The Associations of Plant Protein Intake With All-Cause Mortality in CKD. (bibtex)
by Xiaorui Chen, Guo Wei, Thunder Jalili, Julie Metos, Ajay Giri, Monique E Cho, Robert Boucher, Tom Greene and Srinivasan Beddhu
Abstract:
BACKGROUND: Plant protein intake is associated with lower production of uremic toxins and lower serum phosphorus levels. Therefore, at a given total protein intake, a higher proportion of dietary protein from plant sources might be associated with lower mortality in chronic kidney disease. STUDY DESIGN: Observational study. SETTINGS & PARTICIPANTS: 14,866 NHANES III participants 20 years or older without missing data for plant and animal protein intake and mortality. PREDICTORS: Plant protein to total protein ratio and total plant protein intake. Patients were stratified by estimated glomerular filtration rate (eGFR)<60 or ≥60mL/min/1.73m(2). OUTCOMES: All-cause mortality. MEASUREMENTS: Plant and total protein intakes were estimated from 24-hour dietary recalls. Mortality was ascertained by probabilistic linkage with National Death Index records through December 31, 2000. RESULTS: Mean values for plant protein intake and plant protein to total protein ratio were 24.6$\pm$13.2 (SD) g/d and 33.0% $\pm$ 14.0%, respectively. The prevalence of eGFRs<60mL/min/1.73m(2) was 4.9%. There were 2,163 deaths over an average follow-up of 8.4 years. Adjusted for demographics, smoking, alcohol use, comorbid conditions, body mass index, calorie and total protein intake, and physical inactivity, each 33% increase in plant protein to total protein ratio was not associated with mortality (HR, 0.88; 95% CI, 0.74-1.04) in the eGFR≥60mL/min/1.73m(2) subpopulation, but was associated with lower mortality risk (HR, 0.77; 95% CI, 0.61-0.96) in the eGFR<60mL/min/1.73m(2) subpopulation. In sensitivity analyses, results were similar in those with eGFR<60mL/min/1.73m(2) defined by serum cystatin C level. LIMITATIONS: Whether results are related to plant protein itself or to other factors associated with more plant-based diets is difficult to establish. CONCLUSIONS: A diet with a higher proportion of protein from plant sources is associated with lower mortality in those with eGFR<60mL/min/1.73m(2). Future studies are warranted to determine the causal role of plant protein intake in reducing mortality in those with eGFR<60mL/min/1.73m(2).
Reference:
The Associations of Plant Protein Intake With All-Cause Mortality in CKD. (Xiaorui Chen, Guo Wei, Thunder Jalili, Julie Metos, Ajay Giri, Monique E Cho, Robert Boucher, Tom Greene and Srinivasan Beddhu), In Am J Kidney Dis, volume 67, 2016.
Bibtex Entry:
@article{Chen:2016aa,
	abstract = {BACKGROUND: Plant protein intake is associated with lower production of uremic toxins and lower serum phosphorus levels. Therefore, at a given total protein intake, a higher proportion of dietary protein from plant sources might be associated with lower mortality in chronic kidney disease. STUDY DESIGN: Observational study. SETTINGS & PARTICIPANTS: 14,866 NHANES III participants 20 years or older without missing data for plant and animal protein intake and mortality. PREDICTORS: Plant protein to total protein ratio and total plant protein intake. Patients were stratified by estimated glomerular filtration rate (eGFR)<60 or ≥60mL/min/1.73m(2). OUTCOMES: All-cause mortality. MEASUREMENTS: Plant and total protein intakes were estimated from 24-hour dietary recalls. Mortality was ascertained by probabilistic linkage with National Death Index records through December 31, 2000. RESULTS: Mean values for plant protein intake and plant protein to total protein ratio were 24.6$\pm$13.2 (SD) g/d and 33.0% $\pm$ 14.0%, respectively. The prevalence of eGFRs<60mL/min/1.73m(2) was 4.9%. There were 2,163 deaths over an average follow-up of 8.4 years. Adjusted for demographics, smoking, alcohol use, comorbid conditions, body mass index, calorie and total protein intake, and physical inactivity, each 33% increase in plant protein to total protein ratio was not associated with mortality (HR, 0.88; 95% CI, 0.74-1.04) in the eGFR≥60mL/min/1.73m(2) subpopulation, but was associated with lower mortality risk (HR, 0.77; 95% CI, 0.61-0.96) in the eGFR<60mL/min/1.73m(2) subpopulation. In sensitivity analyses, results were similar in those with eGFR<60mL/min/1.73m(2) defined by serum cystatin C level. LIMITATIONS: Whether results are related to plant protein itself or to other factors associated with more plant-based diets is difficult to establish. CONCLUSIONS: A diet with a higher proportion of protein from plant sources is associated with lower mortality in those with eGFR<60mL/min/1.73m(2). Future studies are warranted to determine the causal role of plant protein intake in reducing mortality in those with eGFR<60mL/min/1.73m(2).},
	address = {Department of Nephrology, University of Utah School of Medicine, Salt Lake City, UT; Division of Nutrition, University of Utah, Salt Lake City, UT.; Department of Nephrology, University of Utah School of Medicine, Salt Lake City, UT.; Division of Nutrition, University of Utah, Salt Lake City, UT.; Division of Nutrition, University of Utah, Salt Lake City, UT.; Department of Nephrology, University of Utah School of Medicine, Salt Lake City, UT.; Department of Nephrology, University of Utah School of Medicine, Salt Lake City, UT; VA Healthcare System, Salt Lake City, UT.; Department of Nephrology, University of Utah School of Medicine, Salt Lake City, UT.; VA Healthcare System, Salt Lake City, UT.; Department of Nephrology, University of Utah School of Medicine, Salt Lake City, UT; VA Healthcare System, Salt Lake City, UT. Electronic address: Srinivasan.beddhu@hsc.utah.edu.},
	author = {Chen, Xiaorui and Wei, Guo and Jalili, Thunder and Metos, Julie and Giri, Ajay and Cho, Monique E and Boucher, Robert and Greene, Tom and Beddhu, Srinivasan},
	copyright = {Published by Elsevier Inc.},
	crdt = {2015/12/22 06:00},
	date = {2016 Mar},
	date-added = {2023-09-16 15:12:29 +0100},
	date-modified = {2023-09-16 15:13:50 +0100},
	dcom = {20160708},
	dep = {20151210},
	doi = {10.1053/j.ajkd.2015.10.018},
	edat = {2015/12/22 06:00},
	gr = {UL1-RR025764/RR/NCRR NIH HHS/United States; UL1 RR025764/RR/NCRR NIH HHS/United States; R01 DK078112/DK/NIDDK NIH HHS/United States; R01-DK077298/DK/NIDDK NIH HHS/United States; C06 RR011234/RR/NCRR NIH HHS/United States; R01 DK091437/DK/NIDDK NIH HHS/United States; R01 DK077298/DK/NIDDK NIH HHS/United States; R01-DK078112/DK/NIDDK NIH HHS/United States},
	issn = {1523-6838 (Electronic); 0272-6386 (Print); 0272-6386 (Linking)},
	jid = {8110075},
	journal = {Am J Kidney Dis},
	jt = {American journal of kidney diseases : the official journal of the National Kidney Foundation},
	keywords = {Plant Protein},
	language = {eng},
	lid = {S0272-6386(15)01339-6 {$[$}pii{$]$}; 10.1053/j.ajkd.2015.10.018 {$[$}doi{$]$}},
	lr = {20181113},
	mh = {Adult; Body Mass Index; Cystatin C/blood; Dietary Proteins/*metabolism; Feeding Behavior/*physiology; Female; Follow-Up Studies; Glomerular Filtration Rate; Humans; Male; Middle Aged; Mortality; Nutrition Surveys; Plant Proteins/*metabolism; *Renal Insufficiency, Chronic/blood/diagnosis/mortality/physiopathology; Risk Assessment; Risk Factors; United States/epidemiology},
	mhda = {2016/07/09 06:00},
	mid = {NIHMS742281},
	month = {Mar},
	number = {3},
	oto = {NOTNLM},
	own = {NLM},
	pages = {423--430},
	phst = {2015/02/12 00:00 {$[$}received{$]$}; 2015/10/10 00:00 {$[$}accepted{$]$}; 2017/03/01 00:00 {$[$}pmc-release{$]$}; 2015/12/22 06:00 {$[$}entrez{$]$}; 2015/12/22 06:00 {$[$}pubmed{$]$}; 2016/07/09 06:00 {$[$}medline{$]$}},
	pii = {S0272-6386(15)01339-6},
	pl = {United States},
	pmc = {PMC4769135},
	pmcr = {2017/03/01},
	pmid = {26687923},
	pst = {ppublish},
	pt = {Journal Article; Observational Study; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't},
	rn = {0 (Cystatin C); 0 (Dietary Proteins); 0 (Plant Proteins)},
	sb = {IM},
	status = {MEDLINE},
	title = {The Associations of Plant Protein Intake With All-Cause Mortality in CKD.},
	volume = {67},
	year = {2016},
	bdsk-url-1 = {https://doi.org/10.1053/j.ajkd.2015.10.018}}
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