Plant-Based Diets for Kidney Disease: A Guide for Clinicians

Key stakeholders' perspectives on the development of an early dietary phosphate self-management strategy for children and young people with chronic kidney disease stages 1-3: A modified Delphi consensus process

BACKGROUND

An early dietary phosphate intervention (EPI) can provide vital medical benefits supporting self-management of chronic kidney disease (CKD) in childhood.

OBJECTIVE

To utilise expert consensus to provide early modelling for an EPI to guide clinical practice across a paediatric renal network.

METHODS

Forty-eight statements across six domains were constructed following a systematic review and semi-structured interviews with children and young people (CYP), parents and healthcare professionals (HCP). A three-round online Delphi survey with parents and paediatric renal multi-disciplinary healthcare experts was undertaken.

RESULTS

Twenty-one experts agreed on 56 statements over three Delphi rounds. Statements were accepted in all six domains: definition of an EPI (2), rationale (12), intended users (3), delivery (14) (when [1], where [3], who [2], how [8]), other considerations (16) and potential concerns (9).

CONCLUSIONS

Consensus was reached on a definition and a set of guiding principles, providing some early modelling for implementation and future research on the development of an EPI strategy for CYP with CKD.

Preventing potential pitfalls of a liberalized potassium diet in the hemodialysis population

Emerging research suggests that a more liberalized diet, specifically a more plant-based diet resulting in liberalization of potassium intake, for people receiving hemodialysis is necessary and the benefits outweigh previously thought risks. If the prescribed hemodialysis diet is to be liberalized, the need to illuminate and prevent potential pitfalls of a liberalized potassium diet is warranted. This paper explores such topics as partial to full adherence to a liberalized diet and its consequences if any, the advantages of a high-fiber intake, the theoretical risk of anemia when consuming a more plant-dominant diet, the potential benefits against renal acid load and effect on metabolic acidosis with increased fruit and vegetable intake, the putative change in serum potassium levels, carbohydrate quality, and the healthfulness of meat substitutes. The benefits of a more plant-based diet for the hemodialysis population are multifold; however, the possible pitfalls of this type of diet must be reviewed and addressed upon meal planning in order to be avoided.

The Management of Dietary Fiber Intake in Children With Chronic Kidney Disease - Clinical Practice Recommendations From the Pediatric Renal Nutrition Taskforce

The benefits of dietary fiber are widely accepted. Nevertheless, a substantial proportion of children fail to meet the recommended intake of dietary fiber. Achieving adequate fiber intake is especially challenging in children with chronic kidney disease (CKD). An international team of pediatric renal dietitians and pediatric nephrologists from the Pediatric Renal Nutrition Taskforce (PRNT) has developed clinical practice recommendations (CPRs) for the dietary intake of fiber in children and adolescents with CKD. In this CPR paper, we propose a definition of fiber, provide advice on the requirements and assessment of fiber intake, and offer practical guidance on optimizing dietary fiber intake in children with CKD. In addition, given the paucity of available evidence and to achieve consensus from international experts, a Delphi survey was performed in which all the clinical practice recommendations were reviewed.

Analysis of the Nutritional Composition of Ready-to-Use Meat Alternatives in Belgium

BACKGROUND

The interest in meat alternatives has increased over the years as people embrace more varied food choices because of different reasons. This study aims to analyse the nutritional composition of ready-to-use meat alternatives and compare them with meat (products).

METHODS

Nutritional composition values were collected in 2022 of all ready-to-use meat alternatives in Belgian supermarkets, as well as their animal-based counterparts. A one-sample t-test was performed to test the nutritional composition of ready-to-use meat alternatives against norm values, while an independent samples t-test was used to make the comparison with meat.

RESULTS

Minced meat and pieces/strips/cubes scored favourably on all norm values. Cheeseburgers/schnitzels, nut/seed burgers and sausages contained more than 10 g/100 g total fat. The saturated fat and salt content was lower than the norm value in each category. Legume burgers/falafel contained less than 10 g/100 g protein. Vegetarian/vegan minced meat and bacon contained fewer calories, total and saturated fat, and more fibre compared to their animal-based counterparts.

CONCLUSIONS

Minced meat and pieces/strips/cubes came out as the most favourable categories regarding nutritional composition norm values. Vegetarian/vegan steak came out the least favourable compared to steak, while vegetarian/vegan minced meat and vegetarian/vegan bacon came out the most favourable compared to their animal-based counterparts.

Role of Nutrients in Pediatric Non-Dialysis Chronic Kidney Disease: From Pathogenesis to Correct Supplementation

Nutrition management is fundamental for children with chronic kidney disease (CKD). Fluid balance and low-protein and low-sodium diets are the more stressed fields from a nutritional point of view. At the same time, the role of micronutrients is often underestimated. Starting from the causes that could lead to potential micronutrient deficiencies in these patients, this review considers all micronutrients that could be administered in CKD to improve the prognosis of this disease.

A Systematic Review of Online Resources for the Dietary Management of Hyperphosphatemia in People With Chronic Kidney Disease

OBJECTIVE

Internet search engines and social media websites are prominent and growing sources of dietary information for people with chronic kidney disease (CKD) and their healthcare providers. However, nutrition therapy for CKD is undergoing a paradigm shift, which may lead to inconsistent advice for managing hyperphosphatemia. The aim of this study was to summarize and evaluate online resources for phosphorus-specific nutrition therapy.

DESIGN AND METHODS

Patient-facing resources were collected from Google, Yahoo, and Facebook in June-July 2021. Using nine independent search terms, the first 100 hits were reviewed. Dietary advice for food types, food groups, food subgroups, and individual food items was categorized as "restricted," "recommended," "mixed," and "not mentioned." Information on publication date, source, and author(s), phosphorus bioavailability, and demineralization were also collected.

RESULTS

After removing duplicates, 199 resources from Google and Yahoo and 33 from Facebook were reviewed. Resources ranged from 2005 to 2021 and were primarily authored by registered dietitians and medical doctors (65% and 31%, respectively). Dietary advice mostly focuses on restricting high-phosphorus foods and phosphorus additive-based processed foods. Dietary restrictions were generally consistent with the traditional low-phosphorus diet, which targets whole grains, dairy, and plant-based protein foods, although major inconsistencies were noted. Phosphorus bioavailability and demineralization were rarely mentioned (16% and 8%, respectively). Similar findings were found on Facebook, but the limited number of resources limited meaningful comparisons.

CONCLUSION

Results showed that online resources for phosphorus-specific nutrition therapy are highly restrictive of heart-healthy food items and contain significant inconsistencies. Given the widespread and increasing use of online resources by people with CKD and health care professionals to inform dietary choices, efforts are urgently needed to establish consensus for phosphorus-specific nutrition therapy. Until then, the findings of this study provide a basis for increasing awareness of the potential for confusion arising from online resources.

The times they are K+-changin': bringing the potassium curriculum out of the 20th century

PURPOSE OF REVIEW

Although most of the current medical education literature has focused on teaching strategies, little attention has been devoted to selecting appropriate course content. Despite elegant descriptions of physiologic mechanisms in recent decades, medical school curricula and students continue to rely on outdated textbooks and certification examination study aids composed to fit an antiquated exam blueprint.

RECENT FINDINGS

Advances in our understanding of potassium physiology offer multiple examples of key concepts that deserve to be included in the modern-day renal physiology curriculum, including the relationship of potassium to blood pressure and the potassium 'switch', the aldosterone paradox, and novel pharmacologic agents that target dietary potassium absorption and potassium handling in the kidney.

SUMMARY

Key advances in our understanding and application of renal physiology to patient care have not been readily integrated into the nephrology curriculum of medical students. Difficult questions remain regarding when new concepts are sufficiently established to be introduced to medical students in the preclinical years.

Food to Prevent Vascular Calcification in Chronic Kidney Disease

Vascular calcification (VC) is a consequence of chronic kidney disease (CKD) which is of paramount importance regarding the survival of CKD patients. VC is far from being controlled with actual medication; as a result, in recent years, diet modulation has become more compelling. The concept of medical nutritional therapy points out the idea that food may prevent or treat diseases. The aim of this review was to evaluate the influence of food habits and nutritional intervention in the occurrence and progression of VC in CKD. Evidence reports the harmfulness of ultra-processed food, food additives, and animal-based proteins due to the increased intake of high absorbable phosphorus, the scarcity of fibers, and the increased production of uremic toxins. Available data are more supportive of a plant-dominant diet, especially for the impact on gut microbiota composition, which varies significantly depending on VC presence. Magnesium has been shown to prevent VC but only in experimental and small clinical studies. Vitamin K has drawn considerable attention due to its activation of VC inhibitors. There are positive studies; unfortunately, recent trials failed to prove its efficacy in preventing VC. Future research is needed and should aim to transform food into a medical intervention to eliminate VC danger in CKD.

Climate crisis and nephrology: a review of climate change's impact on nephrology and how to combat it

Climate change is worsening with tangible effects on our healthcare system. This review aims to examine the repercussions of the climate change on nephrology and explore potential strategies to mitigate its impact. This review examines dialysis's environmental impact, resource recycling methods, and plant-based diets for kidney health. Recent research highlights the advantages of plant-based diets in managing and preventing chronic kidney disease (CKD) and its complications. Integrating these practices can significantly lessen the environmental impact of nephrology.

PURPOSE OF REVIEW

The aim of this study is to discuss the bidirectional relationship of climate change and kidney disease and the impact of nephrology on climate change and to discuss potential solutions.

RECENT FINDINGS

Each dialysis session consumes significant amounts of resource; reusing them will aid the environment. Plant-based diets slow renal disease and have a lower carbon footprint, making them ecologically friendly.

SUMMARY

Climate change is a growing threat to population health and healthcare. Rising temperatures raise the risk of kidney problems. Dialysis treatments also impact the environment through its high resource requirements while generating high volumes of waste and greenhouse gases. Opportunities exist to reduce the environmental impact of dialysis treatments. Plant-based diets serve to benefit both kidney disease and the environment.

Risks of the ketogenic diet in CKD - the con part

The ketogenic diet is a very low carbohydrate diet that has received a lot of attention for its role in the treatment of type 2 diabetes and obesity. For patients with chronic kidney disease, there is limited evidence on the risks and/or benefits of this diet. However, from the limited evidence that does exist, there are several inferences that can be drawn regarding this diet for patients with kidney disease. The ketogenic diet may not be better than comparator higher carbohydrate diets over the long term. The diet also has low adherence levels in studies lasting ≥12 months. The diet's emphasis on fat, which often comes from animal fat, increases the consumption of saturated fat, which may increase the risk of heart disease. It has the potential to worsen metabolic acidosis by increasing dietary acid load and endogenous acid production through the oxidation of fatty acids. In addition, the diet has been associated with an increased risk of kidney stones in patients using it for the treatment of refractory epilepsy. For these reasons, and for the lack of safety data on it, it is reasonable for patients with kidney disease to avoid utilizing the ketogenic diet as a first-line option given alternative dietary patterns (like the plant-dominant diet) with less theoretical risk for harm. For those adopting the ketogenic diet in kidney disease, a plant-based version of the ketogenic diet may mitigate some of the concerns with animal-based versions of the ketogenic diet.

Vegetarian Nutrition in Chronic Kidney Disease

There is rising interest globally with respect to the health implications of vegetarian or plant-based diets. A growing body of evidence has demonstrated that higher consumption of plant-based foods and the nutrients found in vegetarian and plant-based diets are associated with numerous health benefits, including improved blood pressure, glycemic control, lipid levels, body mass index, and acid-base parameters. Furthermore, there has been increasing recognition that vegetarian and plant-based diets may have potential salutary benefits in preventing the development and progression of chronic kidney disease (CKD). While increasing evidence shows that vegetarian and plant-based diets have nephroprotective effects, there remains some degree of uncertainty about their nutritional adequacy and safety in CKD (with respect to protein-energy wasting, hyperkalemia, etc.). In this review, we focus on the potential roles of and existing data on the efficacy/effectiveness and safety of various vegetarian and plant-based diets in CKD, as well as their practical application in CKD management.

An Overview of Chronic Kidney Disease Pathophysiology: The Impact of Gut Dysbiosis and Oral Disease

Chronic kidney disease (CKD) is a severe condition and a significant public health issue worldwide, carrying the burden of an increased risk of cardiovascular events and mortality. The traditional factors that promote the onset and progression of CKD are cardiometabolic risk factors like hypertension and diabetes, but non-traditional contributors are escalating. Moreover, gut dysbiosis, inflammation, and an impaired immune response are emerging as crucial mechanisms in the disease pathology. The gut microbiome and kidney disease exert a reciprocal influence commonly referred to as "the gut-kidney axis" through the induction of metabolic, immunological, and endocrine alterations. Periodontal diseases are strictly involved in the gut-kidney axis for their impact on the gut microbiota composition and for the metabolic and immunological alterations occurring in and reciprocally affecting both conditions. This review aims to provide an overview of the dynamic biological interconnections between oral health status, gut, and renal pathophysiology, spotlighting the dynamic oral-gut-kidney axis and raising whether periodontal diseases and gut microbiota can be disease modifiers in CKD. By doing so, we try to offer new insights into therapeutic strategies that may enhance the clinical trajectory of CKD patients, ultimately advancing our quest for improved patient outcomes and well-being.

Nutrition in Peritoneal Dialysis

The use of peritoneal dialysis (PD) has been associated with improved quality of life, cost-effectiveness, and better outcomes for patients with kidney failure. However, many patients utilizing PD for replacement therapy face numerous nutritional hurdles. As the use of PD continues to increase worldwide, malnutrition has become an increasingly recognized concern for patients undergoing PD. The nephrology community needs to recognize and treat malnutrition to promote optimal nutritional states for our patients. In this review, we discuss several factors that contribute to malnutrition and protein-energy wasting and explore the benefits and limitations of nutritional parameters used to assess protein-calorie malnutrition. We also emphasize updated guidelines on daily caloric, protein, and micronutrient recommendations, as well as their effects on electrolyte homeostasis.

New Insights Into Dietary Approaches to Potassium Management in Chronic Kidney Disease

Potassium disorders are one of the most common electrolyte abnormalities in patients with chronic kidney disease (CKD), contributing to poor clinical outcomes. Maintaining serum potassium levels within the physiologically normal range is critically important in these patients. Dietary potassium restriction has long been considered a core strategy for the management of chronic hyperkalemia in patients with CKD. However, this has been challenged by recent evidence suggesting a paradigm shift toward fostering more liberalized, plant-based dietary patterns. The advent of novel potassium binders and an improved understanding of gastrointestinal processes involved in potassium homeostasis (e.g., gastrointestinal potassium wasting) may facilitate a paradigm shift and incorporation of heart-healthy potassium-enriched food sources. Nevertheless, uncertainty regarding the risk-benefit of plant-based diets in the context of potassium management in CKD remains, requiring well-designed clinical trials to determine the efficacy of dietary potassium manipulation toward improvement of clinical outcomes in patients with CKD.

Hyperkalemia and Plant-Based Diets in Chronic Kidney Disease

Traditional dietary guidelines for patients with kidney disease recommend restriction of plant foods due to concerns about hyperkalemia and associated adverse events. Studies conducted over several decades have shown that the basis for these guidelines does not match the evidence. Serum potassium levels can be elevated in patients with reduced kidney function after consumption of foods with potassium-based additives or with highly concentrated potassium content such as juices, dried fruit, or purees. However, plant foods may have certain qualities that may blunt potassium retention including their alkalinizing effects, the lack of bioavailable potassium, and the impact of dietary fiber in organic plant foods on colonic potassium excretion. Furthermore, there are many benefits of plant foods that patients with kidney disease may be missing by excluding them from their diets by recommending the historical low-potassium "renal diet." Revised dietary recommendations for kidney health may encourage patient-centered kidney recipes that revolve around plant foods and do not restrict them.

Animal Protein Intake and Possible Cardiovascular Risk in People With Chronic Kidney Disease: Mechanisms and Evidence

Individuals with chronic kidney disease (CKD) have an increased risk of cardiovascular disease (CVD), and the kidney function is a critical determinant of this risk. CKD is also a major cause of complications and disease progression in patients with CVD. Practice guidelines suggest that CVD risk in CKD patients can be managed through healthy lifestyle and dietary behaviors. Assessing the impact of diet on heart and kidney health is complex because numerous bioactive compounds from diet may contribute to or prevent CVD or CKD via a myriad of pathways and mechanisms. The objective of this review was to provide a discussion of the mechanisms and evidence linking protein-rich foods and CVD risk in people with CKD. This review highlights the current evidence-based strategies for primary CKD prevention that incorporate a healthy dietary pattern, while tertiary prevention strategies focus on avoiding excess protein and reducing dietary acid load. The effect of protein restriction for improving CVD and CKD outcomes is conflicting; however, these approaches show no negative effects on kidney health. Low-protein and very low-protein diets are promising interventions for reducing the progression of CKD and CVD. Animal-sourced protein may be more detrimental to kidney health than plant-sourced protein due to specific acid load, amino acid composition, generation of uremic toxins, accompanying saturated fat content, low fiber composition, and higher generation of advanced glycation end-products. There are no one-size fits all nutrition prescriptions. Personalized nutrition interventions that target the unique risk factors for CVD associated with reduced kidney function are required to improve the health of people living with CKD.

A Low-Protein, Plant-Dominant Gluten-Free Diet for Immunoglobulin A Nephropathy and Focal Segmental Glomerulosclerosis

Immunoglobulin A nephropathy is the most common glomerulonephritis syndrome in the world, yet there is currently no cure. While blood pressure control, renin-angiotensin-aldosterone system inhibition, and immunosuppression may slow disease progression, low-protein diets, defined as a daily dietary protein intake of 0.6 to 0.8 g/kg body weight, may also decrease immune complex deposition and disease severity, as evidenced in animal models. The link between secondary immunoglobulin A nephropathy and celiac disease has also led to the rise of gluten-free diets and zinc supplementation as potential lifestyle modifications to help manage common immunoglobulin A nephropathy symptoms such as proteinuria and hematuria. In addition, case reports and prospective studies suggest that patients with focal segmental glomerulosclerosis, which manifests as steroid-resistant nephrotic syndrome may also benefit from a gluten-free diet. We highlight the example of a gluten-free, plant-dominant low-protein diet (a different type of low-protein diet that addresses both protein quantity and quality) for patients with immunoglobulin A nephropathy or focal segmental glomerulosclerosis.

Low-Protein Diets and Its Synergistic Role in the SGLT2 Inhibitor Era

Low-protein diets (LPDs), usually defined as a daily dietary protein intake of 0.6 to 0.8 g/kg body weight, have been recommended for decades as a safe and effective lifestyle modification to ameliorate inflammatory damage and proteinuria, reduce glomerular hyperfiltration, and improve metabolic acidosis control in patients with chronic kidney disease (CKD). The mechanism for this is largely attributed to altered tubuloglomerular feedback and afferent arteriole contraction leading to decreased glomerular pressure. Additionally, low protein intake reduces urea generation, which can help delay dialysis initiation in advanced CKD. LPDs have different types including plant-dominant LPDs that can exert additional kidney protective effects as a result of dietary protein quality in addition to quantity. In addition, strong clinical evidence shows that a new class of diabetes mellitus medications, the sodium-glucose cotransporter 2 inhibitors, reduces albuminuria and slows the estimated glomerular filtration rate decline in CKD, even in patients without diabetes mellitus, especially if significant proteinuria is present. Given prior studies investigating the effect of LPDs used in conjunction with angiotensin pathway modulators, we argue that LPDs have a synergistic role in disease management and are expected to display additive effects when combined with sodium-glucose cotransporter 2 inhibitor usage or other pharmacologic agents. Even with medical therapy, it is prudent to implement tailored LPDs for different types of CKD.

Targeting the Gut Microbiota in Kidney Disease: The Future in Renal Nutrition and Metabolism

There is increasing interest in the therapeutic potential of manipulating the gut microbiome of patients with chronic kidney disease (CKD). This is because there is a substantial deviation from a balanced gut microbiota profile in CKD, with many deleterious downstream effects. Nutritional interventions such as plant-based diets with reduced animal protein intake and the use of probiotics, prebiotics, and synbiotics may alter the microbiome. This article aims to briefly describe what is known about the gut microbiome in patients with CKD, factors contributing to gut dysbiosis, and outline important evidence gaps. Future potential therapies, including restoring the microbiota with food and microbiota-based and metabolomic-based therapies, are also discussed.

Nutritional and Dietary Management of Chronic Kidney Disease Under Conservative and Preservative Kidney Care Without Dialysis

While dialysis has been the prevailing treatment paradigm for patients with advanced chronic kidney disease (CKD), emphasis on conservative and preservative management in which dietary interventions are a major cornerstone have emerged. Based on high-quality evidence, international guidelines support the utilization of low-protein diets as an intervention to reduce CKD progression and mortality risk, although the precise thresholds (if any) for dietary protein intake vary across recommendations. There is also increasing evidence demonstrating that plant-dominant low-protein diets reduce the risk of developing incident CKD, CKD progression, and its related complications including cardiometabolic disease, metabolic acidosis, mineral and bone disorders, and uremic toxin generation. In this review, we discuss the premise for conservative and preservative dietary interventions, specific dietary approaches used in conservative and preservative care, potential benefits of a plant-dominant low-protein diet, and practical implementation of these nutritional strategies without dialysis.

Still no direct evidence of postprandial hyperkalemia with plant foods

Although St-Jules et al have presented the case for postprandial hyperkalemia with food, including plant foods, there (still) is little to no direct evidence supporting the occurrence of postprandial hyperkalemia, mostly due to a lack of studies performed exclusively using food. Food is different than salts or supplements, and it is likely that a banana behaves differently than potassium salts. A growing body of evidence supports the use of plant foods without causing hyperkalemia in patients with kidney disease. Currently, only 1 study has reported on the postprandial effects of hyperkalemia. In this study, there was a substantial reduction in the instances of postprandial hyperkalemia in participants consuming a diet that included more plant foods and more fiber. At the time of this writing, there is no evidence to support risk or safety of certain foods with regard to postprandial hyperkalemia, and additional research is warranted.

Moderate stepwise restriction of potassium intake to reduce risk of hyperkalemia in chronic kidney disease: A literature review

A potassium-rich diet has several cardiovascular and renal health benefits; however, it is not recommended for patients with advanced chronic kidney disease or end-stage kidney disease because of the risk of life-threatening hyperkalemia. To assess the strength of evidence supporting potassium intake restriction in chronic kidney disease, the medical literature was searched looking for the current recommended approach and for evidence in support for such an approach. There is a lack of strong evidence supporting intense restriction of dietary potassium intake. There are several ways to reduce potassium intake without depriving the patient from fruits and vegetables, such as identifying hidden sources of potassium (processed food and preservatives) and soaking or boiling food to remove potassium. An individualized and gradual reduction of dietary potassium intake in people at risk of hyperkalemia is recommended. The current potassium dietary advice in chronic kidney disease needs to be reevaluated, individualized, and gradually introduced.

The Role of Plant-Based Diets in Preventing and Mitigating Chronic Kidney Disease: More Light than Shadows

Chronic kidney disease (CKD) is a non-communicable disease that affects >10% of the general population worldwide; the number of patients affected by CKD is increasing due in part to the rise in risk factors such as obesity, hypertension, and diabetes mellitus. As many studies show, diet can be an important tool for preventing and mitigating the onset of non-communicable diseases. Plant-based diets (PBDs) are those that emphasize the consumption of plant foods and may or may not include small or moderate amounts of animal foods. Recently, these diets have received increasing interest because they have been associated with favourable effects on health and also appear to protect against the development and progression of CKD. PBDs, which are associated with protein restrictions, seem to offer adjunctive advantages in patients with chronic kidney disease, as compared to conventional low-protein diets that include animal proteins. The principal aims of this review are to provide a comprehensive overview of the existing literature regarding the role of plant-based diets and low-protein, plant-based diets in the context of chronic kidney disease. Moreover, we try to clarify the definition of plant-based diets, and then we analyse possible concerns about the use of PBDs in patients with chronic kidney disease (nutritional deficiency and hyperkalaemia risk). Finally, we offer some strategies to increase the nutritional value of plant-based low-protein diets. In the Materials and Methods section, many studies about plant-based diets and low-protein plant-based diets (e.g., the very-low-protein diet and vegan low-protein diet, LPD) in chronic kidney disease were considered. In the Results and Conclusion section, current data, most from observational studies, agree upon the protective effect of plant-based diets on kidney function. Moreover, in patients with advanced CKD, low-protein plant-based options, especially a very-low-protein diet supplemented with heteroanalogues (VLPDs), compared to a conventional LPD appear to offer adjunctive advances in terms of delaying dialysis and mitigating metabolic disturbances. However, further studies are necessary to better investigate the possible metabolic and cardiovascular advantages of plant-based LPDs versus conventional LPDs.

Food Insecurity and Chronic Kidney Disease: Considerations for Practitioners

The coronavirus disease 2019 pandemic has exacerbated existing health disparities related to food security status. Emerging literature suggests individuals with Chronic Kidney Disease (CKD) who are also food insecure have a greater likelihood of disease progression compared to food secure individuals. However, the complex relationship between CKD and food insecurity (FI) is understudied relative to other chronic conditions. The purpose of this practical application article is to summarize the recent literature on the social-economic, nutritional, to care through which FI may negatively impact health outcomes in individuals with CKD. While several studies have reported on the cross-sectional prevalence of FI among persons with CKD, literature is lacking about the severity and duration of exposure to FI on CKD outcomes. Future research is needed to better understand how FI impairs CKD care, nutritional and structural barriers that impact disease prevention and disease progression, and effective strategies to support patients.

Gut Microbiota Interventions to Retain Residual Kidney Function

Residual kidney function for patients with chronic kidney disease (CKD) is associated with better quality of life and outcome; thus, strategies should be implemented to preserve kidney function. Among the multiple causes that promote kidney damage, gut dysbiosis due to increased uremic toxin production and endotoxemia need attention. Several strategies have been proposed to modulate the gut microbiota in these patients, and diet has gained increasing attention in recent years since it is the primary driver of gut dysbiosis. In addition, medications and faecal transplantation may be valid strategies. Modifying gut microbiota composition may mitigate chronic kidney damage and preserve residual kidney function. Although various studies have shown the influential role of diet in modulating gut microbiota composition, the effects of this modulation on residual kidney function remain limited. This review discusses the role of gut microbiota metabolism on residual kidney function and vice versa and how we could preserve the residual kidney function by modulating the gut microbiota balance.

Pea hull fiber supplementation does not modulate uremic metabolites in adults receiving hemodialysis: a randomized, double-blind, controlled trial

Background

Fiber is a potential therapeutic to suppress microbiota-generated uremic molecules. This study aimed to determine if fiber supplementation decreased serum levels of uremic molecules through the modulation of gut microbiota in adults undergoing hemodialysis.

Methods

A randomized, double-blinded, controlled crossover study was conducted. Following a 1-week baseline, participants consumed muffins with added pea hull fiber (PHF) (15 g/d) and control muffins daily, each for 4 weeks, separated by a 4-week washout. Blood and stool samples were collected per period. Serum p-cresyl sulfate (PCS), indoxyl sulfate (IS), phenylacetylglutamine (PAG), and trimethylamine N-oxide (TMAO) were quantified by LC-MS/MS, and fecal microbiota profiled by 16S rRNA gene amplicon sequencing and specific taxa of interest by qPCR. QIIME 2 sample-classifier was used to discover unique microbiota profiles due to the consumption of PHF.

Results

Intake of PHF contributed an additional 9 g/d of dietary fiber to the subjects' diet due to compliance. No significant changes from baseline were observed in serum PCS, IS, PAG, or TMAO, or for the relative quantification of Akkermansia muciniphila, Faecalibacterium prausnitzii, Bifidobacterium, or Roseburia, taxa considered health-enhancing. Dietary protein intake and IS (r = -0.5, p = 0.05) and slow transit stool form and PCS (r = 0.7, p < 0.01) were significantly correlated at baseline. PHF and control periods were not differentiated; however, using machine learning, taxa most distinguishing the microbiota composition during the PHF periods compared to usual diet alone were enriched Gemmiger, Collinsella, and depleted Lactobacillus, Ruminococcus, Coprococcus, and Mogibacteriaceae.

Conclusion

PHF supplementation did not mitigate serum levels of targeted microbial-generated uremic molecules. Given the high cellulose content, which may be resistant to fermentation, PHF may not exert sufficient effects on microbiota composition to modulate its activity at the dose consumed.

The Impact of Plant-Based Diets on Dietary Acid Load Metrics in Venezuela: A Cross-Sectional Study

Dietary acid load (DAL) is an important determinant of the acid-base balance in humans and has been associated with several chronic non-communicable diseases. Plant-based diets, including vegetarian and vegan diets, decrease DAL-although their alkalizing potential varies substantially. Their net effect on common DAL scores, including potential renal acid load and net endogenous acid production, has been insufficiently quantified and is poorly understood-particularly in populations outside of Europe and North America. We assessed the associations between three plant-based dietary patterns (flexitarian vs. lacto-ovo-vegetarian vs. vegan diet) and DAL scores in a healthy Venezuelan population in the metropolitan area of Puerto La Cruz, Venezuela. Substantial differences in DAL scores were observed, whereby the vegan diet yielded the highest alkalizing potential, followed by the lacto-ovo-vegetarian and the flexitarian diet. DAL scores were substantially lower in comparison to European and North American plant-based populations, probably due to the higher potassium intake (exceeding 4000 mg/d in vegans), the higher magnesium intake (390.31 ± 1.79 mg/d in vegans) and the lower intake of protein in vegans and lacto-ovo-vegetarians. Additional studies in other non-industrialized populations are warranted to allow for a better understanding of the (numeric) impact of plant-based dietary patterns on DAL scores, potentially allowing for an establishment of reference ranges in the near future.

Should Men Eat More Plants? A Systematic Review of the Literature on the Effect of Plant-Forward Diets on Men's Health

OBJECTIVE

To perform a systematic review of the literature on plant-based and plant-forward diets and the prevention/treatment of the following common men's health conditions: prostate cancer (PCa), erectile dysfunction (ED), and benign prostatic hyperplasia (BPH).

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses system criteria were utilized to search PubMed and Medline databases for the following search terms: "Diet (Mesh)" OR "Diet Therapy (Mesh)" AND "Prostatic Hyperplasia (Mesh)" OR "Prostatic Neoplasm (Mesh)" OR "Erectile Dysfunction (Mesh)." Articles in English published from 1989 to 2022 using human participants were analyzed, data summarized, and assessed for bias.

RESULTS

Studies reporting on plant-based or vegetable-forward diets (Mediterranean) as an intervention were included. Cohort and cross-sectional studies using food frequency questionnaires or diet classification indices to quantify plant-based food intake patterns were included in the study. Ultimately, 12 PCa articles, 4 BPH articles, 6 ED articles, and 2 articles related to both BPH and ED were reviewed. Overall, the literature suggests plant-forward diets confer a protective effect on the men's health conditions reviewed.

CONCLUSIONS

Evaluation of the literature on the impact of plant-forward diets on urologic conditions includes a heterogenous range of dietary patterns and study designs. The greatest amount of research has evaluated the application of plant-forward diets for PCa. While there is currently a lack of high-quality evidence for the use of plant-forward diets as prevention and/or treatment for PCa, ED, or BPH, reported outcomes suggest a consistent small beneficial impact alongside well-established benefits for common chronic conditions.

Hidden Acid Retention with Normal Serum Bicarbonate Level in Chronic Kidney Disease

Management of metabolic acidosis is crucial for preserving bone, muscle, and renal health, as evidenced by the results of several interventional studies conducted on patients with chronic kidney disease (CKD). Considering the continuity of CKD progression over time, it is reasonable to deduce that a subclinical form of metabolic acidosis may exist prior to the manifestation of overt metabolic acidosis. Covert H⁺ retention with normal serum bicarbonate level in patients with CKD may result in maladaptive responses that contribute to kidney function deterioration, even in the early stages of the disease. The loss of adaptive compensatory mechanisms of urinary acid excretion may be a key factor in this process. Early modulation of these responses could be an important therapeutic strategy in preventing CKD progression. However, to date, the optimal approach for alkali therapy in subclinical metabolic acidosis in CKD remains uncertain. There is a lack of established guidelines on when to initiate alkali therapy, potential side effects of alkali agents, and the optimal blood bicarbonate levels based on evidence-based practices. Therefore, further research is necessary to address these concerns and establish more robust guidelines for the use of alkali therapy in patients with CKD. Herein, we provide an overview of recent developments on this subject and examine the potential therapeutic approaches that interventional treatments may present for patients with hidden H⁺ retention, exhibiting normal serum bicarbonate levels - commonly described as subclinical or eubicarbonatemic metabolic acidosis in patients with CKD.

Vaccinium as Potential Therapy for Diabetes and Microvascular Complications

Diabetes mellitus is one of the most critical global health concerns, with a fast-growing prevalence. The incidence of diabetic vascular complications is also rapidly increasing, exacerbating the burden on individuals with diabetes and the consumption of public medical resources. Despite the overall improvements in the prevention, diagnosis, and treatment of diabetic microvascular complications in recent years, safe and effective alternative or adjunctive therapies are urgently needed. The mechanisms underlying diabetic vascular complications are complex, with hyperglycemia-induced oxidative stress and inflammation being the leading causes. Therefore, glycemic control, antioxidation, and anti-inflammation are considered the main targets for the treatment of diabetes and its vascular comorbidities. Vaccinium L. (Ericaceae) is a genus of plants enriched with polyphenolic compounds in their leaves and fruits. Vaccinium and its extracts have demonstrated good bioactivity in reducing blood glucose, oxidative stress, and inflammation, making them excellent candidates for the management of diabetes and diabetic vascular complications. Here, we review recent preclinical and clinical studies on the potential effect of Vaccinium on ameliorating diabetes and diabetic complications, particularly diabetic kidney disease and diabetic retinopathy.

Plant or Animal-Based or PLADO Diets: Which Should Chronic Kidney Disease Patients Choose?

Nutrition therapy is the cornerstone treatment for chronic kidney disease (CKD). Although much attention has been given to dietary protein intake in CKD patients, many findings now demonstrate that the type of dietary protein intake may be more critical for CKD patients. In protein bioavailability and malnutrition prevention, many physicians recommend that CKD patients adhere to a low protein diet and restrict their plant foods, such as vegetables, fruits, and soybeans. However, nephrologists should not ignore the potential benefits of plant foods for CKD patients. It is not advisable to restrict the intake of plant foods in the later stage of CKD simply to prevent the development of hyperkalemia and malnutrition. This article highlights the benefits and possible problems of a plant-dominant low protein diet (PLADO) diet, defined as an LPD with dietary protein intake of 0.6-0.8 g/kg/day with at least 50% plant-based source for CKD patients. We hope to provide new opinions for clinical work and CKD patients.

Prevalence and management of hyperkalemia in chronic kidney disease and heart failure patients in the Gulf Cooperation Council (GCC)

Hyperkalemia is a frequent complication in patients with chronic kidney disease (CKD) or heart failure (HF) and associated with neuromuscular manifestations, changes in the electrocardiogram, and increased risk of mortality. While data on the prevalence and management of hyperkalemia in the gulf region are scarce, risk factors such as preference for potassium-rich foods (e.g., dates and dried fruits/vegetables), periods of intense fasting (e.g., Ramadan), and diabetes (an ancestor of CKD and HF) are common. Therefore, a panel of nephrologists and cardiologists from countries of the Gulf Cooperation Council (GCC) convened to collate and review available data on the prevalence, regional drivers, and current practice in the management of hyperkalemia in the region. Eventually, this review provides consensus recommendations on a balanced utilization of dietary and pharmacological options including new potassium binders for achieving and sustainably maintaining desirable serum potassium levels in countries of the GCC region. Alignment with regional habits and practice was a key aspect to facilitate the uptake of the recommendations into physicians' practice and patients' lives.

Risks and Benefits of Different Dietary Patterns in CKD

Food has the potential to cause and exacerbate many lifestyle diseases. Or it can be used to prevent and treat illnesses like primary hypertension, the metabolic syndrome, and insulin resistance. In parallel, there is also a growing body of evidence of the role of diet in the treatment of kidney disease and its ensuing complications. Popular diets for this purpose have included low-carbohydrate diets, including the ketogenic diet, and higher carbohydrate diets like Mediterranean diets and other plant-based dietary patterns. Low-carbohydrate diets have not shown harm in patients with kidney disease and may benefit a select few. Mediterranean diets have an established record of cardioprotective benefits but also may be beneficial for the kidney. Intermittent fasting has benefits for metabolic health, but limited research exists on the risk or benefit for patients with kidney disease. Plant-based diets, especially those that are lower in protein, may slow kidney disease progression, mitigate uremia, and delay dialysis initiation. Although each dietary pattern has its unique pros and cons, most healthful dietary patterns favor the inclusion of whole, unprocessed foods, preferably from plant-based sources. In this perspective, we discuss the risks and benefits of major popular diets to help guide health care professionals in treating patients with kidney disease.

The impact of protein source on serum potassium and phosphate levels in adults living with advanced kidney disease

BACKGROUND AND AIMS

Plant proteins may be restricted on low potassium/phosphorus diets. The primary objective was to investigate the impact of protein source on serum potassium and phosphate levels in adults with stage 4-5 chronic kidney disease (CKD), including hemodialysis (HD).

METHODS AND RESULTS

Using a cross-sectional design, 24-h recalls or food frequency questionnaires were used to assess dietary intake. Serum values were obtained from medical records. Quartiles (Q1-4) of plant:animal protein serving ratios was considered to investigate outcomes, with Q1 having high animal and low plant serving intake and those in Q4 having high plant and low animal servings. 216 participants were enrolled, 135 on HD and 81 stage 4/5 CKD. For both HD and CKD, there was no difference in either serum potassium or phosphate levels between those in Q4 consuming high plant:animal vs Q1 low plant:animal (for HD: potassium 4.6 mmol/L vs 4.6 mmol/L; phosphate 1.8 mmol/L vs 1.6 mmol/L, respectively; for CKD: potassium 4.7 mmol/L vs 4.6 mmol/L; phosphate 1.4 mmol/L vs 1.4 mmol/L; all p > 0.05). Those in Q4 consuming high plant:animal consumed 7.5 g (62%) more fibre than those in Q1 (low plant:animal). For diet quality, Q4 (high plant:animal) had a 12.8 point (24%) higher healthy eating index score than Q1 (low plant:animal). There was no relationship between plant:animal and serum albumin or hospital admissions (all p > 0.05).

CONCLUSIONS

Consumption of higher proportions of plant protein was not associated with higher serum potassium or phosphate levels but was associated with higher fibre and diet quality.

Bionanotechnology in Agriculture: A One Health Approach

Healthy eating habits are one of the requirements for the health of society. In particular, in natura foods are increasingly encouraged, since they have a high concentration of nutrients. However, these foods are often grown in the presence of agrochemicals, such as fertilizers and pesticides. To increase crop productivity and achieve high vigor standards in less time, farmers make excessive use of agrochemicals that generate various economic, environmental, and clinical problems. In this way, bionanotechnology appears as an ally in developing technologies to improve planting conditions, ranging from the health of farmers and consumers to the production of new foods and functional foods. All these improvements are based on the better use of land use in synergy with the lowest generation of environmental impacts and the health of living beings, with a view to the study and production of technologies that take into account the concept of One Health in its processes and products. In this review article, we will address how caring for agriculture can directly influence the quality of the most desired foods in contemporary society, and how new alternatives based on nanotechnology can point to efficient and safe solutions for living beings on our planet.

Plant-based diets in gastrointestinal diseases: Which evidence?

Plant-based diets (PBDs), rich in high-quality plant foods, offer multiple benefits for the overall and gastrointestinal health. Recently, it has been demostrated that the positive effects of PBDs on gastrointestinal health can be mediated by the gut microbiota, in particular, by inducing a greater diversity of bacteria. This review summarizes current knowledge on the relationship between nutrition, the gut microbiota, and host metabolic status. We discussed how dietary habits modify the composition and physiological activity of the gut microbiota and how gut dysbiosis affects the most prevalent gastrointestinal diseases, including inflammatory bowel diseases, functional bowel disorders, liver disorders, and gastrointestinal cancer. The beneficial role of PBDs is being increasingly recognized as potentially useful in the management of most diseases of the gastrointestinal tract.

Are We What We Eat? The Moral Imperative of the Medical Profession to Promote Plant-Based Nutrition

The typical Western diet, high in processed and animal-based foods, is nutritionally and ethically problematic. Beyond the well-documented cruelty to animals that characterizes the practices of the factory-farming industry, current patterns of meat consumption contribute to medical and moral harm in humans on both an individual level and a public health scale. We aim to deconstruct, by highlighting their fallacies, the common positive and normative arguments that are used to defend current nutritional patterns. Animal-based foods promote the mechanisms that underlie chronic cardiometabolic disease, whereas whole-food plant-based nutrition can reverse them. Factory farming of animals also contributes to climate change, antibiotic resistance, and the spread of infectious diseases. Finally, the current allocation of nutritional resources in the United States is unjust. A societal shift toward more whole-food plant-based patterns of eating stands to provide significant health benefits and ethical advantages, and the medical profession has a duty to advocate accordingly. Although it remains important for individuals to make better food choices to promote their own health, personal responsibility is predicated on sound advice and on resource equity, including the availability of healthy options. Nutrition equity is a moral imperative and should be a top priority in the promotion of public health.

Sodium zirconium cyclosilicate and metabolic acidosis: Potential mechanisms and clinical consequences

Metabolic acidosis is frequent in chronic kidney disease (CKD) and is associated with accelerated progression of CKD, hypercatabolism, bone disease, hyperkalemia, and mortality. Clinical guidelines recommend a target serum bicarbonate ≥ 22 mmol/L, but metabolic acidosis frequently remains undiagnosed and untreated. Sodium zirconium cyclosilicate (SZC) binds potassium in the gut and is approved to treat hyperkalemia. In clinical trials with a primary endpoint of serum potassium, SZC increased serum bicarbonate, thus treating CKD-associated metabolic acidosis. The increase in serum bicarbonate was larger in patients with more severe pre-existent metabolic acidosis, was associated to decreased serum urea and was maintained for over a year of SZC therapy. SZC also decreased serum urea and increased serum bicarbonate after switching from a potassium-binding resin in normokalemic individuals. Mechanistically, these findings are consistent with SZC binding the ammonium ion (NH₄⁺) generated from urea by gut microbial urease, preventing its absorption and, thus, preventing the liver regeneration of urea and promoting the fecal excretion of H⁺. This mechanism of action may potentially result in benefits dependent on corrected metabolic acidosis (e.g., improved well-being, decreased catabolism, improved CKD mineral bone disorder, better control of serum phosphate, slower progression of CKD) and dependent on lower urea levels, such as decreased protein carbamylation. A roadmap is provided to guide research into the mechanisms and clinical consequences of the impact of SZC on serum bicarbonate and urate.

Plant-Based Diet and Risk of Frailty in Older Chinese Adults

OBJECTIVES

This study examined the relationship between the consumption of plant-based diet and frailty in older Chinese adults.

DESIGN

Prospective cohort study.

SETTING

Community-based setting in 22 provinces of China.

PARTICIPANTS

The final sample included data from 3990 older adults from 2011-2014 from the Chinese Longitudinal Healthy Longevity Survey.

MEASUREMENTS

A plant-based diet index (PDI) was calculated based on a qualitative food frequency questionnaire. Frailty was defined using modified Fried criteria. A Generalized Estimating Equation was used to estimate risk ratios (RRs) and 95% confidence intervals (CIs) for frailty. We further performed subgroup analyses stratified by sex and lifestyle factors.

RESULTS

557 cases of frailty were observed. After adjustment for covariates, the RR for frailty of a high PDI was 0.792 (95% CI: 0.644-0.973), relative to a low PDI. During follow-up, compared with respondents with a continually low PDI, the respondents with a continually high PDI had a significantly reduced risk of frailty (RR = 0.683, 95% CI: 0.514-0.908). In further subgroup analysis, a consistently high PDI over time resulted in a significantly reduced risk of frailty for male (RR = 0.591, 95% CI: 0.391-0.893); for never smokers (RR = 0.670, 95% CI: 0.458-0.979); for people who did never consume alcohol (RR = 0.654, 95% CI: 0.454-0.941); and for people with current or former exercise habits (RR = 0.488, 95% CI: 0.313-0.762).

CONCLUSION

Plant-based diet was associated with low risk of frailty in men and in older adults with healthy lifestyle. These findings stress that plant-based diet should be recommended as a dietary strategy to prevent and reduce frailty in older adults; in addition, more dietary interventions along with lifestyle modification should be adopted to promote successful ageing, especially for women.

Nutrition in Conservative Kidney Management: From Evidence to Practice

Conservative kidney management (CKM) is a treatment option for kidney failure, particularly for the elderly and those with co-morbidities. Dietitians can play an important role in the provision of CKM by enhancing patients' quality of life through the management of nutrition impact symptoms (symptoms that result in decreased eating, including anorexia, nausea, dry mouth, and taste changes), as well as symptoms that result from malnutrition, including fatigue, weakness, activity intolerance, slow wound healing, and low mood. There are many gaps in the literature regarding optimal nutritional recommendations for patients on CKM. More research is needed on symptom management and interventions to delay or slow the progression of malnutrition and frailty. This article provides an overview of important nutritional considerations, a synthesis of the current literature, and recommendations for application of evidence into the practice of CKM.

Hyperkalemia: Prevalence, Predictors and Emerging Treatments

It is well established that an elevated potassium level (hyperkalemia) is associated with a risk of adverse events including morbidity, mortality and healthcare system cost. Hyperkalemia is commonly encountered in many chronic conditions including kidney disease, diabetes and heart failure. Furthermore, hyperkalemia may result from the use of renin-angiotensin-aldosterone system inhibitors (RAASi), which are disease-modifying treatments for these conditions. Therefore, balancing the benefits of optimizing treatment with RAASi while mitigating hyperkalemia is crucial to ensure patients are optimally treated. In this review, we will briefly discuss the definition, causes, epidemiology and consequences of hyperkalemia. The majority of the review will be focused on management of hyperkalemia in the acute and chronic setting, emphasizing contemporary approaches and evolving data on the relevance of dietary restriction and the use of novel potassium binders.

Plant-Based Diets Improve Maternal-Fetal Outcomes in CKD Pregnancies

Reducing protein intake in patients with chronic kidney disease (CKD) limits glomerular stress induced by hyperfiltration and can prevent the progression of kidney disease; data in pregnancy are limited. The aim of this study is to analyze the results obtained in CKD patients who followed a plant-based moderately protein-restricted diet during pregnancy in comparison with a propensity-score-matched cohort of CKD pregnancies on unrestricted diets. A total of 52 CKD pregnancies followed up with a protein-restricted plant-based diet (Torino, Italy) were matched with a propensity score based on kidney function and proteinuria with CKD pregnancies with unrestricted protein intake (Cagliari Italy). Outcomes included preterm (<37 weeks) and very preterm (<34 weeks) delivery and giving birth to a small-for-gestational-age baby. The median age in our cohort was 34 years, 63.46% of women were primiparous, and the median body mass index (BMI) was 23.15 kg/m² with 13.46% of obese subjects. No statistical differences were found between women on a plant-based diet and women who were not in terms of age, parity, BMI, obesity, CKD stage, timing of referral, or cause of CKD. No differences were found between the two groups regarding the week of delivery. However, the combined negative outcome (birth before 37 completed gestational weeks or birth-weight centile <10) occurred less frequently in women following the diet than in women in the control group (61.54% versus 80.77%; p = 0.03). The lower risk was confirmed in a multivariable analysis adjusted for renal function and proteinuria (OR: 0.260 [Q1:0.093-Q3:0.724]; p = 0.010), in which the increase in proteinuria from the first to the last check-up before delivery was lower in patients on plant-based diets (median from 0.80 to 1.87 g/24 h; p: ns) than in controls (0.63 to 2.39 g/24 h p <0.0001). Plant-based, moderately protein-restricted diets in pregnancy in patients with CKD are associated with a lower risk of preterm delivery and small-for-gestational-age babies; the effect may be mediated by better stabilization of proteinuria.

Dietary Risk Factors and Eating Behaviors in Peripheral Arterial Disease (PAD)

Dietary risk factors play a fundamental role in the prevention and progression of atherosclerosis and PAD (Peripheral Arterial Disease). The impact of nutrition, however, defined as the process of taking in food and using it for growth, metabolism and repair, remains undefined with regard to PAD. This article describes the interplay between nutrition and the development/progression of PAD. We reviewed 688 articles, including key articles, narrative and systematic reviews, meta-analyses and clinical studies. We analyzed the interaction between nutrition and PAD predictors, and subsequently created four descriptive tables to summarize the relationship between PAD, dietary risk factors and outcomes. We comprehensively reviewed the role of well-studied diets (Mediterranean, vegetarian/vegan, low-carbohydrate ketogenic and intermittent fasting diet) and prevalent eating behaviors (emotional and binge eating, night eating and sleeping disorders, anorexia, bulimia, skipping meals, home cooking and fast/ultra-processed food consumption) on the traditional risk factors of PAD. Moreover, we analyzed the interplay between PAD and nutritional status, nutrients, dietary patterns and eating habits. Dietary patterns and eating disorders affect the development and progression of PAD, as well as its disabling complications including major adverse cardiovascular events (MACE) and major adverse limb events (MALE). Nutrition and dietary risk factor modification are important targets to reduce the risk of PAD as well as the subsequent development of MACE and MALE.

Plant Nutrition for Human Health: A Pictorial Review on Plant Bioactive Compounds for Sustainable Agriculture

Is there any relationship between plant nutrition and human health? The overall response to this question is very positive, and a strong relationship between the nutrition of plants and humans has been reported in the literature. The nutritional status of edible plants consumed by humans can have a negative or positive impact on human health. This review was designed to assess the importance of plant bioactive compounds for human health under the umbrella of sustainable agriculture. With respect to the first research question, it was found that plant bioactives (e.g., alkaloids, carotenoids, flavonoids, phenolics, and terpenoids) have a crucial role in human health due to their therapeutic benefits, and their potentiality depends on several factors, including botanical, environmental, and clinical attributes. Plant bioactives could be produced using plant tissue culture tools (as a kind of agro-biotechnological method), especially in cases of underexploited or endangered plants. Bioactive production of plants depends on many factors, especially climate change (heat stress, drought, UV radiation, ozone, and elevated CO2), environmental pollution, and problematic soils (degraded, saline/alkaline, waterlogged, etc.). Under the previously mentioned stresses, in reviewing the literature, a positive or negative association was found depending on the kinds of stress or bioactives and their attributes. The observed correlation between plant bioactives and stress (or growth factors) might explain the importance of these bioactives for human health. Their accumulation in stressed plants can increase their tolerance to stress and their therapeutic roles. The results of this study are in keeping with previous observational studies, which confirmed that the human nutrition might start from edible plants and their bioactive contents, which are consumed by humans. This review is the first report that analyzes this previously observed relationship using pictorial presentation.

Low variability of plant protein intake in the CKiD cohort does not demonstrate changes in estimated GFR nor electrolyte balance

BACKGROUND

Vegetable or plant-based sources of protein may confer health benefits in children with progressive kidney disease. Our aims were to understand the effect of the proportion of vegetable protein intake on changes in estimated GFR and to understand the effect of the proportion of vegetable protein intake on serum levels of bicarbonate, phosphorus, and potassium.

METHODS

Children with baseline eGFR between 30 and 90 mL/min/1.73 m² were recruited from 59 centers across North America as part of the chronic kidney disease in children (CKiD) study. The percentage of dietary vegetable protein (VP%) was gathered from annual Food Frequency Questionnaires. We performed longitudinal linear mixed models to determine the effect of VP% on eGFR and longitudinal logistic mixed models to determine the effect of VP% on electrolyte balance (potassium, phosphorus, bicarbonate).

RESULTS

Two thousand visits from 631 subjects. Across all dichotomized groups of children (sex, African American race, Hispanic ethnicity, glomerular etiology of CKD, hypertension, anemia, hyperkalemia, hyperphosphatemia, acidosis, BMI < 95th percentile), the median VP% was 32-35%. The longitudinal mixed model analysis did not show any effect of VP% on eGFR electrolyte (bicarbonate, phosphorus, and potassium) abnormalities (p > 0.1).

CONCLUSIONS

A diverse cohort of children with CKD has a narrow and homogeneous intake of vegetable protein. Due to the low variability of plant-based protein in the cohort, there were no associations between the percentage of plant protein intake and changes in eGFR nor electrolyte balance. A higher resolution version of the Graphical abstract is available as Supplementary information.