Effects of vegetarian versus Mediterranean diet on kidney function: Findings from the CARDIVEG study

Association between more plant-based diets and 24-h urinary creatinine excretion in 98,813 Dutch females and males: a cross-sectional study

BACKGROUND

Despite the potential health benefits and environmental gains of more plant-based diets, concerns remain about the quantity and quality of plant-based protein. Sufficient dietary protein is essential to prevent muscle loss and maintain muscle mass. However, evidence regarding the relation between plant-based diets and objectively measured muscle mass is scarce.

OBJECTIVES

We investigated, cross-sectionally, the association between groups with different dietary identities and muscle mass, indicated by their 24-h urinary creatinine excretion rate (CER).

METHODS

From the baseline assessment of the Dutch Lifelines cohort 2007-2013, 59,719 females aged 42 ± 12 y and 39,094 males aged 43 ± 12 y were included in this study. Participants' CER was used to estimate total body muscle mass. Dietary identities were self-reported and categorized as vegetarian, flexitarian, other, and no dietary identity. Associations between dietary identities and CER in females and males, separately and adjusted for relevant covariates, were analyzed using linear regression modeling.

RESULTS

Individuals with dietary identities (vegetarian, flexitarian, or other diet) had a lower protein intake than those without. Vegetarians had the lowest protein intake: vegetarian females and males consumed 0.88 ± 0.27 g/kg/d and 0.94 ± 0.29 g/kg/d, whereas females and males without an explicit dietary identity consumed 1.00 ± 0.27 g/kg/d and 1.02 ± 0.29 g/kg/d. Compared with the group without an explicit dietary identity, groups with vegetarian or flexitarian dietary identities were associated with lower CER for both females {β [95% confidence interval (CI)]: -84.9 (-97.1, -72.7) for vegetarian; -32.5 (-41.7, -23.3) for flexitarian} and males [β (95% CI): -112.4 (-151.4, -73.4) for vegetarian; -26.7 (-50.5, -2.9) for flexitarian].

CONCLUSIONS

Individuals with identities favoring plant-based diets have a lower dietary protein intake and a lower CER, indicating lower total body muscle mass. When plant-based diets are being promoted, it is important to monitor and evaluate the potential public health impact on muscle mass.

Effects of dietary interventions for metabolic acidosis in chronic kidney disease: a systematic review and meta-analysis

BACKGROUND

Metabolic acidosis is a common complication of kidney disease and can result in further disease progression. Alkali therapy has been used to treat metabolic acidosis for decades. However, some concerns have been raised regarding its safety and long-term tolerability. Existing data suggest that dietary interventions can be beneficial in the management of chronic kidney disease (CKD). This systematic review and meta-analysis aims to summarize findings from studies comparing dietary interventions with placebo/usual care/no treatment in the management of metabolic acidosis in outpatient adults with CKD.

METHODS

Medline, Embase, Cochrane Central, CINAHL and Web of Science Core Collection were searched from inception to June 2022. Our primary outcome measure was change in serum bicarbonate. Any dietary intervention looking to manipulate dietary acid load was considered as an intervention. Data screening and extraction were performed by two independent reviewers. Random effects meta-analysis was performed to pool data.

RESULTS

Dietary interventions resulted in clinically significant improvement in serum bicarbonate [mean difference 2.98 (95% confidence interval 0.77, 5.19); I2: 91%] and higher estimated glomerular filtration rate (eGFR) levels [mean difference 3.16 (95% confidence interval 0.24, 6.08); I2: 67%] compared with controls. Serum potassium, albumin and body mass index remained unchanged. Dietary interventions were reported to be safe. Subgroup analyses indicated a superiority of plant-based over non-plant-based interventions in the improvement of acid-base balance and eGFR; however, these findings are from low-quality and heterogenous studies.

CONCLUSION

Our findings support the beneficial effects of dietary interventions aimed at reducing acid or adding base in the management of metabolic acidosis and kidney function in adults with CKD, with no adverse effects on serum potassium and nutritional status. Well-designed clinical trials looking at the treatment of metabolic acidosis with dietary interventions with a focus on adding base through fruit and vegetables are required.

Sex-Specific Biochemical and Histopathological Effects of Chronic Meat-Based vs. Plant-Based Burger Consumption in a Rodent Model

The growing consumption of processed foods, including meat-based and plant-based burgers (PBM), raises concerns about their long-term health effects. While PBM burgers are marketed as healthier alternatives, their biochemical and histological impacts remain unclear. This study investigates the effects of chronic meat-based and PBM burger consumption on metabolic and organ health, considering sex differences. Thirty-six Wistar rats (18 males and 18 females) were divided into three groups: control (standard chow), meat burger-fed, and PBM burger-fed. Improved chow was prepared using lyophilized burger powder. Over eight weeks, food intake, weight gain, and food efficiency ratio (FER) were monitored. Serum biochemical markers, including AST, ALT, urea, creatinine, lipid profile (TG, CHOL, HDL, LDL), and leptin, were analyzed, alongside histopathological evaluation of the liver, kidneys, and heart. PBM-fed rats exhibited significantly higher FER than the meat group (p < 0.05). AST and ALT levels were slightly elevated in meat-fed rats, while PBM-fed males had increased urea levels. Triglyceride levels were significantly higher in the meat group, but cholesterol levels did not differ significantly. Serum leptin was elevated in both experimental groups, suggesting leptin resistance. Histological findings showed mild hepatic inflammation and microvacuolar changes, with minor cardiac fibrosis. These findings highlight the need for further research on PBM's long-term health effects.

Plant-based diets for kidney disease prevention and treatment

PURPOSE OF REVIEW

Plant-based diets are associated with a lower risk of hypertension, diabetes, cardiovascular disease, and mortality. Using the most recent evidence, we critically appraised the role of plant-based diets in primary and secondary prevention of chronic kidney disease (CKD) with a focus on key nutritional factors (dietary acid load, phosphorus, potassium, sodium, and fiber).

RECENT FINDINGS

In healthy individuals, observational studies found that greater intake of plant protein and higher adherence to plant-based diets (overall, healthful, and provegetarian) was associated with a lower risk of CKD. In those with CKD, plant-based diets were associated with a lower risk of mortality, improved kidney function, and favorable metabolic profiles (fibroblast growth factor-23, uremic toxins, insulin sensitivity, inflammatory biomarkers). Only few studies reported nutrient content of plant-based diets. These studies found that plant-based diets had lower dietary acid load, lower or no significant difference in phosphorus and sodium, and higher potassium and fiber. One study reported that vegetarian diets were associated with severe vitamin D deficiency compared to nonvegetarian diets.

SUMMARY

Plant-based diets provide several benefits for prevention and management of CKD, with little risk for individuals with CKD. Incorporation of vitamin D rich foods in plant-based diets may be helpful.

Association of blood urea nitrogen with all-cause and cardiovascular mortality in hyperlipidemia: NHANES 1999-2018

OBJECTIVE

Although blood urea nitrogen (BUN) has a crucial impact on many diseases, its effect on outcomes in patients with hyperlipidemia remains unknown. The study aimed to investigate the relationships between BUN levels and all-cause and cardiovascular disease (CVD) mortality in individuals with hyperlipidemia.

METHODS

This analysis comprised 28,122 subjects with hyperlipidemia from the National Health and Nutrition Examination Survey (NHANES) spanning 1999 to 2018. The risk of BUN on mortality was evaluated using weighted Cox regression models. Additionally, to illustrate the dose-response association, the restricted cubic spline (RCS) was used.

RESULTS

During the observation period, 4276 participant deaths were recorded, of which 1206 were due to CVD. Compared to patients with hyperlipidemia in the third BUN quintile, the hazard ratios (HRs) for all-cause mortality were 1.26 (95% CIs: 1.09, 1.45) and 1.22 (95% CIs: 1.09, 1.37) for patients in the first and fifth quintiles of BUN, respectively. The HRs for CVD mortality among patients in the fifth quintile of BUN were 1.48 (95% CIs: 1.14, 1.93). BUN levels were found to have a U-shaped association with all-cause mortality and a linear association with CVD mortality using restricted triple spline analysis.

CONCLUSIONS

This study revealed that both low and high BUN levels in patients with hyperlipidemia are associated with heightened all-cause mortality. Furthermore, elevated BUN levels are also associated with increased CVD mortality. The findings indicate that patients with hyperlipidemia may face an elevated risk of death if they have abnormal BUN levels.

Plant-based diets in patients with chronic kidney disease

Dietary protein restriction has been considered to be a nutritional-related strategy to reduce risk for end-stage kidney disease among patients with non-dialysis-dependent chronic kidney disease (CKD). However, there is insufficient evidence to recommend a particular type of protein to slow down the CKD progression. Recently, various plant-based diets could demonstrate some additional benefits such as a blood pressure-lowering effect, a reduction of metabolic acidosis as well as hyperphosphatemia, and gut-derived uremic toxins. Furthermore, the former concerns about the risk of undernutrition and hyperkalemia observed with plant-based diets may be inconsistent in real clinical practice. In this review, we summarize the current evidence of the proposed pleiotropic effects of plant-based diets and their associations with clinical outcomes among pre-dialysis CKD patients.

The impact of a vegetarian diet on chronic kidney disease (CKD) progression - a systematic review

BACKGROUND

A vegetarian diet is a popular alternative to the casual diet - it is considered healthy, and was proven to positively affect cardiovascular health. The Chronic Kidney Disease (CKD) progression is a major issue in the healthcare system, and constitutes a leading cause of death for 1.5% of the global population. The objective of this systematic review was to investigate the potential impact of a vegetarian diet on kidney function in CKD patients.

METHOD

Our systematic review focused on randomized controlled trials (RCTs) which compared the effects of a vegetarian diet (experimental) and a standard omnivore diet (comparator) in terms of the estimated glomerular filtration rate (eGFR) in CKD patients. Inclusion criteria were based on PICO elements, with two researchers involved in browsing the Cochrane and Pubmed search engines. The investigation was performed using the PRISMA 2020 Checklist and PRISMA 2020 flow diagram. The search terms included: 'vegetarian diet' AND 'nephropathy', 'eGFR', 'albuminuria', 'chronic kidney disease'. Bias assessment was performed using RoB 2 tool to determine the validity of the data collected from studies.

RESULTS

Four RCTs with a total of 346 participants were included in the presented systematic review. Two largest RCTs reported an increase in eGFR following a change to a vegetarian diet (p = 0.01 and p = 0.001). Another two found no significant differences between the experimental and control groups, also these trials were associated with a high risk of bias in terms of missing data outcome and the randomization process.

CONCLUSIONS

The findings collected in this systematic review suggest that a vegetarian diet improves renal filtration function in CKD patients. Therefore, it seems essential to conduct further research involving the impact of the diet on the progression of CKD.

The effects of vegetarian diets on glycemia and lipid parameters in adult patients with overweight and obesity: a systematic review and meta-analysis

Several randomized controlled trials have reported the effects of vegetarian diets on blood lipids and glucose homeostasis in adults, but not in overweight or obese individuals. Thus, the purpose of this study was to evaluate the effects of vegetarian diets on blood lipids and glucose homeostasis in overweight or obese adults by systematic review and meta-analysis. We searched Medline, Embase, and the Cochrane Library through October 2021. We chose to include overweight or obese patients in the studies of the vegetarian diet for metabolic control. Seven trials with a total of 783 overweight or obese adult were included in the meta-analysis. The analysis of the data revealed that the vegetarian diets significantly reduced low-density lipoprotein cholesterol (LDL-C) (WMD, -0.31; 95% CI, -0.46 to -0.16), total cholesterol (TC) (WMD, -0.37; 95% CI, -0.52 to -0.22), and HbA1c (WMD (%), -0.33; 95% CI, -0.55 to -0.11). The vegetarian diets had an elevated effect on blood triglycerides (WMD, 0.29; 95% CI, 0.11-0.47). However, there were no significant effects of vegetarian diets on high-density lipoprotein cholesterol (HDLC), Fasting plasma glucose(FPG), and HOMA-IR in these individuals. The results of this study suggest that vegetarian diets effectively reduce LDL-C, TC, and HbA1c levels, thus functioning as a promising therapeutic strategy for improving the metabolic dysfunction in overweight or obese individuals. However, further large-scale clinical trials are required to confirm the validity of these findings.

Serum creatinine as an indicator of lean body mass in vegetarians and omnivores

Growing numbers of Americans are adopting vegetarian or vegan diets. While risk for some chronic conditions may be lower when following these diets, concern remains over the ability to consume adequate amounts of various nutrients, notably, protein. Knowing that serum creatinine is a reliable marker of muscle mass, this study examined the relationships between serum creatinine, lean body mass (LBM), handgrip strength, and protein intake in healthy vegetarian (n = 55) and omnivorous (n = 27) adults. Significantly higher protein intakes (+31%), LBM (+7%), serum creatinine (+12%) and handgrip strength (+14%) were observed for the omnivore participants compared to vegetarian participants. Positive correlations (p < 0.001) were noted between creatinine and LBM (R² = 0.42), creatinine and handgrip strength (R² = 0.41), protein intake and LBM (R² = 0.29), and handgrip strength and LBM (R² = 0.69). These data show that serum creatinine concentrations were lower in vegetarian women and men in comparison to their omnivorous counterparts and that serum creatinine concentrations correlate with LBM and strength in healthy adults, regardless of diet.