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The Associations of Plant Protein Intake With All-Cause Mortality in CKD.

Abstract

BACKGROUND

Plant protein intake is associated with lower production of uremic toxins and lower serum phosphorus levels. Therefore, at a given total protein intake, a higher proportion of dietary protein from plant sources might be associated with lower mortality in chronic kidney disease.

STUDY DESIGN

Observational study.

SETTINGS & PARTICIPANTS

14,866 NHANES III participants 20 years or older without missing data for plant and animal protein intake and mortality.

PREDICTORS

Plant protein to total protein ratio and total plant protein intake. Patients were stratified by estimated glomerular filtration rate (eGFR)<60 or ≥60mL/min/1.73m(2).

OUTCOMES

All-cause mortality.

MEASUREMENTS

Plant and total protein intakes were estimated from 24-hour dietary recalls. Mortality was ascertained by probabilistic linkage with National Death Index records through December 31, 2000.

RESULTS

Mean values for plant protein intake and plant protein to total protein ratio were 24.6±13.2 (SD) g/d and 33.0% ± 14.0%, respectively. The prevalence of eGFRs<60mL/min/1.73m(2) was 4.9%. There were 2,163 deaths over an average follow-up of 8.4 years. Adjusted for demographics, smoking, alcohol use, comorbid conditions, body mass index, calorie and total protein intake, and physical inactivity, each 33% increase in plant protein to total protein ratio was not associated with mortality (HR, 0.88; 95% CI, 0.74-1.04) in the eGFR≥60mL/min/1.73m(2) subpopulation, but was associated with lower mortality risk (HR, 0.77; 95% CI, 0.61-0.96) in the eGFR<60mL/min/1.73m(2) subpopulation. In sensitivity analyses, results were similar in those with eGFR<60mL/min/1.73m(2) defined by serum cystatin C level.

LIMITATIONS

Whether results are related to plant protein itself or to other factors associated with more plant-based diets is difficult to establish.

CONCLUSIONS

A diet with a higher proportion of protein from plant sources is associated with lower mortality in those with eGFR<60mL/min/1.73m(2). Future studies are warranted to determine the causal role of plant protein intake in reducing mortality in those with eGFR<60mL/min/1.73m(2).

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  • Authors+Show Affiliations

    ,

    Department of Nephrology, University of Utah School of Medicine, Salt Lake City, UT; Division of Nutrition, University of Utah, Salt Lake City, UT.

    ,

    Department of Nephrology, University of Utah School of Medicine, Salt Lake City, UT.

    ,

    Division of Nutrition, University of Utah, Salt Lake City, UT.

    ,

    Division of Nutrition, University of Utah, Salt Lake City, UT.

    ,

    Department of Nephrology, University of Utah School of Medicine, Salt Lake City, UT.

    ,

    Department of Nephrology, University of Utah School of Medicine, Salt Lake City, UT; VA Healthcare System, Salt Lake City, UT.

    ,

    Department of Nephrology, University of Utah School of Medicine, Salt Lake City, UT.

    ,

    VA Healthcare System, Salt Lake City, UT.

    Department of Nephrology, University of Utah School of Medicine, Salt Lake City, UT; VA Healthcare System, Salt Lake City, UT. Electronic address: Srinivasan.beddhu@hsc.utah.edu.

    Source

    MeSH

    Adult
    Body Mass Index
    Cystatin C
    Dietary Proteins
    Feeding Behavior
    Female
    Follow-Up Studies
    Glomerular Filtration Rate
    Humans
    Male
    Middle Aged
    Mortality
    Nutrition Surveys
    Plant Proteins
    Renal Insufficiency, Chronic
    Risk Assessment
    Risk Factors
    United States

    Pub Type(s)

    Journal Article
    Observational Study
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    26687923

    Citation

    TY - JOUR T1 - The Associations of Plant Protein Intake With All-Cause Mortality in CKD. AU - Chen,Xiaorui, AU - Wei,Guo, AU - Jalili,Thunder, AU - Metos,Julie, AU - Giri,Ajay, AU - Cho,Monique E, AU - Boucher,Robert, AU - Greene,Tom, AU - Beddhu,Srinivasan, Y1 - 2015/12/10/ PY - 2015/02/12/received PY - 2015/10/10/accepted PY - 2017/03/01/pmc-release PY - 2015/12/22/entrez PY - 2015/12/22/pubmed PY - 2016/7/9/medline KW - NHANES (National Health and Nutrition Examination Survey) KW - Plant protein KW - animal protein KW - chronic kidney disease (CKD) KW - decreased renal function KW - diet KW - dietary recall KW - disease progression KW - estimated glomerular filtration rate (eGFR) KW - mortality KW - nutrition KW - protein intake SP - 423 EP - 30 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am. J. Kidney Dis. VL - 67 IS - 3 N2 - BACKGROUND: Plant protein intake is associated with lower production of uremic toxins and lower serum phosphorus levels. Therefore, at a given total protein intake, a higher proportion of dietary protein from plant sources might be associated with lower mortality in chronic kidney disease. STUDY DESIGN: Observational study. SETTINGS & PARTICIPANTS: 14,866 NHANES III participants 20 years or older without missing data for plant and animal protein intake and mortality. PREDICTORS: Plant protein to total protein ratio and total plant protein intake. Patients were stratified by estimated glomerular filtration rate (eGFR)<60 or ≥60mL/min/1.73m(2). OUTCOMES: All-cause mortality. MEASUREMENTS: Plant and total protein intakes were estimated from 24-hour dietary recalls. Mortality was ascertained by probabilistic linkage with National Death Index records through December 31, 2000. RESULTS: Mean values for plant protein intake and plant protein to total protein ratio were 24.6±13.2 (SD) g/d and 33.0% ± 14.0%, respectively. The prevalence of eGFRs<60mL/min/1.73m(2) was 4.9%. There were 2,163 deaths over an average follow-up of 8.4 years. Adjusted for demographics, smoking, alcohol use, comorbid conditions, body mass index, calorie and total protein intake, and physical inactivity, each 33% increase in plant protein to total protein ratio was not associated with mortality (HR, 0.88; 95% CI, 0.74-1.04) in the eGFR≥60mL/min/1.73m(2) subpopulation, but was associated with lower mortality risk (HR, 0.77; 95% CI, 0.61-0.96) in the eGFR<60mL/min/1.73m(2) subpopulation. In sensitivity analyses, results were similar in those with eGFR<60mL/min/1.73m(2) defined by serum cystatin C level. LIMITATIONS: Whether results are related to plant protein itself or to other factors associated with more plant-based diets is difficult to establish. CONCLUSIONS: A diet with a higher proportion of protein from plant sources is associated with lower mortality in those with eGFR<60mL/min/1.73m(2). Future studies are warranted to determine the causal role of plant protein intake in reducing mortality in those with eGFR<60mL/min/1.73m(2). SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/26687923/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(15)01339-6 ER -