may be unwarranted. Background Patients with CKD are encouraged to choose refined grains instead of whole grains as part of the low-phosphorus diet for managing CKD-mineral and bone disorders (CKD-MBD). However, there is no direct evidence indicating that limiting whole grains has a beneficial impact on CKD outcomes. Methods This study analyzed Chronic Renal Insufficiency Cohort data in two ways, namely cross-sectional examination of CKD-MBD biomarkers and prospective examination of health outcomes. A total of 4067 (cross-sectional) and 4331 (prospective) participants were included. The primary exposure was reported intake of whole grains (analyzed as servings/d, servings/1,000 kcal, and refined grain servings/whole grain servings). CKD-MBD biomarkers included serum phosphorus, fibroblast growth factor-23, parathyroid hormone, calcitriol, and calcium. Outcomes included cardiovascular events, kidney failure, and all-cause mortality. Results In adjusted models, reported intake of whole grains was associated with higher phosphorus intake and serum phosphorus when assessed crudely (serving/d), but not when analyzed in relation to energy. Higher intake of refined grain relative to whole grains was associated (all models) with higher risk of kidney failure (model 4: 1.01; 95% confidence interval, 1.00 to 1.02; P = 0.01, all-cause mortality (model 4: 1.01; 95% confidence interval, 1.00 to 1.01; P = 0.01), and cardiovascular disease except for the fully adjusted model. Higher dietary density was associated with lower mortality in models adjusted for demographic and clinical factors including kidney function, but not in the fully adjusted model that further adjusted for dietary factors. Conclusions Intake of whole grains was not associated with CKD-MBD biomarkers. Intake of whole grains in relation to refined grains was associated with lower risk of cardiovascular disease, kidney failure, and mortality. The results of this study put into question the long-standing practice of restricting whole grains in patients with CKD....

中文翻译：

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慢性肾功能不全队列研究中全谷物摄入量与健康结果的关联


可能是没有根据的。背景 鼓励 CKD 患者选择精制谷物而不是全谷物，作为管理 CKD 矿物质和骨骼疾病 （CKD-MBD） 的低磷饮食的一部分。然而，没有直接证据表明限制全谷物对 CKD 结局有有益影响。方法 本研究以两种方式分析慢性肾功能不全队列数据，即 CKD-MBD 生物标志物的横断面检查和健康结局的前瞻性检查。共纳入 4067 名 （横断面） 和 4331 名 （前瞻性） 参与者。据报道，主要暴露是全谷物的摄入量（分析为份/天、份/1,000 大卡和精制谷物份量/全谷物份量）。CKD-MBD 生物标志物包括血清磷、成纤维细胞生长因子-23 、甲状旁腺激素、骨化三醇和钙。结局包括心血管事件、肾衰竭和全因死亡率。结果在调整后的模型中，粗略评估 （份量/d） 时，报告的全谷物摄入量与较高的磷摄入量和血清磷相关，但与能量相关的分析则不相关。相对于全谷物，精制谷物摄入量较高（所有模型）与肾衰竭风险较高相关（模型 4：1.01;95% 置信区间，1.00 至 1.02;P = 0.01，全因死亡率（模型 4：1.01;95% 置信区间，1.00 至 1.01;P = 0.01） 和心血管疾病（完全调整模型除外）。在根据人口统计学和临床因素（包括肾功能）调整的模型中，较高的饮食密度与较低的死亡率相关，但在进一步调整饮食因素的完全调整模型中则不相关。结论 全谷物摄入量与 CKD-MBD 生物标志物无关。 与精制谷物相关的全谷物摄入量与心血管疾病、肾衰竭和死亡率的风险较低有关。这项研究的结果对 CKD 患者限制全谷物的长期做法提出了质疑。