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Rodrigo-Carbó C, Madinaveitia-Nisarre L, Pérez-Calahorra S, Gracia-Rubio I, Cebollada A, Galindo-Lalana C, Mateo-Gallego R, Lamiquiz-Moneo I. Low-calorie, high-protein diets, regardless of protein source, improve glucose metabolism and cardiometabolic profiles in subjects with prediabetes or type 2 diabetes and overweight or obesity. Diabetes Obes Metab 2024. [PMID: 39420528 DOI: 10.1111/dom.16013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 09/23/2024] [Accepted: 10/01/2024] [Indexed: 10/19/2024]
Abstract
AIM The aim was to study the effect of two low-calorie, high-protein (HP) diets, with most of the protein coming from animal or plant sources, on glycaemic and other cardiometabolic outcomes in subjects with overweight or obesity and glucose metabolism disorders. MATERIALS AND METHODS A total of 117 participants aged >18 years with body mass index over 27.5 kg/m2 and prediabetes or type 2 diabetes mellitus (T2DM) were randomized to one of two HP low-calorie diets (35% of total calories from protein), in which 75% of the protein was from either plant-based sources (HPP) or animal sources (HPA). For both diets, 30% and 35% of the total calories were from fat and carbohydrates, respectively. The dietary intervention lasted 6 months. RESULTS Both diets improved body composition to a similar extent, including weight loss (-8.05 ± 5.12 kg for the HPA diet and -7.70 ± 5.47 kg for the HPP diet at 6 months) and fat mass, mainly visceral fat. Both diets had a similar beneficial effect on glucose metabolism, including fasting glucose, insulin, homeostasis model assessment of insulin resistance index and glycated haemoglobin. Other biochemical parameters, including lipid profiles, liver enzymes, adipokines and inflammatory biomarkers, similarly improved in both groups. Fasting incretins, mainly glucagon-like peptide 1, decreased significantly in both groups, and this effect correlated with weight loss. CONCLUSIONS Low-calorie HP diets improved body composition, glucose metabolism and other cardiometabolic outcomes, regardless of protein source (either animal or plant sources), in outpatients with prediabetes or T2DM. CLINICAL TRIAL REGISTRATION The clinical trial was registered in ClinicalTrials.gov (identifier: NCT05456347) https://clinicaltrials.gov/study/NCT05456347?term=NCT05456347&rank=1.
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Affiliation(s)
- Carmen Rodrigo-Carbó
- Miguel Servet University Hospital, Aragon Health Research Institute, CIBERCV, Zaragoza, Spain
- Departament of Physiatry and Nursing, Faculty of Health and Sport Science, University of Zaragoza, Huesca, Spain
| | | | - Sofía Pérez-Calahorra
- Departament of Physiatry and Nursing, Faculty of Health Science, University of Zaragoza, Zaragoza, Spain
| | - Irene Gracia-Rubio
- Miguel Servet University Hospital, Aragon Health Research Institute, CIBERCV, Zaragoza, Spain
- Department of Human Anatomy and Histology, Faculty of Medicine, University of Zaragoza, Zaragoza, Spain
| | - Alberto Cebollada
- Biocomputing Unit, Aragon Institute of Health Sciences, Zaragoza, Spain
| | - Carlos Galindo-Lalana
- Miguel Servet University Hospital, Aragon Health Research Institute, CIBERCV, Zaragoza, Spain
| | - Rocío Mateo-Gallego
- Miguel Servet University Hospital, Aragon Health Research Institute, CIBERCV, Zaragoza, Spain
- Departament of Physiatry and Nursing, Faculty of Health and Sport Science, University of Zaragoza, Huesca, Spain
| | - Itziar Lamiquiz-Moneo
- Miguel Servet University Hospital, Aragon Health Research Institute, CIBERCV, Zaragoza, Spain
- Department of Human Anatomy and Histology, Faculty of Medicine, University of Zaragoza, Zaragoza, Spain
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de Lorenzo A, Bomback AS, Mihic N. High Protein Diets and Glomerular Hyperfiltration in Athletes and Bodybuilders: Is Chronic Kidney Disease the Real Finish Line? Sports Med 2024; 54:2481-2495. [PMID: 39196487 DOI: 10.1007/s40279-024-02086-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2024] [Indexed: 08/29/2024]
Abstract
Several observational and experimental studies in humans have suggested that high protein intake (PI) causes intraglomerular hypertension leading to hyperfiltration. This phenomenon results in progressive loss of renal function with long-term exposure to high-protein diets (HPDs), even in healthy people. The recommended daily allowance for PI is 0.83 g/kg per day, which meets the protein requirement for approximately 98% of the population. A HPD is defined as a protein consumption > 1.5 g/kg per day. Athletes and bodybuilders are encouraged to follow HPDs to optimize muscle protein balance, increase lean body mass, and enhance performance. A series of studies in resistance-trained athletes looking at HPD has been published concluding that there are no harmful effects of HPD on renal health. However, the aim of these studies was to evaluate body composition changes and they were not designed to assess safety or kidney outcomes. Here we review the effects of HPD on kidney health in athletes and healthy individuals with normal kidney function.
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Affiliation(s)
- Alberto de Lorenzo
- Department of Nephrology, Hospital Universitario HM Sanchinarro, Madrid, Spain.
- Department of Nephrology, Hospital Universitario de Getafe, Universidad Europea de Madrid, Madrid, Spain.
| | - Andrew S Bomback
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, Presbyterian Hospital, New York, USA
| | - Niko Mihic
- Chief Medical Officer of Real Madrid CF, Madrid, Spain
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3
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Pezzuoli C, Biagini G, Magistroni R. Ketogenic Interventions in Autosomal Dominant Polycystic Kidney Disease: A Comprehensive Review of Current Evidence. Nutrients 2024; 16:2676. [PMID: 39203812 PMCID: PMC11356904 DOI: 10.3390/nu16162676] [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: 07/10/2024] [Revised: 08/03/2024] [Accepted: 08/08/2024] [Indexed: 09/03/2024] Open
Abstract
Autosomal Dominant Polycystic Kidney Disease (ADPKD) is a genetic disorder characterized by the development and enlargement of multiple kidney cysts, leading to progressive kidney function decline. To date, Tolvaptan, the only approved treatment for this condition, is able to slow down the loss of annual kidney function without stopping the progression of the disease. Furthermore, this therapy is approved only for patients with rapid disease progression and its compliance is problematic because of the drug's impact on quality of life. The recent literature suggests that cystic cells are subject to several metabolic dysregulations, particularly in the glucose pathway, and mitochondrial abnormalities, leading to decreased oxidative phosphorylation and impaired fatty acid oxidation. This finding paved the way for new lines of research targeting potential therapeutic interventions for ADPKD. In particular, this review highlights the latest studies on the use of ketosis, through ketogenic dietary interventions (daily calorie restriction, intermittent fasting, time-restricted feeding, ketogenic diets, and exogenous ketosis), as a potential strategy for patients with ADPKD, and the possible involvement of microbiota in the ketogenic interventions' effect.
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Affiliation(s)
- Carla Pezzuoli
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41125 Modena, Italy
- Division of Nephrology, Dialysis and Renal Transplantation, Azienda Ospedaliero-Universitaria Policlinico di Modena, 41125 Modena, Italy
| | - Giuseppe Biagini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Riccardo Magistroni
- Division of Nephrology, Dialysis and Renal Transplantation, Azienda Ospedaliero-Universitaria Policlinico di Modena, 41125 Modena, Italy
- Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41124 Modena, Italy
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4
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Marinaro M, Alexander DS, de Waal D. Do the high-protein recommendations for athletes set some on a path to kidney injury and dialysis? Semin Dial 2024; 37:301-306. [PMID: 34889483 DOI: 10.1111/sdi.13046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 11/19/2021] [Indexed: 11/29/2022]
Abstract
Athletes and fitness enthusiasts are often encouraged to follow high-protein diets to optimize muscle protein synthesis, modify body composition, and enhance performance, yet the safety of these higher protein intakes has been debated. Many people with kidney dysfunction are unaware of their condition, and the potential harm of excess protein intake on the kidneys may not be adequately reported in the sports nutrition literature. Studies suggesting that high-protein intake may be associated with incident kidney disease have led the nephrology community to make conservative recommendations. In contrast, the fitness community suggests that high dietary protein intake is safe and poses no risk of kidney injury. These claims often fail to acknowledge limitations in the internal validity and generalizability of the study results, despite many studies not being adequately powered to support such claims. It is essential to make dietary recommendations that consider the totality of the data and follow the ethical norm of "do no harm." Studies that evaluate the use of high-protein diets among athletes must consider the balance of efficacy with safety. While an intervention may be safe in one population, it does not mean that safety can be assumed for all groups.
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Affiliation(s)
- Meredith Marinaro
- Department of Health and Human Performance, Concordia University Chicago, River Forest, Illinois, USA
| | - Dayna S Alexander
- Department of Health and Human Performance, Concordia University Chicago, River Forest, Illinois, USA
| | - Desiree de Waal
- Department of Nephrology, University of Vermont Medical Center, Burlington, Vermont, USA
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5
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Cheng Y, Zheng G, Song Z, Zhang G, Rao X, Zeng T. Association between dietary protein intake and risk of chronic kidney disease: a systematic review and meta-analysis. Front Nutr 2024; 11:1408424. [PMID: 38946781 PMCID: PMC11212527 DOI: 10.3389/fnut.2024.1408424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 05/30/2024] [Indexed: 07/02/2024] Open
Abstract
Objective There is suggestive data indicating a correlation among dietary protein intake and the progression of chronic kidney disease (CKD). Nonetheless, the exact associations between dietary protein intake and the incidence of CKD have remained uncertain. We performed the first meta-analysis to explore the correlation among total protein, plant protein, animal protein intake and CKD risk. Methods The study conformed the PRISMA statement guidelines. We comprehensively searched PubMed, Web of Science, and Embase until to December 2023. The retrieved studies underwent rigorous evaluation for eligibility, and relevant data were meticulously extracted. The Newcastle-Ottawa Scale (NOS) tool was applied to evaluate the risk of bias. Subsequently, relevant data were extracted and pooled to evaluate the relations among dietary protein intake and CKD incidence. Results Totally, 6,191 articles were identified, six studies were eligible. A total of 148,051 participants with 8,746 CKD cases were included. All studies had a low overall risk of bias. Higher total, plant and animal protein intake were all correlated with decreased CKD incidence, pooled risk ratios (RRs) and 95% confidence intervals (CIs) were as follows: (RR = 0.82, 95% CI = 0.71-0.94, p = 0.005; I2 = 38%, p = 0.17); (RR = 0.77, 95% CI = 0.61-0.97, p = 0.03; I2 = 77%, p = 0.001); (RR = 0.86, 95% CI = 0.76-0.97, p = 0.02; I2 = 0%, p = 0.59), respectively. For fish and seafood within animal protein: RR = 0.84, 95% CI = 0.74-0.94. Subgroup analysis showed that geographical region, sample size, follow-up time, not assessing protein by food frequency questionnaire, using %energy as the measurement index, not adjusting for several covariates may be the sources of heterogeneity for plant protein. A significant non-linear relation among plant protein and incident CKD was observed by dose-response analysis. Conclusion The data showed a lower CKD risk significantly associated higher-level dietary total, plant or animal protein (especially for fish and seafood) intake. Further prospective studies demonstrating the correlations of precise sources, intake and duration of dietary protein and incident CKD are warranted.
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Affiliation(s)
| | | | | | | | | | - Tao Zeng
- The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
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Alaseem AM. Continued elevation of creatinine and uric acid in a male athlete: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241260229. [PMID: 38859872 PMCID: PMC11163930 DOI: 10.1177/2050313x241260229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 05/22/2024] [Indexed: 06/12/2024] Open
Abstract
Whey protein and other protein-fortified supplements are frequently consumed as nutritional supplements to aid in muscle hypertrophy and myogenesis. This case presents a 36-year-old athletic male with elevated creatinine and uric acid levels during routine laboratory evaluation. The patient had no history of kidney disease, diabetes, or hypertension. It was revealed that the patient had been regularly consuming whey protein as a dietary supplement for 2 months. Given the potential association between the elevated creatinine and uric acid levels and the use of whey protein, the patient was advised to discontinue the supplement. The patient then switched to protein-fortified milk to mitigate the possible harmful connection between the dietary intake and the laboratory findings. However, despite the dietary change, the increased levels of creatinine and uric acid persisted. This observation suggests that the elevated levels may be attributed to chronic whey protein consumption along with high-protein dietary consumption.
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Affiliation(s)
- Ali M Alaseem
- Department of Pharmacology, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
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7
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Shibata M, Sato KK, Koh H, Shibata I, Okamura K, Takeuchi Y, Oue K, Morimoto M, Hayashi T. The Relationship of Alcohol Consumption and Drinking Pattern to the Risk of Glomerular Hyperfiltration in Middle-aged Japanese Men: The Kansai Healthcare Study. J Epidemiol 2024; 34:137-143. [PMID: 37211396 PMCID: PMC10853046 DOI: 10.2188/jea.je20220312] [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: 11/02/2022] [Accepted: 03/31/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND Glomerular hyperfiltration has been reported to be associated with adverse renal outcomes in the general population. It is not known whether drinking pattern is associated with the risk of glomerular hyperfiltration in healthy individuals. METHODS We prospectively followed middle-aged 8,640 Japanese men with normal renal function, no proteinuria, no diabetes, and no use of antihypertensive medications at entry. Data on alcohol consumption were gathered by questionnaire. Glomerular hyperfiltration was defined as estimated glomerular filtration rate (eGFR) ≥117 mL/min/1.73 m2, which was the upper 2.5th percentile value of eGFR in the entire cohort. RESULTS During 46,186 person-years of follow-up, 330 men developed glomerular hyperfiltration. In a multivariate model, for men who consumed alcohol on 1-3 days per week, alcohol consumption of ≥69.1 g ethanol/drinking day was significantly associated with the risk of glomerular hyperfiltration (hazard ratio [HR] 2.37; 95% confidence interval [CI], 1.18-4.74) compared with non-drinkers. For those who consumed alcohol on 4-7 days per week, higher alcohol consumption per drinking day was associated with a higher risk of glomerular hyperfiltration: the HRs for alcohol consumption of 46.1-69.0, and ≥69.1 g ethanol/drinking day were 1.55 (95% CI, 1.01-2.38), and 1.78 (95% CI, 1.02-3.12), respectively. CONCLUSION For high drinking frequency per week, more alcohol intake per drinking day was associated with an increased risk of glomerular hyperfiltration, while for low drinking frequency per week, only very high alcohol intake per drinking day was associated with an increased risk of glomerular hyperfiltration in middle-aged Japanese men.
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Affiliation(s)
- Mikiko Shibata
- Preventive Medicine and Environmental Health, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Kyoko Kogawa Sato
- Preventive Medicine and Environmental Health, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hideo Koh
- Preventive Medicine and Environmental Health, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Izumi Shibata
- Preventive Medicine and Environmental Health, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Kaori Okamura
- Preventive Medicine and Environmental Health, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yuka Takeuchi
- Preventive Medicine and Environmental Health, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Keiko Oue
- Health Administration Center (Kansai region), Nippon Telegraph and Telephone West Corporation, Osaka, Japan
| | - Michio Morimoto
- Health Administration Center (Kansai region), Nippon Telegraph and Telephone West Corporation, Osaka, Japan
| | - Tomoshige Hayashi
- Preventive Medicine and Environmental Health, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
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Patel V, Aggarwal K, Dhawan A, Singh B, Shah P, Sawhney A, Jain R. Protein supplementation: the double-edged sword. Proc AMIA Symp 2023; 37:118-126. [PMID: 38174000 PMCID: PMC10761008 DOI: 10.1080/08998280.2023.2280417] [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: 08/09/2023] [Accepted: 10/30/2023] [Indexed: 01/05/2024] Open
Abstract
Protein supplements are widely consumed by athletes as well as young adults and teenagers going to the gym and are an excellent source to increase protein intake, build muscle mass, and enhance recovery. They are available in the form of powders, gummies, protein bars, and ready-to-drink shakes and have been shown to have effects on almost every system in the body. Subjects consuming whey protein-based supplements regularly show significantly lower systolic blood pressure, while subjects who consume soy-based protein supplements have been reported to show a significant decrease in their systolic and diastolic blood pressures. Favorable effects of soy protein consumption have been observed on the serum lipid profile, with significant decreases in serum low-density lipoprotein and triglyceride levels. Lower postprandial glucose levels have been observed in diabetic subjects as well, which can be attributed to the lower glycemic index of these supplements. This can lead to an indirect decrease in diabetes-related complications. While these supplements affect the body positively, caution has to be exercised while consuming them in excess, as they have been shown to cause hyperfiltration and increased urinary calcium excretion which can, in turn, lead to chronic kidney disease development. This article focuses on the effects of protein supplementation on the human body, with emphasis on the cardiovascular, endocrine, and renal systems.
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Affiliation(s)
- Vishw Patel
- Department of Medicine, Pandit Deendayal Upadhyay Government Medical College, Rajkot, India
| | - Kanishk Aggarwal
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Ashish Dhawan
- Department of Medicine, Gian Sagar Medical College and Hospital, Punjab, India
| | - Bhupinder Singh
- Department of Medicine, Government Medical College, Amritsar, India
| | - Priyanshi Shah
- Department of Medicine, Narendra Modi Medical College, Ahmedabad, India
| | - Aanchal Sawhney
- Department of Internal Medicine, Crozer Chester Medical Center, Upland, Pennsylvania, USA
| | - Rohit Jain
- Department of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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Morgan PT, Witard OC, Højfeldt G, Church DD, Breen L. Dietary protein recommendations to support healthy muscle ageing in the 21st century and beyond: considerations and future directions. Proc Nutr Soc 2023:1-14. [PMID: 37818636 DOI: 10.1017/s0029665123003750] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
This review explores the evolution of dietary protein intake requirements and recommendations, with a focus on skeletal muscle remodelling to support healthy ageing based on presentations at the 2023 Nutrition Society summer conference. In this review, we describe the role of dietary protein for metabolic health and ageing muscle, explain the origins of protein and amino acid (AA) requirements and discuss current recommendations for dietary protein intake, which currently sits at about 0⋅8 g/kg/d. We also critique existing (e.g. nitrogen balance) and contemporary (e.g. indicator AA oxidation) methods to determine protein/AA intake requirements and suggest that existing methods may underestimate requirements, with more contemporary assessments indicating protein recommendations may need to be increased to >1⋅0 g/kg/d. One example of evolution in dietary protein guidance is the transition from protein requirements to recommendations. Hence, we discuss the refinement of protein/AA requirements for skeletal muscle maintenance with advanced age beyond simply the dose (e.g. source, type, quality, timing, pattern, nutrient co-ingestion) and explore the efficacy and sustainability of alternative protein sources beyond animal-based proteins to facilitate skeletal muscle remodelling in older age. We conclude that, whilst a growing body of research has demonstrated that animal-free protein sources can effectively stimulate and support muscle remodelling in a manner that is comparable to animal-based proteins, food systems need to sustainably provide a diversity of both plant and animal source foods, not least for their protein content but other vital nutrients. Finally, we propose some priority research directions for the field of protein nutrition and healthy ageing.
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Affiliation(s)
- Paul T Morgan
- Department of Sport and Exercise Sciences, Institute of Sport, Manchester Metropolitan University, 99 Oxford Road, Manchester M1 7EL, UK
| | - Oliver C Witard
- Centre for Human and Applied Physiological Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Grith Højfeldt
- Department of Orthopedic Surgery, Institute of Sports Medicine Copenhagen, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - David D Church
- Department of Geriatrics, Donald W. Reynolds Institute on Aging, Center for Translational Research in Aging and Longevity, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Leigh Breen
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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Remer T, Kalotai N, Amini AM, Lehmann A, Schmidt A, Bischoff-Ferrari HA, Egert S, Ellinger S, Kroke A, Kühn T, Lorkowski S, Nimptsch K, Schwingshackl L, Zittermann A, Watzl B, Siener R. Protein intake and risk of urolithiasis and kidney diseases: an umbrella review of systematic reviews for the evidence-based guideline of the German Nutrition Society. Eur J Nutr 2023; 62:1957-1975. [PMID: 37133532 PMCID: PMC10349749 DOI: 10.1007/s00394-023-03143-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 04/03/2023] [Indexed: 05/04/2023]
Abstract
PURPOSE Changes in dietary protein intake metabolically affect kidney functions. However, knowledge on potential adverse consequences of long-term higher protein intake (HPI) for kidney health is lacking. To summarise and evaluate the available evidence for a relation between HPI and kidney diseases, an umbrella review of systematic reviews (SR) was conducted. METHODS PubMed, Embase and Cochrane Database of SRs published until 12/2022 were searched for the respective SRs with and without meta-analyses (MA) of randomised controlled trials or cohort studies. For assessments of methodological quality and of outcome-specific certainty of evidence, a modified version of AMSTAR 2 and the NutriGrade scoring tool were used, respectively. The overall certainty of evidence was assessed according to predefined criteria. RESULTS Six SRs with MA and three SRs without MA on various kidney-related outcomes were identified. Outcomes were chronic kidney disease, kidney stones and kidney function-related parameters: albuminuria, glomerular filtration rate, serum urea, urinary pH and urinary calcium excretion. Overall certainty of evidence was graded as 'possible' for stone risk not to be associated with HPI and albuminuria not to be elevated through HPI (above recommendations (> 0.8 g/kg body weight/day)) and graded as 'probable' or 'possible' for most other kidney function-related parameters to be physiologically increased with HPI. CONCLUSION Changes of the assessed outcomes may have reflected mostly physiological (regulatory), but not pathometabolic responses to higher protein loads. For none of the outcomes, evidence was found that HPI does specifically trigger kidney stones or diseases. However, for potential recommendations long-term data, also over decades, are required.
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Affiliation(s)
- Thomas Remer
- DONALD Study Center Dortmund, Department of Nutritional Epidemiology, Institute of Nutrition and Food Science, University of Bonn, Heinstück 11, 44225, Dortmund, Germany.
| | | | | | | | | | - Heike A Bischoff-Ferrari
- Department of Aging Medicine and Aging Research, University Hospital Zurich, University of Zurich, and City Hospital Zurich, Zurich, Switzerland
| | - Sarah Egert
- Department of Nutrition and Food Science, Nutritional Physiology, University of Bonn, Bonn, Germany
| | - Sabine Ellinger
- Department of Nutrition and Food Science, Human Nutrition, University of Bonn, Bonn, Germany
| | - Anja Kroke
- Department of Nutritional, Food and Consumer Sciences, Fulda University of Applied Sciences, Fulda, Germany
| | - Tilman Kühn
- The Institute for Global Food Security, Queen's University Belfast, Belfast, Northern Ireland, UK
- Faculty of Medicine and University Hospital, Heidelberg Institute of Global Health (HIGH), Heidelberg, Germany
- Department of Nutritional Sciences, University of Vienna, Vienna, Austria
- Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Stefan Lorkowski
- Institute of Nutritional Sciences, Friedrich Schiller, University Jena, Jena, Germany
- Competence Cluster for Nutrition and Cardiovascular, Health (nutriCARD) Halle-Jena-Leipzig, Jena, Germany
| | - Katharina Nimptsch
- Molecular Epidemiology Research Group, Max Delbrück Center for Molecular Medicine (MDC) in the Helmholtz Association, Berlin, Germany
| | - Lukas Schwingshackl
- Faculty of Medicine, Institute for Evidence in Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Armin Zittermann
- Clinic for Thoracic and Cardiovascular Surgery, Herz- Und Diabeteszentrum Nordrhein-Westfalen, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Bernhard Watzl
- Department of Physiology and Biochemistry of Nutrition, Max Rubner-Institut, Karlsruhe, Germany
| | - Roswitha Siener
- Department of Urology, University Stone Center, University Hospital Bonn, Bonn, Germany
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11
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Mak RH, Iyengar A, Wang AYM. Nutrition Management for Chronic Kidney Disease: Differences and Special Needs for Children and Adults. Semin Nephrol 2023; 43:151441. [PMID: 37981474 DOI: 10.1016/j.semnephrol.2023.151441] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Common goals of nutritional therapy across the spectrum of pediatric and adult chronic kidney disease (CKD) include maintaining normal body mass and composition and reducing associated morbidity and mortality. Adult nephrologists caring for children and adolescents may be challenged by the existing complexities in identifying and interpreting the nutritional status and growth in children. Pediatric nephrologists may face situations that call for a sound knowledge of assessing nutritional status and providing nutrition therapy for adolescents and young adults. One important additional nutrition goal in children is to achieve normal growth and development. Children are growing and therefore need more calories and nutrients than just maintaining their body weight and composition. Lack of weight and height gain actually is considered failure to thrive in children. Some fundamental differences in approaches to nutritional therapy in CKD are necessitated based on the etiology of CKD. A large proportion of adults with CKD are diabetics, so the approach would be a low-carbohydrate diet. Children with CKD, especially young ones, often are anorexic, so calorie supplements that could include quite a lot of carbohydrates often are prescribed. More adults with CKD have hypertension and atherosclerotic comorbidities, which result in recommendations for low-salt and low-fat diets. Children with CKD often have salt and electrolyte wasting disease states and would require normal- or even high-salt diets, and fats often are included in supplements to bolster calorie intake. Low-protein diets often are recommended in adults with predialysis CKD to slow disease progression. Children are growing and have a higher protein daily requirement. Low-protein diets have not been found to be efficacious in children with CKD, in achieving normal growth, or in slowing disease progression. Adult nephrologists caring for children and adolescents may be challenged by the existing complexities in identifying and interpreting nutritional status and growth in children. Pediatric nephrologists may face situations that call for a sound knowledge of assessing nutritional status and providing nutrition therapy for adolescents and young adults. This article discusses the differences in the assessment of nutritional status between children and adults, as well as provides a comprehensive approach to nutritional management for CKD across the age spectrum. Semin Nephrol 43:x-xx © 2023 Elsevier Inc. All rights reserved.
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Affiliation(s)
- Robert H Mak
- Division of Pediatric Nephrology, Rady Children's Hospital, University of California, San Diego, CA.
| | - Arpana Iyengar
- Department of Pediatric Nephrology, St John's Medical College Hospital, Bangalore, India
| | - Angela Yee-Moon Wang
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, China
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Bagheri R, Shakibaee A, Camera DM, Sobhani V, Ghobadi H, Nazar E, Fakhari H, Dutheil F. Effects of 8 weeks of resistance training in combination with a high protein diet on body composition, muscular performance, and markers of liver and kidney function in untrained older ex-military men. Front Nutr 2023; 10:1205310. [PMID: 37457969 PMCID: PMC10342203 DOI: 10.3389/fnut.2023.1205310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
Background The effects of a high protein diet in combination with chronic resistance training (RT) on skeletal muscle adaptation responses in untrained older ex-military men is unknown. Therefore, we compared the effects of 8 weeks of RT in combination with either a high (1.6 g/kg/d) or low protein diet (0.8 g/kg/d) on body composition [skeletal muscle mass (SMM) and body fat percentage (BFP)], muscular strength, power, and endurance (upper and lower body), markers of liver [alanine transaminase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transferase (GGT)] and kidney (creatinine and urea) function, and lipid profile low-density lipoprotein (LDL), high-density lipoprotein (HDL), and cholesterol levels in a cohort of healthy, untrained older ex-military males. Methods Forty healthy untrained older ex-military males (age: 61 ± 2 yr, body mass index: 23.2 ± 1.3 kg.m-2) performed 8 weeks (three sessions·w-1) of RT with either 1.6 g/kg/d (RHP; n = 20) or 0.8 g/kg/d of protein (RLP; n = 20). Body composition (assessed by Inbody 720), muscular strength (1-RM for chest and leg press), power (Wingate test), endurance (75% 1-RM for chest and leg press), and markers of liver and kidney function (biochemical kits) were assessed pre and post-intervention. Results SMM and muscular strength (upper and lower body) increased post-intervention in both groups and were significantly greater in RHP compared to RLP, while muscular power increased to the same extent in both groups (p < 0.05) with no between-group differences (p > 0.05). In contrast, there were no post-intervention changes in muscular endurance, HDL, and BFP remained in either group (p > 0.05). ALT and creatinine significantly increased in RHP compared to RLP while GGT, AST, and urea only increased in the RLP group (p < 0.05). LDL and cholesterol significantly decreased in both groups (p < 0.05). Conclusion A daily intake of 1.6 g/kg/d protein was superior to 0.8 g/kg/d (current recommended daily intake) for promoting greater improvements in SMM and muscle strength and thus may be a more suitable level of intake for promoting such adaptive responses. Notwithstanding observed between-group differences in ALT and creatinine and the fact that levels remained within normal ranges, it is feasible to conclude that this daily protein intake is efficacious and well tolerated by healthy, untrained older ex-military males.
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Affiliation(s)
- Reza Bagheri
- Exercise Physiology Research Center, Lifestyle Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Abolfazl Shakibaee
- Exercise Physiology Research Center, Lifestyle Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Donny M. Camera
- Department of Health and Biostatistics, Swinburne University, Melbourne, VIC, Australia
| | - Vahid Sobhani
- Exercise Physiology Research Center, Lifestyle Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hamid Ghobadi
- Department of Exercise Physiology, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Eisa Nazar
- Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hadi Fakhari
- Department of Exercise Physiology, University of Isfahan, Isfahan, Iran
| | - Fred Dutheil
- CNRS, LaPSCo, Physiological and Psychosocial Stress, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Preventive and Occupational Medicine, Université Clermont Auvergne, Clermont-Ferrand, France
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Ray S, Singh AK, Mukherjee JJ, Ramachandran R, Sengupta U, Virmani AK, Dutta AR, Sharma SK, Srivastava SL, Batin M. Protein restriction in adults with chronic kidney disease, with or without diabetes: Integrated Diabetes and Endocrine Academy (IDEA) consensus statement for Indian patients. Diabetes Metab Syndr 2023; 17:102785. [PMID: 37210963 DOI: 10.1016/j.dsx.2023.102785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND AND AIMS Most guidelines recommend protein restriction in adults with chronic kidney disease (CKD), with or without diabetes. However, advising protein restriction for every person with CKD is controversial. We aim to arrive at a consensus on this topic, especially among Indian adults with CKD. METHODS A systematic literature search in the PubMed electronic database was undertaken using specific keywords and MeSH terms until May 1, 2022. All the retrieved literature was circulated and rigorously deliberated upon by the panel members. RESULTS Seventeen meta-analyses that evaluated the outcomes of protein restriction in adults with CKD, with or without diabetes, met our inclusion criteria and were analyzed. A low-protein diet (LPD) in people with stages 3-5 of CKD (who are not on haemodialysis [HD]) reduces the severity of uremic symptoms and the rate of decline in glomerular filtration rate, leading to a delay in dialysis initiation. However, LPD in patients on maintenance HD may not be desirable because HD-induced protein catabolism may lead to protein-energy malnutrition. Since the average protein intake among Indians is much lower than recommended, this must be taken into consideration before recommending LPD for all Indian adults with CKD, particularly those on maintenance HD. CONCLUSION It is essential to assess the nutritional status of people with CKD, particularly in countries like India where average daily protein intake is poor, before recommending guideline-directed protein restriction. The prescribed diet, including the quantity and quality of proteins, should be tailored to the person's habits, tastes, and needs.
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Affiliation(s)
- Subir Ray
- Apollo Multi-speciality Hospitals, Kolkata, West Bengal, India
| | | | | | - Raja Ramachandran
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Hajishizari S, Mirzababaei A, Abaj F, Khosroshahi RA, Barekzai AM, Worm N, Abbasy M, Mirzaei K. The association between a low-carbohydrate diet score and the risk of diabetic nephropathy in women: A case-control study. Nutrition 2023; 107:111930. [PMID: 36584662 DOI: 10.1016/j.nut.2022.111930] [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: 06/11/2022] [Revised: 11/05/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Because evidence linking carbohydrate consumption to diabetic nephropathy (DN) is scarce, and the association between a low-carbohydrate diet (LCD) and DN has not been investigated, we sought to investigate whether a higher LCD score is associated with DN among women. METHODS In a case-control study, 105 women with type 2 diabetes mellitus and DN and 105 controls with type 2 diabetes mellitus and without DN who attended Kowsar Diabetes Clinic in Semnan, Iran, were matched for age and diabetes duration. The data related to anthropometric and biochemical measures were collected and a food frequency questionnaire with 147 items was used to assess dietary intake. Based on the food frequency questionnaire, we calculated an LCD score for each study participant. Multivariate logistic regression was performed to examine the association between an LCD score and the odds of developing DN. RESULTS The results of the study demonstrated that the LCD score was not significantly associated with DN in the crude model (odds ratio = 0.39; 95% confidence interval, 0.14-1.07; P = 0.06). However, after adjusting for several confounders, subjects in the top quartile of the LCD score were associated with a 71% lower risk of DN (odds ratio [OR] = 0.29; 95% confidence interval, 0.10-0.86; P = 0.02). A significant trend toward decreased urinary albumin excretion was found with an increase in the LCD score (P = 0.005). CONCLUSIONS A diet low in carbohydrates was inversely associated with risk of DN. Further observational studies, and preferably randomized controlled trials, are needed to confirm the present results.
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Affiliation(s)
- Sara Hajishizari
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Atieh Mirzababaei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Faezeh Abaj
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Reza Amiri Khosroshahi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | | | - Nicolai Worm
- Department of Nutrition, German University of Applied Sciences for Prevention and Health Care Management, Saarbrücken, Germany
| | - Maryam Abbasy
- National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Khadijeh Mirzaei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran; Food Microbiology Research Center, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
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Joshi S, Kalantar-Zadeh K, Chauveau P, Carrero JJ. Risks and Benefits of Different Dietary Patterns in CKD. Am J Kidney Dis 2023; 81:352-360. [PMID: 36682903 DOI: 10.1053/j.ajkd.2022.08.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 08/08/2022] [Indexed: 01/21/2023]
Abstract
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.
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Affiliation(s)
- Shivam Joshi
- Department of Medicine, Grossman School of Medicine, New York University, New York, New York; Department of Medicine, NYC Health + Hospitals/Bellevue, New York, New York.
| | | | | | - Juan Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Smoliga JM, Wilber ZT, Robinson BT. Premature Death in Bodybuilders: What Do We Know? Sports Med 2023; 53:933-948. [PMID: 36715876 PMCID: PMC9885939 DOI: 10.1007/s40279-022-01801-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2022] [Indexed: 01/31/2023]
Abstract
Premature deaths in bodybuilders regularly make headlines and are cited as evidence that bodybuilding is a dangerous activity. A wealth of research has revealed elite athletes typically enjoy lower mortality rates than non-athletes, but research on bodybuilder lifespan is surprisingly limited. Anabolic androgenic steroid (AAS) use is commonly cited as a key contributor to morbidity and premature mortality in bodybuilders, but this area of research is highly nuanced and influenced by numerous confounders unique to bodybuilding. It is quite possible that bodybuilders are at elevated risk and that AAS use is the primary reason for this, but there remains much unknown in this realm. As global participation in bodybuilding increases, and healthcare providers play a more active role in monitoring bodybuilder health, there is a need to identify how numerous factors associated with bodybuilding ultimately influence short- and long-term health and mortality rate. In this Current Opinion, we discuss what is currently known about the bodybuilder lifespan, identify the nuances of the literature regarding bodybuilder health and AAS use, and provide recommendations for future research on this topic.
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Affiliation(s)
- James M. Smoliga
- Department of Physical Therapy, One University Parkway, High Point University, High Point, NC 27268 USA
| | - Z. Taggart Wilber
- Department of Physical Therapy, One University Parkway, High Point University, High Point, NC 27268 USA ,Helix Performance Recovery, Wellington, FL USA
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17
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Vukovic V, Hantikainen E, Raftopoulou A, Gögele M, Rainer J, Domingues FS, Pramstaller PP, Garcia-Larsen V, Pattaro C. Association of dietary proteins with serum creatinine and estimated glomerular filtration rate in a general population sample: the CHRIS study. J Nephrol 2023; 36:103-114. [PMID: 35930180 PMCID: PMC9894942 DOI: 10.1007/s40620-022-01409-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/14/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Diet is known to affect kidney function. However, population-based studies provide contrasting evidence, resulting in a poor understanding of the effect of proteins from specific foods on kidney health. METHODS We analyzed the effect of total daily protein intake (TDPI) and source-specific daily protein intake (DPI) on fasting serum creatinine (SCr) and estimated glomerular filtration rate (eGFR) in the Cooperative Health Research In South Tyrol (CHRIS) cross-sectional study (n = 5889), using the GA2LEN food frequency questionnaire for TDPI and DPI estimation. We fitted multivariable adjusted mixed models of SCr and eGFR on TDPI and DPI quartiles (Q1-Q4) in the overall sample, and after removing individuals with known hypertension, diabetes or chronic kidney disease (CKD). RESULTS Higher TDPI as well as DPI from overall animal sources, fish, and poultry, were associated with higher SCr (trend test p, ptrend < 0.01), with larger effect after excluding individuals with known hypertension, diabetes or CKD. The eGFR was lower at higher TDPI (Q4 vs Q1: - 1.6 ml/min/1.73 m2; 95% CI - 2.5, - 0.7; ptrend = 3e-4) and DPI from fish (Q4 vs Q1: - 2.1 ml/min/1.73 m2; 95% CI - 2.9, - 1.20; ptrend = 4.3e-6), overall animal source (Q4 vs Q1: - 1.6 ml/min/1.73 m2; 95% CI -2.5, - 0.8), processed meat (Q4 vs Q1: - 1.4 ml/min/1.73 m2; ptrend = 0.027), red meat, offal and processed meat (Q4 vs Q1: - 1.4 ml/min/1.73 m2; ptrend = 0.015) and poultry (Q4 vs Q1: - 0.9 ml/min/1.73 m2; ptrend = 0.015). CONCLUSIONS TDPI and DPI from specific animal sources were positively associated with SCr and negatively associated with eGFR. Lacking an alternative marker of kidney function, confounding involving muscle mass metabolism cannot be fully excluded.
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Affiliation(s)
- Vladimir Vukovic
- Eurac Research, Institute for Biomedicine (Affiliated to the University of Lübeck), Via Volta 21, 39100, Bolzano, Italy. .,Department of Epidemiology, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000, Novi Sad, Serbia. .,Centre for Disease Control and Prevention, Institute of Public Health of Vojvodina, Novi Sad, Serbia.
| | - Essi Hantikainen
- Eurac Research, Institute for Biomedicine (Affiliated to the University of Lübeck), Via Volta 21, 39100, Bolzano, Italy
| | - Athina Raftopoulou
- Eurac Research, Institute for Biomedicine (Affiliated to the University of Lübeck), Via Volta 21, 39100, Bolzano, Italy.,Department of Economics, University of Patras, Patras, Greece
| | - Martin Gögele
- Eurac Research, Institute for Biomedicine (Affiliated to the University of Lübeck), Via Volta 21, 39100, Bolzano, Italy
| | - Johannes Rainer
- Eurac Research, Institute for Biomedicine (Affiliated to the University of Lübeck), Via Volta 21, 39100, Bolzano, Italy
| | - Francisco S Domingues
- Eurac Research, Institute for Biomedicine (Affiliated to the University of Lübeck), Via Volta 21, 39100, Bolzano, Italy
| | - Peter P Pramstaller
- Eurac Research, Institute for Biomedicine (Affiliated to the University of Lübeck), Via Volta 21, 39100, Bolzano, Italy
| | - Vanessa Garcia-Larsen
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Cristian Pattaro
- Eurac Research, Institute for Biomedicine (Affiliated to the University of Lübeck), Via Volta 21, 39100, Bolzano, Italy.
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Teymoori F, Farhadnejad H, Jahromi MK, Vafa M, Ahmadirad H, Mirmiran P, Azizi F. Dietary protein score and carbohydrate quality index with the risk of chronic kidney disease: Findings from a prospective cohort study. Front Nutr 2022; 9:1003545. [PMID: 36532536 PMCID: PMC9749551 DOI: 10.3389/fnut.2022.1003545] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/07/2022] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND/AIM This study aimed to examine the associations between dietary protein score and carbohydrate quality index (CQI) and the risk of chronic kidney disease (CKD) in Iranian adults. METHODS This population-based cohort study was performed within the Tehran Lipid and Glucose Study framework on 6,044 subjects aged ≥18 years old, who were followed up for a mean of 7.7 years. Dietary protein score and CQI were determined using a food frequency questionnaire. CKD was defined as an estimated glomerular filtration rate <60 ml/min/1.73 m2. A multivariate Cox proportional hazard regression model was used to estimate the risk of CKD across tertiles of protein score and CQI. RESULTS The mean (standard deviation) of age and body mass index of participants were 37.9 (12.8) years and 26.8 (4.7) kg/m2, respectively. During the 7.7 ± 2.7 years of follow-up, 1,216 cases (20.1%) of CKD were ascertained. In the final adjusted model, individuals in the highest tertile of protein score had decreased risk of CKD (HR: 0.85, 95% CI: 0.74-0.98, P trend = 0.033). Also, there is a significant association between total carbohydrate score (HR: 0.85, 95% CI: 0.73-0.99, P trend = 0.016), the ratio of whole grain/total grains (HR: 0.81, 95% CI: 0.70-0.94, P trend = 0.004), and glycemic index (HR: 1.30, 95% CI: 1.12-1.51, P trend < 0.001) and risk of CKD. However, no significant association was found between total protein intakes, plant-to-animal ratio, and solid carbohydrate/total carbohydrate with the risk of CKD. CONCLUSION Our results revealed a diet with a high protein score and high quality of carbohydrates, characterized by higher intakes of plant proteins, low glycaemic index (GI) carbohydrates, whole grain, fibers, and lower intakes of animal proteins, can be related to reduced CKD risk.
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Affiliation(s)
- Farshad Teymoori
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Farhadnejad
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mitra Kazemi Jahromi
- Endocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mohammadreza Vafa
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Ahmadirad
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvin Mirmiran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Low-protein diet is inversely related to the incidence of chronic kidney disease in middle-aged and older adults: results from a community-based prospective cohort study. Eur J Nutr 2022; 61:3795-3807. [PMID: 35947164 DOI: 10.1007/s00394-022-02981-1] [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: 02/04/2022] [Accepted: 07/29/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE Dietary protein intake can modulate renal health. However, the effect of dietary protein restriction on kidney function in the general population remains unclear. This study aimed to examine the association between total protein intake and new-onset chronic kidney disease (CKD) in Korean adults. METHODS We included 7339 participants from the Korean Genome and Epidemiology Study. Participants were divided into low-protein diet (LPD, < 0.8 g/kg/day), normal-protein diet (NPD, 0.8-1.3 g/kg/day), and high-protein diet (HPD, > 1.3 g/kg/day) groups. New-onset CKD was defined as two consecutive events of estimated glomerular filtration rate < 60 mL/min/1.73 m2. Multivariable Cox hazard regression analysis was conducted to examine the association of total protein intake with new-onset CKD. Subgroup analyses according to diabetes mellitus (DM) status were performed. We performed the same analyses by dividing participants into total protein, plant protein, and animal protein intake tertiles. RESULTS During a median follow-up of 13.7 years, 633 (8.7%) participants newly developed CKD. The fully adjusted hazard ratios (HR) with 95% confidence interval (CI) for incident CKD of the LPD and HPD groups compared with the NPD group were 1.49 (1.18-1.87) and 0.63 (0.45-0.87), respectively. The HR (95% CI) of the highest tertile group of plant protein intake for incident CKD was 0.72 (0.54-0.93), compared with that of the lowest tertile group. Similar trends were observed only in the non-DM subgroup, not in the DM subgroup. CONCLUSION Protein intake, especially plant proteins, was negatively associated with the incidence of new-onset CKD in middle-aged and older Korean adults.
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de Sá JR, Rangel EB, Canani LH, Bauer AC, Escott GM, Zelmanovitz T, Bertoluci MC, Silveiro SP. The 2021-2022 position of Brazilian Diabetes Society on diabetic kidney disease (DKD) management: an evidence-based guideline to clinical practice. Screening and treatment of hyperglycemia, arterial hypertension, and dyslipidemia in the patient with DKD. Diabetol Metab Syndr 2022; 14:81. [PMID: 35690830 PMCID: PMC9188192 DOI: 10.1186/s13098-022-00843-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diabetic kidney disease is the leading cause of end-stage renal disease and is associated with increased morbidity and mortality. This review is an authorized literal translation of part of the Brazilian Diabetes Society (SBD) Guidelines 2021-2022. This evidence-based guideline provides guidance on the correct management of Diabetic Kidney Disease (DKD) in clinical practice. METHODS The methodology was published elsewhere in previous SBD guidelines and was approved by the internal institutional Steering Committee for publication. Briefly, the Brazilian Diabetes Society indicated 14 experts to constitute the Central Committee, designed to regulate methodology, review the manuscripts, and make judgments on degrees of recommendations and levels of evidence. SBD Renal Disease Department drafted the manuscript selecting key clinical questions to make a narrative review using MEDLINE via PubMed, with the best evidence available including high-quality clinical trials, metanalysis, and large observational studies related to DKD diagnosis and treatment, by using the MeSH terms [diabetes], [type 2 diabetes], [type 1 diabetes] and [chronic kidney disease]. RESULTS The extensive review of the literature made by the 14 members of the Central Committee defined 24 recommendations. Three levels of evidence were considered: A. Data from more than 1 randomized clinical trial or 1 metanalysis of randomized clinical trials with low heterogeneity (I2 < 40%). B. Data from metanalysis, including large observational studies, a single randomized clinical trial, or a pre-specified subgroup analysis. C: Data from small or non-randomized studies, exploratory analyses, or consensus of expert opinion. The degree of recommendation was obtained based on a poll sent to the panelists, using the following criteria: Grade I: when more than 90% of agreement; Grade IIa 75-89% of agreement; IIb 50-74% of agreement, and III, when most of the panelist recommends against a defined treatment. CONCLUSIONS To prevent or at least postpone the advanced stages of DKD with the associated cardiovascular complications, intensive glycemic and blood pressure control are required, as well as the use of renin-angiotensin-aldosterone system blocker agents such as ARB, ACEI, and MRA. Recently, SGLT2 inhibitors and GLP1 receptor agonists have been added to the therapeutic arsenal, with well-proven benefits regarding kidney protection and patients' survival.
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Affiliation(s)
- João Roberto de Sá
- Endocrinology Division, Escola Paulista de Medicina, UNIFESP, São Paulo, Brazil
| | - Erika Bevilaqua Rangel
- Nephrology Division, UNIFESP, São Paulo, Brazil
- Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Luis Henrique Canani
- Internal Medicine Department, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Endocrinology Division, Hospital de Clínicas de Porto Alegre (HCPA), Ramiro Barcelos, 2350-Prédio 12, 4º andar, Porto Alegre, RS, Brazil
| | - Andrea Carla Bauer
- Internal Medicine Department, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Endocrinology Division, Hospital de Clínicas de Porto Alegre (HCPA), Ramiro Barcelos, 2350-Prédio 12, 4º andar, Porto Alegre, RS, Brazil
| | - Gustavo Monteiro Escott
- Internal Medicine Department, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Endocrinology Division, Hospital de Clínicas de Porto Alegre (HCPA), Ramiro Barcelos, 2350-Prédio 12, 4º andar, Porto Alegre, RS, Brazil
| | - Themis Zelmanovitz
- Internal Medicine Department, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Endocrinology Division, Hospital de Clínicas de Porto Alegre (HCPA), Ramiro Barcelos, 2350-Prédio 12, 4º andar, Porto Alegre, RS, Brazil
| | - Marcello Casaccia Bertoluci
- Internal Medicine Department, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Endocrinology Division, Hospital de Clínicas de Porto Alegre (HCPA), Ramiro Barcelos, 2350-Prédio 12, 4º andar, Porto Alegre, RS, Brazil
| | - Sandra Pinho Silveiro
- Internal Medicine Department, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
- Endocrinology Division, Hospital de Clínicas de Porto Alegre (HCPA), Ramiro Barcelos, 2350-Prédio 12, 4º andar, Porto Alegre, RS, Brazil.
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Sharma M, Singh V, Sharma R, Koul A, McCarthy ET, Savin VJ, Joshi T, Srivastava T. Glomerular Biomechanical Stress and Lipid Mediators during Cellular Changes Leading to Chronic Kidney Disease. Biomedicines 2022; 10:407. [PMID: 35203616 PMCID: PMC8962328 DOI: 10.3390/biomedicines10020407] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 01/31/2022] [Accepted: 02/04/2022] [Indexed: 02/04/2023] Open
Abstract
Hyperfiltration is an important underlying cause of glomerular dysfunction associated with several systemic and intrinsic glomerular conditions leading to chronic kidney disease (CKD). These include obesity, diabetes, hypertension, focal segmental glomerulosclerosis (FSGS), congenital abnormalities and reduced renal mass (low nephron number). Hyperfiltration-associated biomechanical forces directly impact the cell membrane, generating tensile and fluid flow shear stresses in multiple segments of the nephron. Ongoing research suggests these biomechanical forces as the initial mediators of hyperfiltration-induced deterioration of podocyte structure and function leading to their detachment and irreplaceable loss from the glomerular filtration barrier. Membrane lipid-derived polyunsaturated fatty acids (PUFA) and their metabolites are potent transducers of biomechanical stress from the cell surface to intracellular compartments. Omega-6 and ω-3 long-chain PUFA from membrane phospholipids generate many versatile and autacoid oxylipins that modulate pro-inflammatory as well as anti-inflammatory autocrine and paracrine signaling. We advance the idea that lipid signaling molecules, related enzymes, metabolites and receptors are not just mediators of cellular stress but also potential targets for developing novel interventions. With the growing emphasis on lifestyle changes for wellness, dietary fatty acids are potential adjunct-therapeutics to minimize/treat hyperfiltration-induced progressive glomerular damage and CKD.
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Affiliation(s)
- Mukut Sharma
- Research and Development Service, Kansas City VA Medical Center, Kansas City, MO 64128, USA;
- Midwest Veterans’ Biomedical Research Foundation, Kansas City, MO 64128, USA; (A.K.); (V.J.S.); (T.S.)
- Department of Internal Medicine, The Jared Grantham Kidney Institute, University of Kansas Medical Center, Kansas City, MO 66160, USA;
| | - Vikas Singh
- Neurology, Kansas City VA Medical Center, Kansas City, MO 64128, USA;
| | - Ram Sharma
- Research and Development Service, Kansas City VA Medical Center, Kansas City, MO 64128, USA;
| | - Arnav Koul
- Midwest Veterans’ Biomedical Research Foundation, Kansas City, MO 64128, USA; (A.K.); (V.J.S.); (T.S.)
| | - Ellen T. McCarthy
- Department of Internal Medicine, The Jared Grantham Kidney Institute, University of Kansas Medical Center, Kansas City, MO 66160, USA;
| | - Virginia J. Savin
- Midwest Veterans’ Biomedical Research Foundation, Kansas City, MO 64128, USA; (A.K.); (V.J.S.); (T.S.)
| | - Trupti Joshi
- Department of Health Management and Informatics, University of Missouri, Columbia, MO 65201, USA;
| | - Tarak Srivastava
- Midwest Veterans’ Biomedical Research Foundation, Kansas City, MO 64128, USA; (A.K.); (V.J.S.); (T.S.)
- Section of Nephrology, Children’s Mercy Hospital and University of Missouri, Kansas City, MO 64108, USA
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri, Kansas City, MO 64108, USA
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22
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Joblin-Mills A, Wu Z, Fraser K, Jones B, Yip W, Lim JJ, Lu L, Sequeira I, Poppitt S. The impact of ethnicity and intra-pancreatic fat on the postprandial metabolome response to whey protein in overweight Asian Chinese and European Caucasian women with prediabetes. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:980856. [PMID: 36992769 PMCID: PMC10012149 DOI: 10.3389/fcdhc.2022.980856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 07/27/2022] [Indexed: 03/31/2023]
Abstract
The "Thin on the Outside Fat on the Inside" TOFI_Asia study found Asian Chinese to be more susceptible to Type 2 Diabetes (T2D) compared to European Caucasians matched for gender and body mass index (BMI). This was influenced by degree of visceral adipose deposition and ectopic fat accumulation in key organs, including liver and pancreas, leading to altered fasting plasma glucose, insulin resistance, and differences in plasma lipid and metabolite profiles. It remains unclear how intra-pancreatic fat deposition (IPFD) impacts TOFI phenotype-related T2D risk factors associated with Asian Chinese. Cow's milk whey protein isolate (WPI) is an insulin secretagogue which can suppress hyperglycemia in prediabetes. In this dietary intervention, we used untargeted metabolomics to characterize the postprandial WPI response in 24 overweight women with prediabetes. Participants were classified by ethnicity (Asian Chinese, n=12; European Caucasian, n=12) and IPFD (low IPFD < 4.66%, n=10; high IPFD ≥ 4.66%, n=10). Using a cross-over design participants were randomized to consume three WPI beverages on separate occasions; 0 g (water control), 12.5 g (low protein, LP) and 50 g (high protein, HP), consumed when fasted. An exclusion pipeline for isolating metabolites with temporal (T0-240mins) WPI responses was implemented, and a support vector machine-recursive feature elimination (SVM-RFE) algorithm was used to model relevant metabolites by ethnicity and IPFD classes. Metabolic network analysis identified glycine as a central hub in both ethnicity and IPFD WPI response networks. A depletion of glycine relative to WPI concentration was detected in Chinese and high IPFD participants independent of BMI. Urea cycle metabolites were highly represented among the ethnicity WPI metabolome model, implicating a dysregulation in ammonia and nitrogen metabolism among Chinese participants. Uric acid and purine synthesis pathways were enriched within the high IPFD cohort's WPI metabolome response, implicating adipogenesis and insulin resistance pathways. In conclusion, the discrimination of ethnicity from WPI metabolome profiles was a stronger prediction model than IPFD in overweight women with prediabetes. Each models' discriminatory metabolites enriched different metabolic pathways that help to further characterize prediabetes in Asian Chinese women and women with increased IPFD, independently.
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Affiliation(s)
- Aidan Joblin-Mills
- Food Chemistry and Structure Team, Agresearch, Palmerston North, New Zealand
- High-Value Nutrition, National Science Challenge, Auckland, New Zealand
- *Correspondence: Aidan Joblin-Mills,
| | - Zhanxuan Wu
- Food Chemistry and Structure Team, Agresearch, Palmerston North, New Zealand
- High-Value Nutrition, National Science Challenge, Auckland, New Zealand
- School of Food and Nutrition, Massey University, Palmerston North, New Zealand
| | - Karl Fraser
- Food Chemistry and Structure Team, Agresearch, Palmerston North, New Zealand
- High-Value Nutrition, National Science Challenge, Auckland, New Zealand
| | - Beatrix Jones
- High-Value Nutrition, National Science Challenge, Auckland, New Zealand
- Department of Statistics, University of Auckland, Auckland, New Zealand
| | - Wilson Yip
- High-Value Nutrition, National Science Challenge, Auckland, New Zealand
- Human Nutrition Unit, School of Biological Sciences, University of Auckland, Auckland, New Zealand
| | - Jia Jiet Lim
- High-Value Nutrition, National Science Challenge, Auckland, New Zealand
- Human Nutrition Unit, School of Biological Sciences, University of Auckland, Auckland, New Zealand
| | - Louise Lu
- High-Value Nutrition, National Science Challenge, Auckland, New Zealand
- Human Nutrition Unit, School of Biological Sciences, University of Auckland, Auckland, New Zealand
| | - Ivana Sequeira
- High-Value Nutrition, National Science Challenge, Auckland, New Zealand
- Human Nutrition Unit, School of Biological Sciences, University of Auckland, Auckland, New Zealand
| | - Sally Poppitt
- High-Value Nutrition, National Science Challenge, Auckland, New Zealand
- Human Nutrition Unit, School of Biological Sciences, University of Auckland, Auckland, New Zealand
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23
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Revisiting glomerular hyperfiltration and examining the concept of high dietary protein-related nephropathy in athletes and bodybuilders. Curr Opin Nephrol Hypertens 2022; 31:18-25. [PMID: 34846311 DOI: 10.1097/mnh.0000000000000755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW High-protein diets (HPDs) are popular but their consequences for kidney health, especially among athletes and bodybuilders who typically maintain a high protein intake for a long time, have not been investigated. This review focused on recent studies of the association of HPD with long-term kidney health and the concept of high dietary protein-related nephropathy. RECENT FINDINGS Several long-term observational studies including large populations have reinforced the notion that HPDs are associated with a rapid decline of kidney function. An increase in renal blood flow and glomerular hyperfiltration caused by vasodilation, and increased levels of endocrine and paracrine factors (glucagon, IGF-1, prostanoids, and nitric oxide), facilitates the excretion of protein-derived nitrogenous waste. Inhibition of tubule-glomerular feedback and increased proximal tubular Na+ reabsorption after a HPD augment glomerular hyperfiltration and may trigger synthesis of proinflammatory cytokines and receptor for advanced glycation end-products (RAGE). Focal segmental glomerulosclerosis reported in association with anabolic steroid may indeed be a HPD nephropathy given that HPD results in progressive glomerulosclerosis, especially in remnant glomeruli or in diabetic kidney disease but can happen in any high-risk situation, such as solitary kidney and polycystic kidneys. SUMMARY HPD among athletes and bodybuilders in an extreme way across a long-term period may pose a risk to renal health including high incidence of HPD nephropathy.
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24
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Adeva-Andany MM, Fernández-Fernández C, Carneiro-Freire N, Vila-Altesor M, Ameneiros-Rodríguez E. The differential effect of animal versus vegetable dietary protein on the clinical manifestations of diabetic kidney disease in humans. Clin Nutr ESPEN 2022; 48:21-35. [DOI: 10.1016/j.clnesp.2022.01.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 01/25/2022] [Indexed: 10/19/2022]
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25
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Fotheringham AK, Solon-Biet SM, Bielefeldt-Ohmann H, McCarthy DA, McMahon AC, Ruohonen K, Li I, Sullivan MA, Whiddett RO, Borg DJ, Cogger VC, Ballard WO, Turner N, Melvin RG, Raubenheimer D, Le Couteur DG, Simpson SJ, Forbes JM. Kidney disease risk factors do not explain impacts of low dietary protein on kidney function and structure. iScience 2021; 24:103308. [PMID: 34820603 PMCID: PMC8602032 DOI: 10.1016/j.isci.2021.103308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/29/2021] [Accepted: 10/15/2021] [Indexed: 02/06/2023] Open
Abstract
The kidneys balance many byproducts of the metabolism of dietary components. Previous studies examining dietary effects on kidney health are generally of short duration and manipulate a single macronutrient. Here, kidney function and structure were examined in C57BL/6J mice randomized to consume one of a spectrum of macronutrient combinations (protein [5%–60%], carbohydrate [20%–75%], and fat [20%–75%]) from weaning to late-middle age (15 months). Individual and interactive impacts of macronutrients on kidney health were modeled. Dietary protein had the greatest influence on kidney function, where chronic low protein intake decreased glomerular filtration rates and kidney mass, whereas it increased kidney immune infiltration and structural injury. Kidney outcomes did not align with cardiometabolic risk factors including glucose intolerance, overweight/obesity, dyslipidemia, and hypertension in mice with chronic low protein consumption. This study highlights that protein intake over a lifespan is an important determinant of kidney function independent of cardiometabolic changes. Chronic high macronutrient intake from any source increases kidney function (GFR) Low protein intake led to greater kidney tubular structural injury and inflammation Lower protein intake decreased kidney mass and glomerular filtration capacity Kidney outcomes did not align with longevity or cardiometabolic outcomes
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Affiliation(s)
- Amelia K Fotheringham
- Glycation and Diabetes Complications Group, Mater Research Institute-The University of Queensland, Translational Research Institute, 37 Kent Street, Woolloongabba, Brisbane 4072, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane 4067, QLD, Australia
| | - Samantha M Solon-Biet
- Charles Perkins Centre, University of Sydney, Sydney 2006, NSW, Australia.,School of Medical Sciences, University of Sydney, Sydney 2006, NSW, Australia
| | - Helle Bielefeldt-Ohmann
- School of Veterinary Science, University of Queensland, Gatton Campus, Gatton 4343, QLD, Australia.,School of Chemistry & Molecular Biosciences, University of Queensland, Brisbane 4067, QLD, Australia
| | - Domenica A McCarthy
- Glycation and Diabetes Complications Group, Mater Research Institute-The University of Queensland, Translational Research Institute, 37 Kent Street, Woolloongabba, Brisbane 4072, QLD, Australia
| | - Aisling C McMahon
- Charles Perkins Centre, University of Sydney, Sydney 2006, NSW, Australia.,Centre for Education and Research on Aging, and Aging and Alzheimer's Institute, Concord Hospital, Sydney 2139, NSW, Australia.,ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney 2139, NSW, Australia
| | - Kari Ruohonen
- Animal Nutrition and Health, Cargill, Sandnes, Norway
| | - Isaac Li
- Faculty of Medicine, University of Queensland, Brisbane 4067, QLD, Australia
| | - Mitchell A Sullivan
- Glycation and Diabetes Complications Group, Mater Research Institute-The University of Queensland, Translational Research Institute, 37 Kent Street, Woolloongabba, Brisbane 4072, QLD, Australia
| | - Rani O Whiddett
- Glycation and Diabetes Complications Group, Mater Research Institute-The University of Queensland, Translational Research Institute, 37 Kent Street, Woolloongabba, Brisbane 4072, QLD, Australia
| | - Danielle J Borg
- Glycation and Diabetes Complications Group, Mater Research Institute-The University of Queensland, Translational Research Institute, 37 Kent Street, Woolloongabba, Brisbane 4072, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane 4067, QLD, Australia
| | - Victoria C Cogger
- Charles Perkins Centre, University of Sydney, Sydney 2006, NSW, Australia.,Centre for Education and Research on Aging, and Aging and Alzheimer's Institute, Concord Hospital, Sydney 2139, NSW, Australia.,ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney 2139, NSW, Australia
| | - William O Ballard
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney 2052, NSW, Australia
| | - Nigel Turner
- Department of Pharmacology, School of Medical Sciences, Faculty of Medicine, University of New South Wales Sydney, NSW 2052, Australia
| | - Richard G Melvin
- Department of Biomedical Sciences, University of Minnesota Medical School, 1035 University Drive, Duluth 55812, MN, USA
| | - David Raubenheimer
- Charles Perkins Centre, University of Sydney, Sydney 2006, NSW, Australia.,School of Life and Environmental Sciences, University of Sydney, NSW, Australia
| | - David G Le Couteur
- Charles Perkins Centre, University of Sydney, Sydney 2006, NSW, Australia.,Centre for Education and Research on Aging, and Aging and Alzheimer's Institute, Concord Hospital, Sydney 2139, NSW, Australia.,ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney 2139, NSW, Australia
| | - Stephen J Simpson
- Charles Perkins Centre, University of Sydney, Sydney 2006, NSW, Australia.,School of Life and Environmental Sciences, University of Sydney, NSW, Australia
| | - Josephine M Forbes
- Glycation and Diabetes Complications Group, Mater Research Institute-The University of Queensland, Translational Research Institute, 37 Kent Street, Woolloongabba, Brisbane 4072, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane 4067, QLD, Australia.,Department of Medicine, University of Melbourne, Heidelberg, VIC 3084, Australia
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26
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Strubl S, Oehm S, Torres JA, Grundmann F, Haratani J, Decker M, Vuong S, Kaur Bhandal A, Methot N, Haynie-Cion R, Meyer F, Siedek F, Korst U, Müller RU, Weimbs T. Ketogenic dietary interventions in autosomal dominant polycystic kidney disease-a retrospective case series study: first insights into feasibility, safety and effects. Clin Kidney J 2021; 15:1079-1092. [PMID: 35664270 PMCID: PMC9155228 DOI: 10.1093/ckj/sfab162] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Indexed: 01/13/2023] Open
Abstract
Background Our laboratory published the first evidence that nutritional ketosis, induced by a ketogenic diet (KD) or time-restricted diet (TRD), ameliorates disease progression in polycystic kidney disease (PKD) animal models. We reasoned that, due to their frequent use for numerous health benefits, some autosomal dominant PKD (ADPKD) patients may already have had experience with ketogenic dietary interventions (KDIs). This retrospective case series study is designed to collect the first real-life observations of ADPKD patients about safety, feasibility and possible benefits of KDIs in ADPKD as part of a translational project pipeline. Methods Patients with ADPKD who had already used KDIs were recruited to retrospectively collect observational and medical data about beneficial or adverse effects and the feasibility and safety of KDIs in questionnaire-based interviews. Results A total of 131 ADPKD patients took part in this study. About 74 executed a KD and 52 a TRD for 6 months on average. A total of 86% of participants reported that KDIs had improved their overall health, 67% described improvements in ADPKD-associated health issues, 90% observed significant weight loss, 64% of participants with hypertension reported improvements in blood pressure, 66% noticed adverse effects that are frequently observed with KDIs, 22 participants reported safety concerns like hyperlipidemia, 45 participants reported slight improvements in estimated glomerular filtration rate and 92% experienced KDIs as feasible while 53% reported breaks during their diet. Conclusions Our preliminary data indicate that KDIs may be safe, feasible and potentially beneficial for ADPKD patients, highlighting that prospective clinical trials are warranted to confirm these results in a controlled setting and elucidate the impact of KDIs specifically on kidney function and cyst progression.
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Affiliation(s)
- Sebastian Strubl
- Department of Molecular, Cellular, and Developmental Biology and Neuroscience Research Institute, University of California Santa Barbara, Santa Barbara, CA, USA,Department II of Internal Medicine and Center for Molecular Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Simon Oehm
- Department II of Internal Medicine and Center for Molecular Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jacob A Torres
- Department of Molecular, Cellular, and Developmental Biology and Neuroscience Research Institute, University of California Santa Barbara, Santa Barbara, CA, USA
| | - Franziska Grundmann
- Department II of Internal Medicine and Center for Molecular Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jazmine Haratani
- Department of Molecular, Cellular, and Developmental Biology and Neuroscience Research Institute, University of California Santa Barbara, Santa Barbara, CA, USA
| | - Morgan Decker
- Department of Molecular, Cellular, and Developmental Biology and Neuroscience Research Institute, University of California Santa Barbara, Santa Barbara, CA, USA
| | - Sabrina Vuong
- Department of Molecular, Cellular, and Developmental Biology and Neuroscience Research Institute, University of California Santa Barbara, Santa Barbara, CA, USA
| | - Amrit Kaur Bhandal
- Department of Molecular, Cellular, and Developmental Biology and Neuroscience Research Institute, University of California Santa Barbara, Santa Barbara, CA, USA
| | - Nils Methot
- Department of Molecular, Cellular, and Developmental Biology and Neuroscience Research Institute, University of California Santa Barbara, Santa Barbara, CA, USA
| | - Rhianna Haynie-Cion
- Department of Molecular, Cellular, and Developmental Biology and Neuroscience Research Institute, University of California Santa Barbara, Santa Barbara, CA, USA
| | - Franziska Meyer
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Florian Siedek
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Uwe Korst
- PKD Familiäre Zystennieren e.V., Bensheim, Germany
| | - Roman-Ulrich Müller
- Department II of Internal Medicine and Center for Molecular Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, Cologne, Germany
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27
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van der Aart‐van der Beek AB, Cherney D, Laverman GD, Stefansson B, van Raalte DH, Hoogenberg K, Reyner D, Li Q, Di Tanna GL, Greasley PJ, Heerspink HJL. Renal haemodynamic response to sodium-glucose cotransporter-2 inhibition does not depend on protein intake: An analysis of three randomized controlled trials. Diabetes Obes Metab 2021; 23:1961-1967. [PMID: 33908683 PMCID: PMC8360160 DOI: 10.1111/dom.14411] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/14/2021] [Accepted: 04/26/2021] [Indexed: 12/17/2022]
Abstract
High protein intake may increase intraglomerular pressure through dilation of the afferent arteriole. Sodium-glucose cotransporter-2 (SGLT2) inhibitors may reduce intraglomerular pressure through activation of tubuloglomerular feedback. Given these opposing effects, we assessed whether the effect of dapagliflozin on glomerular filtration rate (GFR) and urinary albumin-to-creatinine ratio (UACR) was modified by estimated dietary protein intake using data from three separate randomized controlled trials (DELIGHT, IMPROVE and DIAMOND). The median protein intake was 58.4, 63.6 and 90.0 g/d, respectively. In the DELIGHT trial (n = 233), dapagliflozin compared to placebo caused an acute and reversible dip in GFR of 2.1 and 2.2 mL/min/1.73 m2 , and reduced UACR by 20.5% and 28.4% in participants with high and low protein intake, respectively. Similarly, in IMPROVE (n = 30) and DIAMOND (n = 53), the effect of dapagliflozin on GFR and UACR was comparable in participants with high and low protein intake (all P for interaction > 0.40). This post hoc, exploratory analysis of three clinical trials suggests that dietary protein intake does not modify the individual response of clinical kidney variables to dapagliflozin.
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Affiliation(s)
| | - David Cherney
- Division of Nephrology, Department of MedicineUniversity Health Network and University of TorontoTorontoOntarioCanada
| | | | - Bergur Stefansson
- Late Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&DAstraZenecaGothenburgSweden
| | - Daniel H. van Raalte
- Diabetes Centre, Department of Internal MedicineAmsterdam University Medical Centers, Location VUMCAmsterdamThe Netherlands
| | - Klaas Hoogenberg
- Internal MedicineUniversity of GroningenGroningenThe Netherlands
| | - Daniel Reyner
- R&D Bio Pharmaceuticals, Late CVRMAstraZenecaGaithersburgMarylandUSA
| | - Qiang Li
- George Institute for Global HealthUniversity of New South Wales SydneySydneyNew South WalesAustralia
| | - Gian Luca Di Tanna
- George Institute for Global HealthUniversity of New South Wales SydneySydneyNew South WalesAustralia
| | - Peter J. Greasley
- Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&DAstraZenecaGothenburgSweden
| | - Hiddo J. L. Heerspink
- Clinical Pharmacy and PharmacologyUniversity of GroningenGroningenThe Netherlands
- George Institute for Global HealthUniversity of New South Wales SydneySydneyNew South WalesAustralia
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28
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Siener R. Nutrition and Kidney Stone Disease. Nutrients 2021; 13:1917. [PMID: 34204863 PMCID: PMC8229448 DOI: 10.3390/nu13061917] [Citation(s) in RCA: 104] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 05/29/2021] [Accepted: 05/31/2021] [Indexed: 12/12/2022] Open
Abstract
The prevalence of kidney stone disease is increasing worldwide. The recurrence rate of urinary stones is estimated to be up to 50%. Nephrolithiasis is associated with increased risk of chronic and end stage kidney disease. Diet composition is considered to play a crucial role in urinary stone formation. There is strong evidence that an inadequate fluid intake is the major dietary risk factor for urolithiasis. While the benefit of high fluid intake has been confirmed, the effect of different beverages, such as tap water, mineral water, fruit juices, soft drinks, tea and coffee, are debated. Other nutritional factors, including dietary protein, carbohydrates, oxalate, calcium and sodium chloride can also modulate the urinary risk profile and contribute to the risk of kidney stone formation. The assessment of nutritional risk factors is an essential component in the specific dietary therapy of kidney stone patients. An appropriate dietary intervention can contribute to the effective prevention of recurrent stones and reduce the burden of invasive surgical procedures for the treatment of urinary stone disease. This narrative review has intended to provide a comprehensive and updated overview on the role of nutrition and diet in kidney stone disease.
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Affiliation(s)
- Roswitha Siener
- University Stone Center, Department of Urology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
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29
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Kim JY. Optimal Diet Strategies for Weight Loss and Weight Loss Maintenance. J Obes Metab Syndr 2021; 30:20-31. [PMID: 33107442 PMCID: PMC8017325 DOI: 10.7570/jomes20065] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/14/2020] [Accepted: 08/19/2020] [Indexed: 12/22/2022] Open
Abstract
Obesity has become one of the most important public health problems worldwide, which suggests the need for evidence-based dietary strategies for weight loss and its maintenance. Weight management depends upon complex factors such as amount of food eaten, type of food eaten, and timing of meals. In this review, we identified evidence-based dietary strategies for weight management based on these three components. An energy deficit is the most important factor in weight loss. A low-calorie diet with a low fat or carbohydrate content has been recommended; however, in some cases, a very-low-calorie diet is required for a short period. Some macronutrient composition-based diets, such as the ketogenic diet or high-protein diet, could be considered in some cases, although the potential risks and long-term effectiveness remain unknown. Meal timing is also an important factor in weight management, and higher-calorie breakfasts in combination with overnight fasting may help to prevent obesity. Our review indicated that there is no single best strategy for weight management. Hence, strategies for weight loss and its maintenance should be individualized, and healthcare providers must choose the best strategy based on patient preferences.
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Affiliation(s)
- Ju Young Kim
- Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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30
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Schutz Y, Montani JP, Dulloo AG. Low-carbohydrate ketogenic diets in body weight control: A recurrent plaguing issue of fad diets? Obes Rev 2021; 22 Suppl 2:e13195. [PMID: 33471427 DOI: 10.1111/obr.13195] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 01/02/2023]
Abstract
The most appropriate type of diets to maintain or lose body weight over the medium to long term has been a matter of controversy and debates for more than half a century. Both voluntarily and coercive food restriction, resulting in negative energy and macronutrient balance and hence weight loss, have not been designed to be maintained for the long term. By contrast, when a classical and traditional type of alimentation is consumed in ad lib conditions (e.g., the Mediterranean "diet"), it generally provides an appropriate nutritional density of essential macronutrients and micronutrients; it is hence appropriate for long-term use, and it provides several benefits for health if the compliance of the individuals is maintained over time. In this short review, we focus on four specific aspects: first, the need to agree on a clear definition of what is "low" versus "high" in terms of total carbohydrate intake and total fat intakes, both generally inversely related, in a representative individual with a certain lifestyle and a certain body morphology; second, the importance of discussing the duration over which it could be prescribed, that is, acute versus chronic conditions, focusing on the comparison between the fashion and often ephemeral low-carbohydrate diet (acute) with the well-recognized traditional Mediterranean type of alimentation (chronic), which includes lifestyle changes; third, the particular metabolic characteristics induced by the low-carbohydrate (high fat) diet, namely, the scramble up of ketone bodies production. The recent debate on ketogenic diets concern whether or not, in iso-energetic conditions, low-carbohydrate diets would significantly enhance energy expenditure. This is an issue that is more "academic" than practical, on the ground that the putative difference of 100-150 kcal/day or so (in the recent studies) is not negligible but within the inherent error of the methodology used to track total energy expenditure in free living conditions by the doubly labeled water technique. Fourth, the potential medical risks and shortcomings of ingesting (over the long term) low-carbohydrate ketogenic diets could exacerbate underlying renal dysfunction, consecutive to the joint combination of high-fat, high-protein diets, particularly in individuals with obesity. This particular diet promotes metabolic acidosis and renal hyperfiltration, which ultimately may contribute to a significant reduction in life expectancy in middle-age people.
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Affiliation(s)
- Yves Schutz
- Department of Endocrinology, Metabolism and Cardiovascular System, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Jean-Pierre Montani
- Department of Endocrinology, Metabolism and Cardiovascular System, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Abdul G Dulloo
- Department of Endocrinology, Metabolism and Cardiovascular System, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
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Syauqy A, Hsu CY, Lee HA, Rau HH, Chao JCJ. Association between Dietary Patterns and Kidney Function Parameters in Adults with Metabolic Syndrome: A Cross-Sectional Study. Nutrients 2020; 13:nu13010040. [PMID: 33374257 PMCID: PMC7823384 DOI: 10.3390/nu13010040] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 12/14/2022] Open
Abstract
This study explored the association between dietary patterns and kidney function parameters in adults with metabolic syndrome in Taiwan. This cross-sectional study was undertaken in 56,476 adults from the health screening centers in Taiwan from 2001 to 2010. Dietary intake and dietary patterns were assessed using a food frequency questionnaire and principal component analysis, respectively. Blood urea nitrogen (BUN), creatinine, estimated glomerular filtration rate (eGFR), and uric acid were measured as clinical parameters of kidney function. Multivariate linear regression was conducted to explore the relationship between dietary patterns and kidney function parameters. After adjusting for confounders, the highest tertiles of the processed food–sweets dietary pattern and the meat–seafood–eggs dietary pattern were associated with increased BUN, creatinine, and uric acid but decreased eGFR (all adjusted p < 0.05). Meanwhile, the highest tertiles of the veggie–fruit–grains dietary pattern and the milk–dairy dietary pattern were associated with decreased BUN, creatinine, and uric acid but increased eGFR (all adjusted p < 0.05). A processed food–sweets dietary pattern or a meat–seafood–eggs dietary pattern is associated with worse kidney function parameters in adults with metabolic syndrome. In contrast, a veggie–fruit–grains dietary pattern or a milk–dairy dietary pattern is associated with better kidney function parameters.
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Affiliation(s)
- Ahmad Syauqy
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, 250 Wu-Hsing Street, Taipei 11031, Taiwan;
- Department of Nutrition Science, Faculty of Medicine, Diponegoro University, Jl. Prof. H. Soedarto, SH., Tembalang, Semarang 50275, Indonesia
| | - Chien-Yeh Hsu
- Department of Information Management, National Taipei University of Nursing and Health Sciences, 365 Ming-Te Road, Peitou District, Taipei 11219, Taiwan;
- Master Program in Global Health and Development, College of Public Health, Taipei Medical University, 250 Wu-Hsing Street, Taipei 11031, Taiwan
| | - Hsiu-An Lee
- Department of Computer Science and Information Engineering, Tamkang University, 151 Yingzhuan Road, Tamsui District, New Taipei City 25137, Taiwan;
| | - Hsiao-Hsien Rau
- Joint Commission of Taiwan, 5F, 31, Section 2, Sanmin Road, Banqiao District, New Taipei City 22069, Taiwan;
| | - Jane C.-J. Chao
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, 250 Wu-Hsing Street, Taipei 11031, Taiwan;
- Master Program in Global Health and Development, College of Public Health, Taipei Medical University, 250 Wu-Hsing Street, Taipei 11031, Taiwan
- Nutrition Research Center, Taipei Medical University Hospital, 252 Wu-Hsing Street, Taipei 11031, Taiwan
- Correspondence: ; Tel.: +886-2-2736-1661 (ext. 6548); Fax: +886-2-2736-3112
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Ebrahim Z, Moosa MR, Blaauw R. Obesity and Other Nutrition Related Abnormalities in Pre-Dialysis Chronic Kidney Disease (CKD) Participants. Nutrients 2020; 12:E3608. [PMID: 33255334 PMCID: PMC7760142 DOI: 10.3390/nu12123608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/13/2020] [Accepted: 11/16/2020] [Indexed: 11/16/2022] Open
Abstract
Chronic kidney disease (CKD) is increasing in sub-Saharan Africa. Undernutrition has been prevalent amongst end stage CKD patients, with limited data on the prevalence of obesity. The aim of this study was to assess the nutritional status of CKD patients using various methods sensitive to over and under-nutrition. Stage 3 to 5 CKD patients (glomerular filtration rate (GFR) < 60 mL/min/1.73 m2) attending a pre-dialysis clinic in Cape Town, were enrolled. Exclusion criteria included infectious and autoimmune conditions. Sociodemographic, clinical and biochemical data were collected, and anthropometric measurements were performed. Dietary intake was measured with a quantified food frequency questionnaire (FFQ). Statistical Package for the Social Sciences (SPSS) version 26 was used for statistical analysis. Seventy participants, with mean age of 41.8 ± 11.8 years, 52.9% females and 47.1% males were enrolled. Participants enrolled mainly had stage 5 kidney failure. Thirty percent were overweight (21) and 25 (36%) were obese, 22 (60%) of females were overweight and obese, while 13 (39.4%) of males were predominantly normal weight. Abdominal obesity was found in 42 (60%) of participants, mainly in females. Undernutrition prevalence was low at 3%. Dietary assessment showed a high sugar and protein intake. There was a high prevalence of overweight, obesity and abdominal obesity in CKD stage 35 patients, with unhealthy dietary intake and other nutritional abnormalities.
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Affiliation(s)
- Zarina Ebrahim
- Division of Human Nutrition, Stellenbosch University, Cape Town 8000, South Africa;
| | - M. Rafique Moosa
- Department of Medicine, Stellenbosch University, Cape Town 8000, South Africa;
| | - Renée Blaauw
- Division of Human Nutrition, Stellenbosch University, Cape Town 8000, South Africa;
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A comparative and simultaneous analysis of indoxyl sulfate and sodium butyrate in human plasma by SPE and HPLC methods for kidney patients. J Chromatogr B Analyt Technol Biomed Life Sci 2020; 1159:122356. [DOI: 10.1016/j.jchromb.2020.122356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 08/29/2020] [Indexed: 01/22/2023]
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34
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Kim SM, Jung JY. Nutritional management in patients with chronic kidney disease. Korean J Intern Med 2020; 35:1279-1290. [PMID: 32872726 PMCID: PMC7652660 DOI: 10.3904/kjim.2020.408] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 09/09/2020] [Indexed: 12/11/2022] Open
Abstract
The global prevalence of chronic kidney disease (CKD) is increasing with the aging of populations worldwide. As kidney function declines, the accumulation of metabolic waste products and excessive electrolytes can significantly impair the health of patients with CKD. As nutritional management of patients with CKD is thought to control uremic symptoms and provide beneficial effects on the progression of kidney dysfunction, the diet of patients with CKD should be an important consideration in their care. Many guidelines recommend limiting protein intake in these patients, as high-protein diets aggravate kidney dysfunction. Excess sodium may be associated with CKD progression and all-cause mortality and, therefore, limiting salt intake is generally recommended. Low potassium is associated with muscle weakness and hypertension, whereas high potassium is associated with cardiac arrhythmia. Therefore, recent guidelines recommend adjusting dietary potassium intake on an individual basis to maintain serum potassium levels within the normal range. Appropriate dietary calcium intake is recommended to maintain calcium balance in patients with CKD G3, G4. Given the many dietary considerations for patients with CKD, effective nutritional management is challenging. Individualized strategies are needed to ensure the best outcome for patients with CKD.
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Affiliation(s)
- Sun Moon Kim
- Division of Nephrology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Ji Yong Jung
- Division of Nephrology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
- Department of Internal Medicine, Gachon University College of Medicine, Incheon, Korea
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35
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Nutrient-dense protein as a primary dietary strategy in healthy ageing: please sir, may we have more? Proc Nutr Soc 2020; 80:264-277. [PMID: 33050965 DOI: 10.1017/s0029665120007892] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A progressive decrement in muscle mass and muscle function, sarcopoenia, accompanies ageing. The loss of skeletal muscle mass and function is the main feature of sarcopoenia. Preventing the loss of muscle mass is relevant since sarcopoenia can have a significant impact on mobility and the quality of life of older people. Dietary protein and physical activity have an essential role in slowing muscle mass loss and helping to maintain muscle function. However, the current recommendations for daily protein ingestion for older persons appear to be too low and are in need of adjustment. In this review, we discuss the skeletal muscle response to protein ingestion, and review the data examining current dietary protein recommendations in the older subjects. Furthermore, we review the concept of protein quality and the important role that nutrient-dense protein (NDP) sources play in meeting overall nutrient requirements and improving dietary quality. Overall, the current evidence endorses an increase in the daily ingestion of protein with emphasis on the ingestion of NDP choices by older adults.
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36
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Bauer JM, Mikušová L, Verlaan S, Bautmans I, Brandt K, Donini LM, Maggio M, Mets T, Wijers SLJ, Garthoff JA, Luiking Y, Sieber C, Cederholm T. Safety and tolerability of 6-month supplementation with a vitamin D, calcium and leucine-enriched whey protein medical nutrition drink in sarcopenic older adults. Aging Clin Exp Res 2020; 32:1501-1514. [PMID: 32162241 PMCID: PMC7452877 DOI: 10.1007/s40520-020-01519-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 02/17/2020] [Indexed: 12/13/2022]
Abstract
Aims Safety and tolerability of prolonged supplementation with a vitamin D, calcium and leucine-enriched whey protein medical nutrition drink (WP-MND) was evaluated in sarcopenic older adults. Methods A 13-week double-blinded, randomized, isocaloric placebo-controlled trial (PROVIDE study; n = 380) was extended with a voluntary 13-week open-label extension (OLE). OLE participants were randomized to receive daily 1 or 2 servings of WP-MND (21 g protein, 3 g leucine, 10 µg vitD and 500 mg calcium per serving). Gastro-intestinal tolerability, kidney function and serum levels of calcidiol, parathyroid hormone (PTH) and calcium were evaluated at week 0, 13 and 26. Results and discussion In response to the high daily protein intake (median1.5; IQR: 1.3, 1.7 g/kg BW/day), the estimated glomerular filtration rate (eGFR) increased in the test group during the RCT (p = 0.013). The same trend was observed for those participants with moderate chronic kidney disease. During OLE no eGFR change was observed in any of the groups. Serum calcidiol and calcium reached a plateau after 13-week WP-MND supplementation. As expected, PTH significantly changed in the opposite direction, decreasing during RCT in the test group (T vs C: p < 0.001) and during OLE in former control groups. During RCT, 20/366 participants with normal baseline calcidiol reached levels ≥ 100 nmol/L (T: n = 18; C: n = 2) and 6 developed albumin-corrected calcium levels > 2.55 mmol/L (T: n = 3; C: n = 3), without associated adverse events. Conclusion A 6 months intervention with up to 2 servings of WP-MND did neither result in kidney function deterioration nor symptoms of vitamin D or calcium toxicity. The product was overall well tolerated.
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Affiliation(s)
- Jürgen M Bauer
- Center for Geriatric Medicine, University Heidelberg, Agaplesion Bethanien Krankenhaus Heidelberg, Heidelberg, Germany.
| | - Lucia Mikušová
- Danone Nutricia Research, Nutricia Advanced Medical Nutrition, Utrecht, The Netherlands
| | - Sjors Verlaan
- Department of Internal Medicine, Section of Gerontology and Geriatrics, VU, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Ivan Bautmans
- Frailty in Ageing Research Group (FRIA), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Kirsten Brandt
- Human Nutrition Research Centre, School of Agriculture, Food and Rural Development, Newcastle University Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK
| | - Lorenzo M Donini
- Department of Experimental Medicine, Section of Medical Pathophysiology, Endocrinology and Human Nutrition, "Sapienza" University of Rome, Rome, Italy
| | - Marcello Maggio
- Department of Clinical and Experimental Medicine, Section of Geriatrics, University of Parma, Parma, Italy
| | - Tony Mets
- Frailty in Ageing Research Group (FRIA), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Sander L J Wijers
- Danone Nutricia Research, Nutricia Advanced Medical Nutrition, Utrecht, The Netherlands
| | | | - Yvette Luiking
- Danone Nutricia Research, Nutricia Advanced Medical Nutrition, Utrecht, The Netherlands
| | - Cornel Sieber
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences/Clinical Nutrition and Metabolism, Department of Geriatric Medicine, Uppsala University Hospital, Uppsala, Sweden
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37
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Ko GJ, Rhee CM, Kalantar-Zadeh K, Joshi S. The Effects of High-Protein Diets on Kidney Health and Longevity. J Am Soc Nephrol 2020; 31:1667-1679. [PMID: 32669325 PMCID: PMC7460905 DOI: 10.1681/asn.2020010028] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Although high-protein diets continue to be popular for weight loss and type 2 diabetes, evidence suggests that worsening renal function may occur in individuals with-and perhaps without-impaired kidney function. High dietary protein intake can cause intraglomerular hypertension, which may result in kidney hyperfiltration, glomerular injury, and proteinuria. It is possible that long-term high protein intake may lead to de novo CKD. The quality of dietary protein may also play a role in kidney health. Compared with protein from plant sources, animal protein has been associated with an increased risk of ESKD in several observational studies, including the Singapore Chinese Health Study. Potential mediators of kidney damage from animal protein include dietary acid load, phosphate content, gut microbiome dysbiosis, and resultant inflammation. In light of such findings, adopting current dietary approaches that include a high proportion of protein for weight reduction or glycemic control should be considered with care in those at high risk for kidney disease. Given the possibility of residual confounding within some observational studies and the conflicting evidence from previous trials, long-term studies including those with large sample sizes are warranted to better ascertain the effects of high protein intake on kidney health.
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Affiliation(s)
- Gang-Jee Ko
- Harold Simmons Center for Kidney Disease Research and Epidemiology, School of Medicine, University of California Irvine, Orange, California
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Connie M Rhee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, School of Medicine, University of California Irvine, Orange, California
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, School of Medicine, University of California Irvine, Orange, California
- Department of Medicine, Long Beach Veteran Affairs Health System, Long Beach, California
- Los Angeles Biomedical Research Institute at Harbor-University of California, Los Angeles, Torrance, California
| | - Shivam Joshi
- Division of General Internal Medicine, Department of Medicine, New York University School of Medicine, New York, New York
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38
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Wang Z, Jiang H, Chen X, Song X, Xu F, Chen F, Mao Z, Gao S, Chen W. A rapid and sensitive method for simultaneous determination of eight protein-bound uremic toxins in human serum by UHPLC-MS/MS: application in assessing peritoneal dialysis. J Pharm Biomed Anal 2020; 186:113312. [PMID: 32361090 DOI: 10.1016/j.jpba.2020.113312] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/08/2020] [Accepted: 04/10/2020] [Indexed: 11/19/2022]
Abstract
A simple, rapid, reliable and sensitive ultra-high performance liquid chromatography tandem spectrometry (UHPLC-MS/MS) method was established for determination of eight serum protein-bound uremic toxins (hippuric acid, indoxyl sulfate, indole-3-acetic acid, kynurenic acid, L-kynurenine, melatonin, 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid, 4-hydroxyhippuric acid) in serum from chronic kidney disease (CKD) dialysis patients. The chromatographic separation was achieved on an Atlantis T3 column (3 μm, 2.1 mm × 100 mm) using a gradient elution with acetonitrile (phase B) and 0.1% formic acid and 10 mmol/L ammonium acetate aqueous solution (phase A). The flow rate was 0.3 mL/min with analytical time of 5 min. The pretreatment procedure was developed with a simple protein precipitation and the hydrochlorothiazide was used as internal standard. The calibration ranges were set as 156.250-20000.000 ng/mL for indoxyl sulfate, hippuric acid, 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid; 78.125-10000.000 ng/mL for L-kynurenine, indole-3-acetic acid and 4-hydroxyhippuricacid; 1.562-200.000 ng/mL for kynurenic acid; 0.078-10.000 ng/mL for melatonin. The UHPLC-MS/MS method for quantification of eight protein-bound uremic toxins was successfully developed and validated, and its clinical practicability was assessed on 81 serum samples from CKD patients.
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Affiliation(s)
- Zhipeng Wang
- Department of Pharmacy, Changzheng Hospital, Second Military Medical University, Shanghai 200003, PR China
| | - Hong Jiang
- Department of Pharmacy. Changhai Hospital. Second Military Medical University. Shanghai 200433, PR China
| | - Xujiao Chen
- Department of Nephrology, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310002, Zhejiang Province, PR China
| | - Xinhua Song
- College of Chemistry and Bio-engineering, Yichun University, Yichun 336000, Jiangxi Province, PR China
| | - Fengjing Xu
- Traditional Chinese medicine college, Yunnan University of Traditional Chinese Medicine, Kunming 650500, Yunnan Province, PR China
| | - Fangchao Chen
- School of Pharmacy, Shanghai University of Medicine & Health Sciences, Shanghai 201318, PR China
| | - Zhiguo Mao
- Division of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai 200003, PR China.
| | - Shouhong Gao
- Department of Pharmacy, Changzheng Hospital, Second Military Medical University, Shanghai 200003, PR China.
| | - Wansheng Chen
- Department of Pharmacy, Changzheng Hospital, Second Military Medical University, Shanghai 200003, PR China
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Phillips SM, Paddon-Jones D, Layman DK. Optimizing Adult Protein Intake During Catabolic Health Conditions. Adv Nutr 2020; 11:S1058-S1069. [PMID: 32666115 PMCID: PMC7360447 DOI: 10.1093/advances/nmaa047] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/12/2020] [Accepted: 03/25/2020] [Indexed: 12/29/2022] Open
Abstract
The DRIs define a range of acceptable dietary intakes for each nutrient. The range is defined from the minimum intake to avoid risk of inadequacy (i.e., the RDA) up to an upper limit (UL) based on a detectable risk of adverse effects. For most nutrients, the minimum RDA is based on alleviating a clear deficiency condition, whereas higher intakes are often recommended to optimize specific health outcomes. Evidence is accumulating that similar logic should be applied to dietary recommendations for protein. Although the RDA for protein of 0.8 g/kg body weight is adequate to avoid obvious inadequacies, multiple studies provide evidence that many adults may benefit from protein quantity, quality, and distribution beyond guidelines currently defined by the RDA. Further, the dietary requirement for protein is a surrogate for the constituent amino acids and, in particular, the 9 considered to be indispensable. Leucine provides an important example of an essential amino acid where the RDA of 42 mg/kg body weight is significantly less than the 100-110 mg/kg required to optimize metabolic regulation and skeletal muscle protein synthesis. This review will highlight the benefits of higher protein diets to optimize health during aging, inactivity, bed rest, or metabolic dysfunction such as type 2 diabetes.
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Affiliation(s)
| | - Douglas Paddon-Jones
- Department of Nutrition and Metabolism, The University of Texas Medical Branch, Galveston, TX, USA
| | - Donald K Layman
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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40
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Simons N, Debray FG, Schaper NC, Feskens EJ, Hollak CE, Bons JA, Bierau J, Houben AJ, Schalkwijk CG, Stehouwer CD, Cassiman D, Brouwers MC. Kidney and vascular function in adult patients with hereditary fructose intolerance. Mol Genet Metab Rep 2020; 23:100600. [PMID: 32426234 PMCID: PMC7225396 DOI: 10.1016/j.ymgmr.2020.100600] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 01/10/2023] Open
Abstract
Objective: Previous studies have shown that patients with hereditary fructose intolerance (HFI) are characterized by a greater intrahepatic triglyceride content, despite a fructose-restricted diet. The present study aimed to examine the long-term consequences of HFI on other aldolase-B-expressing organs, i.e. the kidney and vascular endothelium. Methods: Fifteen adult HFI patients were compared to healthy control individuals matched for age, sex and body mass index. Aortic stiffness was assessed by carotid-femoral pulse wave velocity (cf-PWV) and endothelial function by peripheral arterial tonometry, skin laser doppler flowmetry and the endothelial function biomarkers soluble E-selectin [sE-selectin] and von Willebrand factor. Serum creatinine and cystatin C were measured to estimate the glomerular filtration rate (eGFR). Urinary glucose and amino acid excretion and the ratio of tubular maximum reabsorption of phosphate to GFR (TmP/GFR) were determined as measures of proximal tubular function. Results: Median systolic blood pressure was significantly higher in HFI patients (127 versus 122 mmHg, p = .045). Pulse pressure and cf-PWV did not differ between the groups (p = .37 and p = .49, respectively). Of all endothelial function markers, only sE-selectin was significantly higher in HFI patients (p = .004). eGFR was significantly higher in HFI patients than healthy controls (119 versus 104 ml/min/1.73m2, p = .001, respectively). All measurements of proximal tubular function did not differ significantly between the groups. Conclusions: Adult HFI patients treated with a fructose-restricted diet are characterized by a higher sE-selectin level and slightly higher systolic blood pressure, which in time could contribute to a greater cardiovascular risk. The exact cause and, hence, clinical consequences of the higher eGFR in HFI patients, deserves further study.
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Key Words
- 95% confidence interval, (95% CI)
- Blood
- CKD-EPI equation based on creatinine and cystatin c combined, (eGFRcr-cys)
- CKD-EPI equation based on cystatin c, (eGFRcys)
- CKD-EPI equation based on serum creatinine, (eGFRcr)
- Case-control study
- Fanconi syndrome
- Hereditary fructose intolerance
- Kidney
- Vessels
- alanine, (Ala)
- aldolase B, (ALDOB)
- arginine, (Arg)
- asparagine, (Asn)
- carotid-femoral pulse wave velocity, (cf-PWV)
- chronic kidney disease epidemiology collaboration, (CKD-EPI)
- citrulline, (Cit)
- cysteine, (Cys)
- difference, (Δ)
- estimated glomerular filtration rate, (eGFR)
- glucokinase regulatory protein, (GKRP)
- glutamic acid, (Glu)
- glutamine, (Gln)
- glycine, (Gly)
- hereditary fructose intolerance, (HFI)
- histidine, (His)
- intrahepatic triglyceride, (IHTG)
- isoleucine, (Ile)
- laser doppler flowmetry, (LDF)
- leucine, (Leu)
- lysine, (Lys)
- methionine, (Met)
- ornithine, (Orn)
- perfusion units, (PU)
- phenylalanine, (Phe)
- proline, (Pro)
- ratio of tubular maximum reabsorption of phosphate to GFR, (TmP/GFR)
- reactive hyperemia index, (RHI)
- reactive hyperemia peripheral arterial tonometry, (RH-PAT)
- serine, (Ser)
- soluble E-selectin, (sE-selectin)
- statistical package of social sciences, (SPSS)
- taurine, (Tau)
- threonine, (Thr)
- tryptophan, (Try)
- tubular reabsorption of phosphate, (TRP)
- tyrosine, (Tyr)
- valine, (Val)
- von willebrand factor, (vWF)
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Affiliation(s)
- Nynke Simons
- Division of Endocrinology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Laboratory for Metabolism and Vascular Medicine, Division of General Internal Medicine, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands
| | | | - Nicolaas C. Schaper
- Division of Endocrinology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands
- CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands
| | - Edith J.M. Feskens
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - Carla E.M. Hollak
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Judith A.P. Bons
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jörgen Bierau
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Alfons J.H.M. Houben
- Laboratory for Metabolism and Vascular Medicine, Division of General Internal Medicine, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands
- Division of General Internal Medicine, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Casper G. Schalkwijk
- Laboratory for Metabolism and Vascular Medicine, Division of General Internal Medicine, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands
| | - Coen D.A. Stehouwer
- Laboratory for Metabolism and Vascular Medicine, Division of General Internal Medicine, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands
- Division of General Internal Medicine, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - David Cassiman
- Department of Gastroenterology-Hepatology and Metabolic Center, University Hospital Leuven, Leuven, Belgium
| | - Martijn C.G.J. Brouwers
- Division of Endocrinology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Laboratory for Metabolism and Vascular Medicine, Division of General Internal Medicine, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands
- Corresponding author at: Department of Internal Medicine, Division of Endocrinology, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
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Collo A, Ferro A, Belci P, Cerutti F, Rabbone I, Ignaccolo MG, Carletto G, Vallini C, Cadario F, Savastio S, Carrera D, Gruden G, Siliquini R, Traversi D, Durazzo M. Nutritional behavior in Italian and immigrant children. Minerva Pediatr 2019; 71:481-487. [PMID: 31840968 DOI: 10.23736/s0026-4946.19.05654-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND There are 1.2 million of immigrant children living in Italy. However, data on their nutritional habits are limited. The aim of this study was to assess the nutritional profile in a cohort of both Italian and immigrant children. METHODS The study included 86 children aged 5-15 consecutively enrolled from January 2016 to May 2017 within a larger epidemiological study on determinants of diabetes. Immigrant state was defined on the basis of the parent origin. Data on nutritional profile, frequency of food group consumption, and eating habits were collected using the 24-hour dietary recall method and a questionnaire. Anthropometric parameters were measured. RESULTS In the cohort of immigrant children there was a higher prevalence of both overweight (27.3 vs. 14.1%) and obesity (18.2 vs. 3.1%) subjects and a greater total calorie intake compared to Italian children, mainly due to excess simple carbohydrate intake. Immigrant children had a higher consumption of sweets, snacks, and drinks with added sugar. Moreover, unhealthy habits, such as eating alone and eating while watching TV, were more frequent among immigrant children. CONCLUSIONS In this cohort, immigrant children had a higher prevalence of overweight/obesity possibly due to less healthy nutritional habits. Culturally-tailored nutritional interventions may help preventing the development of obesity-related diseases in this population.
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Affiliation(s)
- Alessandro Collo
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Arianna Ferro
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Paola Belci
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Franco Cerutti
- Unit of Pediatric Endocrinology and Diabetology, Regina Margherita Children's Hospital, Turin, Italy
| | - Ivana Rabbone
- Unit of Pediatric Endocrinology and Diabetology, Regina Margherita Children's Hospital, Turin, Italy
| | - Maria G Ignaccolo
- Unit of Pediatric Endocrinology and Diabetology, Regina Margherita Children's Hospital, Turin, Italy
| | - Giulia Carletto
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Camilla Vallini
- Unit of Pediatric Endocrinology and Diabetology, Regina Margherita Children's Hospital, Turin, Italy
| | - Francesco Cadario
- Unit of Pediatric Endocrinology, Maggiore della Carità Hospital, Novara, Italy
| | - Silvia Savastio
- Unit of Pediatric Endocrinology, Maggiore della Carità Hospital, Novara, Italy
| | - Deborah Carrera
- Unit of Pediatric Endocrinology, Maggiore della Carità Hospital, Novara, Italy
| | - Gabriella Gruden
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Roberta Siliquini
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Deborah Traversi
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Marilena Durazzo
- Department of Medical Sciences, University of Turin, Turin, Italy -
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42
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Durainayagam B, Mitchell CJ, Milan AM, Zeng N, Sharma P, Mitchell SM, Ramzan F, Knowles SO, Sjödin A, Wagner KH, Roy NC, Fraser K, Cameron-Smith D. Impact of a High Protein Intake on the Plasma Metabolome in Elderly Males: 10 Week Randomized Dietary Intervention. Front Nutr 2019; 6:180. [PMID: 31867339 PMCID: PMC6910071 DOI: 10.3389/fnut.2019.00180] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 11/13/2019] [Indexed: 12/26/2022] Open
Abstract
High protein diets may improve the maintenance of skeletal muscle mass in the elderly, although it remains less clear what broader impact such diets have on whole body metabolic regulation in the elderly. Non-targeted polar metabolomics analysis using HILIC HPLC-MS was used to profile the circulating plasma metabolome of elderly men (n = 31; 74.7 ± 4.0 years) who were randomized to consume for 10 weeks a diet designed to achieve either protein (RDA; 0.8·g−1·kg−1) or that doubled this recommend intake (2RDA; 1.6.g.kg−1). A limited number of plasma metabolites (n = 24) were significantly differentially regulated by the diet. These included markers of protein anabolism, which increased by the 2RDA diet, including; urea, creatine, and glutarylcarnitine. Whilst in response to the RDA diet; glutamine, glutamic acid, and proline were increased, relative to the 2RDA diet (p < 0.05). Metaboanalyst identified six major metabolic pathways to be influenced by the quantity of protein intake, most notably the arginine and proline pathways. Doubling of the recommended protein intake in older males over 10 weeks exerted only a limited impact on circulating metabolites, as determined by LC-MS. This metabolomic response was almost entirely due to increased circulating abundances of metabolites potentially indicative of altered protein anabolism, without evidence of impact on pathways for metabolic health. Trial Registration: This trial was registered on 3rd March 2016 at the Australia New Zealand Clinical Trial Registry (www.anzctr.org.au) at ACTRN 12616000310460.
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Affiliation(s)
- Brenan Durainayagam
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Division of Systems Medicine and Digestive Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - Cameron J Mitchell
- Liggins Institute, University of Auckland, Auckland, New Zealand.,School of Kinesiology, The University of British Columbia, Vancouver, BC, Canada
| | - Amber M Milan
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Food Nutrition & Health Team, AgResearch, Palmerston North, New Zealand
| | - Nina Zeng
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Pankaja Sharma
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Sarah M Mitchell
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Farha Ramzan
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Scott O Knowles
- Food Nutrition & Health Team, AgResearch, Palmerston North, New Zealand
| | - Anders Sjödin
- Department of Nutrition, Exercise and Sport, Copenhagen University, Copenhagen, Denmark
| | - Karl-Heinz Wagner
- Department of Nutritional Sciences and Research Platform Active Ageing, University of Vienna, Vienna, Austria
| | - Nicole C Roy
- The High-Value Nutrition National Science Challenge, Auckland, New Zealand.,Food & Bio-based Products Group, AgResearch, Palmerston North, New Zealand.,Riddet Institute, Massey University, Palmerston North, New Zealand
| | - Karl Fraser
- The High-Value Nutrition National Science Challenge, Auckland, New Zealand.,Food & Bio-based Products Group, AgResearch, Palmerston North, New Zealand.,Riddet Institute, Massey University, Palmerston North, New Zealand
| | - David Cameron-Smith
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Riddet Institute, Massey University, Palmerston North, New Zealand.,Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore, Singapore
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43
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Schoufour JD, Overdevest E, Weijs PJM, Tieland M. Dietary Protein, Exercise, and Frailty Domains. Nutrients 2019; 11:E2399. [PMID: 31597289 PMCID: PMC6835617 DOI: 10.3390/nu11102399] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 01/08/2023] Open
Abstract
Increasing awareness of the impact of frailty on elderly people resulted in research focusing on factors that contribute to the development and persistence of frailty including nutrition and physical activity. Most effort so far has been spent on understanding the association between protein intake and the physical domain of frailty. Far less is known for other domains of frailty: cognition, mood, social health and comorbidity. Therefore, in the present narrative review, we elaborate on the evidence currently known on the association between protein and exercise as well as the broader concept of frailty. Most, but not all, identified studies concluded that low protein intake is associated with a higher prevalence and incidence of physical frailty. Far less is known on the broader concept of frailty. The few studies that do look into this association find a clear beneficial effect of physical activity but no conclusions regarding protein intake can be made yet. Similar, for other important aspects of frailty including mood, cognition, and comorbidity, the number of studies are limited and results are inconclusive. Future studies need to focus on the relation between dietary protein and the broader concept of frailty and should also consider the protein source, amount and timing.
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Affiliation(s)
- Josje D Schoufour
- Faculty of Sports and Nutrition, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, 1097 DZ Amsterdam, The Netherlands.
- Faculty Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, 1097 DZ Amsterdam, The Netherlands.
| | - Elvera Overdevest
- Faculty of Sports and Nutrition, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, 1097 DZ Amsterdam, The Netherlands.
| | - Peter J M Weijs
- Faculty of Sports and Nutrition, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, 1097 DZ Amsterdam, The Netherlands.
- Amsterdam University Medical Centers, University of Amsterdam, 1012 WX Amsterdam, The Netherlands.
| | - Michael Tieland
- Faculty of Sports and Nutrition, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, 1097 DZ Amsterdam, The Netherlands.
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44
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Ajjarapu AS, Hinkle SN, Li M, Francis EC, Zhang C. Dietary Patterns and Renal Health Outcomes in the General Population: A Review Focusing on Prospective Studies. Nutrients 2019; 11:E1877. [PMID: 31412575 PMCID: PMC6723758 DOI: 10.3390/nu11081877] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/07/2019] [Accepted: 08/09/2019] [Indexed: 12/14/2022] Open
Abstract
Healthy dietary patterns may promote kidney health and prevent adverse renal outcomes. Although reviews have summarized the findings from studies on dietary patterns for chronic kidney disease (CKD) management, less is known about dietary patterns for maintaining kidney health prior to CKD development. The current review summarized the results from observational studies from March 2009 to March 2019 investigating associations between dietary patterns and renal outcomes in the general population. The main renal outcome assessed was CKD (estimated glomerular filtration rate < 60 mL/min/1.73 m2). A total of twenty-six research articles met the inclusion criteria. Adherence to the Dietary Approaches to Stop Hypertension (DASH) and Mediterranean diets were significantly associated with a decreased risk of CKD in the majority of the studies. Furthermore, a posteriori "unhealthy" dietary patterns were associated with an increased risk of CKD. In conclusion, the findings from this review suggest that adherence to DASH and Mediterranean dietary patterns may be useful in promoting kidney health and preventing CKD in the general population. More studies, in particular among minorities, are warranted to investigate the role of diet, a potentially modifiable factor, in promoting kidney health.
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Affiliation(s)
- Aparna S Ajjarapu
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20817, USA
| | - Stefanie N Hinkle
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20817, USA
| | - Mengying Li
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20817, USA
| | - Ellen C Francis
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20817, USA
- National Institutes of Health Graduate Partnerships Program, Bethesda, MD 20817, USA
- Department of Public Health Sciences, Clemson University, Clemson, SC 29634, USA
| | - Cuilin Zhang
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20817, USA.
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45
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Kelly JT, Campbell KL, Carrero JJ. Primary Versus Secondary Prevention of Chronic Kidney Disease: The Case of Dietary Protein. J Ren Nutr 2019; 28:225-228. [PMID: 29935606 DOI: 10.1053/j.jrn.2018.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 04/18/2018] [Indexed: 12/30/2022] Open
Affiliation(s)
- Jaimon T Kelly
- Faculty of Health Sciences and Medicine, Bond University, Australia
| | | | - Juan J Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
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46
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Mitchell NS, Scialla JJ, Yancy WS. Are low-carbohydrate diets safe in diabetic and nondiabetic chronic kidney disease? Ann N Y Acad Sci 2019; 1461:25-36. [PMID: 30644556 DOI: 10.1111/nyas.13997] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/04/2018] [Accepted: 12/12/2018] [Indexed: 12/14/2022]
Abstract
Diabetes mellitus and obesity both contribute to chronic kidney disease (CKD) and diabetic kidney disease (DKD), and they can accelerate the loss of kidney function. Dietary intake can potentially have wide-reaching effects on the risk of CKD/DKD and their progression by reducing weight and blood pressure, improving glycemic control, reducing hyperfiltration, and modulating inflammation. Low-carbohydrate (LC) diets can reduce weight and improve glycemic control, but the relatively higher protein content also raises concern in CKD/DKD. Empiric evidence supporting the kidney-related benefits or risks of LC diets is needed to understand the balance of these potential harms and benefits for patients with DKD and is the subject of our review.
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Affiliation(s)
- Nia S Mitchell
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.,Duke Diet and Fitness Center, Duke University Health System, Durham, North Carolina
| | - Julia J Scialla
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - William S Yancy
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.,Duke Diet and Fitness Center, Duke University Health System, Durham, North Carolina.,Department of Veterans Affairs, Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina
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47
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Measuring serum total and free indoxyl sulfate and p-cresyl sulfate in chronic kidney disease using UPLC-MS/MS. J Food Drug Anal 2018; 27:502-509. [PMID: 30987721 PMCID: PMC9296214 DOI: 10.1016/j.jfda.2018.10.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/09/2018] [Accepted: 10/29/2018] [Indexed: 01/01/2023] Open
Abstract
Chronic kidney disease (CKD) is a complex disorder that affects multiple organs and increases the risk of cardiovascular complications. CKD affects approximately 12% of the population in Taiwan. Loss of kidney function leads to accumulation of potentially toxic compounds such as indoxyl sulfate (IS) and p-cresyl sulfate (pCS), two protein-bound uremic solutes that can stimulate the progression of CKD. The aim of this study was to assess whether IS and pCS levels were correlated with CKD stage. We developed and validated a method for quantitating total and free IS and pCS in serum by ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). Serum samples were pretreated using protein precipitation with acetonitrile containing stable isotope-labeled IS and pCS as internal standards. After centrifugation, the supernatant was diluted and injected into a UPLC-MS/MS system. Analyte concentrations were calculated from the calibration curve and ion ratios between the analyte and the internal standard. The calibration curves were linear with a correlation coefficient of >0.999; the analytical measurement range was 0.05–5 mg/L. The limit of quantitation of this assay was 0.05 mg/L for both analytes. The reference interval was ≤0.05–1.15 mg/L for total-form IS, ≤0.05 −5.33 mg/L for total-form pCS, ≤0.05 mg/L for free-form IS, and ≤0.12 mg/L for free-form pCS. A positive correlation was observed between analyte concentration and CKD stage. Our sensitive UPLC-MS/MS method for quantifying total and free-form IS and pCS in serum can be used to monitor the progression of CKD in clinical settings, identify patients at risk, and facilitate development of further therapies for this devastating disease.
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48
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Filler G, Lee M. Educational review: measurement of GFR in special populations. Pediatr Nephrol 2018; 33:2037-2046. [PMID: 29218435 DOI: 10.1007/s00467-017-3852-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 11/13/2017] [Accepted: 11/16/2017] [Indexed: 12/31/2022]
Abstract
IMPORTANCE Changes in kidney function are typically followed by the sequential estimation of glomerular filtration rate (eGFR). Formulae for eGFR work well on a population basis, but there are well-known conditions where they do not work. OBJECTIVE The purpose of this review is to summarize the existing literature on special populations in the pediatric age range and provide recommendations on how to estimate GFR in these populations. FINDINGS The reliability of creatinine depends on muscle mass, while cystatin C (not widely available) is limited by inflammation and changes in protein catabolism. Various dietary factors can alter eGFR. Renal function in neonates changes drastically every day, and there are currently no satisfactory reference intervals for routine pediatric use. Gender effects and conditions such as wasting disease and obesity require alternative ways to obtain eGFR. In oncology patients, chemotherapy may negatively affect renal function, and nuclear GFR measurements may be necessary. For body builders, high muscle mass may lead to underestimation of eGFR using creatinine. CONCLUSIONS AND RELEVANCE Clinicians should be aware of special populations that may yield misleading eGFRs with conventional creatinine-based formulae, and that the alternative methods may be more appropriate for some populations.
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Affiliation(s)
- Guido Filler
- Department of Pediatrics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, N6A 5W9, Canada. .,Department of Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, N6A 5W9, Canada. .,Department of Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, N5A 5A5, Canada. .,Children's Hospital, London Health Science Centre, University of Western Ontario, 800 Commissioners Road East, London, ON, N6A 5W9, Canada.
| | - Misan Lee
- Department of Pediatrics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, N6A 5W9, Canada
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49
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Burdett SW, Mansilla WD, Shoveller AK. Many Canadian dog and cat foods fail to comply with the guaranteed analyses reported on packages. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2018; 59:1181-1186. [PMID: 30410174 PMCID: PMC6190176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We compared analyzed nutrient contents of Canadian-specific dry dog and cat foods to the guaranteed analyses on packages and to the Association of American Feed Control Officials (AAFCO) 2018 nutrient targets to assess compliance with the Consumer Packaging and Labelling Act. We also explored differences in macronutrient content between species (dog and cat) and life stage for adult pet foods (all life stages and senior). Extruded dog (n = 16) or cat (n = 11) foods advertised as all life stage or senior, sold only in Canada, and carrying an AAFCO nutritional adequacy statement were selected. Proximate analyses and amino acid analyses were completed on all diets. Of the 27 foods, 25 met or exceeded the AAFCO nutrient recommendations. Only 9 foods met all nutrient content claims listed in their guaranteed analyses. Nutrient content between species or life stages was not different (P > 0.10).
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Affiliation(s)
- Stuart W Burdett
- Department of Animal Biosciences, University of Guelph, Guelph, Ontario
| | | | - Anna K Shoveller
- Department of Animal Biosciences, University of Guelph, Guelph, Ontario
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50
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Devries MC, Sithamparapillai A, Brimble KS, Banfield L, Morton RW, Phillips SM. Changes in Kidney Function Do Not Differ between Healthy Adults Consuming Higher- Compared with Lower- or Normal-Protein Diets: A Systematic Review and Meta-Analysis. J Nutr 2018; 148:1760-1775. [PMID: 30383278 PMCID: PMC6236074 DOI: 10.1093/jn/nxy197] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 11/01/2017] [Accepted: 07/24/2018] [Indexed: 01/09/2023] Open
Abstract
Background Higher-protein (HP) diets are advocated for several reasons, including mitigation of sarcopenia, but their effects on kidney function are unclear. Objective This meta-analysis was conducted to determine the effect of HP intakes on kidney function in healthy adults. Methods We conducted a systematic review and meta-analysis of trials comparing HP (≥1.5 g/kg body weight or ≥20% energy intake or ≥100 g protein/d) with normal- or lower-protein (NLP; ≥5% less energy intake from protein/d compared with HP group) intakes on kidney function. Medline and EMBASE databases were searched. Randomized controlled trials comparing the effects of HP with NLP (>4 d duration) intakes on glomerular filtration rate (GFR) in adults without kidney disease were included. Results A total of 2144 abstracts were reviewed, with 40 articles selected for full-text review; 28 of these were analyzed and included data from 1358 participants. Data were analyzed using random-effects meta-analysis (RevMan 5; The Cochrane Collaboration), meta-regression (STATA; StataCorp), and dose-response analysis (Prism; GraphPad). Analyses were conducted using postintervention (post) GFR and the change in GFR from preintervention to post. The post-only comparison showed a trivial effect for GFR to be higher after HP intakes [standardized mean difference (SMD): 0.19; 95% CI: 0.07, 0.31; P = 0.002]. The change in GFR did not differ between interventions (SMD: 0.11; 95% CI: -0.05, 0.27; P = 0.16). There was a linear relation between protein intake and GFR in the post-only comparison (r = 0.332, P = 0.03), but not between protein intake and the change in GFR (r = 0.184, P = 0.33). The main limitation of the current analysis is the unclear risk of selection bias of the included trials. Conclusions Postintervention GFR comparisons indicate that HP diets result in higher GFRs; however, when changes in GFR were compared, dietary protein had no effect. Our analysis indicates that HP intakes do not adversely influence kidney function on GFR in healthy adults.
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Affiliation(s)
- Michaela C Devries
- Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Canada
| | | | | | - Laura Banfield
- Health Sciences Library, Faculty of Health Sciences, McMaster University, Hamilton, Canada
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