-2010 did not present the healthiest beverage patterns.

scholarly journals Carbon Footprint of Canadian Self-Selected Diets: Trade-Offs With Nutrient Intakes and Diet Quality

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 84-84
Author(s):  
Olivia Auclair ◽  
Sergio A Burgos
Keyword(s):  
Carbon Footprint ◽  
Diet Quality ◽  
Environmental Sustainability ◽  
Food Policy ◽  
Canadian Community Health Survey ◽  
Healthy Eating Index ◽  
Health Concern ◽  
Processed Meat ◽  
Food Groups ◽  
Trade Offs

Abstract Objectives Individuals' dietary choices are critical determinants of human and planetary health. Although the environmental impact of animal-based foods typically exceeds that of plants, trade-offs among nutritional outcomes and environmental sustainability in the context of self-selected diets are less understood. The objectives were to estimate the carbon footprint of Canadian self-selected diets and to compare low- and high-GHGE diets in terms of intake of food groups, nutrients, and diet quality. Methods Twenty-four-hour recalls from the 2015 Canadian Community Health Survey (CCHS) – Nutrition were used to determine dietary intake among adults ≥19 y (n = 13,612). Estimates from the database of Food Impacts on the Environment for Linking to Diets were used to link foods and beverages reported in the CCHS to their greenhouse gas emissions (GHGE). Intake of food groups, nutrients, and diet quality based on the Alternative Healthy Eating Index – 2010 were compared between low- and high-GHGE diets (lowest and highest quintiles of dietary GHGE expressed per 1,000 kcal). Results Dietary GHGE (mean ± SE) was 3.98 ± 0.06 kg CO2-equivalents (eq) per person per d or 2.15 ± 0.03 kg CO2-eq per person per 1,000 kcal. Animal-based foods contributed three-quarters of Canadians' total dietary GHGE, with red and processed meat alone accounting for 47.05 ± 0.82%. High-GHGE diets contained more animal-based foods, but also more vegetables and fruits and miscellaneous foods and beverages; low-GHGE diets contained more cereals, grains, and breads. High-GHGE diet respondents had higher intakes of nutrients of public health concern (iron, potassium, calcium, and vitamin D), but also higher intakes of nutrients to limit (saturated fat and sodium). Moreover, low-GHGE diets had higher diet quality scores compared to high-GHGE diets (55.31 ± 0.49 vs. 47.27 ± 0.46 points; p &lt; 0.0001). Conclusions Self-selected Canadian diets with the highest GHGE contained more animal-based foods and were characterized by higher intakes of nutrients of concern but a lower overall diet quality. These trade-offs warrant attention in shaping future food policy and dietary guidance in Canada aimed at meeting global targets for climate change. Funding Sources None.

scholarly journals Association of Diet Quality Indices with Longitudinal Changes in Kidney Function in U.S. Hispanics/Latinos

Kidney360 ◽  
2020 ◽  
pp. 10.34067/KID.0004552020
Author(s):  
Celestin Missikpode ◽  
Ana C. Ricardo ◽  
Ramon A. Durazo-Arvizu ◽  
Anjella Manoharan ◽  
Josiemer Mattei ◽  
...  
Keyword(s):  
Kidney Function ◽  
Diet Quality ◽  
Healthy Eating Index ◽  
Dietary Quality ◽  
Health Study ◽  
Linear Regression Models ◽  
Urine Albumin ◽  
Incident Chronic Kidney Disease ◽  
The Difference ◽  
Egfr Decline

Background: Recent studies suggest an association between diet quality and incident chronic kidney disease. However, Hispanics/Latinos were under-represented in these studies. We examined the relationship of diet quality with change in kidney function in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Methods: Individuals who participated in HCHS/SOL Visits 1 (2008-2011) and 2 (2014-2017) were analyzed (n=9921). Alternate Healthy Eating Index 2010 (AHEI-2010), Dietary Approaches to Stop Hypertension (DASH), and Mediterranean Diet (MeDS) scores were used as measures of dietary quality and were calculated from two 24-hour dietary recalls administered at Visit 1 and categorized into quartiles of each dietary score (higher quartiles correspond to a healthier diet). Kidney function was assessed at both visits using estimated glomerular filtration rate (eGFR), and urine albumin-to-creatinine ratio (UACR). Annualized change was computed as the difference in eGFR or UACR between visits divided by follow-up time in years. Linear regression models were used to examine the association between quartiles of each dietary quality index and annualized change in eGFR and UACR adjusted for potential confounders. Results: At Visit 1, mean (SD) age was 41 (SD=0.28) years and 56% were female. The baseline mean eGFR was 107.1 mL/min/1.73 m2 and baseline median UACR was 6.1 mg/g. On average, eGFR declined by 0.65 mL/min/1.73 m2 per year and UACR increased by 0.79 mg/g per year over a 6-year period. Lower AHEI-2010 quartiles were associated with eGFR decline in a dose-response manner (p trend=0.02). Higher AHEI-2010 quartiles showed trend toward lower annualized change in UACR, but the result was not significant. Neither MeDS nor DASH scores were associated with eGFR decline or change in UACR. Conclusions: Unhealthy diet assessed by AHEI-2010 was associated with kidney function decline. Improving the quality of the foods/nutrients comprised within the AHEI-2010 may help maintain kidney function in the Hispanic/Latino community

scholarly journals Socio-demographic Factors Associated with Diet Quality Among a Cohort of People Living with HIV (P04-075-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Joachim Sackey ◽  
Grace Wang ◽  
Christine Wanke ◽  
Alice Tang ◽  
Tamsin Knox
Keyword(s):  
Diet Quality ◽  
Repeated Measures ◽  
Healthy Eating Index ◽  
Community Dwelling ◽  
People Living With Hiv ◽  
Term Survival ◽  
Factors Associated ◽  
Cardiovascular Assessment ◽  
Living With Hiv ◽  
Over Time

Abstract Objectives To identify social, demographic and health factors associated with diet quality over time in a community-dwelling population of people living with HIV (PLHIV) in the Greater-Boston area. Methods Secondary analysis of data from the Cardiovascular Assessment Risk Examination (CARE) prospective cohort study carried out between 2007 and 2013. The study included 288 PLHIV recruited from the Greater-Boston area with study visits annually. Repeated measures linear regression models with diet quality [assessed using Healthy Eating Index (HEI-2010)] as the dependent variable was used to analyze the data. The HEI-2010 ranges from 0–100 with a higher score indicating higher diet quality. Results At baseline, study participants were mostly male (73%), 51 ± 7 years, unemployed (56%) and White (51%). They had been living with HIV for an average of 16years with an average CD4 count of 520 cells/mm3. Approximately one third reported being depressed (35%), being food insecure (37%), and binge drinking in the previous 6 months (30%). The mean HEI-2010 score at baseline was 48.7 ± 16.2 with male participants having a higher score (50.5) than females (43.7) (P = 0.004). Longer duration of highly active antiretroviral therapy (HAART), having an undetectable viral load, being food secure, fewer pack-years of smoking, and increasing age were independently associated with higher diet quality over time (P < 0.0001). There were no significant interactions between time and the significant independent variables. Conclusions Among this cohort of PLHIV, several sociodemographic and clinical factors were associated with higher diet quality. Interventions to improve diet quality in PLHIV should focus on younger people and those who are food insecure. In addition, clinicians should continue to push for treatment adherence and viral suppression, along with curtailing smoking. With improved long term survival due to HAART, assessment of food security and diet quality may reduce cardiometabolic risk factors and further improve mortality. Funding Sources National Heart, Lung, And Blood Institute.

Abstract P182: Diet Quality and Longitudinal Change in Kidney Function: Findings From the Hispanic Community Health Study/Study of Latinos (hchs/sol)

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Celestin Missikpode ◽  
Ana Ricardo ◽  
Ramon Durazo-Arvizu ◽  
Josiemer Mattei ◽  
Carmen R Isasi ◽  
...  
Keyword(s):  
Community Health ◽  
Kidney Function ◽  
Diet Quality ◽  
Complete Information ◽  
Estimating Equation ◽  
Potential Effect ◽  
Healthy Eating Index ◽  
Longitudinal Change ◽  
Health Study ◽  
Hispanic Community

Introduction: Recent studies suggest an association between healthy diet and incident chronic kidney disease (CKD), but these included few Hispanics/Latinos. We examined the relationship of diet quality with change in kidney function in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Given the bidirectional relationship between CKD and cardiovascular disease (CVD), we assessed prevalent CVD as a potential effect modifier. Methods: Data from HCHS/SOL Visits 1 (2008-2011) and 2 (2014-2017) were used. The Alternative Healthy Eating Index (AHEI-2010), a measure of diet quality, was calculated from two 24-hour dietary recalls administered at Visit 1 and analyzed as quintiles (lowest to highest quality). Kidney function was assessed using CKD-EPI creat glomerular filtration rate estimating equation (eGFR), and urine albumin-to-creatinine ratio (UACR). Annualized change was computed as the difference in eGFR or UACR between visits divided by follow-up time in years. CVD was defined at Visit 1 as self-reported coronary heart disease, cerebrovascular events, peripheral artery disease or heart failure. Of 16415 HCHS/SOL participants, data from 9336 and 9209 persons with complete information on dietary intake, and change in eGFR and UACR, respectively, were analyzed using linear regression. Interaction between AHEI-2010 and CVD was explored. Analyses accounted for complex sampling design. Results: Average age was 41 years, 52% were women, and 22% had prevalent CVD. On average, eGFR declined by 0.67 mL/min/1.73 m 2 / year, and UACR increased by 2.0 mg/g/year. A significant interaction between diet quality and CVD was seen (p < 0.01). Lower AHEI-2010 quintiles were associated with greater decline in eGFR in a dose-response manner in persons without CVD (P-trend <0.01, Table). The association between diet quality and eGFR was stronger in those with CVD. AHEI-2010 was not associated with change in UACR. Conclusion: These findings have important implications for CKD prevention, especially for those with CVD.

scholarly journals Associations of Maternal Sociodemographic Characteristics and Eating Behaviors with Infant Feeding Behaviors

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1046-1046
Author(s):  
Tonja Nansel ◽  
Leah Lipsky ◽  
Carolina Schwedhelm ◽  
Breanne Wright ◽  
Chelsie Temmen ◽  
...  
Keyword(s):  
Infant Feeding ◽  
Diet Quality ◽  
Maternal Education ◽  
Healthy Eating Index ◽  
Fruit And Vegetables ◽  
Infant Food ◽  
Food Groups ◽  
Feeding Behaviors ◽  
White Race ◽  
Maternal Characteristics

Abstract Objectives This study examines associations of maternal characteristics with infant feeding of discretionary and health-promoting foods. Methods Mothers in PEAS, a prospective cohort study, reported maternal and child dietary intake, demographics, and eating competence (EC). Maternal diet quality (Healthy Eating Index-2015, HEI) was calculated combining 24-hour diet recalls at 6 weeks, 6, and 12 months postpartum (n = 209). Infant food frequency questionnaires were completed at 6, 9, and 12 months, assessing age of introduction and intake frequency of food groups. T-tests examined bivariate associations of demographics with feeding of discretionary sweets, discretionary savory foods, fruit, and vegetables. Linear regressions examined associations of maternal EC and HEI with infant feeding controlling for demographics. Results Fruit, vegetables, discretionary sweet, and discretionary savory foods were introduced at 5.8 ± 1.7, 5.9 ± 1.7, 8.0 ± 2.0, and 8.8 ± 1.8 months, respectively. Earlier introduction of fruit and vegetables was associated with higher maternal education, white race, and nulliparity; earlier introduction of vegetables was also associated with higher income. Age of introduction of discretionary sweet and savory foods was not associated with maternal demographics, HEI, or EC. At age 12 months, greater infant intake frequency of fruit and vegetables was associated with higher education and income, white race, and breastfeeding, while greater intake frequency of discretionary sweet and savory foods was associated with lower maternal education and minority race. Greater intake frequency of sweets was also associated with multiparity and greater intake frequency of discretionary savory foods was associated with lower income. Maternal HEI was positively associated with infant intake frequency of fruit, vegetables, and discretionary sweet and savory foods. Maternal EC was positively associated with infant intake frequency of fruit and vegetables. Conclusions Demographic differences in infant feeding behaviors indicates these behaviors as critical intervention targets to address disparities in child diet quality. Associations of maternal HEI and EC with infant feeding behaviors suggest potential pathways of maternal influence on infant diet. Funding Sources This research was supported by the NICHD Intramural Research Program.

scholarly journals Diet quality in relation to the risk of hypertension among Iranian adults: cross-sectional analysis of Fasa PERSIAN cohort study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Amir Motamedi ◽  
Maryam Ekramzadeh ◽  
Ehsan Bahramali ◽  
Mojtaba Farjam ◽  
Reza Homayounfar
Keyword(s):  
Blood Pressure ◽  
Cohort Study ◽  
Diet Quality ◽  
Dietary Diversity ◽  
Antihypertensive Drugs ◽  
Healthy Eating Index ◽  
Cross Sectional ◽  
Common Chronic Disease ◽  
History Of ◽  
Prevention Of Hypertension

Abstract Background Hypertension is a common chronic disease with various complications and is a main contributing factor to cardiovascular disease (CVD). This study aimed to assess the association of diet quality, assessed by dietary diversity score (DDS), Mediterranean dietary score (MDS), diet quality index-international (DQI-I), and healthy eating index-2015 (HEI-2015) with the risk of hypertension. Methods This study recruited a total of 10,111 individuals (45.14% male) with mean age of 48.63 ± 9.57 years from the Fasa Cohort Study, Iran. Indices of diet quality, including MDS, HEI-2015, DQI-I, and DDS were computed by a 125-item Food Frequency Questionnaire. Participants were diagnosed as hypertensive if they had a diastolic blood pressure (DBP) ≥90 mmHg, systolic blood pressure (SBP) ≥140 mmHg,, or used antihypertensive drugs. Results Hypertension was prevalent in 28.3% of the population (21.59% in males and 33.74% in females). In the whole population, after adjustment for potential covariates, including daily energy intake, age, gender, physical activity, smoking, family history of hypertension, body mass index, and the level of education, higher adherence to the MDS (OR: 0.86, 95%CI = 0.75–0.99) and HEI-2015 (OR: 0.79, 95%CI = 0.68–0.90) was significantly associated with decreased risk of hypertension. The protective effect of HEI-2015 against hypertension remained significant for both males (OR: 0.80, 95%CI = 0.64–0.99) and females (OR: 0.78, 95%CI = 0.66–0.94), while, for MDS, this relationship disappeared in the subgroup analysis by gender. DQI-I and DDS were not related to the odds of hypertension. Conclusions Adhering to MDS and HEI-2015 diets could contribute to the prevention of hypertension.

scholarly journals Early Coaching to Increase Water Intake in CKD

2021 ◽  
Author(s):  
Mariia D. Ivanova ◽  
Anatoliy I. Gozhenko ◽  
Tommy Crestanello ◽  
Dmytro D. Ivanov
Keyword(s):  
Renal Function ◽  
Randomized Trial ◽  
Kidney Function ◽  
Water Intake ◽  
Urine Volume ◽  
Oral Solution ◽  
Increase Water Intake ◽  
Group Randomized Trial ◽  
Ckd Stage ◽  
Patient Reported

<b><i>Introduction:</i></b> In observational studies, increased water intake improves kidney function but not in adults with CKD stage 3 and more. CKD WIT trial has shown a nonsignificant gradual decline in kidney function after 1 year of coaching to increase water intake (CIWI) [<xref ref-type="bibr" rid="ref1">1</xref>]. We propose that CIWI may benefit in CKD stage 1–2 (G1 and G2) and depends on functional renal functional reserve (RFR) [<xref ref-type="bibr" rid="ref2">2</xref>, <xref ref-type="bibr" rid="ref3">3</xref>]. <b><i>Objective:</i></b> Parallel-group randomized trial was aimed to determinate the effectiveness of CIWI dependence of estimated glomerular filtration rate (eGFR) stage and RFR in adults with CKD 1–2 stages. <b><i>Methods:</i></b> CKD WIT trial was taken as the basis for prospective multicenter randomized trial named “Early Coaching to Increase Water Intake in CKD (ECIWIC).” The primary outcome was the change in kidney function by eGFR from baseline to 12 months. Secondary outcomes included 1-year change in urine albumin/Cr ratio, and patient-reported overall quality of health (QH) ranged from 0 (worst possible) to 10 (best possible). CIWI aimed to have the diuresis being 1.7–2 L. There were 4 groups with nondiet sodium restriction which consisted of 31 patients each: 2 groups with CKD G1 and CKD G2, undergoing CIWI and 2 others with CKD G1 and CKD G2 without CIWI (Fig. 1a). Overall checks were made at 0, 6, and 12 months. RFR evaluation was performed using 0.45% sodium chloride oral solution. <b><i>Results:</i></b> Of our randomized 124 patients (mean age 53.2 years; men 83 [67%], 0 died), mean change in 24-h urine volume was 0.6 L per day in G1 with CIWI group and 0.5 L in G2. No statistically significant data on eGFR depending CIWI were obtained (Fig. <xref ref-type="fig" rid="f01">1</xref>b). However, the trend suggests that CIWI improves eGFR in CKD G1 (from 95 to 96 mL/min/1.73 m<sup>2</sup>) and preserves eGFR decline in CKD G2 (78–78). The QH values were also preserved (from 7 to 7 in G1 and G2 groups). Although coaching to maintain the same water intake did not preserve physiological and pathological eGFR decreasing in CKD G1-2 (G1 from 96 to 93, G2 from 76 to 73; <i>t</i> = 0.6, <i>p</i> = 0.29, and <i>p</i> ≤ 0.05 in all groups) and the QH was declined (from 7 to 6 in both groups). An individual analysis of the RFR has shown that patients with RFR more than 50% (G1 19 patients, 61%, and G2 13 patients, 42%) had reliable preservation of eGFR with its increase of 1.5 mL/min on CIWI, while patients with low functional renal reserve had a drop of eGFR at 1.1 mL/min/m<sup>2</sup> within 12 months. Patients with low normal serum sodium levels have shown worse results on CIWI. <b><i>Conclusions:</i></b> With CKD G1, the CIWI leads to the preservation of the renal function with its increase of GFR per 1 mL/min/m<sup>2</sup>/per year in comparison with the same water intake. In CKD G2, the CIWI prevents physiological and pathological loss of renal function, and RFR above 50% aids restoration of eGFR both in CKD G1-2. ECIWIC trial demonstrates benefit of CIWI in patients with CKD 1–2 and preserved RFR.

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