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Luzardo ML. Effects of higher dietary acid load: a narrative review with special emphasis in children. Pediatr Nephrol 2024:10.1007/s00467-024-06466-7. [PMID: 39093454 DOI: 10.1007/s00467-024-06466-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 07/05/2024] [Accepted: 07/08/2024] [Indexed: 08/04/2024]
Abstract
Metabolic effects of high diet acid load (DAL) have been studied for years in adults, although only recently in children. Contemporary diets, especially those of Western societies, owe their acidogenic effect to high animal-origin protein content and low contribution of base-forming elements, such as fruits and vegetables. This imbalance, where dietary acid precursors exceed the body's buffering capacity, results in an acid-retaining state known by terms such as "eubicarbonatemic metabolic acidosis," "low-grade metabolic acidosis," "subclinical acidosis," or "acid stress". Its consequences have been linked to chronic systemic inflammation, contributing to various noncommunicable diseases traditionally considered more common in adulthood, but now have been recognized to originate at much earlier ages. In children, effects of high DAL are not limited to growth impairment caused by alterations of bone and muscle metabolism, but also represent a risk factor for conditions such as obesity, insulin resistance, diabetes, hypertension, urolithiasis, and chronic kidney disease (CKD). The possibility that high DAL may be a cause of chronic acid-retaining states in children with growth impairment should alert pediatricians and pediatric nephrologists, since its causes have been attributed traditionally to inborn errors of metabolism and renal pathologies such as CKD and renal tubular acidosis. The interplay between DAL, overall diet quality, and its cascading effects on children's health necessitates comprehensive nutritional assessments and interventions. This narrative review explores the clinical relevance of diet-induced acid retention in children and highlights the potential for prevention through dietary modifications, particularly by increasing fruit and vegetable intake alongside appropriate protein consumption.
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Wang S, Fan X, Zheng X, Xia P, Zou H, Zhang Z, Chen L. Association between Dietary Acid Load and Chronic Kidney Disease in the Chinese Population: A Comprehensive Analysis of the China Health and Nutrition Survey (2009). Nutrients 2024; 16:2461. [PMID: 39125342 PMCID: PMC11314566 DOI: 10.3390/nu16152461] [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: 06/24/2024] [Revised: 07/21/2024] [Accepted: 07/23/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Dietary acid load (DAL) is closely related to several chronic diseases. However, the link between DAL and chronic kidney disease (CKD) remains scarce and without data from the Chinese populations whose diet is quite different from people in Western countries. METHODS This study evaluated DAL by potential renal acid load (PRAL) and net endogenous acid production (NEAP). We clarified the relationship between DAL and CKD by logistic regression analysis based on data from the China Health and Nutrition Survey (CHNS). RESULTS The final analysis included 7699 individuals, of whom 811 (11.44%) were CKD patients. Although there was no notable link between PRAL and CKD, higher NEAP levels were independently correlated with CKD. As NEAP values rise, so does CKD prevalence. This trend remains highly significant even after adjustments. In subgroup analyses, the relationship between NEAP and CKD was more consistent in the elderly and subjects with a waistline of less than 82 cm and those without diabetes and heart disease. RCS analysis further confirmed the clear linear relationship between the OR of CKD and NEAP score. CONCLUSIONS This study highlighted that higher NEAP was positively correlated with the risk of CKD.
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Affiliation(s)
- Shurui Wang
- School of Nursing, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; (S.W.); (H.Z.)
- Department of Nephrology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China; (X.F.); (X.Z.); (P.X.)
| | - Xiaohong Fan
- Department of Nephrology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China; (X.F.); (X.Z.); (P.X.)
| | - Xixi Zheng
- Department of Nephrology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China; (X.F.); (X.Z.); (P.X.)
| | - Peng Xia
- Department of Nephrology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China; (X.F.); (X.Z.); (P.X.)
| | - Haiou Zou
- School of Nursing, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; (S.W.); (H.Z.)
| | - Zhaofeng Zhang
- Department of Nutrition & Food Hygiene, School of Public Health, Peking University Health Science Center, Haidian District, Beijing 100191, China
| | - Limeng Chen
- Department of Nephrology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China; (X.F.); (X.Z.); (P.X.)
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Goraya N, Madias NE, Simoni J, Kahlon M, Aksan N, Wesson DE. Kidney and Cardiovascular Protection Using Dietary Acid Reduction in Primary Hypertension: A Five-Year, Interventional, Randomized, Control Trial. Am J Med 2024:S0002-9343(24)00357-7. [PMID: 39107215 DOI: 10.1016/j.amjmed.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/28/2024] [Accepted: 06/05/2024] [Indexed: 08/09/2024]
Abstract
BACKGROUND High fruit and vegetable diets are associated with reduced chronic kidney disease and cardiovascular disease but are infrequently used in hypertension treatment. Low acid diets are also associated with reduced chronic kidney disease and cardiovascular disease, and fruits and vegetables or oral sodium bicarbonate (NaHCO3) lowers dietary acid. METHODS We randomized 153 hypertensive macroalbuminuric patients receiving pharmacologic chronic kidney disease and cardiovascular disease protection to get fruits and vegetables, oral NaHCO3, or Usual Care. We assessed the course of kidney disease progression and cardiovascular disease risk indices over five years. RESULTS Chronic kidney disease progression was slower in participants receiving fruits and vegetables or oral NaHCO3 than Usual Care [mean (SE)] [-1.08 (0.06) and -1.17 (0.07) vs. -1.94 (0.11) mL/min/1.73m2/ year, respectively, P's< .001). Yet, systolic blood pressure was lower, and cardiovascular disease risk indices improved more in participants receiving fruits and vegetables than in those receiving NaHCO3 or Usual Care. These cardiovascular benefits of fruits and vegetables were achieved despite lower doses of pharmacologic chronic kidney disease and cardiovascular disease protection. CONCLUSION The trial supports fruits and vegetables as foundational hypertension treatment to reduce chronic kidney disease progression and cardiovascular disease risk.
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Affiliation(s)
- Nimrit Goraya
- Department of Internal Medicine, Baylor Scott and White Health, Temple, Tex; Department of Internal Medicine, Texas A&M Health Sciences Center College of Medicine, Temple, Tex
| | - Nicolaos E Madias
- St. Elizabeth's Medical Center and Department of Medicine, Tufts University School of Medicine, Boston, Mass
| | - Jan Simoni
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock Tex
| | - Maninder Kahlon
- Department of Population Health, Dell Medical School-The University of Texas at Austin, Austin, Tex
| | - Nazan Aksan
- Department of Population Health, Dell Medical School-The University of Texas at Austin, Austin, Tex
| | - Donald E Wesson
- Department of Internal Medicine, Dell Medical School - The University of Texas at Austin, Austin, Tex.
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Zhong Y, Yang C, Zhang B, Chen Y, Cai W, Wang G, Zhao C, Zhao W. Causal impact of human blood metabolites and metabolic pathways on serum uric acid and gout: a mendelian randomization study. Front Endocrinol (Lausanne) 2024; 15:1378645. [PMID: 39027467 PMCID: PMC11256090 DOI: 10.3389/fendo.2024.1378645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 06/20/2024] [Indexed: 07/20/2024] Open
Abstract
Objective Hyperuricaemia and gout are common metabolic disorders. However, the causal relationships between blood metabolites and serum urate levels, as well as gout, remain unclear. A systematic evaluation of the causal connections between blood metabolites, hyperuricemia, and gout could enhance early screening and prevention of hyperuricemia and gout in clinical settings, providing novel insights and approaches for clinical treatment. Methods In this study, we employed a bidirectional two-sample Mendelian randomization analysis utilizing data from a genome-wide association study involving 7,286 participants, encompassing 486 blood metabolites. Serum urate and gout data were sourced from the Chronic Kidney Disease Genetics consortium, including 288,649 participants for serum urate and 9,819 African American and 753,994 European individuals for gout. Initially, LDSC methodology was applied to identify blood metabolites with a genetic relationship to serum urate and gout. Subsequently, inverse-variance weighting was employed as the primary analysis method, with a series of sensitivity and pleiotropy analyses conducted to assess the robustness of the results. Results Following LDSC, 133 blood metabolites exhibited a potential genetic relationship with serum urate and gout. In the primary Mendelian randomization analysis using inverse-variance weighting, 19 blood metabolites were recognized as potentially influencing serum urate levels and gout. Subsequently, the IVW p-values of potential metabolites were corrected using the false discovery rate method. We find leucine (IVW P FDR = 0.00004), N-acetylornithine (IVW P FDR = 0.0295), N1-methyl-3-pyridone-4-carboxamide (IVW P FDR = 0.0295), and succinyl carnitine (IVW P FDR = 0.00004) were identified as significant risk factors for elevated serum urate levels. Additionally, 1-oleoylglycerol (IVW P FDR = 0.0007) may lead to a substantial increase in the risk of gout. Succinyl carnitine exhibited acceptable weak heterogeneity, and the results for other blood metabolites remained robust after sensitivity, heterogeneity, and pleiotropy testing. We conducted an enrichment analysis on potential blood metabolites, followed by a metabolic pathway analysis revealing four pathways associated with serum urate levels. Conclusion The identified causal relationships between these metabolites and serum urate and gout offer a novel perspective, providing new mechanistic insights into serum urate levels and gout.
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Affiliation(s)
- Yan Zhong
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - ChengAn Yang
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - BingHua Zhang
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - YingWen Chen
- College of Integrated Chinese and Western Medicine, Tianjin University of Chinese Medicine, Tianjin, China
| | - WenJun Cai
- Department of Orthopaedic Center, The Third Clinical Hospital of Changchun University of Chinese Medicine, Changchun, China
| | - GuoChen Wang
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - ChangWei Zhao
- Department of Orthopedics Center, Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
| | - WenHai Zhao
- Department of Orthopedics Center, Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
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Amir S, Kim H, Hu EA, Ricardo AC, Mills KT, He J, Fischer MJ, Pradhan N, Tan TC, Navaneethan SD, Dobre M, Anderson CAM, Appel LJ, Rebholz CM. Adherence to Plant-Based Diets and Risk of CKD Progression and All-Cause Mortality: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis 2024; 83:624-635. [PMID: 38103719 PMCID: PMC11034716 DOI: 10.1053/j.ajkd.2023.09.020] [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: 03/20/2023] [Revised: 08/15/2023] [Accepted: 09/18/2023] [Indexed: 12/19/2023]
Abstract
RATIONALE & OBJECTIVE Studies have shown that generally healthy individuals who consume diets rich in plant foods have a lower risk of incident chronic kidney disease (CKD) and cardiovascular disease. This study investigated the prospective associations of plant-based diets with the risk of CKD progression and all-cause mortality in individuals with CKD. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS 2,539 participants with CKD recruited between 2003-2008 into the Chronic Renal Insufficiency Cohort (CRIC) Study. EXPOSURE Responses on the Diet History Questionnaire were used to calculate scores for the overall plant-based diet index, healthy plant-based diet index, and unhealthy plant-based diet index. OUTCOME (1) CKD progression defined as≥50% estimated glomerular filtration rate decline from baseline or kidney replacement therapy (dialysis, transplant) and (2) all-cause mortality. ANALYTICAL APPROACH Cox proportional hazards models to compute hazard ratios and 95% confidence intervals adjusting for lifestyle, socioeconomic, and clinical covariates. RESULTS There were 977 CKD progression events and 836 deaths during a median follow-up period of 7 and 12 years, respectively. Participants with the highest versus lowest adherence to overall plant-based diets and healthy plant-based diets had 26% (HR, 0.74 [95% CI, 0.62-0.88], P trend<0.001) and 21% (HR, 0.79 [95% CI, 0.66-0.95], P trend=0.03) lower risks of all-cause mortality, respectively. Each 10-point higher score of unhealthy plant-based diets was modestly associated with a higher risk of CKD progression (HR, 1.14 [95% CI, 1.03-1.25) and all-cause mortality (HR, 1.11 [95% CI, 1.00-1.23). LIMITATIONS Self-reported diet may be subject to measurement error. CONCLUSIONS Adherence to an overall plant-based diet and a healthy plant-based diet is associated with a reduced risk of all-cause mortality among individuals with CKD. An unhealthy plant-based was associated with an elevated risk of CKD progression and all-cause mortality. PLAIN-LANGUAGE SUMMARY Plant-based diets are healthful dietary patterns that have been linked to a lower risk of chronic diseases. However, the impact of plant-based diets on clinical outcomes in patients with chronic kidney disease (CKD) is not well established. In 2,539 individuals with CKD, we examined the associations of adherence to 3 different types of plant-based diets with the risks of CKD progression and all-cause mortality. We found that following an overall plant-based diet and a healthy plant-based diet was associated with a lower risk of all-cause mortality. By contrast, following an unhealthy plant-based diet was associated with a higher risk of CKD progression and all-cause mortality. These results suggest that the quality of plant-based diets may be important for CKD management.
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Affiliation(s)
- Saira Amir
- Department of Medicine, UNC Health Southeastern, Lumberton, North Carolina; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Hyunju Kim
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | | | - Ana C Ricardo
- Division of Nephrology, Department of Medicine, University of Illinois, Chicago, Illinois
| | - Katherine T Mills
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Jiang He
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Michael J Fischer
- Division of Nephrology, Department of Medicine, University of Illinois, Chicago, Illinois
| | - Nishigandha Pradhan
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Thida C Tan
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | | | - Mirela Dobre
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Cheryl A M Anderson
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California-San Diego, San Diego, California
| | - Lawrence J Appel
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Casey M Rebholz
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
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Bodker K, Freidin N, Arora N. A basic solution for a complex problem: does treatment of metabolic acidosis slow CKD progression? Curr Opin Nephrol Hypertens 2024; 33:304-310. [PMID: 38420899 DOI: 10.1097/mnh.0000000000000978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
PURPOSE OF THIS REVIEW Metabolic acidosis is frequently encountered in patients with chronic kidney disease (CKD), with increasing prevalence as kidney function worsens. Treating electrolyte disturbances is the sine qua non of Nephrologists, and alkali therapy to normalize serum bicarbonate levels and slow progression of kidney disease has been embedded in clinical practice guidelines for decades on the basis of animal models and controversial clinical trials. This review will critically appraise the literature base for this recommendation and determine whether the available evidence supports this common practice, which is a timely endeavor considering the impending demotion of metabolic acidosis treatment from recommendation to practice point in forthcoming KDIGO guidelines. RECENT FINDINGS Earlier, open-label, studies supporting the utility of sodium bicarbonate therapy to slow progression of chronic kidney disease have been challenged by more recent, blinded, studies failing to show benefit on CKD progression. This was further demonstrated in the absence of concomitant sodium administration with the hydrochloric acid binder veverimer, which failed to demonstrate benefit on renal death, end stage kidney disease or 40% reduction in estimated glomerular filtration rate in a large multicenter trial. SUMMARY The current body of literature does not support the routine treatment of metabolic acidosis in patients with CKD and the authors agree with the forthcoming KDIGO guidelines to de-emphasize this common practice.
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Affiliation(s)
| | | | - Nayan Arora
- University of Washington, Seattle, Washington, USA
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Kim HJ, Koh HB, Heo GY, Kim HW, Park JT, Chang TI, Yoo TH, Kang SW, Kalantar-Zadeh K, Rhee C, Han SH. Higher potassium intake is associated with a lower risk of chronic kidney disease: population-based prospective study. Am J Clin Nutr 2024; 119:1044-1051. [PMID: 38346560 DOI: 10.1016/j.ajcnut.2024.02.004] [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: 10/23/2023] [Revised: 01/25/2024] [Accepted: 02/05/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND High-potassium intake is associated with a lower risk of cardiovascular disease. However, the association between potassium intake and the development of chronic kidney disease (CKD) remains unclear. OBJECTIVE The objective of this study was to investigate whether potassium intake is associated with outcomes of incident CKD. METHODS This is a population-based prospective observational cohort study from the UK Biobank cohort between 2006 and 2010. We included 317,162 participants without CKD from the UK Biobank cohort. The main predictor was spot urine potassium-to-creatinine ratio (KCR). The primary outcome was incident CKD, which was defined by the International Classification of Disease 10 codes or Operating Procedure Codes Supplement 4 codes. RESULTS At baseline, individuals with higher KCR had lower blood pressure, body mass index, and inflammation, and were less likely to have diabetes and hypertension. During a median follow-up of 11.9 y, primary outcome events occurred in 15,246 (4.8%) participants. In the cause-specific model, the adjusted hazard ratio (aHR) per 1-standard deviation increase in KCR for incident CKD was 0.90 [95% confidence interval (CI): 0.89, 0.92]. Compared with quartile 1 of KCR, the aHRs (95% CIs) for quartiles 2-4 were 0.98 (0.94, 1.02), 0.90 (0.86, 0.95), and 0.80 (0.76, 0.84), respectively. In sensitivity analysis with different definitions of CKD, the results were similar. In addition, further analysis with dietary potassium intake also showed a negatively graded association with the primary outcome. CONCLUSIONS Higher urinary potassium excretion and intake were associated with a lower risk of incident CKD.
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Affiliation(s)
- Hyo Jeong Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Institute of Kidney Disease Research, Seoul, Republic of Korea; Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Hee Byung Koh
- Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University, Incheon, Republic of Korea
| | - Ga Young Heo
- Department of Internal Medicine, Yonsei University College of Medicine, Institute of Kidney Disease Research, Seoul, Republic of Korea
| | - Hyung Woo Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Institute of Kidney Disease Research, Seoul, Republic of Korea
| | - Jung Tak Park
- Department of Internal Medicine, Yonsei University College of Medicine, Institute of Kidney Disease Research, Seoul, Republic of Korea
| | - Tae Ik Chang
- Department of Internal Medicine, National Health Insurance Service Medical Center, Ilsan Hospital, Goyang, Gyeonggi-do, Republic of Korea
| | - Tae-Hyun Yoo
- Department of Internal Medicine, Yonsei University College of Medicine, Institute of Kidney Disease Research, Seoul, Republic of Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Institute of Kidney Disease Research, Seoul, Republic of Korea
| | - Kamyar Kalantar-Zadeh
- The Lundquist Institute at Harbor-University of California, Los Angeles Medical Center, Torrance, CA, United States; Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA, United States
| | - Connie Rhee
- Department of Medicine, Division of Nephrology, David Geffen School of Medicine, Los Angeles, CA, United States
| | - Seung Hyeok Han
- Department of Internal Medicine, Yonsei University College of Medicine, Institute of Kidney Disease Research, Seoul, Republic of Korea.
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Attaye I, Beynon-Cobb B, Louca P, Nogal A, Visconti A, Tettamanzi F, Wong K, Michellotti G, Spector TD, Falchi M, Bell JT, Menni C. Cross-sectional analyses of metabolites across biological samples mediating dietary acid load and chronic kidney disease. iScience 2024; 27:109132. [PMID: 38433906 PMCID: PMC10907771 DOI: 10.1016/j.isci.2024.109132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/14/2023] [Accepted: 02/01/2024] [Indexed: 03/05/2024] Open
Abstract
Chronic kidney disease (CKD) is a major public health burden, with dietary acid load (DAL) and gut microbiota playing crucial roles. As DAL can affect the host metabolome, potentially via the gut microbiota, we cross-sectionally investigated the interplay between DAL, host metabolome, gut microbiota, and early-stage CKD (TwinsUK, n = 1,453). DAL was positively associated with CKD stage G1-G2 (Beta (95% confidence interval) = 0.34 (0.007; 0.7), p = 0.046). After adjusting for covariates and multiple testing, we identified 15 serum, 14 urine, 8 stool, and 7 saliva metabolites, primarily lipids and amino acids, associated with both DAL and CKD progression. Of these, 8 serum, 2 urine, and one stool metabolites were found to mediate the DAL-CKD association. Furthermore, the stool metabolite 5-methylhexanoate (i7:0) correlated with 26 gut microbial species. Our findings emphasize the gut microbiota's therapeutic potential in countering DAL's impact on CKD through the host metabolome. Interventional and longitudinal studies are needed to establish causality.
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Affiliation(s)
- Ilias Attaye
- Department of Twin Research, King’s College London, St Thomas' Hospital Campus, London SE1 7EH, UK
- Amsterdam Cardiovascular Sciences, Diabetes & Metabolism, Amsterdam, the Netherlands
| | - Beverley Beynon-Cobb
- Department of Twin Research, King’s College London, St Thomas' Hospital Campus, London SE1 7EH, UK
- Department of Nutrition & Dietetics, University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK
| | - Panayiotis Louca
- Department of Twin Research, King’s College London, St Thomas' Hospital Campus, London SE1 7EH, UK
| | - Ana Nogal
- Department of Twin Research, King’s College London, St Thomas' Hospital Campus, London SE1 7EH, UK
| | - Alessia Visconti
- Department of Twin Research, King’s College London, St Thomas' Hospital Campus, London SE1 7EH, UK
| | - Francesca Tettamanzi
- Department of Twin Research, King’s College London, St Thomas' Hospital Campus, London SE1 7EH, UK
| | - Kari Wong
- Metabolon, Research Triangle Park, Morrisville, NC 27560, USA
| | | | - Tim D. Spector
- Department of Twin Research, King’s College London, St Thomas' Hospital Campus, London SE1 7EH, UK
| | - Mario Falchi
- Department of Twin Research, King’s College London, St Thomas' Hospital Campus, London SE1 7EH, UK
| | - Jordana T. Bell
- Department of Twin Research, King’s College London, St Thomas' Hospital Campus, London SE1 7EH, UK
| | - Cristina Menni
- Department of Twin Research, King’s College London, St Thomas' Hospital Campus, London SE1 7EH, UK
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Dolati S, Razmjouei S, Alizadeh M, Faghfouri AH, Moridpour AH. A high dietary acid load can potentially exacerbate cardiometabolic risk factors: An updated systematic review and meta-analysis of observational studies. Nutr Metab Cardiovasc Dis 2024; 34:569-580. [PMID: 38316575 DOI: 10.1016/j.numecd.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 02/07/2024]
Abstract
AIMS Chronic metabolic acidosis has been shown to be associated with cardiometabolic risk factors. The aim of the currently updated meta-analysis was to explore the association between Potential Renal Acid Load (PRAL) and Net Endogenous Acid Production (NEAP) with these risk factors. DATA SYNTHESIS Databases were searched up to May 2023. The mean of waist circumference (WC), body mass index (BMI), high- and low-density lipoprotein-cholesterol (HDL-C and LDL-C), triglyceride (TG), total cholesterol (TC), fasting blood sugar (FBS), and systolic- and diastolic blood pressure (SBP and DBP) in highest category vs lowest categories of NEAP and PRAL were recorded. Effect sizes were generated as weighted mean difference (WMD). Results showed that SBP, DBP, and WC had a significant difference in the upper and lower categories of PRAL (WMDSBP: 1.466 mmHg; 95% CI: 2.121, -0.811; P<0.001, WMDDBP: 0.710 mmHg; 95 % CI: 1.170, -0.249; P=0.003, and WMDWC: 0.819 cm; 95% CI: 1.446, -0.192; P=0.010) or NEAP (WMDSBP: 1.690 mmHg; 95% CI: 2.789, -0.591; P=0.003, WMDDBP: 1.076 mmHg, and WMDWC: 1.325 cm; 95% CI: 1.901, -0.749; P<0.001; 95% CI: 1.938, -0.214; P =0.014). The lowest versus highest categories of dietary PRAL were associated with lower BMI (WMDPRAL: 0.297 kg/m2; 95 % CI: 0.440, -0.154; P<0.001) and TG (WMD: 2.280 mg/dl; 95%CI: 3.828, -0.732; P=0.004; I2=99.4 %; P<0.001). CONCLUSIONS High DAL can be considered as an independent risk factor for increasing anthropometric indices, blood pressure, and TG. This study registered in the PROSPERO database (Registration No. CRD42023402985).
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Affiliation(s)
- Shamim Dolati
- Department of Clinical Nutrition, Faculty of Nutrition and Food Science, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Soha Razmjouei
- School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Mohammad Alizadeh
- Department of Clinical Nutrition, Faculty of Nutrition and Food Science, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Amir Hossein Faghfouri
- Maternal and Childhood Obesity Research Center, Urmia University of Medical Sciences, Urmia, Iran.
| | - Amir Hossein Moridpour
- Department of Clinical Nutrition, Faculty of Nutrition and Food Science, Tabriz University of Medical Sciences, Tabriz, Iran
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Moloudpour B, Jam SA, Darbandi M, Janati A, Gholizadeh M, Najafi F, Pasdar Y. Association Between Plant-based Diet and Kidney Function in Adults. J Ren Nutr 2024; 34:125-132. [PMID: 37769752 DOI: 10.1053/j.jrn.2023.09.002] [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: 04/10/2023] [Revised: 08/16/2023] [Accepted: 09/10/2023] [Indexed: 10/03/2023] Open
Abstract
OBJECTIVE A plant-based diet has both antioxidant and anti-inflammatory properties. Therefore, it is hypothesized that adherence to a plant-based diet may have a positive effect on kidney function. The study aimed to determine the association between the plant-based diet index (PDI) and chronic kidney disease (CKD). METHODS This cross-sectional analysis used information from the Ravansar noncommunicable diseases cohort study, which included 9,746 participants between the ages of 35 and 65. By measuring the estimation glomerular filtration rate (eGFR) with the modification of diet in the renal disease equation, CKD was determined. Using a food frequency questionnaire, the PDI was computed based on food intake. To determine odds ratios (ORs), multivariable logistic regression models were utilized. RESULTS 1,058 (10.86%) participants had CKD (eGFR<60 mL/min/1.73 m2), and the mean PDI was 54.22 ± 6.68. The mean eGFR in the group with a high PDI score was significantly higher than the group with a low PDI score (fourth quartile: 79.20 ± 0.36 vs. first quartile: 72.95 ± 0.31, P < .001). Adherence to a plant-based diet was more prevalent in those with a higher socioeconomic status (P < .001). After adjusting for potential confounders, the odds of CKD in the third and fourth quartiles of PDI were 25% (OR: 0.75; 95% confidence interval: 0.62-0.91) and 39% (OR: 0.61; 95% confidence interval: 0.48-0.78, P trend<.001) lower than the first quartile, respectively. CONCLUSIONS The findings of this study suggest that having a plant-based diet may prevent the prevalent CDK. However, further studies with a cohort design are recommended.
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Affiliation(s)
- Behrooz Moloudpour
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Samira Arbabi Jam
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mitra Darbandi
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ali Janati
- Scientific and Educational Center of Iran Health Management, School of Management and Medical Information, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masoumeh Gholizadeh
- Scientific and Educational Center of Iran Health Management, School of Management and Medical Information, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farid Najafi
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran; Cardiovascular Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Yahya Pasdar
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran; Cardiovascular Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Goraya N, Wesson DE. Pathophysiology of Diet-Induced Acid Stress. Int J Mol Sci 2024; 25:2336. [PMID: 38397012 PMCID: PMC10888592 DOI: 10.3390/ijms25042336] [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: 01/05/2024] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
Diets can influence the body's acid-base status because specific food components yield acids, bases, or neither when metabolized. Animal-sourced foods yield acids and plant-sourced food, particularly fruits and vegetables, generally yield bases when metabolized. Modern diets proportionately contain more animal-sourced than plant-sourced foods, are, thereby, generally net acid-producing, and so constitute an ongoing acid challenge. Acid accumulation severe enough to reduce serum bicarbonate concentration, i.e., manifesting as chronic metabolic acidosis, the most extreme end of the continuum of "acid stress", harms bones and muscles and appears to enhance the progression of chronic kidney disease (CKD). Progressive acid accumulation that does not achieve the threshold amount necessary to cause chronic metabolic acidosis also appears to have deleterious effects. Specifically, identifiable acid retention without reduced serum bicarbonate concentration, which, in this review, we will call "covert acidosis", appears to cause kidney injury and exacerbate CKD progression. Furthermore, the chronic engagement of mechanisms to mitigate the ongoing acid challenge of modern diets also appears to threaten health, including kidney health. This review describes the full continuum of "acid stress" to which modern diets contribute and the mechanisms by which acid stress challenges health. Ongoing research will develop clinically useful tools to identify stages of acid stress earlier than metabolic acidosis and determine if dietary acid reduction lowers or eliminates the threats to health that these diets appear to cause.
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Affiliation(s)
- Nimrit Goraya
- Department of Internal Medicine, Baylor Scott & White Health, Temple, TX 76508, USA;
- Department of Internal Medicine, Texas A&M Health Science Center College of Medicine, Temple, TX 76508, USA
| | - Donald E. Wesson
- Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Dallas, TX 78712, USA
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Machado AD, Marchioni DM, Lotufo PA, Benseñor IM, Titan SM. Dietary acid load and the risk of events of mortality and kidney replacement therapy in people with chronic kidney disease: the Progredir Cohort Study. Eur J Clin Nutr 2024; 78:128-134. [PMID: 37891227 DOI: 10.1038/s41430-023-01361-0] [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: 11/04/2022] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND/OBJECTIVES The association between dietary acid load (DAL) and chronic kidney disease (CKD) progression remains controversial. Also, there is a gap in the literature on the association between DAL and mortality. In this study, we evaluated the association between NEAP (net endogenous acid production) and PRAL (potential renal acid load) and the risk of events of all-cause mortality and kidney replacement therapy (KRT) in people with CKD. SUBJECTS/METHODS We included 442 patients (250 diabetics) from the Progredir Cohort Study, based in São Paulo, Brazil. We estimated NEAP and PRAL from dietary intake. Events of death before KRT and KRT were ascertained after a median follow-up of 5.8 and 5.1 years, respectively. Cox proportional hazards regression, Weibull regression, and competing risk models were performed. RESULTS Median NEAP and PRAL were 49.5 and 4.8 mEq/d. There were 200 deaths and 75 KRT events. Neither NEAP nor PRAL were associated with mortality or KRT when all participants were analyzed. After stratification for diabetes, both estimates were positively related to the risk of KRT even after adjustment for age, sex, weight status, glomerular filtration rate, serum bicarbonate, and intakes of protein, phosphorus, and energy (HR 1.31; 95% CI 1.07, 1.60 for NEAP, and HR 1.27; 95% CI 1.04, 1.57 for every 10 mEq/d increments). Competing risk analyses confirmed these findings. CONCLUSIONS DAL estimates were associated with the risk of KRT in people with CKD and diabetes but not in non-diabetics. There was no association between all-cause mortality and DAL.
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Affiliation(s)
- Alisson Diego Machado
- Division of Nephrology, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil.
| | - Dirce Maria Marchioni
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, SP, Brazil
| | - Paulo Andrade Lotufo
- Epidemiological and Clinical Research Center, University Hospital of the University of São Paulo, São Paulo, SP, Brazil
| | - Isabela Martins Benseñor
- Epidemiological and Clinical Research Center, University Hospital of the University of São Paulo, São Paulo, SP, Brazil
| | - Silvia Maria Titan
- Division of Nephrology, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
- Division of Nephrology & Hypertension, Mayo Clinic, Rochester, MN, USA
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Thompson AS, Candussi CJ, Tresserra-Rimbau A, Jennings A, Bondonno NP, Hill C, Sowah SA, Cassidy A, Kühn T. A healthful plant-based diet is associated with lower type 2 diabetes risk via improved metabolic state and organ function: A prospective cohort study. DIABETES & METABOLISM 2024; 50:101499. [PMID: 38036055 DOI: 10.1016/j.diabet.2023.101499] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/15/2023] [Accepted: 11/21/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Plant-based diets are becoming increasingly popular due to favourable environmental footprints and have been associated with lower risk of type 2 diabetes mellitus (T2DM). Here, we investigated the potential mechanisms to explain the lower T2DM risk observed among individuals following plant-based diets. METHODS Prospective data from the UK Biobank, a cohort study of participants aged 40 to 69 years at baseline, was evaluated. Associations between healthful and unhealthful plant-based indices (hPDI and uPDI) and T2DM risk were analysed by multivariable Cox regression models, followed by causal mediation analyses to investigate which cardiometabolic risk factors explained the observed associations. RESULTS Of 113,097 study participants 2,628 developed T2DM over 12 years of follow-up. Participants with the highest hPDI scores (Quartile 4) had a 24 % lower T2DM risk compared to those with the lowest scores (Quartile 1) [Hazard Ratio (HR): 0.76, 95 % Confidence Interval (CI): 0.68-0.85]. This association was mediated by a lower BMI (proportion mediated: 28 %), lower waist circumference (28 %), and lower concentrations of HBA1c (11 %), triglycerides (9 %), alanine aminotransferase (5 %), gamma glutamyl transferase (4 %), C-reactive protein (4 %), insulin-like growth factor 1 (4 %), cystatin C (4 %) and urate (4 %). Higher uPDI scores were associated with a 37 % higher T2DM risk [HR: 1.37, 95 % CI:1.22- 1.53], with higher waist circumference (proportion mediated: 17 %), BMI (7 %), and higher concentrations of triglycerides (13 %) potentially playing mediating roles. CONCLUSION Healthful plant-based diets may protect against T2DM via lower body fatness, but also via normoglycaemia, lower basal inflammation as well as improved kidney and liver function.
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Affiliation(s)
- Alysha S Thompson
- The Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Northern Ireland, United Kingdom
| | - Catharina J Candussi
- Department of Nutritional Sciences, University of Vienna, Vienna, Austria; Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Anna Tresserra-Rimbau
- The Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Northern Ireland, United Kingdom; Department of Nutrition, Food Science and Gastronomy, XIA, School of Pharmacy and Food Sciences, INSA, University of Barcelona, 08921 Barcelona, Spain; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
| | - Amy Jennings
- The Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Northern Ireland, United Kingdom
| | - Nicola P Bondonno
- The Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Northern Ireland, United Kingdom; Danish Cancer Institute, Copenhagen, Denmark; Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Claire Hill
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Solomon A Sowah
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Aedín Cassidy
- The Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Northern Ireland, United Kingdom.
| | - Tilman Kühn
- The Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Northern Ireland, United Kingdom; Department of Nutritional Sciences, University of Vienna, Vienna, Austria; Center for Public Health, Medical University of Vienna, Vienna, Austria.
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Zheng H, Li H, Pan L, Hu L, Chen X, Hou J, Liang H. Association of fresh vegetable and salt-preserved vegetable consumptions with estimated glomerular filtration rate. BMC Nephrol 2023; 24:369. [PMID: 38087232 PMCID: PMC10717767 DOI: 10.1186/s12882-023-03353-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/26/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE This study aimed to investigate the relationship between the consumption of fresh and salt-preserved vegetables and the estimated glomerular filtration rate (eGFR), which requires further research. METHODS For this purpose, the data of those subjects who participated in the 2011-2012 and 2014 surveys of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) and had biomarker data were selected. Fresh and salt-preserved vegetable consumptions were assessed at each wave. eGFR was assessed using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation based on plasma creatinine. Furthermore, a linear mixed model was used to evaluate associations between fresh/salt-preserved vegetables and eGFR. RESULTS The results indicated that the median baseline and follow-up eGFRs were 72.47 mL/min/1.73 m² and 70.26 mL/min/1.73 m², respectively. After applying adjusted linear mixed model analysis to the data, the results revealed that compared to almost daily intake, occasional consumption of fresh vegetables was associated with a lower eGFR (β=-2.23, 95% CI: -4.23, -0.23). Moreover, rare or no consumption of salt-preserved vegetables was associated with a higher eGFR (β = 1.87, 95% CI: 0.12, 3.63) compared to individuals who consumed salt-preserved vegetables daily. CONCLUSION Fresh vegetable consumption was direct, whereas intake of salt-preserved vegetables was inversely associated with eGFR among the oldest subjects, supporting the potential benefits of diet-rich fresh vegetables for improving eGFR.
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Affiliation(s)
- Haiqing Zheng
- Medical Big Data Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, No.106, Zhongshan Er Road, Guangzhou, Guangdong, China
| | - Huixian Li
- Medical Big Data Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, No.106, Zhongshan Er Road, Guangzhou, Guangdong, China
| | - Liyan Pan
- Medical Big Data Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, No.106, Zhongshan Er Road, Guangzhou, Guangdong, China
| | - Lianting Hu
- Medical Big Data Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, No.106, Zhongshan Er Road, Guangzhou, Guangdong, China
| | - Xuanhui Chen
- Medical Big Data Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, No.106, Zhongshan Er Road, Guangzhou, Guangdong, China
| | - Jiaxin Hou
- Medical Big Data Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, No.106, Zhongshan Er Road, Guangzhou, Guangdong, China
| | - Huiying Liang
- Medical Big Data Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, No.106, Zhongshan Er Road, Guangzhou, Guangdong, China.
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15
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D'Arrigo G, Gori M, Leonardis D, Tripepi G, Mallamaci F, Zoccali C. Venous bicarbonate and CKD progression: a longitudinal analysis by the group-based trajectory model. Clin Kidney J 2023; 16:1986-1992. [PMID: 37915885 PMCID: PMC10616435 DOI: 10.1093/ckj/sfad207] [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: 05/11/2023] [Indexed: 11/03/2023] Open
Abstract
Background Metabolic acidosis accelerates chronic kidney disease (CKD) progression towards kidney failure in animal models. Clinical trials testing the effect of bicarbonate on kidney outcomes are underpowered and/or of suboptimal quality. On the other hand, observational studies testing the same hypothesis are generally based on bicarbonate measured at a single time point. Methods We studied the longitudinal relationship between repeated venous bicarbonate levels and a predefined composite renal outcome (a ≥30% estimated glomerular filtration rate reduction, dialysis or transplantation) by using group-based trajectory model (GBTM) analysis. The GBTM analysis was used to classify patients based on individual bicarbonate levels over time. The relationship between trajectory groups and renal outcomes was investigated using crude and adjusted Cox regression models. A total of 528 patients with stage 2-5 CKD were included in the analysis. Results The GBTM analysis identified four distinct trajectories of bicarbonate levels: low, moderate, moderate-high and high. During the follow-up period, 126 patients experienced the combined renal endpoint. The hazard rate of renal events decreased dose-dependently from the lowest to the highest bicarbonate trajectory. After adjusting for potential confounders, there was a 63% risk reduction for the composite renal endpoint for patients in the high trajectory category compared with those in the low trajectory category. Conclusion The study found that higher bicarbonate trajectories were associated with a lower risk of adverse renal outcomes in CKD patients. These results suggest that strategies to maintain higher bicarbonate levels may benefit patients with CKD. However, further high-quality randomised trials are needed to confirm these findings and recommend bicarbonate supplementation as a strategy to delay CKD progression.
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Affiliation(s)
| | | | | | | | - Francesca Mallamaci
- CNR-IFC, Reggio Cal, Italy
- Nefrologia e Trapianto Renale, GOM, Reggio Cal, Italy
| | - Carmine Zoccali
- Renal Research Institute NY, USA
- BIOGEM, Ariano Irpino, Italy
- IPNET, Reggio Cal, Italy
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Mokiao RH, Fretts AM, Deen JF, Umans JG. Diet Quality and Kidney Outcomes in Adolescent and Adult American Indians: the Strong Heart Family Study. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01735-x. [PMID: 37526878 DOI: 10.1007/s40615-023-01735-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/17/2023] [Accepted: 07/21/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND The burden of kidney disease is exceedingly high among American Indians (AIs). We sought to examine the relationship of diet quality, a modifiable risk factor, and kidney outcomes in AI adolescents and adults, hypothesizing that healthier diets are associated with lower odds of incident albuminuria and eGFR decline. METHODS This is an analysis from the Strong Heart Family Study, a longitudinal study of cardiovascular disease and its risk factors among AIs from Arizona, North and South Dakota, and Oklahoma (n = 1720, mean age 39 + / - 16 years, 16% adolescents at baseline). Participants completed two exams (baseline: 2001-2003; follow-up: 2007-2009). The primary exposure was diet quality, expressed as the Alternative Healthy Eating Index 2010 (AHEI), on a 110-point scale (assessed using a 119-item Block food frequency questionnaire). The primary outcomes were as follows: 1) incident albuminuria (albumin to creatinine ratio 30 mg/g or greater); and 2) eGFR decline of 30% or greater. Generalized estimating equations were used to examine the association of AHEI (in quartiles) with outcomes. RESULTS Ten percent of participants (6% of adolescents) had incident albuminuria and 2% of participants (2% of adolescents) had eGFR decline. For those with normal fasting glucose levels, the odds ratio (OR) for incident albuminuria comparing extreme quartiles of diet quality (least healthy [reference] versus healthiest quartiles) was 0.48 (95% CI 0.28, 0.81) after adjustment for demographics and comorbidities. CONCLUSIONS For American Indians with normal fasting glucose, higher diet quality decreases the odds of developing albuminuria. These findings inform future efforts to prevent CKD in American Indian adolescents and young adults.
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Affiliation(s)
- Reya H Mokiao
- Seattle Children's Hospital, 4800 Sandpoint Way NE, Seattle, WA, 98105, USA.
- University of Washington, Seattle, WA, USA.
| | | | - Jason F Deen
- Seattle Children's Hospital, 4800 Sandpoint Way NE, Seattle, WA, 98105, USA
- University of Washington, Seattle, WA, USA
| | - Jason G Umans
- MedStar Health Research Institute, Hyattsville, MD, USA
- Georgetown University, Washington, DC, USA
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Detopoulou P, Dedes V, Pylarinou I, Syka D, Tzirogiannis K, Panoutsopoulos GI. Dietary acid load is associated with waist circumference in university students with low adherence to the Mediterranean diet: The potential role of ultra-processed foods. Clin Nutr ESPEN 2023; 56:43-51. [PMID: 37344082 DOI: 10.1016/j.clnesp.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 04/28/2023] [Accepted: 05/04/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND AND AIMS Dietary acid load (DAL), as expressed by potential renal acid load (PRAL) and net acid production (NEAP), is connected to cardiometabolic disorders and obesity. Mediterranean diet relates to lower, while western diets to higher DAL values. The present study aimed to assess the association of PRAL and NEAP with adiposity measures in young adults (19.61 ± 3.15 years, mean ± standard deviation) and explore the implication of Mediterranean diet adherence and ultra-processed foods (UPF) intake in this relation. METHODS 346 students (269 women) participated. Anthropometry was performed, and a food frequency questionnaire was administered. The MedDietScore was calculated, UPF consumption was calculated based on the NOVA classification and PRAL/NEAP was estimated from published equations. Waist Circumference (WC) was transformed to WC-1 (1/WC) in order to achieve normality and run linear regression models. RESULTS In subjects with MedDietScore ≤ 28.00, PRAL and NEAP were negatively associated with 1/WC (B = -1.594 × 10-5± 8 × 10-6, p = 0.044 for PRAL and B = -2.84 × 10-5 ± 1 × 10-5, p = 0.048 for NEAP). Moreover, in this subgroup, subjects with medium to high UPF intake i.e., in the 2nd or 3rd tertile of UPF intake representing more than 34.16% of energy, PRAL (2nd tertile B = -0.00007, SE = 0.00003, p = 0.018; 3rd tertile B = -0.00002, SE = 0.00001, p = 0.024) and NEAP (2nd tertile B = -0.00004, SE = 0.00002, p = 0.040; 3rd tertile B = -0.00007, SE = 0.00004, p = 0.055) were connected to central obesity. In similar models, PRAL and NEAP were not significant predictors of BMI. CONCLUSION The DAL may be related to central obesity, especially in individuals with worse dietary quality, as reflected by lower adherence to the Mediterranean diet, and high intake of UPF. Nutrition guidance aiming at the reduction of DAL may be useful in the reduction of central obesity in these subgroups.
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Affiliation(s)
- Paraskevi Detopoulou
- Department of Clinical Nutrition, General Hospital Korgialenio Benakio, Athanassaki 2, 11526, Athens, Greece
| | - Vassilios Dedes
- Department of Nutritional Science and Dietetics, Faculty of Health Sciences, University of Peloponnese, New Building, Antikalamos, 24100 Kalamata, Greece
| | - Ioanna Pylarinou
- Department of Nutritional Science and Dietetics, Faculty of Health Sciences, University of Peloponnese, New Building, Antikalamos, 24100 Kalamata, Greece
| | - Dimitra Syka
- Department of Nutritional Science and Dietetics, Faculty of Health Sciences, University of Peloponnese, New Building, Antikalamos, 24100 Kalamata, Greece
| | | | - Georgios I Panoutsopoulos
- Department of Nutritional Science and Dietetics, Faculty of Health Sciences, University of Peloponnese, New Building, Antikalamos, 24100 Kalamata, Greece.
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Bernard L, Chen J, Kim H, Wong KE, Steffen LM, Yu B, Boerwinkle E, Rebholz CM. Metabolomics of Dietary Intake of Total, Animal, and Plant Protein: Results from the Atherosclerosis Risk in Communities (ARIC) Study. Curr Dev Nutr 2023; 7:100067. [PMID: 37304852 PMCID: PMC10257224 DOI: 10.1016/j.cdnut.2023.100067] [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: 01/26/2023] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 06/13/2023] Open
Abstract
Background Dietary consumption has traditionally been studied through food intake questionnaires. Metabolomics can be used to identify blood markers of dietary protein that may complement existing dietary assessment tools. Objectives We aimed to identify associations between 3 dietary protein sources (total protein, animal protein, and plant protein) and serum metabolites using data from the Atherosclerosis Risk in Communities Study. Methods Participants' dietary protein intake was derived from a food frequency questionnaire administered by an interviewer, and fasting serum samples were collected at study visit 1 (1987-1989). Untargeted metabolomic profiling was performed in 2 subgroups (subgroup 1: n = 1842; subgroup 2: n = 2072). Multivariable linear regression models were used to assess associations between 3 dietary protein sources and 360 metabolites, adjusting for demographic factors and other participant characteristics. Analyses were performed separately within each subgroup and meta-analyzed with fixed-effects models. Results In this study of 3914 middle-aged adults, the mean (SD) age was 54 (6) y, 60% were women, and 61% were Black. We identified 41 metabolites significantly associated with dietary protein intake. Twenty-six metabolite associations overlapped between total protein and animal protein, such as pyroglutamine, creatine, 3-methylhistidine, and 3-carboxy-4-methyl-5-propyl-2-furanpropanoic acid. Plant protein was uniquely associated with 11 metabolites, such as tryptophan betaine, 4-vinylphenol sulfate, N-δ-acetylornithine, and pipecolate. Conclusions The results of 17 of the 41 metabolites (41%) were consistent with those of previous nutritional metabolomic studies and specific protein-rich food items. We discovered 24 metabolites that had not been previously associated with dietary protein intake. These results enhance the validity of candidate markers of dietary protein intake and introduce novel metabolomic markers of dietary protein intake.
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Affiliation(s)
- Lauren Bernard
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Jingsha Chen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Hyunju Kim
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kari E. Wong
- Metabolon, Research Triangle Park, Morrisville, NC, USA
| | - Lyn M. Steffen
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Bing Yu
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Eric Boerwinkle
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
- Human Genome Sequencing Center, Baylor Colleague of Medicine, Houston, TX, USA
| | - Casey M. Rebholz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Abstract
Metabolic acidosis is a common complication in patients with chronic kidney disease that occurs when the daily nonvolatile acid load produced in metabolism cannot be excreted fully by the kidney. A reduction in urine net acid excretion coupled with a high nonvolatile acid load may play a role in its pathogenesis. Diet is important in generation of the nonvolatile acid load. Acids are produced from metabolism of dietary protein and from the endogenous production of organic anions from neutral precursors. Acids can be balanced by alkali precursors ingested in the diet in the form of combustible organic anions. These typically are reflected indirectly by the excess of mineral cations to mineral anions in a food or diet. These principles underscore widely used methods to estimate the nonvolatile acid load from dietary intake using formulas such as the net endogenous acid production equation and the potential renal acid load equation. Empiric data largely validate these paradigms with high net endogenous acid production and potential renal acid load contributed by foods such as protein, grains, and dairy, and low net endogenous acid production and potential renal acid load contributed by fruits and vegetables along with corresponding dietary patterns. Although further studies are needed to understand the health benefits of altering nonvolatile acid load via diet, this review provides a detailed assessment on our current understanding of the role of diet in chronic kidney disease-related acidosis, providing an updated resource for researchers and clinicians.
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Affiliation(s)
- Anita Vincent-Johnson
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA
| | - Brenda Davy
- Department of Human Nutrition, Foods and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, VA
| | - Julia J Scialla
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA; Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA.
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Storz MA, Ronco AL. How Well Do Low-PRAL Diets Fare in Comparison to the 2020-2025 Dietary Guidelines for Americans? Healthcare (Basel) 2023; 11:healthcare11020180. [PMID: 36673547 PMCID: PMC9859335 DOI: 10.3390/healthcare11020180] [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: 12/12/2022] [Revised: 01/01/2023] [Accepted: 01/03/2023] [Indexed: 01/11/2023] Open
Abstract
The regular consumption of net acid-producing diets can produce "acid stress" detrimental to human health. Alkalizing diets characterized by a negative potential renal acid load (also called low-PRAL diets (LPD)) enjoy uninterrupted popularity. However, the nutritional adequacy of said diets has rarely been assessed in large populations. Using data from the National Health and Nutrition Examination Surveys, we estimated nutrient intake in individuals consuming an LPD and contrasted the results in an age- and sex-specific manner to individuals on an acidifying diet (high-PRAL diet, HPD). Both groups were compared with the daily nutritional goals (DNG) specified in the 2020-2025 Dietary Guidelines for Americans (DGA). Our analysis included 29,683 individuals, including 7234 participants on an LPD and 22,449 participants on an HPD. Individuals on an LPD numerically met more nutritional goals than individuals on an HPD, yet both failed to meet the goals for several nutrients of public health concern (vitamin D and calcium). As opposed to individuals on an HPD, LPD consumers met the DGA recommendations for saturated fat and potassium. Individuals on an LPD consumed significantly more fiber than individuals on an HPD, as well as yielded a more favorable potassium-to-sodium intake ratio.
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Affiliation(s)
- Maximilian Andreas Storz
- Center for Complementary Medicine, Department of Internal Medicine II, Freiburg University Hospital, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- Correspondence:
| | - Alvaro Luis Ronco
- Unit of Oncology and Radiotherapy, Pereira Rossell Women’s Hospital, Bvard. Artigas 1590, Montevideo 11600, Uruguay
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Moghari L, Taghizadeh M, Soleimani A, Akbari H, Sharifi N. Dietary Acid Load and Predialysis Serum Bicarbonate Levels in Patients With End-Stage Renal Disease. J Ren Nutr 2023; 33:172-180. [PMID: 35597317 DOI: 10.1053/j.jrn.2022.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 03/08/2022] [Accepted: 05/01/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES Maintaining the predialysis serum bicarbonate at a recommended level is critical in patients undergoing hemodialysis. Therefore, the present study investigated the association between dietary acid load (DAL) and serum predialysis bicarbonate levels in patients with end-stage renal disease. METHODS Adult patients undergoing hemodialysis were enrolled in this cross-sectional study. Diet was assessed using a semiquantitative food frequency questionnaire. DAL was calculated with 2 validated indices: potential renal acid load (PRAL) and net endogenous acid production (NEAP). Values regarding predialysis serum bicarbonate level and serum electrolytes were obtained from the participant's medical records. The multiple linear regression analysis was used to determine the association between DAL indices and predialysis serum bicarbonate level. RESULTS The number of hemodialysis patients eligible for this study was 122. The participants' mean age and body mass index was 57.14 ± 3.8 years and 25.2 ± 4.9 kg/m2, respectively. About 65.6% of participants were male. The mean serum levels of predialysis bicarbonate were 21.59 ± 3.1 mEq/L. Also, 47.5% of patients had predialysis serum bicarbonate levels below the recommended value. The mean values of PRAL and NEAP were -2.8 ± 7.48 and 42.7 ± 10.1 mEq/day, respectively. PRAL significantly and inversely predicted predialysis serum bicarbonate level independent of covariates (standardized β = -0.38; P < .001). Also, NEAP was independently and inversely associated with predialysis bicarbonate level (standardized β = -0.40; P < .001). Consuming vegetables such as lettuce, tomato, cucumber, spinach, and dried fruits as well as low-fat milk, plain yogurt, and cream cheese were positively correlated to predialysis serum bicarbonate level. However, the canned tuna had a negative correlation with the predialysis serum bicarbonate. CONCLUSIONS The study's findings showed that the lower DAL was associated with higher predialysis serum bicarbonate levels in patients with end-stage renal disease. Due to the cross-sectional nature of the present study, prospective cohorts or well-controlled clinical trials are needed to confirm our result.
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Affiliation(s)
- Leila Moghari
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Basic Science Research Institute, Kashan University of Medical Sciences, Kashan, Iran
| | - Mohsen Taghizadeh
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Basic Science Research Institute, Kashan University of Medical Sciences, Kashan, Iran
| | - Alireza Soleimani
- Department of Internal Medicine, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Hossein Akbari
- Social Determinants of Health Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Nasrin Sharifi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Basic Science Research Institute, Kashan University of Medical Sciences, Kashan, Iran.
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Xue W, Cheng J, Zhao J, Wang L, Peng A, Liu X. Comparison potassium sodium hydrogen citrate with sodium bicarbonate in urine alkalization: a prospective crossover-controlled trial. Int Urol Nephrol 2023; 55:61-68. [PMID: 36261757 DOI: 10.1007/s11255-022-03387-y] [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: 07/30/2022] [Accepted: 10/09/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Excessive alkalization will increase the incidence of nephrolithiasis. Sodium bicarbonate (NaHCO3) and potassium sodium hydrogen citrate (PSHC) are commonly used drugs for urinary alkalization. We designed a trial to compare PSHC with NaHCO3 in the urine alkalization for the Chinese healthy participants and to explore the effects of PSHC and NaHCO3 on circadian rhythms of urine pH value. METHOD This study was a prospective, crossover, randomized, controlled trial, in which a total of 34 healthy volunteers participated in two study phases and took PSHC and NaHCO3 at the maintenance dose, respectively. RESULT The average level of urine pH of PSHC participants in 24 h was significantly higher than that of NaHCO3 (P < 0.001). The urine pH value of participants taking PSHC and NaHCO3 or under physiological conditions showed significant variation in 24 h (P < 0.05) and fitted to a mathematical model (Fourier series). Under physiological conditions, the average urine pH value in the daytime was higher than that in the night, and reached the peak at about 10:00, 16:00, and 22:00. The peak of urine pH at 24 h after taking PSHC and NaHCO3 was both higher than the baseline. The peak time of urine pH and the curve trend were similar, but the peak value in PSHC group was significantly higher than that in NaHCO3 group. CONCLUSIONS There was a circadian rhythm of urine pH value under physiological conditions. PSHC was more effective in urinary alkalization than NaHCO3 at the current maintenance oral dose and administration time without changing the rhythm of urine pH value. CLINICAL TRIAL REGISTRATION NCT04352153.
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Affiliation(s)
- Wen Xue
- Department of Nephrology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Middle Road, Shanghai, 200072, People's Republic of China
| | - Jiafen Cheng
- Department of Nephrology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Middle Road, Shanghai, 200072, People's Republic of China
| | - Jing Zhao
- Department of Nephrology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Middle Road, Shanghai, 200072, People's Republic of China
| | - Ling Wang
- Department of Nephrology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Middle Road, Shanghai, 200072, People's Republic of China
| | - Ai Peng
- Department of Nephrology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Middle Road, Shanghai, 200072, People's Republic of China
| | - Xinying Liu
- Department of Nephrology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Middle Road, Shanghai, 200072, People's Republic of China.
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Karandikar VM, Honda Y, Ishigami J, Lutsey PL, Hall M, Solomon S, Coresh J, Shah A, Matsushita K. Cardiac Valve Disease and Prevalent and Incident CKD in Community-Dwelling Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study. Kidney Med 2022; 4:100559. [PMID: 36483991 PMCID: PMC9722472 DOI: 10.1016/j.xkme.2022.100559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Rationale & Objective Recent literature suggests improvement in kidney function after percutaneous valvular replacement therapies, implying a pathophysiological contribution of valvular heart disease to chronic kidney disease (CKD). However, this association has not been investigated epidemiologically. We aimed to assess the association of valvular abnormality with prevalent and incident CKD. Study Design Cross-sectional and prospective analyses. Setting & Participants Community-dwelling participants (mean age 75.5 [standard deviation 5.1] years) from the Atherosclerosis Risk in Communities study (2011-2013). Exposure Valvular abnormality defined as echocardiography-based aortic stenosis, aortic regurgitation, and mitral regurgitation. Outcomes Prevalent CKD was defined as estimated glomerular filtration rate (eGFR]) <60 mL/min/1.73 m2. Incident CKD was defined as progression to eGFR <60 mL/min/1.73 m2 with ≥25% decline or hospitalization/deaths with CKD diagnosis. Analytical Approach We cross-sectionally evaluated the association between valvular abnormality and prevalent CKD with logistic regression in 5,216 participants. Then, 3,752 participants without prevalent CKD were analyzed for incident CKD using Cox models. Results There were 1.4% (n = 74) with any aortic stenosis, 10.6% (n = 555) with any aortic regurgitation, and 43.1% (n = 2,249) with any mitral regurgitation. After adjustment for potential confounders, any mitral regurgitation and moderate/severe aortic regurgitation showed significant associations with prevalent CKD (adjusted OR, 1.17 [95% CI, 1.03-1.34] and 2.82 [95% CI, 1.12-7.10]), as did any aortic stenosis in a sensitivity analysis with prevalent CKD defined including albuminuria ≥30 mg/g (1.83 [95% CI, 1.10-3.05]). Only any aortic stenosis showed an independent association with incident CKD (adjusted HR, 2.12 [95% CI, 1.13-4.00]). Limitations Despite a relatively large study population, some subgroups had small numbers. Although we minimized reverse causation, we cannot completely rule it out. Conclusions Different valvular abnormality types were associated with prevalent CKD. Only aortic stenosis was robustly associated with incident CKD. These findings suggest an etiological link between valvular abnormality and CKD, highlighting the importance of clinical attention to kidney function in individuals with aortic stenosis.
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Affiliation(s)
- Vedika M. Karandikar
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Yasuyuki Honda
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Junichi Ishigami
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Pamela L. Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Michael Hall
- Department of Medicine-Cardiology, University of Mississippi Medical Center, Jackson, MS
- Mississippi Center for Heart Research, Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, MS
| | - Scott Solomon
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Josef Coresh
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Amil Shah
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Kunihiro Matsushita
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Naude, MTech (Hom) DF. Chronic Sub-Clinical Systemic Metabolic Acidosis - A Review with Implications for Clinical Practice. J Evid Based Integr Med 2022; 27:2515690X221142352. [PMID: 36448194 PMCID: PMC9716591 DOI: 10.1177/2515690x221142352] [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] [Indexed: 12/03/2022] Open
Abstract
When arterial serum pH remains near the lower pH limit of 7.35 for protracted periods of time, a low-grade, sub-clinical form of acidosis results, referred to in this review as chronic, sub-clinical, systemic metabolic acidosis (CSSMA). This narrative review explores the scientific basis for CSSMA, its consequences for health, and potential therapeutic interventions. The major etiology of CSSMA is the shift away from the ancestral, alkaline diet which was rich in fruit and vegetables, toward the contemporary, acidogenic 'Westernized' diet characterized by higher animal protein consumption and lack of base forming minerals. Urine pH is reduced with high dietary acid load and may be a convenient marker of CSSMA. Evidence suggests further that CSSMA negatively influences cortisol levels potentially contributing significantly to the pathophysiology thereof. Both CSSMA and high dietary acid load are associated with the risk and prognosis of various chronic diseases. Clinical trials show that CSSMA can be addressed successfully through alkalizing the diet by increasing fruit and vegetable intake and/or supplementing with alkaline minerals. This review confirms the existence of a significant body of evidence regarding this low-grade form of acidosis as well as evidence to support its diverse negative implications for health, and concludes that CSSMA is a condition warranting further research.
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Affiliation(s)
- David Francis Naude, MTech (Hom)
- Irma Schutte Foundation, Drummond, South Africa,David Francis Naude, Irma Schutte Foundation, 42 Protea Hill Rd, Drummond, KwaZulu Natal, 3626, South Africa. Postal address: P.O Box 8, Hillcrest, KwaZulu Natal, 3650, South Africa.
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25
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Coelho-Júnior HJ, Azzolino D, Calvani R, Gonçalves IDO, Tosato M, Landi F, Cesari M, Picca A, Marzetti E. Lower-Limb Muscle Power Is Negatively Associated with Protein Intake in Older Adults: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14579. [PMID: 36361463 PMCID: PMC9653676 DOI: 10.3390/ijerph192114579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 10/27/2022] [Accepted: 11/02/2022] [Indexed: 06/16/2023]
Abstract
The present study examined the association between lower-limb muscle power and protein-related parameters in older adults. This study followed a cross-sectional design. Participants were community-dwelling older adults. Candidates were considered eligible if they were 60 years or older, lived independently, and possessed sufficient physical and cognitive abilities to perform all the measurements required by the protocol. The 5 times sit-to-stand (5STS) test was performed as fast as possible according to a standard protocol. Absolute, relative, and allometric muscle power measures were estimated using 5STS-based equations. Diet was assessed by 24-h dietary recall and diet composition was estimated using a nutritional software. One-hundred and ninety-seven older adults participated to the present study. After adjustment for covariates, absolute and allometric muscle power were negatively associated with body weight-adjusted protein intake. Our findings indicate that absolute and allometric muscle power estimated through a simple equation are negatively associated with body weight-adjusted protein intake in community-dwelling older adults.
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Affiliation(s)
- Hélio José Coelho-Júnior
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Domenico Azzolino
- Department of Clinical and Community Sciences, University of Milan, 20122 Milan, Italy
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, 20138 Milan, Italy
| | - Riccardo Calvani
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy
| | | | - Matteo Tosato
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Francesco Landi
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy
| | - Matteo Cesari
- Department of Clinical and Community Sciences, University of Milan, 20122 Milan, Italy
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, 20138 Milan, Italy
| | - Anna Picca
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy
- Department of Medicine and Surgery, LUM University, 70100 Casamassima, Italy
| | - Emanuele Marzetti
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy
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26
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Observational and clinical evidence that plant-based nutrition reduces dietary acid load. J Nutr Sci 2022; 11:e93. [PMID: 36405093 PMCID: PMC9641522 DOI: 10.1017/jns.2022.93] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 09/29/2022] [Indexed: 12/14/2022] Open
Abstract
Contemporary diets in Western countries are largely acid-inducing and deficient in potassium alkali salts, resulting in low-grade metabolic acidosis. The chronic consumption of acidogenic diets abundant in animal-based foods (meats, dairy, cheese and eggs) poses a substantial challenge to the human body's buffering capacities and chronic retention of acid wherein the progressive loss of bicarbonate stores can cause cellular and tissue damage. An elevated dietary acid load (DAL) has been associated with systemic inflammation and other adverse metabolic conditions. In this narrative review, we examine DAL quantification methods and index observational and clinical evidence on the role of plant-based diets, chiefly vegetarian and vegan, in reducing DAL. Quantitation of protein and amino acid composition and of intake of alkalising organic potassium salts and magnesium show that plant-based diets are most effective at reducing DAL. Results from clinical studies and recommendations in the form of expert committee opinions suggest that for a number of common illnesses, wherein metabolic acidosis is a contributing factor, the regular inclusion of plant-based foods offers measurable benefits for disease prevention and management. Based on available evidence, dietary shifts toward plant-based nutrition effectively reduces dietary-induced, low-grade metabolic acidosis.
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27
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Storz MA, Ronco AL. Carbohydrate Intake and Its Association With Dietary Acid Load in U.S. Adults: Results From a Cross-Sectional Study. Am J Lifestyle Med 2022. [DOI: 10.1177/15598276221133297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: The safety profile of low-carbohydrate diets is controversial and poorly understood. We investigated the effects of low-moderate carbohydrate intake on dietary acid load (DAL), an emerging health risk factor and novel clinical marker associated with numerous adverse clinical outcomes. Methods: We used data from the National Health and Nutrition Examination Surveys to investigate how low-moderate carbohydrate intake quantitatively affects DAL (as assessed by PRAL and NEAP scores) and to contrast the results to DAL scores in individuals that meet carbohydrate intake recommendations. Results: We analyzed data from 23 825 individuals, of which 4891 consumed a low-moderate carbohydrate diet. Said individuals derived 37.84% of energy from carbohydrates, tended to be male, had a mean BMI of 28.47 kg/m2, and consumed significantly more energy from fat and protein ( P≤.01 for both) than individuals that met carbohydrate recommendations Low-moderate carbohydrate intake was associated with a significantly higher DAL. Mean PRALR, NEAPR, and NEAPF values were 26.12, 71.02, and 68.98 mEq/d, respectively. Multivariate regression revealed the highest DAL scores in individuals on a low-carbohydrate diet, obtaining <26% of energy from carbohydrates. Conclusions: Low-moderate carbohydrate intake is associated with increased DAL scores, which has been repeatedly associated with various health repercussions.
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Affiliation(s)
- Maximilian A. Storz
- Centre for Complementary Medicine, Department of Internal Medicine II, Faculty of Medicine, University of Freiburg, Freiburg, Germany (MAS); Unit of Oncology and Radiotherapy, Pereira Rossell Women’s Hospital, Montevideo, Uruguay (ALR); School of Medicine, CLAEH University, Maldonado, Uruguay (ALR); and Biomedical Sciences Center, University of Montevideo, Montevideo, Uruguay (ALR)
| | - Alvaro L. Ronco
- Centre for Complementary Medicine, Department of Internal Medicine II, Faculty of Medicine, University of Freiburg, Freiburg, Germany (MAS); Unit of Oncology and Radiotherapy, Pereira Rossell Women’s Hospital, Montevideo, Uruguay (ALR); School of Medicine, CLAEH University, Maldonado, Uruguay (ALR); and Biomedical Sciences Center, University of Montevideo, Montevideo, Uruguay (ALR)
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28
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Valle-Hita C, Becerra-Tomás N, Díaz-López A, Vázquez-Ruiz Z, Megías I, Corella D, Goday A, Martínez JA, Alonso-Gómez ÁM, Wärnberg J, Vioque J, Romaguera D, López-Miranda J, Estruch R, Tinahones FJ, Lapetra J, Serra-Majem L, Bueno-Cavanillas A, Tur JA, Martín-Sánchez V, Pintó X, Gaforio JJ, Matía-Martín P, Vidal J, Amengual-Galbarte A, Daimiel L, Ros E, García-Arellano A, Barragán R, Fitó M, Peña-Orihuela PJ, Asencio-Aznar A, Gómez-Gracia E, Martinez-Urbistondo D, Morey M, Casas R, Garrido-Garrido EM, Tojal-Sierra L, Damas-Fuentes M, Goñi E, Ortega-Azorín C, Castañer O, Garcia-Rios A, Gisbert-Sellés C, Sayón-Orea C, Schröder H, Salas-Salvadó J, Babio N. Longitudinal association of dietary acid load with kidney function decline in an older adult population with metabolic syndrome. Front Nutr 2022; 9:986190. [PMID: 36245494 PMCID: PMC9563235 DOI: 10.3389/fnut.2022.986190] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background Diets high in acid load may contribute to kidney function impairment. This study aimed to investigate the association between dietary acid load and 1-year changes in glomerular filtration rate (eGFR) and urine albumin/creatinine ratio (UACR). Methods Older adults with overweight/obesity and metabolic syndrome (mean age 65 ± 5 years, 48% women) from the PREDIMED-Plus study who had available data on eGFR (n = 5,874) or UACR (n = 3,639) at baseline and after 1 year of follow-up were included in this prospective analysis. Dietary acid load was estimated as potential renal acid load (PRAL) and net endogenous acid production (NEAP) at baseline from a food frequency questionnaire. Linear and logistic regression models were fitted to evaluate the associations between baseline tertiles of dietary acid load and kidney function outcomes. One year-changes in eGFR and UACR were set as the primary outcomes. We secondarily assessed ≥ 10% eGFR decline or ≥10% UACR increase. Results After multiple adjustments, individuals in the highest tertile of PRAL or NEAP showed higher one-year changes in eGFR (PRAL, β: -0.64 ml/min/1.73 m2; 95% CI: -1.21 to -0.08 and NEAP, β: -0.56 ml/min/1.73 m2; 95% CI: -1.13 to 0.01) compared to those in the lowest category. No associations with changes in UACR were found. Participants with higher levels of PRAL and NEAP had significantly higher odds of developing ≥10% eGFR decline (PRAL, OR: 1.28; 95% CI: 1.07-1.54 and NEAP, OR: 1.24; 95% CI: 1.03-1.50) and ≥10 % UACR increase (PRAL, OR: 1.23; 95% CI: 1.04-1.46) compared to individuals with lower dietary acid load. Conclusions Higher PRAL and NEAP were associated with worse kidney function after 1 year of follow-up as measured by eGFR and UACR markers in an older Spanish population with overweight/obesity and metabolic syndrome.
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Affiliation(s)
- Cristina Valle-Hita
- Departament de Bioquímica i Biotecnologia, Universitat Rovira i Virgili, Unitat de Nutrició Humana, Reus, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
- Consorcio CIBER (Centro de Investigación Biomédica en Red), Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
| | - Nerea Becerra-Tomás
- Departament de Bioquímica i Biotecnologia, Universitat Rovira i Virgili, Unitat de Nutrició Humana, Reus, Spain
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, St Mary's Campus, London, United Kingdom
| | - Andrés Díaz-López
- Departament de Bioquímica i Biotecnologia, Universitat Rovira i Virgili, Unitat de Nutrició Humana, Reus, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
- Consorcio CIBER (Centro de Investigación Biomédica en Red), Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
- Serra Hunter Programme, Universitat Rovira i Virgili, Nutrition and Mental Health Research Group (NUTRISAM), Reus, Spain
| | - Zenaida Vázquez-Ruiz
- Consorcio CIBER (Centro de Investigación Biomédica en Red), Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Navarra, IdiSNA (Instituto de Investigación Sanitaria de Navarra), Pamplona, Spain
| | - Isabel Megías
- Departament de Bioquímica i Biotecnologia, Universitat Rovira i Virgili, Unitat de Nutrició Humana, Reus, Spain
| | - Dolores Corella
- Consorcio CIBER (Centro de Investigación Biomédica en Red), Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
- Department of Preventive Medicine, University of Valencia, Valencia, Spain
| | - Albert Goday
- Consorcio CIBER (Centro de Investigación Biomédica en Red), Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
- Cardiovascular Risk and Nutrition Research Group (CARIN), Hospital del Mar Research Institute (IMIM), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J. Alfredo Martínez
- Consorcio CIBER (Centro de Investigación Biomédica en Red), Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
- Department of Nutrition, University of Navarra, Food Science and Physiology, IdiSNA (Instituto de Investigación Sanitaria de Navarra), Pamplona, Spain
- Precision Nutrition Program, IMDEA (Institutos Madrileño de Estudios Avanzados) Food, CEI UAM (Comité de Ética para la Investigación-Universidad Autónoma de Madrid) + CSIC (Consejo Superior de Investigaciones Científicas), Madrid, Spain
| | - Ángel M. Alonso-Gómez
- Consorcio CIBER (Centro de Investigación Biomédica en Red), Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
- Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country/Euskal Herriko Unibertsitatea UPV/EHU, Vitoria-Gasteiz, Spain
| | - Julia Wärnberg
- Consorcio CIBER (Centro de Investigación Biomédica en Red), Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
- Department of Nursing, University of Málaga, Institute of Biomedical Research in Malaga (IBIMA), Málaga, Spain
| | - Jesús Vioque
- Instituto de Investigación Sanitaria y Biomédica de Alicante, Miguel Hernandez University (ISABIAL-UMH), Alicante, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Dora Romaguera
- Consorcio CIBER (Centro de Investigación Biomédica en Red), Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
| | - José López-Miranda
- Consorcio CIBER (Centro de Investigación Biomédica en Red), Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
- Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Ramon Estruch
- Consorcio CIBER (Centro de Investigación Biomédica en Red), Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
- Department of Internal Medicine, Institutd'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Francisco J. Tinahones
- Consorcio CIBER (Centro de Investigación Biomédica en Red), Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
- Department of Endocrinology, Virgen de la Victoria Hospital, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain
| | - José Lapetra
- Consorcio CIBER (Centro de Investigación Biomédica en Red), Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
- Department of Family Medicine, Research Unit, Distrito Sanitario Atención Primaria Sevilla, Sevilla, Spain
| | - Lluís Serra-Majem
- Consorcio CIBER (Centro de Investigación Biomédica en Red), Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
- Preventive Medicine Service, Research Institute of Biomedical and Health Sciences (IUIBS), Centro Hospitalario Universitario Insular Materno Infantil (CHUIMI), Canarian Health Service, University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Aurora Bueno-Cavanillas
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Department of Preventive Medicine, University of Granada, Granada, Spain
| | - Josep A. Tur
- Consorcio CIBER (Centro de Investigación Biomédica en Red), Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
- Research Group on Community Nutrition and Oxidative Stress, University of Balearic Islands, Palma de Mallorca, Spain
| | - Vicente Martín-Sánchez
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Institute of Biomedicine (IBIOMED), University of León, León, Spain
| | - Xavier Pintó
- Consorcio CIBER (Centro de Investigación Biomédica en Red), Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
- Lipids and Vascular Risk Unit, Internal Medicine, Hospital Universitario de Bellvitge-IDIBELL (Instituto de Investigación Biomédica de Bellvitge), Hospitalet de Llobregat, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - José J. Gaforio
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Department of Health Sciences, Instituto Universitario de Investigación en Olivar y Aceites de Oliva, University of Jaén, Jaén, Spain
| | - Pilar Matía-Martín
- Department of Endocrinology and Nutrition, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense, Madrid, Spain
| | - Josep Vidal
- Departament of Endocrinology, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Barcelona, Spain
- CIBER Diabetes y Enfermedades Metabólicas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | | | - Lidia Daimiel
- Nutritional Control of the Epigenome Group, IMDEA (Institutos Madrileño de Estudios Avanzados) Food, CEI UAM (Comité de Ética para la Investigación-Universidad Autónoma de Madrid) + CSIC (Consejo Superior de Investigaciones Científicas), Madrid, Spain
| | - Emilio Ros
- Consorcio CIBER (Centro de Investigación Biomédica en Red), Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
- Departament of Endocrinology, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Ana García-Arellano
- Consorcio CIBER (Centro de Investigación Biomédica en Red), Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Navarra, IdiSNA (Instituto de Investigación Sanitaria de Navarra), Pamplona, Spain
- Emergency Department, Hospital Universitario de Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain
| | - Rocío Barragán
- Consorcio CIBER (Centro de Investigación Biomédica en Red), Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
- Department of Preventive Medicine, University of Valencia, Valencia, Spain
| | - Montse Fitó
- Consorcio CIBER (Centro de Investigación Biomédica en Red), Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
- Cardiovascular Risk and Nutrition Research Group (CARIN), Hospital del Mar Research Institute (IMIM), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Patricia J. Peña-Orihuela
- Consorcio CIBER (Centro de Investigación Biomédica en Red), Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
- Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | | | - Enrique Gómez-Gracia
- Department of Preventive Medicine and Public Health, School of Medicine, University of Málaga, Málaga, Spain
- Institute of Biomedical Research in Malaga-IBIMA, Málaga, Spain
| | | | - Marga Morey
- Consorcio CIBER (Centro de Investigación Biomédica en Red), Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
| | - Rosa Casas
- Consorcio CIBER (Centro de Investigación Biomédica en Red), Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
- Department of Internal Medicine, Institutd'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | - Lucas Tojal-Sierra
- Consorcio CIBER (Centro de Investigación Biomédica en Red), Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
- Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country/Euskal Herriko Unibertsitatea UPV/EHU, Vitoria-Gasteiz, Spain
| | - Miguel Damas-Fuentes
- Consorcio CIBER (Centro de Investigación Biomédica en Red), Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
- Department of Endocrinology, Virgen de la Victoria Hospital, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain
| | - Estibaliz Goñi
- Department of Nutrition, University of Navarra, Food Science and Physiology, IdiSNA (Instituto de Investigación Sanitaria de Navarra), Pamplona, Spain
| | - Carolina Ortega-Azorín
- Consorcio CIBER (Centro de Investigación Biomédica en Red), Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
- Department of Preventive Medicine, University of Valencia, Valencia, Spain
| | - Olga Castañer
- Consorcio CIBER (Centro de Investigación Biomédica en Red), Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
- Cardiovascular Risk and Nutrition Research Group (CARIN), Hospital del Mar Research Institute (IMIM), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonio Garcia-Rios
- Consorcio CIBER (Centro de Investigación Biomédica en Red), Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
- Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | | | - Carmen Sayón-Orea
- Consorcio CIBER (Centro de Investigación Biomédica en Red), Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Navarra, IdiSNA (Instituto de Investigación Sanitaria de Navarra), Pamplona, Spain
| | - Helmut Schröder
- Cardiovascular Risk and Nutrition Research Group (CARIN), Hospital del Mar Research Institute (IMIM), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Jordi Salas-Salvadó
- Departament de Bioquímica i Biotecnologia, Universitat Rovira i Virgili, Unitat de Nutrició Humana, Reus, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
- Consorcio CIBER (Centro de Investigación Biomédica en Red), Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
| | - Nancy Babio
- Departament de Bioquímica i Biotecnologia, Universitat Rovira i Virgili, Unitat de Nutrició Humana, Reus, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
- Consorcio CIBER (Centro de Investigación Biomédica en Red), Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
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Abaj F, Esmaeily Z, Naeini Z, Rafiee M, Koohdani F. Dietary acid load modifies the effects of ApoA2-265 T > C polymorphism on lipid profile and serum leptin and ghrelin levels among type 2 diabetic patients. BMC Endocr Disord 2022; 22:190. [PMID: 35883173 PMCID: PMC9316730 DOI: 10.1186/s12902-022-01083-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 06/23/2022] [Indexed: 12/15/2022] Open
Abstract
This investigation with aimed the effect of APOA2-265 T > C polymorphism and dietary acid load (DAL) as either potential renal acid load (PRAL) and net endogenous acid production (NEAP) intake interaction on metabolic markers in type 2 diabetes mellitus (T2DM). In present cross-sectional study, 737 patients with T2DM (290 men and 447 women) were enlisted from diabetes centers in Tehran. The dietary intakes of all participants during the last year was acquired by a validated semi-quantitative food frequency (FFQ) questionnaire. Polymerase chain reaction (PCR) was used for genotyping the APOA2-265 T > C. Biochemical indises containing leptin, ghrelin, total cholesterol (Bailey et al., J Clin Invest 97:1147-1453, 1996), low-density lipoprotein cholestrol (LDL-C), high-density lipoprotein cholestrol (HDL-C), triglyceride (TG), superoxide dismutase (SOD), high sensitivy C-reactive protein (hs-CRP), total antioxidant capacity (TAC), pentraxin-3 (PTX3), prostaglandin F2α (PGF2α) and interleukin 18 (IL18) were measured by standard method. Atherogenic indices (AIP, AC, CR-I, CR-II) were calculated. The gene-diet interactions were evaluated using an GLM. The frequency overall prevalence of rs5082 genotypes was 63.82 and 36.17% for T-allele and C-allele respectively. TG, Ghrelin, and hs-CRP concentrations were significantly higher among carriers with C allele than TT homozygotes. However, TC/CC genotypes have lower PTX3 than TT homozygotes (P < 0.05). C-allele carriers had highest mean of BMI (PNEAP=0.04, PPRAL = 0.006), WC (PNEAP=0.04, PPRAL = 0.04), TC (PNEAP=0.03, PPRAL = 0.01), ghrelin (PNEAP=0.01, PPRAL = 0.04), and leptin (PNEAP=0.04, PPRAL = 0.03) when placed in top tertiles of NEAP and PRAL.BMI, WC, TC, ghrelin, and leptin levels may be modified in C carriers by decreasing DAL, though, further investigations are required to confirm these findings.
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Affiliation(s)
- Faezeh Abaj
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Esmaeily
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Naeini
- Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, PO Box: 141556117, Tehran, Iran
| | - Masoumeh Rafiee
- Department of Clinical Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Fariba Koohdani
- Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, PO Box: 141556117, Tehran, Iran.
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30
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Wesson DE. The Importance of Recognizing and Addressing the Spectrum of Acid Stress. Adv Chronic Kidney Dis 2022; 29:364-372. [PMID: 36175074 DOI: 10.1053/j.ackd.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/01/2022] [Accepted: 06/09/2022] [Indexed: 01/25/2023]
Abstract
Acid accumulation sufficient to reduce plasma bicarbonate concentration, thereby recognized as chronic metabolic acidosis, harms bones and muscles and appears to enhance progression of CKD. Evolving evidence supports that progressive acid accumulation that is not enough to cause chronic metabolic acidosis nevertheless has deleterious effects. Measurable acid retention without reduced plasma bicarbonate concentration, called eubicarbonatemic acidosis, also appears to cause kidney injury and exacerbate CKD progression. Furthermore, chronic engagement of mechanisms to mitigate the ongoing acid challenge of net acid-producing diets of developed societies also appears to be deleterious, including for kidney health. This review challenges clinicians to consider the growing evidence for a spectrum of acid-accumulation disorders that include lesser degrees of acid accumulation than metabolic acidosis yet are harmful. Further research will develop clinically useful tools to identify individuals suffering from these earlier stages of acid stress and determine if the straightforward and comparatively inexpensive intervention of dietary acid reduction relieves or eliminates the harm they appear to cause.
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Affiliation(s)
- Donald E Wesson
- The University of Texas at Austin Dell Medical School, Austin, TX; Donald E Wesson Consulting LLC, Dallas, TX.
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31
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Geng T, Chang X, Wang L, Liu G, Liu J, Khor CC, Neelakantan N, Yuan JM, Koh WP, Pan A, Dorajoo R, Heng CK. The association of genetic susceptibility to smoking with cardiovascular disease mortality and the benefits of adhering to a DASH diet: The Singapore Chinese Health Study. Am J Clin Nutr 2022; 116:386-393. [PMID: 35551603 PMCID: PMC9348979 DOI: 10.1093/ajcn/nqac128] [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: 04/18/2021] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Understanding the genetic predisposition to cardiovascular disease (CVD) may help to improve clinical intervention strategies. Lifestyle factors, such as diet, may differ among ethnic groups and may, in turn, modify individuals' risks to diseases. OBJECTIVES We examined the genetic predisposition to ever smoking in relation to CVD mortality and assessed whether such an association could be modified by dietary intake. METHODS A total of 23,760 Chinese adults from the Singapore Chinese Heath Study who were free of cancer and CVD at recruitment (1993-1998) were included in the study. A weighted genetic risk score (wGRS) was calculated to define the genetically determined regular smoking behavior (never or ever). Multivariable-adjusted Cox regression models were used to assess the association between the wGRS and CVD mortality. We also conducted a 1-sample Mendelian randomization analysis for ever smoking and CVD mortality. RESULTS Over a mean of 22.6 years of follow-up, 2301 CVD deaths were identified. A genetic predisposition to ever smoking was significantly associated with CVD mortality; the multivariable-adjusted HR of CVD mortality was 1.07 (95% CI: 1.03-1.12), with a per-SD increment in the wGRS. However, the Mendelian randomization analysis did not support a causal relationship between ever smoking and CVD mortality (OR, 1.13; 95% CI: 0.87-1.45). Additionally, the Dietary Approaches to Stop Hypertension (DASH) score significantly modified the association between the smoking wGRS and CVD mortality; the association between a genetic predisposition to smoking and CVD mortality was only observed among individuals with a low DASH score (P-interaction = 0.004). CONCLUSIONS A genetic predisposition to smoking was associated with CVD mortality in the Chinese population. In addition, we detected a significant interaction showing higher CVD mortality related to genetically determined smoking among those with lower DASH scores.
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Affiliation(s)
- Tingting Geng
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,Department of Nutrition and Food Hygiene, Ministry of Education Key Lab of Environment and Health and School of Public Health, Tongji Medical College, Huazhong University of Science and Technology Wuhan, China
| | - Xuling Chang
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore,Khoo Teck Puat - National University Children's Medical Institute, National University Health System, Singapore, Singapore
| | - Ling Wang
- Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore, Singapore
| | - Gang Liu
- Department of Nutrition and Food Hygiene, Ministry of Education Key Lab of Environment and Health and School of Public Health, Tongji Medical College, Huazhong University of Science and Technology Wuhan, China
| | - Jianjun Liu
- Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore, Singapore,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chiea Chuen Khor
- Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore, Singapore,Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Nithya Neelakantan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Jian-Min Yuan
- Division of Cancer Control and Population Sciences, University of Pittsburgh Medical Center Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA,Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Woon-Puay Koh
- Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore,Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore, Singapore
| | - An Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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32
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Tariq A, Chen J, Yu B, Boerwinkle E, Coresh J, Grams ME, Rebholz CM. Metabolomics of Dietary Acid Load and Incident Chronic Kidney Disease. J Ren Nutr 2022; 32:292-300. [PMID: 34294549 PMCID: PMC8766597 DOI: 10.1053/j.jrn.2021.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/29/2021] [Accepted: 05/15/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Blood biomarkers of dietary intake are more objective than self-reported dietary intake. Metabolites associated with dietary acid load were previously identified in 2 chronic kidney disease (CKD) populations. We aimed to extend these findings to a general population, replicating their association with dietary acid load, and investigating whether the individual biomarkers were prospectively associated with incident CKD. METHODS Among 15,792 participants in the Atherosclerosis Risk in Communities cohort followed up from 1987 to 1989 (baseline) to 2019, we evaluated 3,844 black and white men and women with dietary and metabolomic data in cross-sectional and prospective analyses. We hypothesized that a higher dietary acid load (using equations for potential renal acid load and net endogenous acid production) was associated with lower serum levels of 12 previously identified metabolites: indolepropionylglycine, indolepropionate, N-methylproline, N-δ-acetylornithine, threonate, oxalate, chiro-inositol, methyl glucopyranoside, stachydrine, catechol sulfate, hippurate, and tartronate. In addition, we hypothesized that lower serum levels of these 12 metabolites were associated with higher risk of incident CKD. RESULTS Eleven out of 12 metabolites were significantly inversely associated with dietary acid load, after adjusting for demographics, socioeconomic status, health behaviors, health status, and estimated glomerular filtration rate: indolepropionylglycine, indolepropionate, N-methylproline, threonate, oxalate, chiro-inositol, catechol sulfate, hippurate, methyl glucopyranoside (α + β), stachydrine, and tartronate. N-methylproline was inversely associated with incident CKD (hazard ratio: 0.95, 95% confidence interval: 0.91, 0.99, P = .01). The metabolomic biomarkers of dietary acid load significantly improved prediction of elevated dietary acid load estimated using dietary data, beyond covariates (difference in C statistics: 0.021-0.077, P ≤ 1.08 × 10-3). CONCLUSION Inverse associations between candidate biomarkers of dietary acid load were replicated in a general population. N-methylproline, representative of citrus fruit consumption, is a promising marker of dietary acid load and could represent an important pathway between dietary acid load and CKD.
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Affiliation(s)
- Anam Tariq
- Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jingsha Chen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Bing Yu
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center at Houston, Houston, Texas
| | - Eric Boerwinkle
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center at Houston, Houston, Texas
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Morgan E Grams
- Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Casey M Rebholz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
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Azim A, Murray J, Beddhu S, Raphael KL. Urinary Sulfate, Kidney Failure, and Death in CKD: The African American Study of Kidney Disease and Hypertension. KIDNEY360 2022; 3:1183-1190. [PMID: 35919537 PMCID: PMC9337883 DOI: 10.34067/kid.0000322022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/26/2022] [Indexed: 01/11/2023]
Abstract
Background Sulfur is an important mineral element whose principal source is animal protein. Animal protein contributes to the daily acid load, which is associated with poor outcomes in individuals with chronic kidney disease (CKD). We hypothesized that higher urinary sulfate, as a reflection of the daily acid load, is associated with a greater risk of death and CKD progression. Methods Urinary sulfate was measured in 1057 African American Study of Kidney Disease and Hypertension (AASK) participants at baseline. Participants were categorized by tertiles of daily sulfate excretion. The longitudinal outcome of interest was the composite of death, dialysis, or 50% reduction in measured glomerular filtration rate (GFR). Multivariable adjusted Cox regression models were fit to relate the composite outcome to daily sulfate excretion using the lowest tertile as the reference. Results Participants in the highest urinary sulfate tertile were more likely to be men and have a higher body mass index, protein intake, measured GFR, and urinary ammonium and phosphate excretion, and lower urinary protein/creatinine. Compared with those in the lowest tertile of sulfate, those in the highest tertile had a 44% lower hazard (95% CI, 0.37 to 0.84), and those in the middle tertile had a 27% lower hazard (95% CI, 0.55 to 0.96) of death, dialysis, or 50% reduction in measured GFR during follow-up after adjusting for demographics, GFR, protein intake, and other potential confounders. Protein intake was not associated with risk of these events. Conclusions Higher urinary sulfate excretion is associated with more favorable outcomes in Blacks who have CKD attributed to hypertension.
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Affiliation(s)
- Aniqa Azim
- Department of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Jennifer Murray
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Srinivasan Beddhu
- Department of Internal Medicine, University of Utah Health, Salt Lake City, Utah
| | - Kalani L. Raphael
- Department of Medicine, Oregon Health and Science University, Portland, Oregon,Division of Hospital and Specialty Medicine, VA Portland Health Care System, Portland, Oregon
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Mottl AK, Alicic R, Argyropoulos C, Brosius FC, Mauer M, Molitch M, Nelson RG, Perreault L, Nicholas SB. KDOQI US Commentary on the KDIGO 2020 Clinical Practice Guideline for Diabetes Management in CKD. Am J Kidney Dis 2022; 79:457-479. [PMID: 35144840 PMCID: PMC9740752 DOI: 10.1053/j.ajkd.2021.09.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 12/14/2022]
Abstract
In October 2020, KDIGO (Kidney Disease: Improving Global Outcomes) published its first clinical practice guideline directed specifically to the care of patients with diabetes and chronic kidney disease (CKD). This commentary presents the views of the KDOQI (Kidney Disease Outcomes Quality Initiative) work group for diabetes in CKD, convened by the National Kidney Foundation to provide an independent expert perspective on the new guideline. The KDOQI work group believes that the KDIGO guideline takes a major step forward in clarifying glycemic targets and use of specific antihyperglycemic agents in diabetes and CKD. The purpose of this commentary is to carry forward the conversation regarding optimization of care for patients with diabetes and CKD. Recent developments for prevention of CKD progression and cardiovascular events in people with diabetes and CKD, particularly related to sodium/glucose cotransporter 2 (SGLT2) inhibitors, have filled a longstanding gap in nephrology's approach to the care of persons with diabetes and CKD. The multifaceted benefits of SGLT2 inhibitors have facilitated interactions between nephrology, cardiology, endocrinology, and primary care, underscoring the need for innovative approaches to multidisciplinary care in these patients. We now have more interventions to slow kidney disease progression and prevent or delay kidney failure in patients with diabetes and kidney disease, but methods to streamline their implementation and overcome barriers in access to care, particularly cost, are essential to ensuring all patients may benefit.
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Associations between dietary patterns and stages of chronic kidney disease. BMC Nephrol 2022; 23:115. [PMID: 35317735 PMCID: PMC8939097 DOI: 10.1186/s12882-022-02739-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 03/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies have revealed that patients with chronic kidney disease (CKD) have dietary patterns different from those of the general population. However, no studies have compared the dietary patterns of between patients with early-stages (stages 1-3a) and late-stages (stages 3b-5) of CKD. Our objective was to investigate the associations between dietary patterns in early and late-stage CKD. METHODS We analyzed 4480 participants with CKD at various stages based on the data recorded between 2007 and 2016 from the database of the American National Health and Nutrition Examination Survey. RESULTS In total, 3683 and 797 participants had early and late-stage CKD, respectively. Through principal components analysis, the dietary intake dimension was reduced from 63 variables to 3 dietary patterns. We adopted logistic regression for analysis. The three dietary patterns are as follows: (1) saturated fatty acids and mono-unsaturated fatty acids (MUFA); (2) vitamins and minerals; and (3) cholesterols and polyunsaturated fatty acids (PUFA). These 3 patterns explained > 50% of dietary nutrient intake. Results indicated that among participants with dietary patterns 2 (vitamins and minerals) and 3 (cholesterols and PUFA), those with low intakes were more likely to have late-stage CKD. The odds ratios for patterns 2 and 3 were 1.74 (95% CI: 1.21-2.50) and 1.66 (95% CI: 1.13-2.43), respectively. CONCLUSIONS This study revealed that intakes of vitamins and minerals and cholesterols and PUFA were associated with the stages of CKD.
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Tantisattamo E, Kalantar-Zadeh K, Molnar MZ. Nutritional and dietary interventions to prolong renal allograft survival after kidney transplantation. Curr Opin Nephrol Hypertens 2022; 31:6-17. [PMID: 34750333 DOI: 10.1097/mnh.0000000000000757] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Diet plays an important role in slowing progression of chronic kidney disease in native and transplanted kidneys. There is limited evidence on the association on dietary intake with renal allograft function. Mechanisms of major nutrients and dietary patterns with focusing on a plant-based diet related to kidney transplant health and longevity are reviewed. RECENT FINDINGS High dietary protein intake may adversely affect renal allograft. Low protein plant-focused diets such as Dietary Approaches to Stop Hypertension, plant-dominant low-protein diet and Mediterranean diets appear associated with favorable outcomes in slowing renal allograft function decline. The mechanism may be related to a change in renal hemodynamic by decreasing glomerular hyperfiltration from low dietary protein intake and plant-based ingredients. Recent observational studies of association between dietary protein intake and kidney allograft outcomes are conflicting. Although strong evidence is still lacking, a low protein diet of 0.6-0.8 g/kg/day with at least 50% of the protein source from plant-based components in kidney transplant recipients with stable kidney allograft function should be considered as the dietary target. SUMMARY Dietary intervention with low-protein plant-focused meals may improve outcomes in kidney transplant recipients, but the evidence remains limited and further studies are warranted.
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Affiliation(s)
- Ekamol Tantisattamo
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange.,Nephrology Section, Department of Medicine, Tibor Rubin Veterans Affairs Medical Center, Veterans Affairs Long Beach Healthcare System, Long Beach, California.,Multi-Organ Transplant Center, Section of Nephrology, Department of Internal Medicine, William Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange.,Nephrology Section, Department of Medicine, Tibor Rubin Veterans Affairs Medical Center, Veterans Affairs Long Beach Healthcare System, Long Beach, California.,Lundquist Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Miklos Z Molnar
- Division of Nephrology and Hypertension, Department of Medicine, University of Utah, Utah, USA
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Mirmiran P, Ramezan M, Farhadnejad H, Asghari G, Tahmasebinejad Z, Azizi F. High Dietary Diabetes Risk Reduction Score Is Associated with Decreased Risk of Chronic Kidney Disease in Tehranian Adults. Int J Clin Pract 2022; 2022:5745297. [PMID: 35685521 PMCID: PMC9159201 DOI: 10.1155/2022/5745297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/29/2021] [Accepted: 01/18/2022] [Indexed: 11/21/2022] Open
Abstract
AIM In the current study, we examined the association of dietary diabetes risk reduction score (DDRRS) with chronic kidney disease (CKD) among an Iranian adult population. METHODS We followed up 2076 ≥20-year-old participants of the Tehran Lipid and Glucose Study (2006-2008), who were initially free of CKD for 5.98 years. The dietary diabetes risk reduction score was calculated based on scoring eight components, including cereal fiber, nuts, coffee, polyunsaturated fatty acids-to-saturated fatty acids ratio, glycemic index, sugar-sweetened beverages, trans fatty acids, and red and processed meat using a valid and reliable 168-item food frequency questionnaire. CKD was defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. A Cox proportional hazard regression model was used to assess the association between the quartiles of DDRRS and CKD incidence. RESULTS Mean ± SD age of the study population (53% women) was 37.6 ± 12.61 years. During 5.98 years of follow-up, 357 incident cases of CKD were reported. The median (25-75 interquartile range) of DDRRS was 20 (18-22). After adjustment for age, sex, smoking status, total energy intake, body mass index, hypertension, diabetes, eGFR, and physical activity, individuals in the highest versus lowest quartile of DDRRS were 33% less likely to have CKD (HR: 0.67; 95% CI: 0.48-0.96, P for trend: 0.043). CONCLUSION The present study's findings suggest that greater adherence to a dietary pattern with a higher score of DDRRS may be associated with a lower risk of CKD incident.
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Affiliation(s)
- Parvin Mirmiran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marjan Ramezan
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti 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
| | - Golaleh Asghari
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zhaleh Tahmasebinejad
- Department of Epidemiology and Biostatistics, 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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Lim CC, He F, Li J, Tham YC, Tan CS, Cheng CY, Wong TY, Sabanayagam C. Application of machine learning techniques to understand ethnic differences and risk factors for incident chronic kidney disease in Asians. BMJ Open Diabetes Res Care 2021; 9:9/2/e002364. [PMID: 34952839 PMCID: PMC8710867 DOI: 10.1136/bmjdrc-2021-002364] [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: 05/03/2021] [Accepted: 11/14/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) is increasing in Asia, but there are sparse data on incident CKD among different ethnic groups. We aimed to describe the incidence and risk factors associated with CKD in the three major ethnic groups in Asia: Chinese, Malays and Indians. RESEARCH DESIGN AND METHODS Prospective cohort study of 5580 general population participants age 40-80 years (2234 Chinese, 1474 Malays and 1872 Indians) who completed both baseline and 6-year follow-up visits. Incident CKD was defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 in those free of CKD at baseline. RESULTS The 6-year incidence of CKD was highest among Malays (10.0%), followed by Chinese (6.1%) and Indians (5.8%). Logistic regression showed that older age, diabetes, higher systolic blood pressure and lower eGFR were independently associated with incident CKD in all three ethnic groups, while hypertension and cardiovascular disease were independently associated with incident CKD only in Malays. The same factors were identified by machine learning approaches, gradient boosted machine and random forest to be the most important for incident CKD. Adjustment for clinical and socioeconomic factors reduced the excess incidence in Malays by 60% compared with Chinese but only 13% compared with Indians. CONCLUSION Incidence of CKD is high among the main Asian ethnic groups in Singapore, ranging between 6% and 10% over 6 years; differences were partially explained by clinical and socioeconomic factors.
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Affiliation(s)
| | - Feng He
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Jialiang Li
- Department of Statistics and Applied Probability, National University of Singapore, Singapore
| | - Yih Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Chieh Suai Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Tien-Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Cai XY, Zhang NH, Cheng YC, Ge SW, Xu G. Sugar-sweetened beverage consumption and mortality of chronic kidney disease: results from the US National Health and Nutrition Examination Survey, 1999–2014. Clin Kidney J 2021; 15:718-726. [PMID: 35371462 PMCID: PMC8967538 DOI: 10.1093/ckj/sfab227] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Indexed: 11/25/2022] Open
Abstract
Background The relationship between intake of sugar-sweetened beverages (SSBs) and the risk of death in patients with chronic kidney disease (CKD) is unclear. We evaluated the association between SSB intake and subsequent overall mortality in CKD patients. Methods We included data from 3996 CKD patients who participated in the 1999–2014 National Health and Nutrition Examination Survey (NHANES). SSB intake was assessed by a 24-h dietary recall, grouped as none, >0 to <1 serving/day, 1 to <2 servings/day and ≥2 servings/day. After adjusting for demographic variables, lifestyle, diet and comorbidities, Cox proportional risk regressions were applied to analyze the associations between the daily intake of SSBs as well as added sugar from beverages and all-cause mortality. Results In the whole research population, the median age at baseline was 67 years, 22% were Black and 54% were female. A total of 42% had stage 3 CKD. During an average follow-up period of 8.3 years, a sum of 1137 (28%) deaths from all causes was recorded. The confounder-adjusted risk of mortality was associated with an increase of 1 serving/day of SSBs, with all-cause mortality of 1.18 [95% confidence interval (95% CI)1.08–1.28], and intakes of increased 20-g added sugar/1000 kcal of total energy per day were associated with all-cause mortality of 1.14 (1.05–1.24). Equivalently substituting 1 serving/day of SSBs with unsweetened coffee [HR (95% CI) 0.82 (0.74–0.91)], unsweetened tea [HR (95% CI) 0.86 (0.76–0.98)], plain water [HR (95% CI) 0.79 (0.71–0.88)], or non- or low-fat milk [HR (95% CI) 0.75 (0.60–0.93)] were related to a 14–25% reduced risk of all-cause mortality. Conclusion Findings suggest that in the CKD population, increased SSB intake was associated with a higher risk of mortality and indicated a stratified association with dose. Plain water and unsweetened coffee/tea might be possible alternatives for SSBs to avert untimely deaths.
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Affiliation(s)
- Xiao-Yu Cai
- Division of Internal Medicine, Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Nan-Hui Zhang
- Department of Nephrology, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei Province, China
| | - Yi-Chun Cheng
- Division of Internal Medicine, Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shu-Wang Ge
- Division of Internal Medicine, Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gang Xu
- Division of Internal Medicine, Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Adamczak M, Surma S. Metabolic Acidosis in Patients with CKD: Epidemiology, Pathogenesis, and Treatment. KIDNEY DISEASES (BASEL, SWITZERLAND) 2021; 7:452-467. [PMID: 34901192 DOI: 10.1159/000516371] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/02/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Metabolic acidosis in CKD is diagnosed in patients with plasma or venous blood bicarbonate concentration lower than 22 mmol/L. Metabolic acidosis occurs in about 20% of patients with CKD. Metabolic acidosis may lead to dysfunction of many systems and organs as well as CKD progression. Currently, sodium bicarbonate is mainly used for pharmacological treatment of metabolic acidosis in patients with CKD. Veverimer is a new drug dedicated to treatment of metabolic acidosis in patients with CKD. Orally given veverimer binds hydrogen ions in the intestines and subsequently is excreted from the body with feces. Clinical studies have shown that veverimer is effective in increasing serum bicarbonate concentrations in CKD patients with metabolic acidosis. Here, we present review of the epidemiology, pathogenesis, diagnosis, treatment, and prevention of metabolic acidosis in CKD patients. SUMMARY Metabolic acidosis is common in patients with CKD and contributes to CKD progression and many complications, which worsen the prognosis in these patients. Currently, sodium bicarbonate is mainly used in metabolic acidosis treatment. The role of the new drug veverimer in the metabolic acidosis therapy needs further studies. KEY MESSAGE The aim of this review article is to summarize the current knowledge concerning the epidemiology, pathogenesis, diagnosis, treatment, and prevention of metabolic acidosis in CKD patients.
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Affiliation(s)
- Marcin Adamczak
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia in Katowice, Katowice, Poland
| | - Stanisław Surma
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia in Katowice, Katowice, Poland
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Ozaki S, Yamamoto R, Shinzawa M, Tomi R, Yoshimura R, Nakanishi K, Nishida M, Nagatomo I, Kudo T, Yamauchi-Takihara K, Isaka Y, Moriyama T. Vegetable Preference and Prediction of Proteinuria: A Retrospective Cohort Study. ANNALS OF NUTRITION AND METABOLISM 2021; 77:337-343. [PMID: 34700317 DOI: 10.1159/000520044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 10/02/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Little information is available about the association between vegetable preference and chronic kidney disease. METHODS This retrospective cohort study included 10,819 university workers in Japan who underwent their annual health checkups between January 2005 and March 2013. According to a question "Do you like vegetables"? with 3 possible answers of "I like vegetables," "I like vegetables somewhat," or "I dislike vegetables," 2,831, 2,249, and 104 male workers and 3,902, 1,648, and 85 female workers were classified into the "like," "somewhat," and "dislike" groups, respectively. An association between vegetable preference and incidence of proteinuria (dipstick urinary protein ≥1+) was assessed using Cox proportional-hazards models adjusted for clinically relevant factors. RESULTS During the median observational period of 5.0 years, the incidence of proteinuria was observed in 650 (12.7%) male and 789 (14.1%) female workers. Among male workers, the "dislike" group had a significantly higher risk of proteinuria (multivariable-adjusted hazard ratio of "like," "somewhat," and "dislike" groups: 1.00 [reference], 1.05 [0.90-1.23], and 1.59 [1.01-2.50], respectively). Among female workers, vegetable preference was associated with the incidence of proteinuria in a dose-dependent manner (1.00 [reference], 1.20 [1.04-1.40], 1.95 [1.26-3.02], respectively). CONCLUSION "Do you like vegetables"? was a clinically useful tool to identify subjects vulnerable to proteinuria.
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Affiliation(s)
- Shingo Ozaki
- Department of Nephrology, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Ryohei Yamamoto
- Department of Nephrology, Graduate School of Medicine, Osaka University, Suita, Japan.,Health and Counseling Center, Osaka University, Toyonaka, Japan.,Health Promotion and Regulation, Department of Health Promotion Medicine, Osaka University Graduate School of Medicine, Toyonaka, Japan
| | - Maki Shinzawa
- Department of Nephrology, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Ryohei Tomi
- Department of Nephrology, Graduate School of Medicine, Osaka University, Suita, Japan
| | | | - Kaori Nakanishi
- Health and Counseling Center, Osaka University, Toyonaka, Japan
| | - Makoto Nishida
- Health and Counseling Center, Osaka University, Toyonaka, Japan
| | - Izumi Nagatomo
- Health and Counseling Center, Osaka University, Toyonaka, Japan
| | - Takashi Kudo
- Health and Counseling Center, Osaka University, Toyonaka, Japan
| | | | - Yoshitaka Isaka
- Department of Nephrology, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Toshiki Moriyama
- Department of Nephrology, Graduate School of Medicine, Osaka University, Suita, Japan.,Health and Counseling Center, Osaka University, Toyonaka, Japan.,Health Promotion and Regulation, Department of Health Promotion Medicine, Osaka University Graduate School of Medicine, Toyonaka, Japan
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Melekoglu E, Samur FG. Dietary strategies for gut-derived protein-bound uremic toxins and cardio-metabolic risk factors in chronic kidney disease: A focus on dietary fibers. Crit Rev Food Sci Nutr 2021:1-15. [PMID: 34704501 DOI: 10.1080/10408398.2021.1996331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Chronic kidney disease (CKD) is associated with altered composition and function of gut microbiota. The cause of gut dysbiosis in CKD is multifactorial and encompasses the following: uremic state, metabolic acidosis, slow colonic transit, dietary restrictions of plant-based fiber-rich foods, and pharmacological therapies. Dietary restriction of potassium-rich fruits and vegetables, which are common sources of fermentable dietary fibers, inhibits the conversion of dietary fibers to short-chain fatty acids (SCFA), which are the primary nutrient source for the symbiotic gut microbiota. Reduced consumption of fermentable dietary fibers limits the population of SCFA-forming bacteria and causes dysbiosis of gut microbiota. Gut dysbiosis induces colonic fermentation of protein and formation of gut-derived uremic toxins. In this review, we discuss the roles and benefits of dietary fiber on gut-derived protein-bound uremic toxins and plant-based dietary patterns that could be recommended to decrease uremic toxin formation in CKD patients. Recent studies have indicated that dietary fiber supplementation may be useful to decrease gut-derived uremic toxin formation and slow CKD progression. However, research on associations between adherence of healthy dietary patterns and gut-derived uremic toxins formation in patients with CKD is lacking.
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Affiliation(s)
- Ebru Melekoglu
- Faculty of Health Sciences, Nutrition and Dietetics Department, Hacettepe University, Ankara, Turkey.,Faculty of Health Sciences, Nutrition and Dietetics Department, Cukurova University, Adana, Turkey
| | - F Gulhan Samur
- Faculty of Health Sciences, Nutrition and Dietetics Department, Hacettepe University, Ankara, Turkey
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Khor BH, Tallman DA, Karupaiah T, Khosla P, Chan M, Kopple JD. Nutritional Adequacy of Animal-Based and Plant-Based Asian Diets for Chronic Kidney Disease Patients: A Modeling Study. Nutrients 2021; 13:3341. [PMID: 34684342 PMCID: PMC8541170 DOI: 10.3390/nu13103341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/21/2021] [Accepted: 09/21/2021] [Indexed: 12/12/2022] Open
Abstract
Plant-based low protein diets (LPDs) have gained popularity for managing chronic kidney disease (CKD) patients. The nutritional adequacy of these and other LPDs prescribed for CKD patients have not been carefully examined. This study assessed the nutrient composition of such LPDs and moderately high protein diets (MHPDs) that might be prescribed for patients in the Asia Pacific region with CKD who are not dialyzed or undergoing maintenance dialysis. Conventional diets containing at least 50% animal-based proteins and plant-based diets were also planned with protein prescriptions of 0.5 to 0.8 g/kg/day and MHPDs with protein prescriptions of 1.0 to 1.2 g/kg/day. Plant-based, lacto-, ovo-, and lacto-ovo-vegetarian and vegan LPDs and MHPDs were planned by replacing some or all of the animal proteins from the conventional diet. With 0.5 g protein/kg/day, all diets were below the Recommended Dietary Allowances (RDA) for at least one essential amino acid (EAA). At a protein prescription of 0.6 g/kg/day, only the conventional LPD met the RDA for all EAAs. This deficiency with the plant-based LPDs persisted even with several plant food substitutions. With a protein prescription ≥0.7 g/kg/day, all the plant-based and vegetarian LPDs provided the RDA for all EAA. The plant-based and vegetarian diets also contained relatively greater potassium, phosphorus, and calcium content but lower long-chain n-3 polyunsaturated fatty acids and vitamin B-12 than the conventional diet. Other essential micronutrients were commonly below the RDA even at higher protein intakes. The low contents of some essential micronutrients were found in both animal-based and plant-based diets. Prescription of all LPDs for CKD patients, especially plant-based and vegetarian LPDs, requires careful planning to ensure the adequacy of all nutrients, particularly essential amino acids. Consideration should be given to supplementing all animal-based and plant-based LPDs and MHPDs with multivitamins and certain trace elements.
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Affiliation(s)
- Ban-Hock Khor
- Faculty of Food Science and Nutrition, Universiti Malaysia Sabah, Kota Kinabalu 56000, Sabah, Malaysia;
| | - Dina A. Tallman
- Department of Nutrition and Food Science, Wayne State University, Detroit, MI 48202, USA; (D.A.T.); (P.K.)
- US Food and Drug Administration, Detroit, MI 48207, USA
| | - Tilakavati Karupaiah
- School of Biosciences, Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya 47500, Selangor, Malaysia;
| | - Pramod Khosla
- Department of Nutrition and Food Science, Wayne State University, Detroit, MI 48202, USA; (D.A.T.); (P.K.)
| | - Maria Chan
- Departments of Renal Medicine and Nutrition and Dietetics, The St. George Hospital, Kogarah, NSW 2217, Australia;
| | - Joel D. Kopple
- Harbor-UCLA Medical Center, The Lundquist Institute, Torrance, CA 90502, USA
- David Geffen School of Medicine at UCLA and UCLA Fielding School of Public Health, Los Angeles, CA 90095, USA
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Müller A, Zimmermann-Klemd AM, Lederer AK, Hannibal L, Kowarschik S, Huber R, Storz MA. A Vegan Diet Is Associated with a Significant Reduction in Dietary Acid Load: Post Hoc Analysis of a Randomized Controlled Trial in Healthy Individuals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18199998. [PMID: 34639299 PMCID: PMC8507786 DOI: 10.3390/ijerph18199998] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/15/2021] [Accepted: 09/17/2021] [Indexed: 12/19/2022]
Abstract
The composition of diet strongly affects acid–base homeostasis. Western diets abundant in acidogenic foods (meat and cheese) and deficient in alkalizing foods (fruits and vegetables) increase dietary acid load (DAL). A high DAL has been associated with numerous health repercussions, including cardiovascular disease and type-2-diabetes. Plant-based diets have been associated with a lower DAL; however, the number of trials exploring this association is limited. This randomized-controlled trial sought to examine whether an isocaloric vegan diet lowers DAL as compared to a meat-rich diet. Forty-five omnivorous individuals were randomly assigned to a vegan diet (n = 23) or a meat-rich diet (n = 22) for 4 weeks. DAL was determined using potential renal acid load (PRAL) and net endogenous acid production (NEAP) scores at baseline and after 3 and 4 weeks, respectively. After 3 weeks, median PRAL (−23.57 (23.87)) and mean NEAPR (12.85 ± 19.71) scores were significantly lower in the vegan group than in the meat-rich group (PRAL: 18.78 (21.04) and NEAPR: 60.93 ± 15.51, respectively). Effects were mediated by a lower phosphorus and protein intake in the vegan group. Our study suggests that a vegan diet is a potential means to reduce DAL, whereas a meat-rich diet substantially increases the DAL burden.
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Affiliation(s)
- Alexander Müller
- Centre for Complementary Medicine, Department of Internal Medicine II, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (A.M.); (A.M.Z.-K.); (A.-K.L.); (S.K.); (R.H.)
| | - Amy Marisa Zimmermann-Klemd
- Centre for Complementary Medicine, Department of Internal Medicine II, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (A.M.); (A.M.Z.-K.); (A.-K.L.); (S.K.); (R.H.)
| | - Ann-Kathrin Lederer
- Centre for Complementary Medicine, Department of Internal Medicine II, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (A.M.); (A.M.Z.-K.); (A.-K.L.); (S.K.); (R.H.)
| | - Luciana Hannibal
- Medical Center, Laboratory of Clinical Biochemistry and Metabolism, Department of General Pediatrics, Adolescent Medicine and Neonatology, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany;
| | - Stefanie Kowarschik
- Centre for Complementary Medicine, Department of Internal Medicine II, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (A.M.); (A.M.Z.-K.); (A.-K.L.); (S.K.); (R.H.)
| | - Roman Huber
- Centre for Complementary Medicine, Department of Internal Medicine II, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (A.M.); (A.M.Z.-K.); (A.-K.L.); (S.K.); (R.H.)
| | - Maximilian Andreas Storz
- Centre for Complementary Medicine, Department of Internal Medicine II, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (A.M.); (A.M.Z.-K.); (A.-K.L.); (S.K.); (R.H.)
- Correspondence:
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Cai Q, Dekker LH, Vinke PC, Corpeleijn E, Bakker SJL, de Borst MH, Navis GJ. Diet quality and incident chronic kidney disease in the general population: The Lifelines Cohort Study. Clin Nutr 2021; 40:5099-5105. [PMID: 34461583 DOI: 10.1016/j.clnu.2021.07.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/17/2021] [Accepted: 07/29/2021] [Indexed: 11/29/2022]
Abstract
RATIONALE & AIMS Healthy dietary patterns have been associated with a lower risk of chronic kidney disease (CKD). We aimed to investigate the association of a fully food-based diet quality score assessed by the Lifelines Diet Score (LLDS) with either incident CKD or eGFR decline in the general population. METHODS For this study, data from a prospective general population-based Lifelines cohort in the Northern Netherlands was used. Diet was assessed with a 110-item food frequency questionnaire at baseline. The LLDS, based on international evidence for diet-disease relations at the food group level, was calculated to assess diet quality. For the analysis, the score was divided into tertiles. Logistic regression was performed to evaluate the association of the LLDS at baseline with either incident CKD (eGFR <60 mL/min/1.73 m2) or a ≥20% eGFR decline at the second study visit, adjusted for relevant confounders. RESULTS A total of 78 346 participants free of CKD at baseline were included. During a mean (SD) follow-up of 3.6 ± 0.9 years, 2071 (2.6%) participants developed CKD and 7611 (9.7%) had a ≥20% eGFR decline. Participants in the highest tertile of LLDS had a lower risk of incident CKD (fully adjusted OR 0.83, [95% CI: 0.72-0.96]) and ≥20% eGFR decline (fully adjusted OR 0.80, [95% CI: 0.75-0.86]), compared with those in the lowest tertile. Similar dose-response associations were observed in continuous LLDS. CONCLUSIONS Higher adherence to a high-quality diet was associated with a lower risk of incident CKD or ≥20% eGFR decline in the general population.
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Affiliation(s)
- Qingqing Cai
- Department of Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - Louise H Dekker
- Department of Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Petra C Vinke
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Eva Corpeleijn
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Stephan J L Bakker
- Department of Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Martin H de Borst
- Department of Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Gerjan J Navis
- Department of Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Fatahi S, Qorbani M, J. Surkan P, Azadbakht L. Associations between dietary acid load and obesity among Iranian women. J Cardiovasc Thorac Res 2021; 13:285-297. [PMID: 35047133 PMCID: PMC8749368 DOI: 10.34172/jcvtr.2021.44] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 07/07/2021] [Accepted: 07/18/2021] [Indexed: 01/29/2023] Open
Abstract
Introduction: Diet-induced acid load may be associated with overweight and obesity as well as with diet quality. We aimed to study how dietary acid load is associated with overweight, obesity and diet quality indices in healthy women.
Methods: We randomly selected 306 healthy 20 to 55 year-old women from health centers affiliated with Tehran University of Medical Science. They were enrolled in a cross-sectional study between June2016 and March 2017. Potential renal acid load (PRAL), net endogenous acid production (NEAP) and dietary acid load (DAL) were calculated for each person. Dietary quality index international (DQI-I),mean adequacy ratio (MAR), and energy density (ED) were estimated. Anthropometry was measured using standard protocols. Nutritional data were obtained from food frequency questionnaires (FFQ). We used multivariable logistic regression models to assess dietary acid load indices in relation to overweight, obesity and abdominal adiposity.
Results: Participants had a mean age of 32.4 years. The number and percentage of women who were overweight, obese and who had abdominal obesity were 94(30.7), 38(12.4) and 126(41.2), respectively.The odds of obesity (adjusted odds ratio; Adj. OR = 2.41, 95% confidence interval; CI:1.01-5.74,P = 0.045) and abdominal adiposity (Adj. OR = 2.4, 95% CI:1.34-4.60, P = 0.004) increased significantly with tertile of DAL. Other dietary acid load indices (PRAL and NEAP) showed no significant association with obesity, overweight or abdominal obesity. As dietary acid load scores (PRAL, NEAP and DAL)increased, DQI-I and MAR significantly decreased whereas ED significantly increased across tertilesof dietary acid load indices (P < 0.001).
Conclusion: Dietary acid load is associated with obesity and abdominal obesity and is also considered an indicator of diet quality.
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Affiliation(s)
- Somaye Fatahi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
- Pediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children’s Health, Shahid Beheshti University of Medical sciences, Tehran, Iran
| | - Mostafa Qorbani
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Pamela J. Surkan
- Department of International Health John Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Leila Azadbakht
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
Acid-related injury from chronic metabolic acidosis is recognized through growing evidence of its deleterious effects, including kidney and other organ injury. Progressive acid accumulation precedes the signature manifestation of chronic metabolic acidosis, decreased plasma bicarbonate concentration. Acid accumulation that is not enough to manifest as metabolic acidosis, known as eubicarbonatemic acidosis, also appears to cause kidney injury, with exacerbated progression of CKD. Chronic engagement of mechanisms to mitigate the acid challenge from Western-type diets also appears to cause kidney injury. Rather than considering chronic metabolic acidosis as the only acid-related condition requiring intervention to reduce kidney injury, this review supports consideration of acid-related injury as a continuum. This "acid stress" continuum has chronic metabolic acidosis at its most extreme end, and high-acid-producing diets at its less extreme, yet detrimental, end.
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Affiliation(s)
- Donald E. Wesson
- Department of Internal Medicine, Texas A&M Health Science Center College of Medicine, Dallas, Texas
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Palo SK, Swain S, Chowdhury S, Pati S. Epidemiology & attributing factors for chronic kidney disease: Finding from a case-control study in Odisha, India. Indian J Med Res 2021; 154:90-98. [PMID: 34782534 PMCID: PMC8715704 DOI: 10.4103/ijmr.ijmr_2148_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Indexed: 11/04/2022] Open
Abstract
Background & objectives Chronic kidney disease (CKD) is one of the leading causes of mortality in developing countries, however, evidence from some geographical areas of India is scantly available on its risk factors. Other than diabetes and hypertension, several personal and environmental factors are also associated with CKD. Methods A population-based case-control study was conducted over a period of 12 months in two high CKD reporting districts of Odisha, India. A total of 236 participants, 1:2 age- and sex-matched cases (83):controls (153), were included. Various factors were modelled with univariate and multivariable conditional logistic regression and analyzed using the Bayesian method in STATA SE v.12. Results Among the study cases, about 81 per cent were male and about 25 per cent were aged <40 yr. CKD-associated risk factors were hypertension for more than five years [adjusted odds ratio (aOR)=4.24; 95% credible interval: 1.23-10.05], scheduled tribe/caste (aOR=2.81; 1.09-5.95), use of tube well/bore well water for drinking (aOR=1.21; 1.02-1.43), consumption of locally made alcohol (aOR=1.09; 1.02-1.17) and eating red meat and vegetarian diet with (aOR=1.24; 1.12-1.39) and (aOR=1.09; 1.04-1.14), respectively. Interpretation & conclusions The presence of CKD among younger age groups and association of multiple factors including personal and environmental suggest for more research to establish the cause and effect relation of these factors.
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Affiliation(s)
- Subrata Kumar Palo
- ICMR-Regional Medical Research Center (RMRC), Bhubaneswar, Odisha, India
| | - Subhasisha Swain
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Sanghamitra Pati
- ICMR-Regional Medical Research Center (RMRC), Bhubaneswar, Odisha, India
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49
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Abstract
BACKGROUND/OBJECTIVES Western diet is characterized by a high acid load that could generate various degrees of metabolic acidosis, of which at least the stronger forms are known to contribute to the progression of chronic kidney disease (CKD). The aim of this study was to estimate the potential renal acid load (PRAL) and acid base status in CKD patients attended at the Children's Hospital J.M. de los Ríos in Caracas, Venezuela from April 2015 to February 2016. SUBJECTS/METHODS Twenty-seven children with CKD were included. Diet composition was evaluated by a food frequency questionnaire and a 24-h intake reminder. PRAL was calculated by the Remer and Manz method. Laboratory tests included serum creatinine, electrolytes and venous gases. RESULTS Protein intake was above recommendations in 21 patients (78.6%). Average vegetable and fruit intake was 0.4 and 1.5 servings per day, respectively. Mean PRAL was 16 ± 10.7 mEq/day. PRAL correlated positively with energy (p = 0.005), protein (p = 0.001) and fat intake (p = 0.0001), daily servings of dairy (p = 0.04) meat (p = 0.001) and cereals (0.001) and negatively with vegetable intake (p = 0.04). Serum pH and bicarbonate were 7.3 ± 0.08 and 20.46 ± 4.5 mEq/L, respectively. Twenty-one patients (80.7%) with metabolic acidosis were treated with sodium bicarbonate. CONCLUSIONS Dietary pattern of Venezuelan children with CKD may constitute a risk factor for the progression of the disease by promoting metabolic acidosis via unfavorable dietary acid loads. PRAL should be assessed as a valuable guide for nutritional counseling in children with CKD.
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50
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Yeung SMH, Gomes-Neto AW, Osté MCJ, van den Berg E, Kootstra-Ros JE, Sanders JSF, Berger SP, Carrero JJ, De Borst MH, Navis GJ, Bakker SJL. Net Endogenous Acid Excretion and Kidney Allograft Outcomes. Clin J Am Soc Nephrol 2021; 16:1398-1406. [PMID: 34135022 PMCID: PMC8729579 DOI: 10.2215/cjn.00780121] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 06/07/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES High dietary acid load may accelerate a decline in kidney function. We prospectively investigated whether dietary acid load is associated with graft outcomes in kidney transplant recipients, and whether venous bicarbonate mediates this association. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We used data from 642 kidney transplant recipients with a functioning graft ≥1 year after transplantation. Net endogenous acid production was estimated using food frequency questionnaires and, alternatively, 24-hour urinary urea and potassium excretion to estimate net endogenous acid production. We defined the composite kidney end point as a doubling of plasma creatinine or graft failure. Multivariable Cox regression analyses, adjusted for potential confounders, were used to study the associations of dietary acid load with the kidney end point. We evaluated potential mediation effects of venous bicarbonate, urinary bicarbonate excretion, urinary ammonium excretion, titratable acid excretion, and net acid excretion on the association between net endogenous acid production and the kidney end point. RESULTS The median net endogenous acid production using food frequency questionnaires and net endogenous acid production using urinary excretion were 40 (interquartile range, 35-45) and 54 (interquartile range, 44-66) mEq/day, respectively. During a median follow-up of 5.3 years (interquartile range, 4.1-6.0), 121 (19%) participants reached the kidney end point. After multivariable adjustment, net endogenous acid production using food frequency questionnaires and net endogenous acid production using urinary excretion (per SD higher) were independently associated with higher risk for kidney end point (hazard ratio, 1.33; 95% confidence interval, 1.12 to 1.57, P=0.001 and hazard ratio, 1.44; 95% confidence interval, 1.24 to 1.69, P<0.001, respectively). Baseline venous bicarbonate mediated 20% of the association between net endogenous acid production using food frequency questionnaires and the kidney end point. Baseline venous bicarbonate, urinary ammonium excretion, and net acid excretion mediated 25%, -14%, and -18%, respectively, of the association between net endogenous acid production using urinary excretion and the kidney end point. CONCLUSIONS Higher dietary acid load was associated with a higher risk of doubling of plasma creatinine or graft failure, and this association was partly mediated by venous bicarbonate, urinary ammonium, and net acid excretion.
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Affiliation(s)
- Stanley M H Yeung
- Department of Internal Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Antonio W Gomes-Neto
- Department of Internal Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Maryse C J Osté
- Department of Internal Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Else van den Berg
- Department of Internal Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Jenny E Kootstra-Ros
- Department of Laboratory Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Jan Stephan F Sanders
- Department of Internal Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Stefan P Berger
- Department of Internal Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Juan Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Martin H De Borst
- Department of Internal Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Gerjan J Navis
- Department of Internal Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, University Medical Centre Groningen, Groningen, The Netherlands
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