Healthy Eating Index-2015, a protective factor for mitochondria-derived methylmalonic acid in the low poverty/income ratio with chronic kidney diseases: results from NHANES 2011-2014.

Abstract

Objective: Serum methylmalonic acid (MMA) arises from impaired metabolism of methylmalonyl-CoA and is exacerbated in chronic kidney disease (CKD) due to reduced renal clearance and nutritional deficiencies. The quality of diet may influence MMA levels by affecting vitamin B12 intake and mitigating inflammatory dietary components. This study aims to explore the relationship between the Healthy Eating Index-2015 (HEI-2015) and the prevalence of high MMA among low poverty/income ratio (PIR) patients with CKD.

Method: We conducted a cross-sectional study of participants aged ≥20 years using the data drawn from the NHANES 2011-2014. Individuals under low PIR suffering from CKD were included. HEI-2015 was calculated to evaluate diet quality. Multivariable logistic regression models were applied to examine the association between HEI-2015 and high MMA prevalence with covariates adjusted. Stratified and interaction analysis were also performed.

Results: A total of 582 CKD patients with low PIR were enrolled. The logistic analysis showed that higher HEI-2015 was significantly associated with a lower prevalence of high MMA. Patients in the highest quartile of HEI-2015 scores (>61.17) showed a 57.8% reduction in high MMA prevalence compared to those in the lowest quartile. Subgroup and interaction analysis revealed that alcohol consumption reduced the diet quality-related protection against high MMA.

Conclusion: The protective role of high-quality diets, as reflected by HEI-2015, in reducing the prevalence of high MMA in low PIR CKD patients is noteworthy. Improving diet quality in this population could potentially mitigate the risks associated with high MMA in CKD patients with low PIR.