Dietary protein intake and kidney function decline after myocardial infarction: the Alpha Omega Cohort

Abstract

Background Post-myocardial infarction (MI) patients have a doubled rate of kidney function decline compared with the general population. We investigated the extent to which high intake of total, animal and plant protein are risk factors for accelerated kidney function decline in older stable post-MI patients. Methods We analysed 2255 post-MI patients (aged 60–80 years, 80% men) of the Alpha Omega Cohort. Dietary data were collected with a biomarker-validated 203-item food frequency questionnaire. At baseline and 41 months, we estimated glomerular filtration rate based on the Chronic Kidney Disease Epidemiology Collaboration equations for serum cystatin C [estimated glomerular filtration rate (eGFRcysC)] alone and both creatinine and cystatin C (eGFRcr–cysC). Results Mean [standard deviation (SD)] baseline eGFRcysC and eGFRcr–cysC were 82 (20) and 79 (19) mL/min/1.73 m2. Of all patients, 16% were current smokers and 19% had diabetes. Mean (SD) total protein intake was 71 (19) g/day, of which two-thirds was animal and one-third plant protein. After multivariable adjustment, including age, sex, total energy intake, smoking, diabetes, systolic blood pressure, renin–angiotensin system blocking drugs and fat intake, each incremental total daily protein intake of 0.1 g/kg ideal body weight was associated with an additional annual eGFRcysC decline of −0.12 (95% confidence interval −0.19 to −0.04) mL/min/1.73 m2, and was similar for animal and plant protein. Patients with a daily total protein intake of ≥1.20 compared with <0.80 g/kg ideal body weight had a 2-fold faster annual eGFRcysC decline of −1.60 versus −0.84 mL/min/1.73 m2. Taking eGFRcr–cysC as outcome showed similar results. Strong linear associations were confirmed by restricted cubic spline analyses. Conclusion A higher protein intake was significantly associated with a more rapid kidney function decline in post-MI patients.

Optimum nutritional strategies for cardiovascular disease prevention and rehabilitation (BACPR)

“…Summary messages regarding dietary protein are presented in table 1. Detailed study7–13 analysis examining protein intake and CVD are presented in online supplementary table 1.…”

Why the Nutritional Management of Acute Versus Chronic Kidney Disease Should Differ

“…In yet another study by Jhee et al 11 in 9,226 South Koreans from a large national contemporary (2001-2014) cohort, the multivariate adjusted likelihood of kidney hyperfiltration was 3.5-fold higher in the highest versus lowest quartile of the dietary protein intake. As in the Dutch study by Esmeijer et al, 9 the Korean study demonstrated a loss of renal function that was faster across higher quartiles of dietary protein intake. 11 Hence, it can be argued that while a high-protein diet poses potential harm to the kidneys' health, a low-protein diet extends the kidneys' longevity.…”

“…A recent study in the Journal of Renal Nutrition by Malhorta et al 8 suggested that among diabetic African-Americans, higher dietary protein intake was associated with greater decline in estimated GFR. A recent study by Esmeijer et al 9 reported on the dietary and kidney data of the Alpha-Omega Cohort, a prospective study of 4,837 Dutch patients aged 60-80 years with a prior history of myocardial infarction who took part in a clinical trial of low-dose omega-3 fatty acids. 10 Esmeijer et al found that for each 0.1 g per kilogram ideal body weight per day (g/kg/day) increase in dietary protein intake, the annual GFR decline was accelerated by -0.12 mL/min/1.73 m 2 per year.…”

The effect of protein and essential amino acid supplementation on muscle strength and performance in patients with chronic heart failure: a systematic review

“…Changes in renal function were also reported to explore the safety of protein and/or EAA supplementation in patients with CHF. Diets that are high in protein may be associated with a decline in renal function in patients with heart disease [24]. Where outcome measures were assessed at multiple time points, testing conducted closest to cessation of supplementation was included for analysis.…”

“…Diets that are high in protein have been associated with a decline in renal function over a 41-month period, in patients with heart disease [24]. Therefore, the benefits of treating sarcopenia in patients with CHF using protein and/or EAA supplementation need to be evaluated against the risk of a decline in renal function.…”