Adherence to the dietary index for gut microbiota (DI-GM) was strongly linked to a reduced risk of incident chronic kidney disease, particularly in individuals with high genetically predicted gut microbial abundance.
Key Findings
Results
Higher DI-GM scores were significantly associated with reduced risk of incident CKD in a dose-response pattern.
Study included 166,865 participants free of CKD at baseline with a median follow-up of 9.44 years
3,977 participants developed CKD during follow-up
Compared to the lowest DI-GM group (0-3 points), participants with 4 points had HR 0.81 (95% CI: 0.74, 0.88)
Participants with 5 points had HR 0.79 (95% CI: 0.72, 0.86), and those with ≥6 points had HR 0.73 (95% CI: 0.67, 0.80)
P for trend <0.0001
Results
Genetically predicted gut microbial abundance significantly modified the association between DI-GM adherence and CKD risk.
A genetic risk score for gut microbial abundance was constructed based on 19 variants
Significant multiplicative interactions were observed between genetically predicted gut microbial abundance and adherence to the DI-GM (P for interaction = 0.004)
The protective association of DI-GM was particularly pronounced in individuals with high gut microbial abundance
Methods
The study used the DI-GM, a recently proposed dietary index designed to reflect gut microbiota diversity from a dietary intake perspective.
DI-GM was assessed through a 24-hour dietary recall questionnaire
The index was scored with categories ranging from 0-3 points (lowest) to ≥6 points (highest)
This is described as a prospective cohort study design
Incident CKD was ascertained using hospital inpatient records, death registry data, and primary care data
Methods
Cox proportional hazards models were used in a fully adjusted framework to estimate the association between DI-GM and CKD incidence.
The Cox proportional hazards model was used to estimate hazard ratios (HR) and 95% confidence intervals (CI)
Results reported are from the fully adjusted model
The study is described as a prospective cohort design with 166,865 participants
What This Means
This research suggests that eating a diet that supports a diverse gut microbiome is associated with a meaningfully lower risk of developing chronic kidney disease (CKD). The study followed nearly 167,000 adults who did not have CKD at the start, and over roughly 9.5 years, about 3,977 of them developed the condition. People who most closely followed the Dietary Index for Gut Microbiota (DI-GM) — a scoring system based on foods thought to promote a healthy and diverse gut bacterial community — had about a 27% lower risk of CKD compared to those with the lowest dietary scores.
The study also found that a person's genetics related to gut microbial abundance interacted with their diet, meaning the benefit of following the DI-GM appeared to be especially strong in people who were genetically predisposed to having higher gut microbial diversity. This suggests that the gut microbiome may play a role in connecting diet to kidney health outcomes.
This research matters because CKD is a serious and growing public health problem, and identifying modifiable factors like diet that may reduce risk is valuable. The findings suggest that dietary patterns supporting gut microbiome diversity could be a promising area for CKD prevention strategies, though as an observational study, it cannot prove that the diet directly causes reduced CKD risk.
Ma Z, Zhang Y, Yang H, Zheng G, Li L, Zhang R, et al.. (2026). The dietary index for gut microbiota, genetically predicted gut microbiome, and the risk of chronic kidney disease: a cohort study.. Food & function. https://doi.org/10.1039/d6fo00453a