Jordi Salas Salvadó
Universitat Rovira i Virgili
Nutrition and Metabolism
Effect of weight loss with a hipocaloric mediterranean diet and physical activity promotion in the prevention of chronic kidney disease: sub-study of Predimed-Plus
Chronic kidney disease (CKD) is a primary health problem affecting between 5-10% of the adult population worldwide and more than 50% in sub-populations at higher risk.
According to the WHO, 30% of the patients with overweight will develop kidney disease. In parallel to the increment in obesity and population aging >65y, it is expected an increase in CKD incidence, which will bring vast socio-economic problems for the health care system. Therefore, it is a priority to develop effective strategies to prevent this disease and its complications, based on lifestyle changes. For example, the diet which plays a key role in the development, perpetuation and prevention of CKD, partly due to its ability to modulate cardiovascular risk factors taking part in the progression of kidney dysfunction. Nevertheless, no study has ever demonstrated the effectiveness of the diet on the prevention and treatment of CKD.
Mediterranean Diet (MedDiet) may be a useful tool for achieving sustained weight-loss and improving obesity-related metabolic alterations, such as the CKD. Current evidence limited to cross-sectional and prospective data suggest that higher adherence to MedDiet is associated to lower risk of CKD and CKD-related mortality.
There are no randomized field trials conducted in large populations demonstrating that sustained weight-loss using an energy-restricted healthy-diet and lifestyle changes have beneficial effects on renal function and reduces the risk of CKD. Furthermore, it is imperative to evaluate the clinical implementation of novel strategies for reducing the burden of CKD.
The present sub-study is nested within the PREDIMED-PLUS study, a randomized clinical-trial for primary cardiovascular prevention. We sought to determine the effectiveness of an intensive weight-loss intervention using an energy-restricted MedDiet, physical activity promotion and behavioral support, as compared to a usual-care advice with traditional MedDiet (control group) on the prevention and reversion of CKD.
For this, a randomized, multicenter, parallel-group clinical-trial with 2-year follow-up, was conducted in 6,000 men and women, aged 55-75 years, with overweight/obesity and metabolic syndrome, comparing the effect of two lifestyle interventions on: a) Glomerular filtration rate, estimated indirectly from serum creatinine and cystatin C using the CKD-EPI equation for Caucasian individuals, and b) urinary albumin-creatinine ratio. The effects of the two interventions on the incidence and reversion of CKD, will be compared at 6 and 12 months follow-up.
The current proposal are the highly structured approach of the intervention and its adequacy within the frame of the PREDIMED-PLUS study for determining the effect of the intervention on main clinical results, including CKD. Furthermore, it will facilitate the translation of the study results and the ability for integrating epidemiological, clinical and basic aspects.
37.5 hours a week
|This project has received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No. 713679|