Adherence to Dietary Patterns and Risk of Incident Dementia: Findings from the Atherosclerosis Risk in Communities Study

Background: Previous studies have suggested that adherence to healthy dietary patterns during late life may be associated with improved cognition. However, few studies have examined the association between healthy dietary patterns during midlife and incident dementia. Objective: Our study aimed to determine the association between adherence to healthy dietary patterns at midlife and incident dementia. Methods: We included 13,630 adults from the Atherosclerosis Risk in Communities (ARIC) Study in our prospective analysis. We used food frequency questionnaire responses to calculate four dietary scores: Healthy Eating Index-2015 (HEI-2015), Alternative Healthy Eating Index-2010 (AHEI-2010), alternate Mediterranean (aMed) diet, and Dietary Approaches to Stop Hypertension (DASH). Participants were followed until the end of 2017 for incident dementia. Cox regression models adjusted for covariates were used to estimate risk of incident dementia by quintile of dietary scores. Results: Over a median of 27 years, there were 2,352 cases of incident dementia documented. Compared with participants in quintile 1 of HEI-2015, participants in quintile 5 (healthiest) had a 14% lower risk of incident dementia (hazard ratio, HR: 0.86, 95% confidence interval, CI: 0.74–0.99). There were no significant associations of incident dementia with the AHEI-2010, aMed, or DASH scores. There were no significant interactions by sex, age, race, education, physical activity, hypertension, or obesity. Conclusion: Adherence to the HEI-2015, but not the other dietary scores, during midlife was associated with lower risk of incident dementia. Further research is needed to elucidate whether timing of a healthy diet may influence dementia risk.

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Dietary patterns and risk of incident chronic kidney disease: the Atherosclerosis Risk in Communities study

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqz146 ◽

2019 ◽

Vol 110 (3) ◽

pp. 713-721 ◽

Cited By ~ 13

Author(s):

Emily A Hu ◽

Lyn M Steffen ◽

Morgan E Grams ◽

Deidra C Crews ◽

Josef Coresh ◽

...

Keyword(s):

Kidney Disease ◽

Healthy Eating ◽

Dietary Patterns ◽

Lower Risk ◽

Filtration Rate ◽

Estimated Glomerular Filtration Rate ◽

Healthy Eating Index ◽

Atherosclerosis Risk In Communities ◽

Atherosclerosis Risk ◽

Dietary Score

ABSTRACTBackgroundAdherence to healthy dietary patterns, measured by the Healthy Eating Index (HEI), Alternative Healthy Eating Index (AHEI), and alternate Mediterranean diet (aMed) scores, is associated with a reduced risk of cardiovascular disease. The association between these scores and chronic kidney disease (CKD) is undetermined.ObjectiveWe aimed to estimate the association between the HEI, AHEI, and aMed scores and risk of incident CKD.MethodsWe conducted a prospective analysis in 12,155 participants aged 45–64 y from the Atherosclerosis Risk in Communities (ARIC) Study. We calculated HEI-2015, AHEI-2010, and aMed scores for each participant and categorized them into quintiles of each dietary score. Incident CKD was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2 accompanied by ≥25% decline in estimated glomerular filtration rate, a kidney disease–related hospitalization or death, or end-stage renal disease. We used cause-specific hazard models to estimate risk of CKD from the quintile of the dietary score through to 31 December 2017.ResultsThere were 3980 cases of incident CKD over a median follow-up of 24 y. Participants who had higher adherence to the HEI-2015, AHEI-2010, and aMed scores were more likely to be female, have higher educational attainment, higher income level, be nonsmokers, more physically active, and diabetic compared with participants who scored lower. All 3 dietary scores were associated with lower CKD risk (P-trend < 0.001). Participants who were in the highest quintile of HEI-2015 score had a 17% lower risk of CKD (HR: 0.83; 95% CI: 0.74, 0.92) compared with participants in the lowest quintile. Those in quintile 5 of AHEI-2010 and aMed scores, respectively, had a 20% and 13% lower risk of CKD compared with those in quintile 1.ConclusionHigher adherence to healthy dietary patterns during middle age was associated with lower risk of CKD.

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Adherence to the Healthy Eating Index-2015 (HEI-2015), Cognitive Function, and Incident Dementia in the Atherosclerosis Risk in Communities (ARIC) Study (OR32-01-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz052.or32-01-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Emily Hu ◽

Aozhou Wu ◽

Jennifer Dearborn ◽

Rebecca Gottesman ◽

Lyn Steffen ◽

...

Keyword(s):

Cognitive Function ◽

Lower Risk ◽

Healthy Eating Index ◽

Dietary Guidelines ◽

Word Fluency ◽

Atherosclerosis Risk In Communities ◽

Incident Dementia ◽

Symbol Substitution ◽

Dietary Guidelines For Americans ◽

Aric Study

Abstract Objectives The Healthy Eating Index-2015 (HEI-2015) score was created to measure adherence to the 2015–2020 Dietary Guidelines for Americans. It remains undetermined whether adherence to the newly released guidelines is associated with improved cognitive function or reduced incident dementia. Methods We assessed the diet of 13,632 participants from the Atherosclerosis Risk in Communities (ARIC) study who were recruited from 1987–1989 and calculated their HEI-2015 scores (0–100) using responses to food frequency questionnaires. Baseline cognitive function was assessed using the Delayed Word Recall, Digit Symbol Substitution, and Word Fluency Tests. We used linear regression models to assess the cross-sectional association of adherence to HEI-2015 and standardized cognitive test scores. Incident dementia was ascertained through the end of 2017. Dementia status at the ARIC Neurocognitive Study visits (2011–13, 2016–17) was determined by detailed neurocognitive battery, informant interviews, and adjudicated review as well as through dementia screening by phone interview and informant review, or by ICD-9 dementia code for a hospitalization or death. We used Cox proportional hazards regression models adjusted for demographic, lifestyle, genetic, and clinical covariates to estimate the association between HEI-2015 score and risk of incident dementia. Results Compared to participants in the lowest quintile of HEI-2015 score, participants in the highest quintile scored higher on the Digit Symbol Substitution Test (β: 0.07, 95% CI: 0.03 to 0.11, P for trend < 0.001), Word Fluency Test (β: 0.07, 95% CI: 0.02 to 0.12, P for trend < 0.001) and global cognitive score (β: 0.05, 95% CI: 0.01 to 0.10, P for trend = 0.003) (Table). In total, there were 2354 cases of incident dementia over a median follow-up of 25 years. Compared to participants in the lowest quintile, participants in other quintiles had a lower risk of incident dementia after adjusting for covariates. Participants in the highest quintile had a 19% lower risk of dementia compared to those in the lowest (HR: 0.81, 95% CI: 0.71–0.93, P for trend = 0.01). Conclusions Higher adherence to the 2015–2020 Dietary Guidelines for Americans was associated with higher baseline cognitive function and lower risk of incident dementia. Funding Sources NHLBI, NIDDK, NIA, NINDS, NIH, HHS. Supporting Tables, Images and/or Graphs

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Mediterranean, DASH, and Alternate Healthy Eating Index Dietary Patterns and Risk of Death in the Physicians’ Health Study

Nutrients ◽

10.3390/nu13061893 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1893

Author(s):

Yash R. Patel ◽

Jeremy M. Robbins ◽

J. Michael Gaziano ◽

Luc Djoussé

Keyword(s):

Healthy Eating ◽

Dietary Patterns ◽

Cancer Mortality ◽

Lower Risk ◽

Cox Regression ◽

Total Mortality ◽

Healthy Eating Index ◽

Health Study ◽

Risk Of Death ◽

All Cause Mortality

Objective: Our primary objective was to examine the associations of the Mediterranean (MED), the Dietary Approaches to Stop Hypertension (DASH), and the Alternate Healthy Eating Index (AHEI) diet with total mortality. Our secondary objective was to examine the association of these three dietary patterns with cardiovascular disease (CVD) and cancer mortality. Research: Design and Methods: We prospectively studied 15,768 men from the Physicians’ Health Study who completed a semi-quantitative food-frequency questionnaire. Scores from each dietary pattern were divided into quintiles. Multivariable Cox regression models were used to estimate hazard ratio’s (95% confidence intervals) of mortality. Results: At baseline, average age was 65.9 ± 8.9 years. There were 1763 deaths, including 488 CVD deaths and 589 cancer deaths. All diet scores were inversely associated with risk for all-cause mortality: Hazard ratios (95% CI) of all-cause mortality from lowest to highest quintile for MED diet were 1.0 (reference), 0.85 (0.73–0.98), 0.80 (0.69–0.93), 0.77 (0.66–0.90), and 0.68 (0.58–0.79); corresponding values were 1.0 (reference), 0.96 (0.82–1.12), 0.95 (0.82–1.11), 0.88 (0.75–1.04), and 0.83 (0.71–0.99) for DASH diet and 1.0 (reference), 0.88 (0.77–1.02), 0.82 (0.71–0.95), 0.69 (0.59, 0.81), and 0.56 (0.47–0.67) for AHEI diet, after adjusting for age, energy, smoking, exercise, BMI, hypertension, coronary heart disease, congestive heart failure, diabetes, and atrial fibrillation. For cause-specific mortality, MED and AHEI scores were inversely associated with lower risk for CVD mortality, whereas AHEI and MED scores were inversely associated with lower risk for cancer mortality. Conclusion: Within this cohort of male physicians, AHEI, MED, and DASH scores were each inversely associated with mortality from all causes.

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Abstract P079: Alcohol Consumption and Risk of Diabetes in the Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽

10.1161/circ.137.suppl_1.p079 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Xintong He ◽

Natalie Daya ◽

Casey M. Rebholz ◽

Mariana Lazo ◽

Elizabeth Selvin

Keyword(s):

Body Mass Index ◽

Alcohol Consumption ◽

Body Mass ◽

Lower Risk ◽

Fasting Glucose ◽

Diabetes Risk ◽

Incident Diabetes ◽

Atherosclerosis Risk In Communities ◽

Atherosclerosis Risk ◽

Aric Study

Background: Moderate alcohol consumption has been reported to be associated with lower risk for diabetes with some studies showing a U-shaped association. Whether and how the association might differ by gender or obesity status is controversial. Objective: To evaluate the prospective association between alcohol consumption and the long-term risk of diabetes in the Atherosclerosis Risk in Communities (ARIC) Study. Methods: A prospective analysis of 11,263 ARIC participants without prevalent diabetes (55% women, 81%white, mean age 54 years). Alcohol consumption was assessed at visit 1 (1987-1989). Participants were followed-up for incident diabetes defined by fasting glucose more than 126 mg/dL, non-fasting glucose more than 200 mg/dL, self-reported diagnosis of diabetes or use of diabetic medication. We used Cox models to estimate hazard ratios of diabetes risk by drinking categories in women and men, respectively. Results: During a median follow-up of 21 years, there were 3518 incident diabetes cases. In the fully adjusted model, compared to never drinkers, among women, 7-14 drinks/week was associated with a significantly lower risk of diabetes; whereas among men, 14-21 drinks/week was associated with a significantly lower risk ( Table ). There was a significant interaction between drinking categories and smoking status or between drinking categories and body mass index in women. Among women, a U-shaped association was mainly present among non-smokers, and significant decreasing risk is only found among normal-weight and overweight participants, but not obese participants. Conclusion: Low levels of alcohol intake (1-2 drinks per day for women and 2-3 drinks per day for men) are inversely associated with diabetes risk. The association is modified by smoking and body mass index in women.

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Dietary Pattern Indices and Incident Peripheral Arterial Disease in Women: A Prospective Cohort Study

Current Developments in Nutrition ◽

10.1093/cdn/nzaa046_013 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 513-513

Author(s):

Guochong Chen ◽

Yasmin Mossavar-Rahmani ◽

Xiaonan Xue ◽

Bernhard Haring ◽

Aladdin Shadyab ◽

...

Keyword(s):

Postmenopausal Women ◽

Healthy Eating ◽

Dietary Patterns ◽

Dietary Pattern ◽

Lower Risk ◽

Kidney Diseases ◽

Healthy Eating Index ◽

Cox Proportional Hazards ◽

Processed Meat ◽

Incident Cases

Abstract Objectives We aimed to evaluate diet quality as reflected by multiple a priori dietary pattern indices in relation to incident PAD. Methods We included 138,506 US postmenopausal women aged 50–79 years without known PAD at baseline (1993–1998) of the Women's Health Initiative. Score of 4 dietary pattern indices, including the alternate Mediterranean diet (aMED) index, the alternate Healthy Eating Index (AHEI)-2010, the Dietary Approaches to Stop Hypertension (DASH) diet index, and the Healthy Eating Index (HEI)-2015, were derived using data collected by a validated food frequency questionnaire. Incident cases of symptomatic PAD in the lower extremities were ascertained and adjudicated through March 2019 by reviewing medical record. Hazard ratios (HR) and 95% confidence interval (CI) were estimated using Cox proportional hazards models, with adjustment for multiple potential confounders including known risk factors for PAD (i.e., smoking, high blood pressure, dyslipidemia, and diabetes). Results During a median 18.6 years of follow-up, 1036 incident cases of PAD were identified. All 4 dietary pattern indices were inversely associated with risk of PAD. The multivariable-adjusted HRs (95% CI) comparing the highest with the lowest score quartiles were 0.74 (0.61–0.91) for aMED index (P-trend across quartile = 0.010), 0.79 (0.65–0.95) for AHEI-2010 (P-trend < 0.001), 0.66 (0.55–0.80) for DASH index (P-trend < 0.001), and 0.68 (0.56–0.82) for HEI-2015 (P-trend < 0.001). Among major foods/nutrients contributing to these dietary patterns, intakes of whole grains (top vs. bottom quartile, HR = 0.81; P-trend = 0.01), legumes (HR = 0.77; P-trend = 0.004), dietary fiber (HR = 0.78; P-trend = 0.01), and vegetable protein (HR = 0.76; P-trend = 0.006) were associated with lower risk of PAD, whereas intakes of red meat (HR = 1.38; P-trend = 0.003), processed meat (HR = 1.36; P-trend = 0.004), and regular soft drinks (HR = 1.26; P-trend = 0.01) were associated with higher risk. Conclusions Adherence to various recommended dietary patterns is associated with lower risk of PAD in a nationwide cohort of US postmenopausal women. Our findings may extend the range of cardiovascular diseases that are potentially preventable by adopting a healthy dietary pattern. Funding Sources National Heart, Lung, and Blood Institute; and National Institute of Diabetes and Digestive and Kidney Diseases.

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Association of Atrial Fibrillation With Incidence of Extracranial Systemic Embolic Events: The ARIC Study

Journal of the American Heart Association ◽

10.1161/jaha.120.016724 ◽

2020 ◽

Vol 9 (18) ◽

Author(s):

Mengyuan Shi ◽

Lin Y. Chen ◽

Wobo Bekwelem ◽

Faye L. Norby ◽

Elsayed Z. Soliman ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cox Regression ◽

Adverse Outcomes ◽

Hospital Discharges ◽

Atherosclerosis Risk In Communities ◽

Entire Cohort ◽

Point Increase ◽

Increased Risk ◽

Atherosclerosis Risk ◽

Aric Study

Background Atrial fibrillation (AF) increases the risk of stroke and extracranial systemic embolic events (SEEs), but little is known about the magnitude of the association of AF with SEE. Methods and Results This analysis included 14 941 participants of the ARIC (Atherosclerosis Risk in Communities) study (mean age, 54.2±5.8, 55% women, 74% White) without AF at baseline (1987–1989) followed through 2017. AF was identified from study ECGs, hospital discharges, and death certificates, while SEEs were ascertained from hospital discharges. CHA 2 DS 2 ‐VASc was calculated at the time of AF diagnosis. Cox regression was used to estimate associations of incident AF with SEE risk in the entire cohort, and between CHA 2 DS 2 ‐VASc score and SEE risk in those with AF. Among eligible participants, 3114 participants developed AF and 270 had an SEE (59 events in AF). Incident AF was associated with increased risk of SEE (hazard ratio [HR], 3.58; 95% CI, 2.57–5.00), after adjusting for covariates. The association of incident AF with SEE was stronger in women (HR, 5.26; 95% CI, 3.28–8.44) than in men (HR, 2.68; 95% CI, 1.66–4.32). In those with AF, higher CHA 2 DS 2 ‐VASc score was associated with increased SEE risk (HR per 1‐point increase, 1.24; 95% CI, 1.05–1.47). Conclusions AF is associated with more than a tripling of the risk of SEE, with a stronger association in women than in men. CHA 2 DS 2 ‐VASc is associated with SEE risk in AF patients, highlighting the value of the score to predict adverse outcomes and guide treatment decisions in people with AF.

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Life-Course Individual and Neighborhood Socioeconomic Status and Risk of Dementia in the Atherosclerosis Risk in Communities Neurocognitive Study

American Journal of Epidemiology ◽

10.1093/aje/kwaa072 ◽

2020 ◽

Vol 189 (10) ◽

pp. 1134-1142

Author(s):

Kristen M George ◽

Pamela L Lutsey ◽

Anna Kucharska-Newton ◽

Priya Palta ◽

Gerardo Heiss ◽

...

Keyword(s):

Socioeconomic Status ◽

Standard Deviation ◽

Life Course ◽

Lower Risk ◽

Cox Regression ◽

The United States ◽

Atherosclerosis Risk In Communities ◽

Neighborhood Socioeconomic Status ◽

Atherosclerosis Risk ◽

Neighborhood Level

Abstract We examined associations of individual- and neighborhood-level life-course (LC) socioeconomic status (SES) with incident dementia in the Atherosclerosis Risk in Communities cohort. Individual- and neighborhood-level SES were assessed at 3 life epochs (childhood, young adulthood, midlife) via questionnaire (2001–2002) and summarized into LC-SES scores. Dementia was ascertained through 2013 using cognitive exams, telephone interviews, and hospital and death certificate codes. Cox regression was used to estimate hazard ratios of dementia by LC-SES scores in race-specific models. The analyses included data from 12,599 participants (25% Black) in the United States, with a mean age of 54 years and median follow-up of 24 years. Each standard-deviation greater individual LC-SES score was associated with a 14% (hazard ratio (HR) = 0.86, 95% confidence interval (CI): 0.81, 0.92) lower risk of dementia in White and 21% (HR = 0.79, 95% CI: 0.71, 0.87) lower risk in Black participants. Education was removed from the individual LC-SES score and adjusted for separately to assess economic factors of LC-SES. A standard-deviation greater individual LC-SES score, without education, was associated with a 10% (HR = 0.90, 95% CI: 0.84, 0.97) lower dementia risk in White and 15% (HR = 0.85, 95% CI: 0.76, 0.96) lower risk in Black participants. Neighborhood LC-SES was not associated with dementia. We found that individual LC-SES is a risk factor for dementia, whereas neighborhood LC-SES was not associated.

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Education and Cardiovascular Health as Effect Modifiers of APOE ε4 on Dementia: The Atherosclerosis Risk in Communities (ARIC) Study

The Journals of Gerontology Series A ◽

10.1093/gerona/glab299 ◽

2021 ◽

Author(s):

Mark Lee ◽

Timothy M Hughes ◽

Kristen M George ◽

Michael E Griswold ◽

Sanaz Sedaghat ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Cardiovascular Health ◽

Apoe Genotype ◽

Protective Effects ◽

Atherosclerosis Risk In Communities ◽

Dementia Risk ◽

Incident Dementia ◽

Atherosclerosis Risk

Abstract Background Both education and cardiovascular risk factors are strongly associated with dementia risk. However, it is not clear whether these associations persist or vary among individuals with high genetic risk for Alzheimer’s Disease. We examined the interactive relationship between lifestyle and genetic dementia risk factors in a prospective cohort study. Methods Our data came from the Atherosclerosis Risk in Communities study participants (n=13,715; baseline age 45-64; 25% Black; 55% female), who were followed for incident dementia from 1987 through 2017. We used Cox proportional hazard models to estimate the risk of dementia (ascertained through in-person examination, telephone cognitive screeners, and/or hospital and death records) associated with baseline education and cardiovascular risk factors (measured using the American Heart Association’s “Life Simple 7”) among ε4 carriers and non-carriers separately. We also examined differences by race and sex. Results 2,226 incident dementia cases occurred over a median 25 years of follow-up. Lower educational attainment and poorer cardiovascular health were associated with greater risk of incident dementia. There was an education by APOE status interaction (p=0.005) whereby the association of education and dementia was weaker for ε4 carriers (HR college graduates vs. less than high school: 0.71 (0.59-0.84) than non-carriers (0.54 (0.47-0.63)). There was no interaction between APOE status and cardiovascular health on dementia risk. These relationships did not vary significantly by race or sex. Conclusions Education and cardiovascular health were associated with lower dementia risk regardless of APOE genotype, though the protective effects of education were somewhat diminished among ε4 carriers.

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Abstract 14043: Association of Non-Alcoholic Steatohepatitis Assessed by Fib-4 Index and Risk of Cardiovascular Disease: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽

10.1161/circ.142.suppl_3.14043 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Aliza Hussain ◽

VIJAY NAMBI ◽

Elizabeth Selvin ◽

Wensheng Sun ◽

Kunihiro Matsushita ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Cox Regression ◽

Advanced Fibrosis ◽

Cvd Risk ◽

Atherosclerosis Risk In Communities ◽

Increased Risk ◽

Atherosclerosis Risk ◽

Aric Study ◽

Cvd Mortality

Introduction: Cardiovascular disease (CVD) is the most common cause of death in nonalcoholic steatohepatitis (NASH). While these conditions share many cardio-metabolic risk factors including metabolic syndrome, diabetes and dyslipidemia, limited data exist on whether NASH is independently and prospectively associated with incident CVD beyond traditional risk factors. Fibrosis-4 (FIB-4) index is a scoring system based on platelet count, age, AST and ALT, shown to be comparable to magnetic resolution elastography for predicting advanced fibrosis in biopsy-proven NASH. We sought to evaluate the association of elevated FIB-4 with global CVD events and CVD mortality in the Atherosclerosis Risk in Communities (ARIC) Study Methods: We studied 5531 individuals, mean age of 76 (SD 5.2) years, 58% female, 22% black, at ARIC visit 5 (2011-2013). FIB-4 was categorized as low risk of advanced fibrosis for score <1.45, intermediate for 1.45-3.25 and high for >3.25. Cox regression was used to estimate the association of FIB-4 with time to first global CVD event (CHD, ischemic stroke or heart failure hospitalization) and CVD mortality adjusted for pooled cohort equation risk factors. Results: Over a median follow up of 6.2 (5.3-6.8) years, there were 1108 global CVD events and 457 CVD deaths. In adjusted models, compared to participants with low FIB-4 (<1.45), those with elevated FIB-4 >3.25, had significantly increased risk for global CVD events (HR 1.58, 95% CI 1.23-2.02) and CVD mortality (HR 1.70, 95% CI 1.16-2.50). Conclusions: In a large prospective cohort, presence of advanced liver fibrosis, as assessed by elevated FIB-4 index >3.25, was associated with increased risk for CVD events and CVD mortality, beyond traditional CVD risk factors. Future clinical trials of candidate medications under study for NASH should examine whether effective NASH treatment will impact CV outcomes.

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Dietary Patterns and Risk of Chronic Kidney Disease Progression and All-Cause Mortality: Findings from the CRIC study

Current Developments in Nutrition ◽

10.1093/cdn/nzaa061_043 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1415-1415

Author(s):

Emily Hu ◽

Josef Coresh ◽

Cheryl Anderson ◽

Lawrence Appel ◽

Morgan Grams ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Healthy Eating ◽

Dietary Patterns ◽

Lower Risk ◽

Healthy Eating Index ◽

Dietary Guidelines ◽

Ckd Progression ◽

Adjusted Risk ◽

All Cause Mortality

Abstract Objectives Current dietary guidelines recommend that chronic kidney disease (CKD) patients reduce intake of individual nutrients, such as sodium, potassium, phosphorus, and protein. This approach can be difficult for patients to implement and ignores important nutrient interactions. Our objective was to define the association of healthy dietary patterns with risk of CKD progression and all-cause mortality among people with CKD. Methods We analyzed data from 2403 participants aged 21–74 years with an estimated glomerular filtration rate (eGFR) of 20–70 mL/min/1.73 m2 and dietary data in the Chronic Renal Insufficiency Cohort (CRIC) study. Healthy Eating Index-2015 (HEI-2015), Alternative Healthy Eating Index-2010 (AHEI-2010), alternate Mediterranean diet (aMed), and Dietary Approaches to Stop Hypertension (DASH) diet scores were calculated using data collected from food frequency questionnaires. We analyzed the association between these dietary patterns and two main outcomes: 1) CKD progression defined as ≥50% eGFR decline, kidney transplantation, or dialysis, and 2) all-cause mortality. Cox proportional hazards regression models adjusted for demographic, lifestyle, and clinical covariates were used to estimate hazard ratios (HR) and 95% confidence intervals (CI). Results There were 855 cases of CKD progression and 773 deaths over a maximum of 14 years. Compared with participants with the lowest adherence, the most highly adherent tertile of AHEI-2010, aMed, and DASH had lower adjusted risk of CKD progression with the strongest association for aMed (HR: 0.75, 95% CI: 0.62–0.90). Nuts and legumes were independently associated with lower risk of CKD progression. Compared with participants with the lowest adherence, the highest adherence tertiles for all four scores had a 24–31% lower adjusted risk of all-cause mortality. Conclusions Greater adherence to a healthy dietary pattern is associated with a lower risk of CKD progression and all-cause mortality among people with CKD. Guidance to adopt healthy dietary patterns should be incorporated into guidelines for individuals with CKD. Funding Sources NIH (NHLBI, NIDDK).

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