Healthy lifestyle ‘cuts chronic disease risk'

The study has been reported in the August 10/24 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

"An impressive body of research has implicated modifiable lifestyle factors such as smoking, physical activity, diet and body weight in the causes of these diseases," the authors write.

To reach the conclusion, Earl S. Ford, M.D., M.P.H., of the Centers for Disease Control and Prevention, Atlanta, and colleagues assessed data from 23,513 German adults age 35 to 65. At the beginning of the European Prospective Investigation Into Cancer and Nutrition–Potsdam (EPIC-Potsdam) study—between 1994 and 1998—participants completed an assessment of their body weight and height, a personal interview that included questions about diseases, a questionnaire on sociodemographic and lifestyle characteristics and a food frequency questionnaire.

Their responses were assessed for adherence to four healthy lifestyle factors: never smoking, having a body mass index lower than 30, exercising for at least three and a half hours per week and following healthy dietary principles (for example, having a diet with high consumption of fruits and vegetables while limiting meat consumption).

Follow-up questionnaires were administered every two to three years.

Most participants had one to three of these health factors, fewer than 4 percent had zero healthy factors and 9 percent had all four factors. Over an average of 7.8 years of follow-up, 2,006 participants developed new cases of diabetes (3.7 percent), heart attack (0.9 percent), stroke (0.8 percent) or cancer (3.8 percent).

After adjusting for age, sex, education level and occupation, individuals with more healthy lifestyle factors were less likely to develop chronic diseases. Participants who had all four factors at the beginning of the study had a 78 percent lower risk of developing any of the chronic diseases during the follow-up period than those who had none of the healthy factors. The four factors were associated with a 93 percent reduced risk of diabetes, 81 percent reduced risk of heart attack, 50 percent reduced risk of stroke and 36 percent reduced risk of cancer.

The largest reduction in risk was associated with having a BMI lower than 30, followed by never smoking, at least 3.5 hours of physical activity and then adhering to good dietary principles.

Tips to keep kidney stones away.

The study claims that loading up on fruits, vegetables, nuts, low-fat dairy products, and whole grains, while limiting salt, red and processed meats, and sweetened beverages is an effective way to ward off kidney stones.

To reach the conclusion, Eric Taylor, MD (Maine Medical Center) and his colleagues at Brigham and Women's Hospital conducted a large study.

The investigators collected information from individuals enrolled in three clinical studies: the Health Professionals Follow-up Study (45,821 men followed for 18 years), the Nurses'''' Health Study I (94,108 older women followed for 18 years), and the Nurses'''' Health Study II (101,837 younger women followed for 14 years).

Dr. Taylor's team assigned a score to each participant based on eight components of a DASH (Dietary Approaches to Stop Hypertension) style diet: high intake of fruits, vegetables, nuts and legumes, low-fat dairy products, and whole grains and low intake of salt, sweetened beverages, and red and processed meats.

Individuals with higher DASH scores consumed diets that were higher in calcium, potassium, magnesium, oxalate, and vitamin C and lower in sodium.

A total of 5,645 incident kidney stones developed in the participants in the three studies. In each study, participants with the highest DASH scores were between 40 percent and 45 percent less likely to develop kidney stones than participants with the lowest DASH scores. The reductions in kidney stone risk were independent of age, body size, fluid intake, and other factors.

Because a DASH-style diet may affect the development of hypertension, diabetes, and other chronic diseases associated with kidney stones, the researchers also performed an analysis limited to study participants without hypertension or diabetes. Even among those individuals the DASH diet reduced the risk of kidney stones.

Diet during kidney failure.

Diet is an important consideration for those with impaired kidney function. Consultation with a dietician may be helpful to understand what foods may or may not be appropriate.

Since the kidneys cannot easily remove excess water, salt, or potassium, they may need to be consumed in limited quantities. Foods high in potassium include bananas, apricots, and salt substitutes.

Phosphorus is a forgotten chemical that is associated with calcium metabolism and may be elevated in kidney failure. Too much phosphorus can leech calcium from the bones and cause osteoporosis and fractures. Foods with high phosphorus content include milk, cheese, nuts, and cola drinks.

Changing the Diet

People with reduced kidney function need to be aware that some parts of a normal diet may speed their kidney failure.

Protein. Protein is important to the body. It helps the body repair muscles and fight disease. Protein comes mostly from meat but can also be found in eggs, milk, nuts, beans, and other foods. Healthy kidneys take wastes out of the blood but leave in the protein. Impaired kidneys may fail to separate the protein from the wastes.

Some doctors tell their kidney patients to limit the amount of protein they eat so the kidneys have less work to do. But a person cannot avoid protein entirely. People with CKD can work with a dietitian to create the right food plan.

Cholesterol. Another problem that may be associated with kidney failure is high cholesterol. High levels of cholesterol in the blood may result from a high-fat diet.

Cholesterol can build up on the inside walls of blood vessels. The buildup makes pumping blood through the vessels harder for the heart and can cause heart attacks and strokes.

Sodium. Sodium is a chemical found in salt and other foods. Sodium in the diet may raise a person’s blood pressure, so people with CKD should limit foods that contain high levels of sodium. High-sodium foods include canned or processed foods like frozen dinners and hot dogs.

Potassium. Potassium is a mineral found naturally in many fruits and vegetables, such as oranges, potatoes, bananas, dried fruits, dried beans and peas, and nuts. Healthy kidneys measure potassium in the blood and remove excess amounts. Diseased kidneys may fail to remove excess potassium. With very poor kidney function, high potassium levels can affect the heart rhythm.

Not Smoking

Smoking not only increases the risk of kidney disease, but it also contributes to deaths from strokes and heart attacks in people with CKD.

What are the symptoms of kidney failure?

People in the early stages of CKD usually do not feel sick at all.

People whose kidney disease has gotten worse may

• need to urinate more often or less often
• feel tired
• lose their appetite or experience nausea and vomiting
• have swelling in their hands or feet
• feel itchy or numb
• get drowsy or have trouble concentrating
• have darkened skin
• have muscle cramps

In the beginning, kidney failure may be asymptomatic (not producing any symptoms). As kidney function decreases, the symptoms are related to the inability to regulate water and electrolyte balances, to clear waste products from the body, and to promote red blood cell production. Lethargy, weakness, shortness of breath, and generalized swelling may occur. Unrecognized or untreated, life-threatening circumstances can develop.

Metabolic acidosis, or increased acidity of the body due to the inability to manufacture bicarbonate, will alter enzyme and oxygen metabolism, causing organ failure.

Inability to excrete potassium and rising potassium levels in the serum (hyperkalemia) is associated with fatal heart rhythm disturbances (arrhythmias).

Rising urea levels in the blood (uremia) can affect the function of a variety of organs ranging from the brain (encephalopathy) with alteration of thinking, to inflammation of the heart lining (pericarditis), to decreased muscle function because of low calcium levels (hypocalcemia).

Generalized weakness can be due to anemia, a decreased red blood cell count, because lower levels of erythropoietin do not adequately stimulate the bone marrow. A decrease in red cells equals a decrease in oxygen-carrying capacity of the blood, resulting in decreased oxygen delivery to cells for them to do work; therefore, the body tires quickly. As well, with less oxygen, cells more readily use anaerobic metabolism (an=without + aerobic=oxygen) leading to increased amounts of acid production that cannot be addressed by the already failing kidneys.

As waste products build in the blood, loss of appetite, lethargy, and fatigue become apparent. This will progress to the point where mental function will decrease and coma may occur.

Because the kidneys cannot address the rising acid load in the body, breathing becomes more rapid as the lungs try to buffer the acidity by blowing off carbon dioxide. Blood pressure may rise because of the excess fluid, and this fluid can be deposited in the lungs, causing congestive heart failure.

What causes kidney failure?

Most kidney diseases attack the nephrons, causing them to lose their filtering capacity. Damage to the nephrons can happen quickly, often as the result of injury or poisoning. But most kidney diseases destroy the nephrons slowly and silently. Only after years or even decades will the damage become apparent. Most kidney diseases attack both kidneys simultaneously.

The two most common causes of kidney disease are diabetes and high blood pressure. People with a family history of any kind of kidney problem are also at risk for kidney disease.

Diabetic Kidney Disease

Diabetes is a disease that keeps the body from using glucose, a form of sugar, as it should. If glucose stays in the blood instead of breaking down, it can act like a poison. Damage to the nephrons from unused glucose in the blood is called diabetic kidney disease. Keeping blood glucose levels down can delay or prevent diabetic kidney disease. Use of medications called angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) to treat high blood pressure can also slow or delay the progression of diabetic kidney disease.

High Blood Pressure

High blood pressure can damage the small blood vessels in the kidneys. The damaged vessels cannot filter wastes from the blood as they are supposed to.

A doctor may prescribe blood pressure medication. ACE inhibitors and ARBs have been found to protect the kidneys even more than other medicines that lower blood pressure to similar levels. The National Heart, Lung, and Blood Institute (NHLBI), one of the National Institutes of Health, recommends that people with diabetes or reduced kidney function keep their blood pressure below 130/80.

Glomerular Diseases

Several types of kidney disease are grouped together under this category, including autoimmune diseases, infection-related diseases, and sclerotic diseases. As the name indicates, glomerular diseases attack the tiny blood vessels, or glomeruli, within the kidney. The most common primary glomerular diseases include membranous nephropathy, IgA nephropathy, and focal segmental glomerulosclerosis. The first sign of a glomerular disease is often proteinuria, which is too much protein in the urine. Another common sign is hematuria, which is blood in the urine. Some people may have both proteinuria and hematuria. Glomerular diseases can slowly destroy kidney function. Blood pressure control is important with any kidney disease. Glomerular diseases are usually diagnosed with a biopsy—a procedure that involves taking a piece of kidney tissue for examination with a microscope. Treatments for glomerular diseases may include immunosuppressive drugs or steroids to reduce inflammation and proteinuria, depending on the specific disease.

Inherited and Congenital Kidney Diseases

Some kidney diseases result from hereditary factors. Polycystic kidney disease (PKD), for example, is a genetic disorder in which many cysts grow in the kidneys. PKD cysts can slowly replace much of the mass of the kidneys, reducing kidney function and leading to kidney failure.

Some kidney problems may show up when a child is still developing in the womb. Examples include autosomal recessive PKD, a rare form of PKD, and other developmental problems that interfere with the normal formation of the nephrons. The signs of kidney disease in children vary. A child may grow unusually slowly, vomit often, or have back or side pain. Some kidney diseases may be silent—causing no signs or symptoms—for months or even years.

If a child has a kidney disease, the child’s doctor should find it during a regular checkup. The first sign of a kidney problem may be high blood pressure; a low number of red blood cells, called anemia; proteinuria; or hematuria. If the doctor finds any of these problems, further tests may be necessary, including additional blood and urine tests or radiology studies. In some cases, the doctor may need to perform a biopsy.

Some hereditary kidney diseases may not be detected until adulthood. The most common form of PKD was once called “adult PKD” because the symptoms of high blood pressure and renal failure usually do not occur until patients are in their twenties or thirties. But with advances in diagnostic imaging technology, doctors have found cysts in children and adolescents before any symptoms appear.

Other Causes of Kidney Disease

Poisons and trauma, such as a direct and forceful blow to the kidneys, can lead to kidney disease.

Some over-the-counter medicines can be poisonous to the kidneys if taken regularly over a long period of time. Anyone who takes painkillers regularly should check with a doctor to make sure the kidneys are not at risk.

Kidney - An overview in a layman's language.

To begin with, first things first. Let me explain kidney and its functionality in a layman's language.

A human body has a pair of kidneys, i.e. 2 kidneys. If at all you are wondering how these organs look like then they look quiet similar to "Rajma". They are located right below u abdomen.. if u want to imagine it then it is a little below, on the extreme sides, of ur naval point. But, how does that matter, even if it were somewhere else then it would have been equally important, isnt it!!!

The function of these organ is to remove the toxins and excess water from your body. These waste is then forwarded to bladder and is excreted out as urine. Finally, the kidneys are important in the production of hormones including vitamin D, renin and Erythropoitin. Greek and Latin??? wait, lemme explain. As we read in school Vitamin D is produced by exposure to early morning sunlight, but this organ is, i suppose, the one responsible for its production. Vitamin D strengthens our bones. Its an fat soluble vitamin besides vitamin A, E and K. Renin regulates the body's mean arterial blood pressure; whereas Erythropoitin, very importantly is responsible for red blood cell production. It also plays an important role in brain's response to neuronal injury and wound healing process.

Well, need less to say that the kidney's failure can affect the above processes of a human body. So basically in a renal chronic disorder, its not just the excreatory system but the whole body from brain to cell that affected.