Adherence to the Mediterranean Diet Is Associated with a More Favorable Left Ventricular Geometry in Patients with End-Stage Kidney Disease

Introduction. The aim of the study was to examine the impact of adherence to a Mediterranean-style diet (MD) on left ventricular hypertrophy (LVH) and cardiac geometry in chronic kidney disease patients on dialysis (CKD-5D), given the high prevalence of cardiovascular morbidity in this population. Methods. n = 127 (77 men and 50 women) CKD-5D patients (69 on hemodialysis and 58 on peritoneal dialysis) with a mean age of 62 +/- 15 years were studied. An MD adherence score (MDS) (range 0-55, 55 representing maximal adherence) was estimated with a validated method. Echocardiographic LVH was defined by LV mass index (LVMI) > 95 g/m(2) in women and >115 g/m(2) in men. Based on LVMI and relative wall thickness (RWT), four LV geometric patterns were defined: normal (normal LVMI and RWT), concentric remodeling (normal LVMI and increased RWT > 0.42), eccentric LVH (increased LVMI and normal RWT), and concentric LVH (increased LVMI and RWT). Results. Patients with LVH (n = 81) as compared to patients with no LVH (n = 46) were older in age (66 +/- 13 vs. 55 +/- 16 years; p < 0.001) had lower MDS (24 +/- 2.7 vs. 25 +/- 4.3; p < 0.05) and higher malnutrition-inflammation score (5.0 +/- 2.7 vs. 3.9 +/- 1.9; p < 0.05), body mass index (27.5 +/- 4.9 vs. 24.1 +/- 3.5 kg/m(2); p < 0.001), prevalence of diabetes (79% vs. 20%; p < 0.05), coronary artery disease (78% vs. 20%; p < 0.05) and peripheral vascular disease (78% vs. 20%; p < 0.01). In a multivariate logistic regression analysis adjusted for all factors mentioned above, each 1-point greater MDS was associated with 18% lower odds of having LVH (OR = 0.82, 95% CI: 0.69-0.98; p < 0.05). MDS was inversely related to LVMI (r = -0.273; p = 0.02), and in a multiple linear regression model (where LVMI was analyzed as a continuous variable), MDS emerged as a significant (Beta = -2.217; p < 0.01) independent predictor of LVH. Considering LV geometry, there was a progressive decrease in MDS from the normal group (25.0 +/- 3.7) to concentric remodeling (25.8 +/- 3.0), eccentric (24.0 +/- 2.8), and then concentric (23.6 +/- 2.7) group (p < 0.05 for the trend). Conclusions. The greater adherence to an MD is associated with lesser LVH, an important cardiovascular disease risk factor; MD preserves normal cardiac geometry and may confer protection against future cardiac dysfunction in dialysis patients.

Automated summary

Adherence to a Mediterranean-style diet has a positive impact on the cardiovascular health of chronic kidney disease patients on dialysis, reducing the occurrence of left ventricular hypertrophy and abnormal cardiac geometry. This is of significant importance in managing the risk of cardiovascular disease in dialysis patients.