Abstract
Insufficient fruit and vegetable intake (FVI) and low potassium intake are associated with many non-communicable diseases, but the association with early renal damage in children is uncertain. We aimed to identify the associations of early renal damage with insufficient FVI and daily potassium intake in a general pediatric population. We conducted four waves of urine assays based on our child cohort (PROC) study from October 2018 to November 2019 in Beijing, China. We investigated FVI and other lifestyle status via questionnaire surveys and measured urinary potassium, β2-microglobulin (β2-MG), and microalbumin (MA) excretion to assess daily potassium intake and renal damage among 1914 primary school children. The prevalence of insufficient FVI (<4/d) was 48.6% (95% CI: 46.4%, 50.9%) and the estimated potassium intake at baseline was 1.63 ± 0.48 g/d. Short sleep duration, long screen time, lower estimated potassium intake, higher β2-MG and MA excretion were significantly more frequent in the insufficient FVI group. We generated linear mixed effects models and observed the bivariate associations of urinary β2-MG and MA excretion with insufficient FVI (β = 0.012, 95% CI: 0.005, 0.020; β = 0.717, 95% CI: 0.075, 1.359), and estimated potassium intake (β = −0.042, 95% CI: −0.052, −0.033; β = −1.778, 95% CI: −2.600, −0.956), respectively; after adjusting for age, sex, BMI, SBP, sleep duration, screen time and physical activity. In multivariate models, we observed that urinary β2-MG excretion increased with insufficient FVI (β = 0.011, 95% CI: 0.004, 0.018) and insufficient potassium intake (<1.5 g/d) (β = 0.031, 95% CI: 0.023, 0.038); and urinary MA excretion increased with insufficient FVI (β = 0.658, 95% CI: 0.017, 1.299) and insufficient potassium intake (β = 1.185, 95% CI: 0.492, 1.878). We visualized different quartiles of potassium intake showing different renal damage with insufficient FVI for interpretation and validation of the findings. Insufficient FVI and low potassium intake aggravate early renal damage in children and underscores that healthy lifestyles, especially adequate FVI, should be advocated.
Highlights
Insufficient fruit and vegetable intake (FVI) is associated with almost all major noncommunicable diseases [1], including emerging chronic kidney disease (CKD) in the general population [2]
There were no significant differences in height, weight, Body mass index (BMI), Systolic blood pressure (SBP), diastolic blood pressure (DBP), prevalence of insufficient physical activity, and spot urinary potassium excretion between the two FVI groups (Table 1)
After adjusting for age, sex, BMI, SBP, sleep duration, screen time and physical activity, the urinary β2-MG excretion increased with insufficient FVI (β = 0.011, 95% confidence interval (95% CI): 0.004, 0.018) and insufficient potassium intake (β = 0.031, 95% CI: 0.023, 0.038); urinary MA excretion increased with insufficient FVI (β = 0.658, 95% CI: 0.017, 1.299) and insufficient potassium intake (β = 1.185, 95% CI: 0.492, 1.878) (Table 3)
Summary
Insufficient fruit and vegetable intake (FVI) is associated with almost all major noncommunicable diseases [1], including emerging chronic kidney disease (CKD) in the general population [2]. Plant-based foods including fruits and vegetables are rich in mineral cations (such as potassium [7]) and bicarbonate precursors with alkalizing effects [8]. Insufficient FVI is associated with increased acidity and kidney function declines in CKD patients [8]. High consumption of fruits and vegetables may have a buffering effect on metabolic acid load [9]. This is postulated as having a potentially protective role in avoiding renal damage. One study showed that increased FVI intake for 8 weeks was associated with a decrease in net endogenous acid production (NEAP) [10]
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