Association between Healthy Eating Index 2015 and albuminuria in US adults with hypertension: a cross-sectional analysis of the National Health and Nutrition Examination Survey 2007-2020.

BACKGROUND: Albuminuria is a critical prognostic indicator for adverse outcomes (eg, chronic kidney disease, cardiovascular events) in adults with hypertension. While healthy dietary patterns are linked to improved renal and cardiovascular health, the association between overall healthy eating (assessed by a comprehensive index) and albuminuria in this population remains insufficiently investigated. OBJECTIVE: This study aimed to explore the association between the Healthy Eating Index 2015 (HEI-2015) and albuminuria in US adults with hypertension using National Health and Nutrition Examination Survey (NHANES) 2007-2020 data. METHODS: This was a cross-sectional analysis of data from the NHANES 2007-2020. Participants aged ≥20 years with hypertension defined in accordance with the American Heart Association (AHA) clinical guidelines were included. HEI-2015 score was evaluated from dietary intake data collected by conducting 24-hour dietary recall interviews. Albuminuria was defined as a urinary albumin-to-creatinine ratio (UACR) ≥30 mg/g. Logistic regression and restricted cubic spline analysis were used to evaluate the association between HEI-2015 and albuminuria. RESULTS: A total of 12 829 US adults with hypertension were included, with 2163 (16.86%) having albuminuria. The weighted mean HEI-2015 score was 53.9, and the weighted mean UACR was 60.6 mg/g. In the fully adjusted logistic regression model (model 3), compared with Q1 (reference), the OR of albuminuria for Q4 was 0.75 (95% CI 0.59 to 0.95, p=0.02). For each 13-point increase in HEI-2015, the OR of albuminuria was 0.91 (95% CI 0.83 to 0.99, p=0.04) in model 3. Restricted cubic spline analysis showed a linear association between HEI-2015 and albuminuria (P for non-linearity=0.239, P overall <0.001). Stratified analyses (by age, sex, race, body mass index, etc) showed no significant interaction (all P for interaction >0.05). CONCLUSION: Higher HEI-2015 scores (indicating healthier dietary patterns) are significantly associated with a lower prevalence of albuminuria in US adults with hypertension. These findings support healthy eating as a potential strategy for preventing albuminuria in hypertensive populations.