Association between dietary patterns and diabetic kidney disease in patients with type 2 diabetes mellitus and a mediational analysis: a cross-sectional study

Abstract

Abstract Aims This study aimed to investigate the relationship between different dietary patterns and diabetic kidney disease (DKD) in patients with type 2 diabetes mellitus (T2DM) and explore the mediating effect produced by blood glucose levels. Materials and Methods This study was conducted according to the China Chronic Disease and Risk Factors Surveillance (CCDRFS). Two districts and two counties were randomly selected from CCDRFS in Shanxi Province to collect general information, dietary records, physical measurements, and laboratory tests. 1,332 patients were enrolled. Results The prevalence of DKD was 21.9%, which was lower in urban than in rural areas. Dietary patterns were constructed: 'animal protein', 'coarse grains and plant protein', 'nuts and fruits', 'refined grains and vegetables', 'dairy', and 'added sugars', with factor contributions of 15.4%, 10.0%, 8.3%, 8.1%, 7.6%, and 7.2% respectively, explaining 56.6% of the total dietary variation. Patients in the highest quartile of dietary pattern scores for 'nuts and fruits' experienced a 50.5% lower risk of albuminuria and 'added sugars' showed a 3.123-fold increase risk of reduced estimated glomerular filtration rate (eGFR) compared with those in the lowest quartile. The 'nuts and fruits' dietary pattern negatively affected UACR through the mediation of fasting plasma glucose (FPG) and haemoglobin A1c (HbA1c), with a total effect value of -0.019. Conclusions In T2DM, the 'nuts and fruits' dietary pattern decreased the risk of albuminuria, and the 'added sugars' dietary pattern increased the risk of decreased eGFR. FPG and HbA1c partially mediated the association between the 'nuts and fruits' dietary pattern and DKD.