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Kiuchi Y, Tsutsumimoto K, Nishimoto K, Misu Y, Ohata T, Makizako H, Shimada H. Association between dietary diversity and chronic kidney disease in community-dwelling older adults. Eur Geriatr Med 2024; 15:545-552. [PMID: 38281299 DOI: 10.1007/s41999-023-00927-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 12/19/2023] [Indexed: 01/30/2024]
Abstract
OBJECTIVE The present study examined whether dietary diversity is associated with chronic kidney disease (CKD) in community-dwelling older Japanese adults. METHODS Participants comprised 8,195 older adults (mean age was 74.0 ± 5.6 years; 42.7% were men) in this cross-sectional study. In this study, CKD was defined as estimated Glomerular Filtration Rate (eGFR) < 45 mL/min/1.73 m2. Diet variety was assessed using the Food Frequency Score (FFS) (maximum, 30 points). The FFS assessed the one-week consumption frequency of ten foods (meat, fish/shellfish, eggs, milk, soybean products, green & yellow vegetables, potatoes, fruits, seafood, and fats & oil). Participants with an FFS of 16 or fewer points were defined as having low dietary diversity. RESULTS The prevalence of CKD was 376 (4.6%), and the low dietary diversity group had higher prevalence (5.6%) compared with the high and low dietary diversity group (4.3%). Multiple logistic regression analysis revealed low dietary diversity was associated with CKD in older adults (OR 1.30, 95%CI 1.01-1.68). Stratified analysis showed that low dietary diversity was independently associated with CKD (OR 1.43, 95% CI 1.07-1.91) in older adults with hypertension, but not in adults without hypertension (OR 0.94, 95% CI 0.54-1.64). CONCLUSIONS AND IMPLICATIONS This cross-sectional study revealed that low dietary diversity was associated with CKD among older adults. Furthermore, low dietary diversity was associated with CKD among older adults with hypertension.
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Affiliation(s)
- Yuto Kiuchi
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Research Institute, Morioka, Obu, Aichi, Japan.
- Department of Health Science, Graduate School of Health Sciences Kagoshima University, Sakuragaoka, Kagoshima, Japan.
| | - Kota Tsutsumimoto
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Research Institute, Morioka, Obu, Aichi, Japan
| | - Kazuhei Nishimoto
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Research Institute, Morioka, Obu, Aichi, Japan
- Medical Science Division, Department of Medical Sciences, Graduate School of Medicine, Science and Technology, Shinshu University, Matsumoto, Nagano, Japan
| | - Yuka Misu
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Research Institute, Morioka, Obu, Aichi, Japan
| | - Tomoka Ohata
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Research Institute, Morioka, Obu, Aichi, Japan
- Division of Creative Physical Therapy, Field of Prevention and Rehabilitation Sciences, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan
| | - Hyuma Makizako
- Department of Physical Therapy, Faculty of Medicine, School of Health Sciences, Kagoshima University, Sakuragaoka, Kagoshima, Japan
| | - Hiroyuki Shimada
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Research Institute, Morioka, Obu, Aichi, Japan
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Sun J, Wei Y, Miao R, Zhang X, Zhang B, Zhang L, Zhao L. Comparison of the effects of different percentages of soy protein in the diet on patients with type 2 diabetic nephropathy: systematic reviews and network meta-analysis. Front Nutr 2023; 10:1184337. [PMID: 37693248 PMCID: PMC10484530 DOI: 10.3389/fnut.2023.1184337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 08/02/2023] [Indexed: 09/12/2023] Open
Abstract
Background Dietary soy protein (SP) is a potential intervention for protecting the kidneys and improving glucose and lipid metabolism. However, whether this effect is related to the percentage of SP intake remains unclear. Objective This study aims to review and analyze the results of randomized clinical trials (RCTs) in patients with type 2 diabetic nephropathy (T2DN) who received diets with different percentages of SP. Methods The databases: PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, China National Knowledge Infrastructure (CNKI), Chinese BioMedical Literature Database (CBM), WanFang, Weipu (VIP), and ClinicalTrials.gov were searched until February 2023, for RCTs on T2DN and SP. Results A total of six studies comprising 116 participants were included. The interventions were classified as 0% SP, 35% SP, and 100% SP. To improve serum creatinine (Scr), blood urea nitrogen (BUN), 24-h urine total protein (24hUTP), and glomerular filtration rate (GFR), a 35% SP diet was the most effective, compared to a 0% SP diet, which showed a mean difference of -154.00 (95% confidence interval: -266.69, -41.31) for 24hUTP. Although it had significant benefits for 24hUTP, great heterogeneity was observed. To improve the glycolipid metabolism-related markers such as cholesterol (CHO), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), fasting blood glucose (FPG), and weight, the 35% SP diet demonstrated superior efficacy compared to the 0% SP diet. Specifically, the mean difference for CHO was -0.55 (95% confidence interval: -1.08, -0.03), and for LDL-C, it was -17.71 (95% confidence interval: -39.67, -4.24). The other indicators were not statistically significant. Most studies had concerns regarding the risk of bias. Conclusion The findings of this study demonstrate that both 35% and 100% SP diets are more effective than a diet with no SP in improving renal function and glucolipid metabolism in patients with T2DN. As a result, a diet incorporating 35% SP may be the optimal choice for individuals with T2DN. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=352638, identifier CRD42022352638.
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Affiliation(s)
- Jun Sun
- Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, China
| | - Yu Wei
- Institute of Metabolic Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate College, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Runyu Miao
- Institute of Metabolic Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate College, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Xiangyuan Zhang
- Institute of Metabolic Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate College, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Boxun Zhang
- Institute of Metabolic Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Lili Zhang
- Institute of Metabolic Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Linhua Zhao
- Institute of Metabolic Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Yin L, Dong X, Liao W, Liu X, Zheng Z, Liu D, Wang C, Liu Z. Relationships of beans intake with chronic kidney disease in rural adults: A large-scale cross-sectional study. Front Nutr 2023; 10:1117517. [PMID: 37081921 PMCID: PMC10111024 DOI: 10.3389/fnut.2023.1117517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 03/14/2023] [Indexed: 04/07/2023] Open
Abstract
Background and aimsDietary factors play an important role in the development of chronic kidney disease (CKD). However, evidence on the relationship of beans consumption with CKD remains limited and inconclusive, especially in the middle-and low-income populations. The current study aimed to investigate the relationships of beans intake with indicators of kidney injury and CKD prevalence in rural adults.MethodsA total of 20,733 rural adults from the Henan Rural Cohort Study in 2018–2022 were included. The total beans intake was collected using a validated food frequency questionnaire. Indicators of kidney injury and CKD was determined by the estimated glomerular filtration rate and the urinary albumin to creatinine ratio. Generalized linear regression and logistic regression models were applied to estimate the relationship of beans intake with continuous and dichotomized indicators of renal function, respectively.ResultsOf the 20,733 participants, 2,676 (12.91%) subjects were identified as CKD patients. After adjusting for potential confounders, participants in the higher quartiles of beans intake had a lower prevalence of CKD (odds ratio and 95% confidence interval, OR (95%CI); Q2: 0.968(0.866–1.082); Q3: 0.836(0.744–0.939); Q4: 0.854(0.751–0.970)) and albuminuria (Q2: 0.982(0.875–1.102); Q3: 0.846(0.750–0.954); Q4: 0.852 (0.746–0.973)), compared with the Q1. Per 50 g/day increment in beans intake was significantly associated with a 5 and 4% decreased prevalence of albuminuria and CKD, respectively. These inverse relationships were also significant in the subgroups of men, elder, and high-income participants (p < 0.05).ConclusionDietary beans intake was inversely associated with the prevalence of albuminuria and CKD in rural adults, suggesting that promoting soy food intake might help reduce the occurrence of CKD in rural adults.
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Affiliation(s)
- Lei Yin
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Xiaokang Dong
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Wei Liao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Xiaotian Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Zhaohui Zheng
- Department of Rheumatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dongwei Liu
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
- *Correspondence: Chongjian Wang,
| | - Zhangsuo Liu
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Zhangsuo Liu,
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Diet and Proteinuria: State of Art. Int J Mol Sci 2022; 24:ijms24010044. [PMID: 36613485 PMCID: PMC9819984 DOI: 10.3390/ijms24010044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/11/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
Proteinuria is a broad term used to describe the pathological presence of proteins, including albumin, globulin, Bence-Jones protein, and mucoprotein in the urine. When persistent, proteinuria is a marker of kidney damage and represents a reliable predictor of the risk of progression of renal failure. Medical nutrition therapy is imperative for patients with proteinuria because it may slow the progression of renal disease. The aim of this review is to explore different nutritional approaches in the management of proteinuria and their influence on pathophysiological processes. As such, protein restriction is the main dietary intervention. Indeed, other management approaches are frequently used to reduce it regarding micro and macronutrients, but also the dietary style. Among these, the nutritional approach represents one of the most used and controversial interventions and the studies rarely take the form of randomized and controlled trials. With this work we aspire to analyze current clinical knowledge of how nutrition could influence proteinuria, potentially representing a useful tool in the management of proteinuric nephropathy.
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Milovanova LY, Taranova MV, Volkov AV, Milovanova SY, Beketov VD. [Soy protein as part of a low-protein diet is a new direction in cardio- and nephroprotection in patients with 3B-4 stages of chronic kidney disease: prospective, randomized, controlled clinical study]. TERAPEVT ARKH 2022; 94:756-762. [PMID: 36286853 DOI: 10.26442/00403660.2022.06.201567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/04/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND It has been established that the use of a low-protein diet (LPD) in combination with ketoanalogues (KA) of essential amino acids can contribute to cardio- and nephroprotection in chronic kidney disease (CKD). Moreover, it has been shown that replacing part of the animal protein with soy protein (SP) in the diet contributed to more pronounced nephro- and cardioprotection in CKD, however, the data, available in the literature, are mainly represented by experimental studies. AIM To compare the effects of 2 types of diets on the main parameters of nephro- and cardioprotection in patients with CKD. MATERIALS AND METHODS We have conducted a prospective, randomized, controlled clinical study which included 85 patients with 3B4 stages of CKD, compliant to LPD (0.6 g of protein/kg body weight) + KA (1 tablet/5 kg body weight). 43 patients (Group 1) received LPD with replacing animal protein with soy (60% soy protein + 40% another vegetable proteins) + KA, and 42 patients (control group, Group 2) received LPD (60% animal protein + 40% vegetable protein) + KA, within 12 months. RESULTS The dietary substitution of animal protein with SP to a greater extent delayed the decrease in glomerular filtration rate (-5.9% vs -13.3%; p=0.048), the increase in left ventricular hypertrophy (+4.7% vs +12.3%; p=0.042), as well as the increase in central systolic blood pressure (+2.6% vs +13.0%; p=0.021), augmentation index (+7.6% vs +23.3%; p=0.010), slowed down the decrease in lean body mass in men (+0.9% vs -11.2%; p=0.017) and women (-1.8% vs -10.3%; p=0.024), increase in phosphorus (-10.3% vs +13.0%; p=0.029), cholesterol (-10.7% vs -3.4%; p=0.047) and urea (+6.3% vs +19.6%; p=0.035) serum levels. CONCLUSION The use of LPD with substitution of animal protein with soy protein + KA provides a more pronounced effect on nephro- and cardioprotection as well as maintenance of nutritional status, than conventional LPD + KA in patients with 3B4 stages of CKD.
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Affiliation(s)
- L Y Milovanova
- Sechenov First Moscow State Medical University (Sechenov University)
| | - M V Taranova
- Sechenov First Moscow State Medical University (Sechenov University)
| | - A V Volkov
- Sechenov First Moscow State Medical University (Sechenov University)
| | - S Y Milovanova
- Sechenov First Moscow State Medical University (Sechenov University)
| | - V D Beketov
- Sechenov First Moscow State Medical University (Sechenov University)
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Mahesaniya A, Williamson CR, Keyvani Chahi A, Martin CE, Mitro AE, Lu P, New LA, Watson KL, Moorehead RA, Jones N. Sex Differences in Glomerular Protein Expression and Effects of Soy-Based Diet on Podocyte Signaling. Can J Kidney Health Dis 2022; 9:20543581221121636. [PMID: 36199279 PMCID: PMC9528100 DOI: 10.1177/20543581221121636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Kidney disease is a major public health issue arising from loss of glomerular podocyte function, and there are considerable sex differences in its prognosis. Evidence suggests a renoprotective effect of estrogen and soy diet-derived phytoestrogens, although the molecular basis for this is poorly understood. Objective: Here, we aim to assess sex differences in expression of key proteins associated with podocyte survival and determine the effects of dietary soy on glomerular and podocyte signaling. Methods: Male and female FVB mice were fed control, low (1%), and high (20%) doses of isolated soy protein (ISP) in utero and until 100 days of age. Spot urine was collected to measure proteinuria and isolated glomeruli were used to quantify activated and total levels of nephrin, Akt, and ERK1/2. To investigate protective effects of specific soy phytoestrogens, cultured podocytes were treated with or without daidzein and subject to control or high glucose as a model of podocyte injury. Results: Nephrin and Akt were elevated at baseline in glomeruli from females compared to males. Both sexes that were fed 1% and 20% ISP displayed robust increases in total glomerular Akt compared to controls, and these effects were more prominent in females. A similar trend at both doses in both sexes was observed with activated Akt and total nephrin. Notably, males exclusively showed increased phosphorylation of nephrin and extracellular signal-regulated kinase (ERK) at the 1% ISP dose; however, no overt changes in urinary albumin excretion or podocin levels were observed, suggesting that the soy diets did not impair podocyte function. Finally, in cultured male and female podocytes, daidzein treatment suppressed high glucose-induced ERK activation. Conclusions: Together, our findings reveal a putative mechanism to explain the protective influence of sex on kidney disease progression, and they provide further evidence to support a beneficial role for dietary soy in preserving glomerular function.
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Affiliation(s)
- Afreeda Mahesaniya
- Department of Molecular and Cellular Biology, University of Guelph, ON, Canada
| | - Casey R. Williamson
- Department of Molecular and Cellular Biology, University of Guelph, ON, Canada
| | - Ava Keyvani Chahi
- Department of Molecular and Cellular Biology, University of Guelph, ON, Canada
- Present address: Department of Biochemistry & Biomedical Sciences, McMaster University, Hamilton, ON, Canada
| | - Claire E. Martin
- Department of Molecular and Cellular Biology, University of Guelph, ON, Canada
- Present address: Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada
| | - Alexander E. Mitro
- Department of Molecular and Cellular Biology, University of Guelph, ON, Canada
| | - Peihua Lu
- Department of Molecular and Cellular Biology, University of Guelph, ON, Canada
| | - Laura A. New
- Department of Molecular and Cellular Biology, University of Guelph, ON, Canada
| | | | | | - Nina Jones
- Department of Molecular and Cellular Biology, University of Guelph, ON, Canada
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Fang L, Du Y, Rao X. A Survey Study on Soy Food Consumption in Patients with Chronic Kidney Diseases. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2022; 59:469580221093450. [PMID: 35435748 PMCID: PMC9019316 DOI: 10.1177/00469580221093450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Chronic kidney disease (CKD) is one of the major and exacerbating global health burdens, which is characterized by no curative treatments and high morbidity and mortality. Since malnutrition has become an important factor determining the final clinical outcomes of CKD, soy products, high-quality plant-based sources of proteins and other nutrients, are recommended by many physicians for CKD patients. However, it has been reported that adherence to this dietary advice among those patients is low. In order to dissect the potential reasons behind this phenomenon and to subsequently develop target intervention to improve the current situation, we designed and conducted a self-administered questionnaire survey in 3 medical centers in China. Total 570 patients responded to our survey and data analysis reveals that 85.6% of the respondents were aware of the necessaries of high-quality protein diets for CKD patients, but only 41.9% of patients knew that soy foods provide high-quality proteins needed. In contrast, up to 90.4% of patients were affected by the notion that patients with CKD should avoid soy products. Besides, comparing with other groups, higher percentage of patients undergoing peritoneal dialysis recognized soy products as foods with high-quality proteins, however, as many as 68.8% of them did not consume any soy foods due to the concerns of adverse effects on the progress of CKD. Our data suggest that a significant portion of patients with CKD do not consume soy foods, which could be mainly resulted from their misconception towards soy products delivered by medical workers or social media. Evidence-based updated education of patients and medical workers on soy foods would be a necessary strategy for improving nutrition status of CKD patients and their clinical outcomes.
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Affiliation(s)
- Lvgui Fang
- South District of Guang'anmen Hospital of the China Academy of Chinese Medical Sciences, Beijing, China
| | - Yating Du
- North District of Guang'anmen Hospital of the China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiangrong Rao
- North District of Guang'anmen Hospital of the China Academy of Chinese Medical Sciences, Beijing, China
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Mocanu CA, Simionescu TP, Mocanu AE, Garneata L. Plant-Based versus Animal-Based Low Protein Diets in the Management of Chronic Kidney Disease. Nutrients 2021; 13:nu13113721. [PMID: 34835976 PMCID: PMC8621419 DOI: 10.3390/nu13113721] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/16/2021] [Accepted: 10/21/2021] [Indexed: 12/14/2022] Open
Abstract
Recent data reiterate low-protein diets (LPDs) as cornerstones in the conservative management of chronic kidney disease (CKD). The reduction in proteinuria, better blood pressure control and the reduction in the rate of decline in kidney function with LPDs were reported, both in non-diabetics and diabetics patients. Supplemented, vegetarian, very-low-protein diets (sVLPD, 0.3 g/kg-day) could postpone kidney replacement therapy (KRT) initiation, mainly through the better control of metabolic disorders of advanced CKD in non-diabetic patients. Plant-based diets could ameliorate gut microbiota and appear to be superior to mixed hypoproteic diets in treating advanced CKD: better control of nitrogen balance, acid-base metabolism and bone mineral disorders. Vegetarian diets generate fewer uremic toxins and reduce salt intake and acid overload. At the same time, they can improve lipid metabolism, providing a high ratio of unsaturated to saturated fatty acids, as well as insulin resistance.
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Affiliation(s)
- Carmen-Antonia Mocanu
- Department of Internal Medicine and Nephrology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Department of Nephrology, “Dr. Carol Davila” Teaching Hospital of Nephrology, 4 Calea Grivitei, Sector 1, 010731 Bucharest, Romania; (T.P.S.); (A.E.M.)
- Correspondence:
| | - Tudor Petrisor Simionescu
- Department of Nephrology, “Dr. Carol Davila” Teaching Hospital of Nephrology, 4 Calea Grivitei, Sector 1, 010731 Bucharest, Romania; (T.P.S.); (A.E.M.)
| | - Andreea Elena Mocanu
- Department of Nephrology, “Dr. Carol Davila” Teaching Hospital of Nephrology, 4 Calea Grivitei, Sector 1, 010731 Bucharest, Romania; (T.P.S.); (A.E.M.)
| | - Liliana Garneata
- Department of Internal Medicine and Nephrology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Department of Nephrology, “Dr. Carol Davila” Teaching Hospital of Nephrology, 4 Calea Grivitei, Sector 1, 010731 Bucharest, Romania; (T.P.S.); (A.E.M.)
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Alvirdizadeh S, Yuzbashian E, Mirmiran P, Eghtesadi S, Azizi F. A prospective study on total protein, plant protein and animal protein in relation to the risk of incident chronic kidney disease. BMC Nephrol 2020; 21:489. [PMID: 33203389 PMCID: PMC7672990 DOI: 10.1186/s12882-020-02079-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 09/23/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The link between dietary protein intake and the risk of kidney dysfunction is always a challenging issue. This study aimed to investigate the relationship between total protein, plant protein, and animal protein intake with the risk of incident chronic kidney disease (CKD). METHODS This study was performed on 1639 adults aged ≥27 years who participated in the Tehran Lipid and Glucose Study. Dietary data were evaluated using a valid and reliable semi-quantitative food frequency questionnaire (FFQ). Total protein content, plant protein, and animal protein of each participant were calculated. Glomerular filtration rate (GFR) less than 60 mL / min / 1.73 m2 has been considered as the definition of CKD. Odds Ratio (OR) was calculated using logistic regression to show the association between the risk of incident CKD and dietary exposures. RESULTS After adjusting for age, sex, body mass index, smoking, total energy intake, total fiber intake, dietary fat, physical activity, diabetes, and hypertension, there was no significant association of total protein and animal protein consumptions with the incidence of CKD. After adjustment for confounders, compared with the lowest tertile of plant protein consumption, OR of incident CKD in the highest tertile was 0.29 (95% confidence interval [95% CI] 0.15 to 0.55) with a significant trend (P for trend < 0.001). CONCLUSION The results of this study confirmed an inverse association between plant protein intake and the risk of incident CKD, which demonstrates the protective role of plant-based protein in a diet on kidney function.
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Affiliation(s)
- Sevda Alvirdizadeh
- Department of Nutrition, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Emad Yuzbashian
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-4763, Tehran, Iran.
| | - Parvin Mirmiran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-4763, Tehran, Iran.
| | - Shahryar Eghtesadi
- Department of Nutrition, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Torreggiani M, Fois A, D’Alessandro C, Colucci M, Orozco Guillén AO, Cupisti A, Piccoli GB. Of Mice and Men: The Effect of Maternal Protein Restriction on Offspring's Kidney Health. Are Studies on Rodents Applicable to Chronic Kidney Disease Patients? A Narrative Review. Nutrients 2020; 12:E1614. [PMID: 32486266 PMCID: PMC7352514 DOI: 10.3390/nu12061614] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/19/2020] [Accepted: 05/28/2020] [Indexed: 12/20/2022] Open
Abstract
In the almost 30 years that have passed since the postulation of the "Developmental Origins of Health and Disease" theory, it has been clearly demonstrated that a mother's dietary habits during pregnancy have potential consequences for her offspring that go far beyond in utero development. Protein malnutrition during pregnancy, for instance, can cause severe alterations ranging from intrauterine growth retardation to organ damage and increased susceptibility to hypertension, diabetes mellitus, cardiovascular diseases and chronic kidney disease (CKD) later in life both in experimental animals and humans. Conversely, a balanced mild protein restriction in patients affected by CKD has been shown to mitigate the biochemical derangements associated with kidney disease and even slow its progression. The first reports on the management of pregnant CKD women with a moderately protein-restricted plant-based diet appeared in the literature a few years ago. Today, this approach is still being debated, as is the optimal source of protein during gestation in CKD. The aim of this report is to critically review the available literature on the topic, focusing on the similarities and differences between animal and clinical studies.
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Affiliation(s)
- Massimo Torreggiani
- Nephrology and Dialysis, Centre Hospitalier Le Mans, Avenue Roubillard 194, 72000 Le Mans, France; (A.F.); (G.B.P.)
| | - Antioco Fois
- Nephrology and Dialysis, Centre Hospitalier Le Mans, Avenue Roubillard 194, 72000 Le Mans, France; (A.F.); (G.B.P.)
| | - Claudia D’Alessandro
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (C.D.); (A.C.)
| | - Marco Colucci
- Unit of Nephrology and Dialysis, ICS Maugeri S.p.A. SB, Via S. Maugeri 10, 27100 Pavia, Italy;
| | | | - Adamasco Cupisti
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (C.D.); (A.C.)
| | - Giorgina Barbara Piccoli
- Nephrology and Dialysis, Centre Hospitalier Le Mans, Avenue Roubillard 194, 72000 Le Mans, France; (A.F.); (G.B.P.)
- Dipartimento di Scienze Cliniche e Biologiche, Università di Torino, 10100 Torino, Italy
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Lecerf JM, Arnoldi A, Rowland I, Trabal J, Widhalm K, Aiking H, Messina M. Soyfoods, glycemic control and diabetes. NUTR CLIN METAB 2020. [DOI: 10.1016/j.nupar.2020.02.437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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12
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Alizadeh S, Esmaeili H, Alizadeh M, Daneshzad E, Sharifi L, Radfar H, Radaei MK. Metabolic phenotypes of obese, overweight, and normal weight individuals and risk of chronic kidney disease: a systematic review and meta-analysis. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2019; 63:427-437. [PMID: 31365625 PMCID: PMC10528657 DOI: 10.20945/2359-3997000000149] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 03/29/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Chronic kidney disease (CKD) risk is inconsistent in the normal-weight, overweight, and obese individuals due to the heterogeneity of metabolic status. This meta-analysis aimed to examine the combined effects of body mass index (BMI) and metabolic status on CKD risk. MATERIALS AND METHODS The MEDLINE, EMBASE, and Web of Knowledge databases were systematically searched up to March 2019 to identify all eligible studies investigating the CKD risk (defined as GFR < 60 mL/min per 1.73 m2 and/or microalbuminuria or proteinuria) associated with the body size phenotypes which are known as metabolically unhealthy normal-weight (MUNW), metabolically healthy overweight (MHOW), metabolically unhealthy overweight, metabolically healthy obese (MHO) and metabolically unhealthy obese (MUHO). The classification of subjects in included studies as metabolically unhealthy was based on the presence of three components of metabolic syndrome. BMI categorization was based on the criteria of included studies. The risk estimates and 95% confidence intervals (CIs) were extracted and pooled using random effects analysis. RESULTS A total of 9 prospective cohort studies with 128773 participants and 4797 incident cases were included in the meta-analysis. Compared with healthy normal-weight individuals as reference, MUNW and MHO subjects showed an increased risk for CKD events with a pooled RR of 1.58 (95% CI = 1.28-1.96) in MUNW and 1.55 (95% CI = 1.34-1.79) in MHO persons. Also, MHOW was at increased risk for CKD (RR = 1.34, 95% CI = 1.20-1.51). MUHO individuals were at the highest risk for the development of CKD (RR = 2.13, 95% CI = 1.66-2.72). CONCLUSIONS Individuals with metabolic abnormality, although at normal-weight, have an increased risk for CKD. Healthy overweight and obese individuals had higher risk; refuting the notion that metabolically healthy overweight and obese phenotypes are benign conditions.
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Affiliation(s)
- Shahab Alizadeh
- Tehran University of Medical SciencesDepartment of Clinical NutritionSchool of Nutritional Sciences and DieteticsTehran University of Medical SciencesTehranIranDepartment of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Hamed Esmaeili
- Baqiyatallah Medical Sciences UniversityDepartment of Nutrition and Food HygieneFaculty of HealthBaqiyatallah University of Medical SciencesTehranIranDepartment of Nutrition and Food Hygiene, Faculty of Health, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Alizadeh
- Mazandaran University of Medical SciencesDepartment of Medical Surgical NursingNasibeh Nursing & Midwifery SchoolMazandaran University of Medical SciencesSariIranDepartment of Medical Surgical Nursing, Nasibeh Nursing & Midwifery School, Mazandaran University of Medical Sciences, Sari, Iran
| | - Elnaz Daneshzad
- Tehran University of Medical SciencesDepartment of Community NutritionSchool of Nutritional Sciences and DieteticsTehran University of Medical SciencesTehranIranDepartment of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Loghman Sharifi
- Tehran University of Medical SciencesDepartment of Cellular and Molecular NutritionSchool of Nutritional Sciences and DieteticsTehran University of Medical SciencesTehranIranDepartment of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Hossein Radfar
- Kharazmi UniversityDepartment of Sports Biomechanicshysical Education and Sport Science CollegeKharazmi UniversityTehranIranDepartment of Sports Biomechanics, hysical Education and Sport Science College, Kharazmi University, Tehran, Iran
| | - Mohammad Kazem Radaei
- Baqiyatallah Medical Sciences UniversityDepartment of Nutrition and Food HygieneFaculty of HealthBaqiyatallah University of Medical SciencesTehranIranDepartment of Nutrition and Food Hygiene, Faculty of Health, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Chiu THT, Liu CH, Chang CC, Lin MN, Lin CL. Vegetarian diet and risk of gout in two separate prospective cohort studies. Clin Nutr 2019; 39:837-844. [PMID: 30955983 DOI: 10.1016/j.clnu.2019.03.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 03/04/2019] [Accepted: 03/14/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUNDS & AIMS Plant-based diets may target multiple pathways in gout pathogenesis (uric acid reduction and anti-inflammation) while improving gout associated cardiometabolic comorbidities. We aim to prospectively examine the relationship between a vegetarian diet and gout, and to explore if this relationship is independent of hyperuricemia. METHODS We followed 4903 participants in the Tzu Chi Health Study (Cohort1, recruited in 2007-2009) and 9032 participants in the Tzu Chi Vegetarian Study (Cohort2, recruited in 2005) until end of 2014. Baseline serum uric acid was measured in Cohort1. Vegetarian status was assessed through a diet questionnaire that includes dietary habits and a food frequency questionnaire. Incidence of gout was ascertained by linkage to the National Health Insurance Database. Hazard Ratio of gout in vegetarians versus nonvegetarians was assessed by Cox regression, adjusted for age, sex, lifestyle and metabolic risk factors. Hyperuricemia was additionally adjusted in Cohort1. RESULTS In Cohort1, lacto-ovo vegetarians had the lowest uric acid concentration, followed by vegans, then nonvegetarians (men: 6.05, 6.19, 6.32 mg/dL, respectively; women: 4.92, 4.96, 5.11 mg/dL, respectively); 65 gout cases occurred in the 29,673 person-years of follow-up; vegetarians experienced a lower risk of gout (without adjustment for hyperuricemia: HR: 0.33; 95% CI: 0.14, 0.79; with adjustment for hyperuricemia: HR: 0.40; 95% CI: 0.17, 0.97). In Cohort2, 161 gout cases occurred in the 83,019 person-years follow-up, and vegetarians also experienced a lower risk of gout (HR: 0.61; 95% CI: 0.41, 0.88). CONCLUSION Taiwanese vegetarian diet is associated with lower risk of gout. This protective association may be independent of baseline hyperuricemia. STUDY REGISTERED URL: https://www.clinicaltrials.gov. Unique Identifier: NCT03470584.
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Affiliation(s)
- Tina H T Chiu
- Department of Nutritional Science, Fu-Jen Catholic University, Taipei, Taiwan
| | - Chin-Hsiu Liu
- Division of Allergy, Immunology and Rheumatology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chia-Chen Chang
- Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi County, Taiwan
| | - Ming-Nan Lin
- Department of Family Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi County, Taiwan; Department of Family Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chin-Lon Lin
- Department of Cardiology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi County, Taiwan; Department of Internal Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan.
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14
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Jayachandran M, Xu B. An insight into the health benefits of fermented soy products. Food Chem 2019; 271:362-371. [PMID: 30236688 DOI: 10.1016/j.foodchem.2018.07.158] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 07/22/2018] [Accepted: 07/24/2018] [Indexed: 10/28/2022]
Abstract
The current review was aimed to summarize the nutritional values and various health benefits of fermented soy products. Several previous researches proved that soy products rich in protein can reduce the serum concentrations of total cholesterol, low-density lipoproteins (LDLs), and triglycerides if consumed instead of animal protein. Apart from these lipid-lowering effects, fermented soy products also proved to be effective in attenuating the effects of diabetes mellitus, blood pressure, cardiac disorders and cancer-related issues. The nutritional value of the fermented soy products gains much attention due to its increased levels compared to the non-fermented ones. The origin, compositions, nutritional values of different fermented soy products and health-promoting benefits of fermented soy products were systematically reviewed. Hence the in-depth analysis of the various research findings on fermented soy products, beneficial activities may help the future researchers to derive a conclusion on its beneficial effects on health.
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Affiliation(s)
- Muthukumaran Jayachandran
- Food Science and Technology Program, Beijing Normal University Hong Kong Baptist University United International College, China
| | - Baojun Xu
- Food Science and Technology Program, Beijing Normal University Hong Kong Baptist University United International College, China.
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15
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Alizadeh S, Ahmadi M, Ghorbani Nejad B, Djazayeri A, Shab-Bidar S. Metabolic syndrome and its components are associated with increased chronic kidney disease risk: Evidence from a meta-analysis on 11 109 003 participants from 66 studies. Int J Clin Pract 2018; 72:e13201. [PMID: 29790628 DOI: 10.1111/ijcp.13201] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 04/06/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND & AIMS Observational studies examining the relationship between metabolic syndrome and the risk of chronic kidney disease (CKD) have reported inconclusive results. This meta-analysis was performed to resolve these controversies. METHODS The MEDLINE, EMBASE, and PubMed databases were systematically searched from their inception until March 2016 to identify all relevant studies. Risk estimates and their corresponding 95% confidence intervals (CIs) for the associations of MetS and its components with CKD risk were extracted and pooled using a random-effects model. RESULTS A total of 66 studies, including 18 prospective cohorts and 48 cross-sectional studies, with 699 065 CKD patients and 11 109 003 participants were included in the meta-analysis. When all definitions were pooled, the presence of MetS was associated with a significant 50% increase of CKD risk (OR = 1.50, 95% CI = 1.43-1.56), with evidence of moderate heterogeneity (I2 = 72.3%, P < .001). The risk of CKD associated with MetS was higher in studies using the American Heart Association/National Heart, Lung, and Blood Institute criteria (OR = 1.68, 95% CI = 1.25-2.10) compared with those using the Adult Treatment Panel III (OR = 1.49, 95% CI = 1.42-1.56) and the International Diabetes Federation (OR = 1.32, 95% CI = 1.22-1.41) definitions. This relationship was independent of diabetes status. Moreover, all individual components of the MetS were significantly associated with CKD, and their coexistence resulted in an escalating dose-response relationship. The sensitivity and subgroup analyses established the stability of the findings. CONCLUSIONS This meta-analysis strongly suggests that the metabolic syndrome and its components are independently associated with the increased risk of CKD.
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Affiliation(s)
- Shahab Alizadeh
- Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mahsa Ahmadi
- Department of Microbiology, Faculty of Basic Sciences, Karaj Branch, Islamic Azad University, Alborz, Iran
| | - Behnam Ghorbani Nejad
- Department of pharmacology, School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Abolghassem Djazayeri
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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Rafieian-Kopaei M, Beigrezaei S, Nasri H, Kafeshani M. Soy Protein and Chronic Kidney Disease: An Updated Review. Int J Prev Med 2017; 8:105. [PMID: 29416834 PMCID: PMC5760843 DOI: 10.4103/ijpvm.ijpvm_244_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 08/23/2017] [Indexed: 12/31/2022] Open
Abstract
Chronic kidney disease (CKD) is a serious universal problem that is the main risk for several diseases including cardiovascular disease. Dietary factors are important to prevent and control the kidney disease. Some evidence has shown that modifying the amount and the types of dietary protein exert a major effect on renal failure so limiting dietary protein and substituting animal protein with soy protein has suggested. However, there is a lot of controversy about it, especially in human. Thus, this paper will review the clinical trial studies conducted on the effects of soy protein intake on CKD in both animal and human and its effect mechanism.
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Affiliation(s)
| | - Sara Beigrezaei
- Department of Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Nasri
- Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marzieh Kafeshani
- Department of Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
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17
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Kelly JT, Carrero JJ. Dietary Sources of Protein and Chronic Kidney Disease Progression: The Proof May Be in the Pattern. J Ren Nutr 2017; 27:221-224. [PMID: 28549571 DOI: 10.1053/j.jrn.2017.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 04/10/2017] [Indexed: 01/22/2023] Open
Affiliation(s)
- Jaimon T Kelly
- Faculty of Health Sciences and Medicine, Bond University, Bond, Australia
| | - Juan Jesús Carrero
- Division of Renal Medicine and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
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18
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Vegetarian Diet in Chronic Kidney Disease-A Friend or Foe. Nutrients 2017; 9:nu9040374. [PMID: 28394274 PMCID: PMC5409713 DOI: 10.3390/nu9040374] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 03/10/2017] [Accepted: 04/05/2017] [Indexed: 12/17/2022] Open
Abstract
Healthy diet is highly important, especially in patients with chronic kidney disease (CKD). Proper nutrition provides the energy to perform everyday activities, prevents infection, builds muscle, and helps to prevent kidney disease from getting worse. However, what does a proper diet mean for a CKD patient? Nutrition requirements differ depending on the level of kidney function and the presence of co-morbid conditions, including hypertension, diabetes, and cardiovascular disease. The diet of CKD patients should help to slow the rate of progression of kidney failure, reduce uremic toxicity, decrease proteinuria, maintain good nutritional status, and lower the risk of kidney disease-related secondary complications (cardiovascular disease, bone disease, and hypertension). It has been suggested that plant proteins may exert beneficial effects on blood pressure, proteinuria, and glomerular filtration rate, as well as results in milder renal tissue damage when compared to animal proteins. The National Kidney Foundation recommends vegetarianism, or part-time vegetarian diet as being beneficial to CKD patients. Their recommendations are supported by the results of studies demonstrating that a plant-based diet may hamper the development or progression of some complications of chronic kidney disease, such as heart disease, protein loss in urine, and the progression of kidney damage. However, there are sparse reports suggesting that a vegan diet is not appropriate for CKD patients and those undergoing dialysis due to the difficulty in consuming enough protein and in maintaining proper potassium and phosphorus levels. Therefore, this review will focus on the problem as to whether vegetarian diet and its modifications are suitable for chronic kidney disease patients.
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19
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Chan M, Kelly J, Tapsell L. Dietary Modeling of Foods for Advanced CKD Based on General Healthy Eating Guidelines: What Should Be on the Plate? Am J Kidney Dis 2017; 69:436-450. [PMID: 28129911 DOI: 10.1053/j.ajkd.2016.09.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 09/19/2016] [Indexed: 12/30/2022]
Abstract
Chronic kidney disease (CKD) is a major public health problem with significant clinical, societal, and psychosocial burdens. Nutrition therapy has been an integral part of the medical management of patients with CKD for more than a century, with the main goals of preserving kidney function and preventing complications. Nutrition abnormalities may emerge well before dialysis therapy is initiated and are associated with poor outcomes. It is therefore important to revisit nutrition management in the advanced stages of CKD to gain a broader insight into its role and effect on patient outcomes. Traditionally, nutrition recommendations have focused on the prescription of energy (calories) and macro- and micronutrients. Today, dietary modeling also focuses on the evidence for food consumption on health. This review argues that advanced non-dialysis-dependent CKD nutrition requirements to a large extent align with healthy eating guidelines for the general population and should not be based on deprivation or be unusually restrictive. The best currently available evidence for the CKD diet is likely to be derived from CKD nutrition prescriptions in conjunction with evidence underpinning national dietary guidelines and evidence of healthy dietary patterns, such as Mediterranean-style and Dietary Approaches to Stop Hypertension (DASH)-style eating. Positive messages from these dietary patterns should improve acceptance of CKD dietary interventions among patients.
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Affiliation(s)
- Maria Chan
- Department of Nutrition and Dietetics, The St. George Hospital, Kogarah, NSW, Australia; Department of Nutrition and Dietetics, School of Medicine, University of Wollongong, Wollongong, NSW, Australia; Department of Renal Medicine, The St. George Hospital, Kogarah, NSW, Australia; St. George Clinical School, School of Medicine, The University of New South Wales, NSW, Australia.
| | - John Kelly
- Department of Renal Medicine, The St. George Hospital, Kogarah, NSW, Australia; St. George Clinical School, School of Medicine, The University of New South Wales, NSW, Australia
| | - Linda Tapsell
- Department of Nutrition and Dietetics, School of Medicine, University of Wollongong, Wollongong, NSW, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
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20
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Piccoli GB, Capizzi I, Vigotti FN, Leone F, D’Alessandro C, Giuffrida D, Nazha M, Roggero S, Colombi N, Mauro G, Castelluccia N, Cupisti A, Avagnina P. Low protein diets in patients with chronic kidney disease: a bridge between mainstream and complementary-alternative medicines? BMC Nephrol 2016; 17:76. [PMID: 27391228 PMCID: PMC4939031 DOI: 10.1186/s12882-016-0275-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 06/14/2016] [Indexed: 01/11/2023] Open
Abstract
Dietary therapy represents an important tool in the management of chronic kidney disease (CKD), mainly through a balanced reduction of protein intake aimed at giving the remnant nephrons in damaged kidneys a "functional rest". While dialysis, transplantation, and pharmacological therapies are usually seen as "high tech" medicine, non pharmacological interventions, including diets, are frequently considered lifestyle-complementary treatments. Diet is one of the oldest CKD treatments, and it is usually considered a part of "mainstream" management. In this narrative review we discuss how the lessons of complementary alternative medicines (CAMs) can be useful for the implementation and study of low-protein diets in CKD. While high tech medicine is mainly prescriptive, prescribing a "good" life-style change is usually not enough and comprehensive counselling is required; the empathic educational approach, on which CAMs are mainly, though not exclusively based, may support a successful personalized nutritional intervention.There is no gold-standard, low-protein diet for all CKD patients: from among a relatively vast choice, the best compliance is probably obtained by personalization. This approach interferes with the traditional RCT-based analyses which are grounded upon an assumption of equal preference of treatments (ideally blinded). Whole system approaches and narrative medicine, that are widely used in the study of CAMs, may offer ways to integrate EBM and personalised medicine in the search for innovative solutions respecting individualization, but gaining sound data, such as with partially-randomised patient preference trials.
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Affiliation(s)
- Giorgina Barbara Piccoli
- />Department of Clinical and Biological Sciences, SS Nephrology, ASOU san Luigi, University of Torino, Torino, Italy
- />Nephrologie, CH du Mans, Le Mans, France
| | - Irene Capizzi
- />Department of Clinical and Biological Sciences, SS Nephrology, ASOU san Luigi, University of Torino, Torino, Italy
- />Nephrologie, CH du Mans, Le Mans, France
| | - Federica Neve Vigotti
- />Department of Clinical and Biological Sciences, SS Nephrology, ASOU san Luigi, University of Torino, Torino, Italy
- />Nephrologie, CH du Mans, Le Mans, France
| | - Filomena Leone
- />Department of Surgery, SS Dietetics, città della salute e della scienza, University of Torino, Torino, Italy
| | - Claudia D’Alessandro
- />Department of Experimental and Clinical Medicine, SCDU Nephrology, University of Pisa, Pisa, Italy
| | - Domenica Giuffrida
- />Department of Surgery, SS Dietetics, città della salute e della scienza, University of Torino, Torino, Italy
| | - Marta Nazha
- />Department of Clinical and Biological Sciences, SS Nephrology, ASOU san Luigi, University of Torino, Torino, Italy
- />Nephrologie, CH du Mans, Le Mans, France
| | - Simona Roggero
- />Department of Clinical and Biological Sciences, SS Nephrology, ASOU san Luigi, University of Torino, Torino, Italy
- />Nephrologie, CH du Mans, Le Mans, France
| | - Nicoletta Colombi
- />Department of Clinical and Biological Sciences and of Oncology, Library, ASOU san Luigi, University of Torino, Torino, Italy
| | - Giuseppe Mauro
- />Department of Clinical and Biological Sciences and of Oncology, Library, ASOU san Luigi, University of Torino, Torino, Italy
| | - Natascia Castelluccia
- />Department of Clinical and Biological Sciences and of Oncology, Library, ASOU san Luigi, University of Torino, Torino, Italy
| | - Adamasco Cupisti
- />Department of Experimental and Clinical Medicine, SCDU Nephrology, University of Pisa, Pisa, Italy
| | - Paolo Avagnina
- />Department of Clinical and Biological Sciences, SSD Clinical Nutrition, ASOU san Luigi, University of Torino, Torino, Italy
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McGraw NJ, Krul ES, Grunz-Borgmann E, Parrish AR. Soy-based renoprotection. World J Nephrol 2016; 5:233-257. [PMID: 27152261 PMCID: PMC4848148 DOI: 10.5527/wjn.v5.i3.233] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 01/16/2016] [Accepted: 03/14/2016] [Indexed: 02/06/2023] Open
Abstract
Chronic kidney disease (CKD) is a significant public health problem as risk factors such as advanced age, obesity, hypertension and diabetes rise in the global population. Currently there are no effective pharmacologic treatments for this disease. The role of diet is important for slowing the progression of CKD and managing symptoms in later stages of renal insufficiency. While low protein diets are generally recommended, maintaining adequate levels of intake is critical for health. There is an increasing appreciation that the source of protein may also be important. Soybean protein has been the most extensively studied plant-based protein in subjects with kidney disease and has demonstrated renal protective properties in a number of clinical studies. Soy protein consumption has been shown to slow the decline in estimated glomerular filtration rate and significantly improve proteinuria in diabetic and non-diabetic patients with nephropathy. Soy’s beneficial effects on renal function may also result from its impact on certain physiological risk factors for CKD such as dyslipidemia, hypertension and hyperglycemia. Soy intake is also associated with improvements in antioxidant status and systemic inflammation in early and late stage CKD patients. Studies conducted in animal models have helped to identify the underlying molecular mechanisms that may play a role in the positive effects of soy protein on renal parameters in polycystic kidney disease, metabolically-induced kidney dysfunction and age-associated progressive nephropathy. Despite the established relationship between soy and renoprotection, further studies are needed for a clear understanding of the role of the cellular and molecular target(s) of soy protein in maintaining renal function.
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Piccoli GB, Vigotti FN, Leone F, Capizzi I, Daidola G, Cabiddu G, Avagnina P. Low-protein diets in CKD: how can we achieve them? A narrative, pragmatic review. Clin Kidney J 2015; 8:61-70. [PMID: 25713712 PMCID: PMC4310428 DOI: 10.1093/ckj/sfu125] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Accepted: 11/01/2014] [Indexed: 12/31/2022] Open
Abstract
Low-protein diets (LPDs) have encountered various fortunes, and several questions remain open. No single study, including the famous Modification of Diet in Renal Disease, was conclusive and even if systematic reviews are in favour of protein restriction, at least in non-diabetic adults, implementation is lagging. LPDs are considered difficult, malnutrition is a threat and compliance is poor. LPDs have been reappraised in this era of reconsideration of dialysis indications and timing. The definition of a normal-adequate protein diet has shifted in the overall population from 1 to 1.2 to 0.8 g/kg/day. Vegan-vegetarian diets are increasingly widespread, thus setting the groundwork for easier integration of moderate protein restriction in Chronic Kidney Disease. There are four main moderately restricted LPDs (0.6 g/kg/day). Two of them require careful planning of quantity and quality of food: a 'traditional' one, with mixed proteins that works on the quantity and quality of food and a vegan one, which integrates grains and legumes. Two further options may be seen as a way to simplify LPDs while being on the safe side for malnutrition: adding supplements of essential amino and keto acids (various doses) allows an easier shift from omnivorous to vegan diets, while protein-free food intake allows for an increase in calories. Very-low-protein diets (vLPDs: 0.3 g/kg/day) combine both approaches and usually require higher doses of supplements. Moderately restricted LPDs may be adapted to virtually any cuisine and should be tailored to the patients' preferences, while vLPDs usually require trained, compliant patients; a broader offer of diet options may lead to more widespread use of LPDs, without competition among the various schemas.
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Affiliation(s)
- Giorgina Barbara Piccoli
- Nephrology, Clinical and Biological Sciences Department, S. Luigi Gonzaga Hospital, University of Turin, Italy
| | - Federica Neve Vigotti
- Nephrology, Clinical and Biological Sciences Department, S. Luigi Gonzaga Hospital, University of Turin, Italy
| | - Filomena Leone
- Dietetics, Surgical Sciences Department, S. Anna Hospital, University of Torino, Turin, Italy
| | - Irene Capizzi
- Nephrology, Clinical and Biological Sciences Department, S. Luigi Gonzaga Hospital, University of Turin, Italy
| | - Germana Daidola
- Nephrology, S. Giovanni Battista Hospital, University of Turin, Italy
| | | | - Paolo Avagnina
- Clinical Nutrition, Clinical and Biological Sciences Department, S. Luigi Gonzaga Hospital, University of Turin, Italy
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