The effects of dietary patterns on urinary albumin excretion: results of the Dietary Approaches to Stop Hypertension (DASH) Trial

Am J Kidney Dis. 2009 Apr;53(4):638-46. doi: 10.1053/j.ajkd.2008.10.048. Epub 2009 Jan 23.


Background: Dietary studies designed to decrease the urinary albumin excretion rate (AER) typically reduce protein by increasing lower protein plant foods and decreasing higher protein animal products.

Study design: We evaluated AER while increasing protein intake in the Dietary Approaches to Stop Hypertension (DASH) Trial (randomized, parallel group, 8 week controlled feeding).

Setting & participants: 378 individuals without diabetes with prehypertension or stage I hypertension.

Intervention: The DASH diet, 18% energy from protein, emphasizes, among other features, low-fat dairy products; and the fruit/vegetable (FV) and control diets, each with 15% energy from protein.

Outcome: AER.

Measurements: We measured AER by using immunoassay and covariates at baseline and after 8 weeks.

Results: Baseline AER had a geometric mean value of 4.0 +/- 0.2 (SE) mg/24 h. In 285 participants with baseline AER less than 7 mg/24 h, AER was unchanged by diet treatment (geometric mean, 2.5 +/- 0.2 mg/24 h in the control diet, 3.0 +/- 0.2 mg/24 h in the FV diet, and 2.8 +/- 0.2 mg/24 h in the DASH diet). Conversely, in 93 participants with baseline AER of 7 mg/24 h or greater, end-of-feeding AER was lower in the FV diet (6.6 +/- 1.0 mg/24 h) than in the control (11.4 +/- 1.8 mg/24 h; P = 0.01) or DASH diets (11.7 +/- 1.6 mg/24 h; P = 0.005). The DASH and control diets were not different (P = 0.9).

Limitations: Long-term AER change not studied.

Conclusions: The decrease in AER after 8 weeks occurred in only those with high-normal baseline AER in the FV diet, in a pattern distinct from the blood pressure decrease. The DASH diet did not increase AER despite a 3% increase in energy from protein.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Albuminuria / diet therapy*
  • Albuminuria / physiopathology*
  • Blood Pressure / physiology
  • Cardiovascular Diseases / epidemiology
  • Diet, Fat-Restricted
  • Energy Metabolism / physiology
  • Feeding Behavior / physiology*
  • Female
  • Fruit
  • Humans
  • Hypertension / complications
  • Hypertension / diet therapy*
  • Hypertension / physiopathology*
  • Kidney Diseases / epidemiology
  • Male
  • Middle Aged
  • Risk Factors
  • Treatment Outcome
  • Vegetables